An uncommon mimicker of renal malignancy: IgG4-related disease.

BACKGROUND: Increased usage of cross sectional imaging for a variety of indications, in particular CT imaging, has led to an increased detection of renal and ureteric masses. Benign ureteric masses are rare, with 95% of identified tumours consisting of transitional cell carcinoma (TCC). IgG4-related disease is a recognised clinical systemic autoimmune, inflammatory condition with a propensity for multi-organ manifestation. Nephritis and pseudo-tumour formation can occur when kidneys are involved. Ureteric involvement is more rare. CASE PRESENTATION: Forty nine-year-old Korean male was found to have an incidental invasive renal pelvis mass during investigation for chronic back pain and fatigue. Appearance of the tumour was consistent with an invasive malignancy, and consensus from multidisciplinary meeting was to have the tumour removed. Procedure involved a prolonged open surgery with reconstruction of contralateral renal blood supply and was complicated by a long recovery process. Final histopathology confirmed IgG4 renal pseudo tumour diagnosis. CONCLUSION: IgG4-related disease is a rare but potentially morbid disease that can mimic various cancers, including lung, pancreas and renal malignancies. A high index of suspicion is required to accurately diagnose this condition, through a targeted history taking, examination and investigation which should include biopsies. Failing to do so may result in unnecessary procedures being performed and exposing a patient to its associated risks.

ChatGPT: Is This Patient Education Tool for Urological Malignancies Readable for the General Population?

Background: With widespread adoption of technological advancements in everyday life, patients are now increasingly able and willing to obtain information about their health conditions, treatment options, and indeed expected outcomes via the convenience of any device than can access the worldwide web. This introduces another aspect of patient care in the provision of healthcare for the modern doctor. ChatGPT is the first of an increasing number of self learning programs that have been released recently which may revolutionize and impact healthcare delivery. Methods: The aim of this study is to obtain an objective measure of the readability of information provided on ChatGPT when compared with current validated patient information sheets provided by government health institutions in Western Australia. The same structured questions were input into the program for three major urological malignancies (urothelial, renal, and prostate), with the response generated evaluated with a validated readability scoring system - Flesch-Kincaid reading ease score. The same scoring system was then applied to current patient information sheets in circulation from Cancer Council Australia and UpToDate. Results: Findings in this study looking at ease of readability of information provided on ChatGPT as compared to other government bodies and healthcare institutions confirm that they are non-inferior and may be a useful tool or adjunct to the traditional clinic based consultations. Ease of use of the information generated from ChatGPT was increased further when the question was modified to target an audience of 16 years of age, the average level of education attained by an Australian. Discussion: Future research can be done to look into incorporating the use of similar technologies to increase efficiency in the healthcare system and reduce healthcare costs.

BCG mycotic aneurysm: Case report on a rare entity.

Mycotic aortic aneurysms (MAA) are rare, accounting for 0.6-2.0% of all aortic aneuryms. MAA secondary to intravesical BCG instillations are even rarer, with less than a hundred reported cases till date. Given the delayed presentation, non specific presenting symptoms and significant risk of mortality (90% without intervention, 10.3-22.7% with intervention), diagnosing this complication is challenging.

The Utility of Renal Mass Biopsy in Large Renal Masses.

Objectives: The role of needle core renal biopsy in large renal masses, defined as lesions larger than 4 cm, is debatable, as larger renal masses are associated with malignant histology. We aim to review the safety and impact of renal biopsy on the management of large renal masses. Methods: A retrospective, single-center review of all renal biopsies performed between January 2011 and December 2020 at Royal Perth Hospital was conducted. Indications for biopsy, complications and final management plans were correlated to assess the value of biopsies in large renal masses. Results: In total, 126 biopsies were performed. Indeterminate imaging findings and comorbidities were the main indications for biopsies. We identified 116 (92.1%) diagnostic biopsies and 10 (8.0%) non-diagnostic biopsies due to insufficient samples or inflammatory tissue. Of the diagnostic biopsies, 99 (78.6%) were malignant and 17 (13.5%) were benign. Unnecessary extirpative surgery was avoided in 17 patients. Histology included renal cell carcinoma (96%) and other malignancies such as urothelial carcinoma (3%) and non-Hodgkin's lymphoma (1%). Benign biopsies identified histology including angiomyolipoma (35.3%) and oncocytoma (52.5%). The median follow-up time was 68 months (range 19-132 months). Conclusion: Renal biopsies in large renal masses may aid in preventing unnecessary surgery, especially in situations where imaging findings are equivocal or in patients with many comorbidities.

Lymph node assessment technique matters in radical cystectomy for bladder cancer.

BACKGROUND: For patients undergoing radical cystectomy with pelvic lymph node dissection for urothelial cancer, a lymph node count of at least 16 is associated with improved cancer-specific and overall survival. Lymph node yield is presumed to relate directly to extent of dissection and surgical quality, however limited studies have reviewed the impact of the pathological assessment process of lymph nodes on lymph node yield. METHOD: A retrospective assessment of 139 patients who had radical cystectomy for urothelial cancer between March 2015 and July 2021 from Fiona Stanley Hospital (Perth, Australia) by a single surgeon was assessed. A change in pathological assessment process from assessment of only palpable lymph nodes to microscopic assessment of the entire submitted specimens occurred in August 2018. Patients were divided into two groups accordingly and other relevant demographic and pathological data was recorded. The impact of pathological processing technique on lymph node yield was assessed using the Student T test and logistical regression was used to assess the impact of other demographic variables. RESULTS: The mean lymph node yield was 16.2 nodes (IQR 12-23) in 54 patients in the pre-process change group compared to 22.4 nodes (IQR 15-28.4) in 85 patients in the post-process change group (P < 0.0001). 53.7% had 16 or more nodes in the pre-process change group compared to 71.3% in the post-process change group (P = 0.04). Age, BMI, and gender were not significant predictors of lymph node yield. CONCLUSION: The current study demonstrates that the microscopic assessment of all lymph node tissue detects significantly more lymph nodes than only examining palpably abnormal tissue. Pathologic assessment protocols should be standardized to this technique to ensure the utility of lymph node yield as a quality metric.

Bladder paraganglioma - Case report on a rare but important differential.

A paraganglioma is a rare extra-adrenal neuroendocrine tumour that can occur at various sites in the body along the paravertebral axis or within organs. These are very rare tumours, accounting for <0.05% of bladder tumours. A bladder paraganglioma is even more rare, consisting <1% of all paragangliomas. Presentation is variable, given that only 1-3% secrete enough catecholamines to be clinically significant. Paragangliomas can mimic other bladder tumours during investigation for haematuria or lower urinary tract symptoms. The following case describes an incidental bladder paraganglioma discovered during routine flexible cystoscopy in a young female with non-visible haematuria and its subsequent management.

An update on management of renal colic.

BACKGROUND: Renal tract pain is a common presentation in the primary care setting that can masquerade as other abdominopelvic conditions, and vice versa. A stepwise approach to a patient with renal tract pain can aid immensely in formulating an accurate diagnosis and providing optimal care. OBJECTIVE: The aim of this article is to present current evidence-based recommendations for renal tract pain to assist in its diagnosis, assessment and management. DISCUSSION: Renal tract pain is mediated by a surge in prostaglandin release, leading to arterial vasodilatation, increased vascular permeability, and subsequently ureteric oedema and spasms. Referred and migratory pain are hallmarks of this condition and are unique to renal colic because of the progressive passage of the stone along the ureter. Diagnosis requires a stepwise approach with history-taking, assessment, blood tests and imaging. Successful management of renal tract pain necessitates a combination of analgesia and medical expulsive therapy, failing which surgical intervention is required.