Renal cell carcinoma with massive cavo-atrial tumor thrombus leading to pulmonary embolism: Case study and literature review.

INTRODUCTION: Renal cell carcinoma (RCC) occasionally involves the inferior vena cava (IVC), but intra-atrial extension is very rare, with the most dreaded complication being thrombi migration into pulmonary arteries. CASE PRESENTATION: A 52-year-old male with rheumatoid arthritis and a smoking history presented with dyspnea, weight loss, and a previous episode of hematuria. Echocardiography revealed an intra-atrial thrombus with signs of pulmonary embolism (PE). Subsequent evaluation found a massive right renal tumor with an extensive thrombus extending into the right atrium, causing PE. Multidisciplinary management included surgery involving nephrectomy and thrombectomy via cavotomy and open-heart surgery along with pre- and postoperative anticoagulation. DISCUSSION: Intra-caval tumor thrombus (TT) in RCC is infrequent, especially when extending into the right atrium. Accurate diagnosis involves imaging modalities, with echocardiography and MRI playing pivotal roles. Multidisciplinary and personalized management is mandatory to ensure a successful outcome. Surgery remains the primary treatment for RCC with TT but carries significant risks. CONCLUSION: Managing RCC with cavo-atrial tumor thrombus is a complex situation that requires a collaborative approach. Accurate staging and tailored treatment are crucial. Surgical intervention remains pivotal in the absence of alternative effective modalities. Ongoing research into adjuvant therapies is crucial for optimal outcomes.

Primary metastatic melanoma of the female urethra: A case report and literature review.

BACKGROUND: Urethral malignant melanoma is an uncommon and aggressive malignancy, frequently diagnosed at an advanced stage, posing diagnostic and therapeutic challenges. CASE PRESENTATION: We present the case of a 74-year-old North African female diagnosed with primary metastatic urethral melanoma. Initial staging included a thorough physical examination, pelvic MRI, and whole-body CT scan, initially showing no signs of distant metastasis. Subsequent FDG PET/CT revealed unexpected bone metastases, prompting a significant shift in our management approach. The patient received immunotherapy with pembrolizumab, resulting in sustained metabolic stability at the six-month follow-up. DISCUSSION: We present recent epidemiological data and risk factors for this uncommon melanoma site. Additionally, we delve into the diagnostic challenges, underlining the expanding role of PET/CT. The discussion also covers managing options in the absence of a consensus. CONCLUSION: Despite several treatment choices, metastatic urethral melanoma still has a poor prognosis. This reality reflects the complexity of the disease and emphasizes the need for further research to unravel its underlying mechanisms and to establish more effective therapeutic approaches.

Isolated prostate tuberculosis: A rare condition.

Tuberculosis remains a global health threat, notably with a considerable burden of extrapulmonary cases. Prostate tuberculosis stands out as a rare and challenging diagnosis, often resulting in substantial management delays. In this report, we present the case of a 55-year-old man in whom initial suspicion of prostate cancer resulted in the diagnosis of prostate tuberculosis. The diagnostic methods, progressive features, and therapeutic tools of this rare condition are discussed.

Penoscrotal elephantiasis: A severe form of genital lymphedema.

Penoscrotal lymphedema is a manifestation of disrupted lymphatic drainage, causing a significant increase in scrotal volume. impacting both aesthetics and quality of life. Elephantiasis, classified as stage III by the International Society of Lymphology, represents the advanced stage of scrotal lymphedema, often linked to parasitic diseases. The diagnosis is clinical, and the treatment involves mass excision. The lymphatic reconstruction is an innovative therapeutic approach that improves postoperative results and better quality of life. In this case report, we present the case of massive genital elephantiasis managed surgically, and we will focus on surgical techniques and reconstructive approaches.

Generalized peritonitis secondary to a renal forniceal rupture in an obstructed pelvic kidney - A case report.

Peritoneal fistulization of pyonephrosis is an uncommon condition, leading to a generalized peritonitis, considered as extreme life-threatening emergency. Secondary to an obstructive uropathy, increasing intra-renal pressure. In most cases, ureteral stones represent the underlying causes followed by stenosis, tumor, or connective tissue disease. Through this case report, we present a 60-year-old patient with a history of urolithiasis, admitted for an atypical instance of spontaneous renal pelvis rupture in an ectopic right kidney managed surgically. This case emphasizes the importance of considering renal etiology in cases of peritonitis and underscores the rarity of such occurrences.

Hybrid Management of a Wünderlich's Syndrome Secondary to a Giant Ruptured Renal Angiomyolipoma: A Case Report.

Wünderlich's syndrome, a rare and life-threatening condition involving spontaneous renal hemorrhage, is commonly associated with renal angiomyolipoma (rAML). Management options for rAML include surveillance, mTOR inhibitors, selective arterial embolization (SAE), and surgery. When complicated by Wünderlich's syndrome, prompt and adequate interventional treatment is necessary to prevent fatal outcomes. We present a unique case of a young female patient with Tuberous Sclerosis Complex who experienced a massive ruptured rAML, leading to Wünderlich's syndrome. Our approach involved a multidisciplinary hybrid strategy, combining SAE and nephrectomy, highlighting SAE's valuable role even when radical treatment is required.

Complex case of ureteropelvic junction obstruction with bifid renal pelvis in ectopic kidney: A rare combination.

INTRODUCTION: Renal pelvis bifidity, ectopic pelvic kidney, and ureteropelvic junction obstruction are rare urinary tract anomalies resulting from embryological developmental variations. Their coexistence in one kidney is exceedingly uncommon. CASE PRESENTATION: An 18-year-old male with no prior medical history presented with right-sided lumbar pain. A CT scan revealed bilateral hydronephrosis, with the left kidney being malrotated and ectopically positioned in the pelvis. Dynamic renal scintigraphy confirmed bilateral ureteropelvic junction obstruction. Surgical management involved laparoscopic pyeloplasty for the right UPJ and open surgery for the left ectopic kidney with bifid pelvis. DISCUSSION: The combination of pelvic kidney, renal pelvis bifidity, and bilateral ureteropelvic junction obstruction is exceptionally rare. Diagnosis often occurs incidentally or when symptoms related to these anomalies emerge. Imaging and dynamic renal scintigraphy play crucial roles in diagnosis. Individualized surgical management is essential for positive outcomes. CONCLUSION: This case highlights the need for individualized management in complex urological cases involving rare anatomical variations. Surgeon experience and a comprehensive understanding of such anomalies are crucial for successful outcomes.

Müllerian Cyst: An Uncommon Etiology of Chronic Pelvic Pain Syndrome in Men.

Chronic pelvic pain syndrome (CPPS) in men is a complex pathological entity with a delicate nosological diagnosis and multiple etiological hypotheses dominated by urological causes. The Müllerian cyst has an embryological origin and is part of an organic anomaly of the male urogenital tract, incidentally detected during an initial infertility examination or in the presence of non-specific urinary symptoms. By its mass effect, it puts tension on the pelvic floor muscles and induces a stimulation of nerves which could explain its implication in the CPPS. Through this case report and literature review, we will clarify the etiopathogenesis and the diagnosis of CPPS as well as the approach to follow for better therapeutic management.

Angiomatous Urethral Caruncle After Ureteroscopy: A Case Report.

Urethral caruncle is a rare condition. Although relatively common in postmenopausal women, its occurrence after a urological endoscopic procedure is unusual. Here, we report the case of a postmenopausal woman who presented with a symptomatic urethral caruncle two weeks after a ureteroscopy for a right ureteral calculus. Treatment consisted of surgical excision of the mass after the failure of local estrogen application, and the postoperative aesthetic and functional result was satisfactory. Through a review of the literature, the etiological, diagnostic, and therapeutic aspects of this pathology will be discussed.

Testicular lymphoma: Atypical presentation of acute scrotal swelling.

INTRODUCTION: Primary testicular lymphoma (PTL) rarely presents as acute scrotal swelling. It is a very aggressive form of extra nodal non-Hodgkin's lymphoma. It accounts for less than 9 % of all testicular tumours. There are limited data characterizing this entity and this case report aim to add to existing literature. CASE PRESENTATION: A 40-year-old patient, with a history of a pulmonary tuberculosis declared cured, presented a scrotal swelling that set rapidly in less than a week evolving in a context of weight loss and fever. The clinical examination was tender and hard on palpation while ultrasound revealed a suspicious oval formation not taking colour in Doppler. The patient underwent a right inguinal orchidectomy due to suspicious clinical presentation. CLINICAL DISCUSSION: MHNL are very rare causes of acute scrotal swelling representing approximately 1 %. It's an aggressive tumour and remains rare in young men. Diagnosis is purely histological. Standard treatment includes orchidectomy, chemotherapy with a poor prognosis. CONCLUSION: PTL can reoccur years after complete remission. It's related to an expression of diffuse lymphomatosis suggesting an aggressive approach. Its management is multidisciplinary based on the tumour's stage according to Ann Arbor classification.

Primary diffuse large B-Cell lymphoma of the female urethra: A case report.

Introduction: Primary diffuse large B-cell lymphoma (DLBCL) of the female urethra is a highly uncommon malignancy. Case report: A 78-year-old woman presents with urethrorrhagia and dysuria. Clinical examination revealed a protruding mass at the urethral meatus, accompanied by bilateral inguinal adenopathies. Imaging studies confirmed the presence of a 2.2 cm mass and widespread adenopathies. Treatment involved surgical removal and adjuvant systemic chemotherapy with a favorable six-month follow-up outcome. Conclusion: Our case report aims to raise awareness of this rare disease. Early diagnosis and treatment may improve the patient survival.

Double-J placement complicated by endogenous endophthalmitis: A rare and serious outcome.

Endogenous endophthalmitis (EE) is a rare intraocular infection resulting from hematogenous microorganism spread, typically associated with underlying risk factors. We present a 52-year-old female with poorly-controlled diabetes and urolithiasis who developed EE following double-J stent placement for obstructive pyelonephritis. EE may occur due to increased intrarenal pressure during urological procedures. Timely recognition and intervention for rare complications like EE in urological patients are essential. This case highlights the importance of vigilance and collaboration between urologists and ophthalmologists in managing such cases.

Blepharoptosis revealing a metastatic renal cell carcinoma: A rare case report.

INTRODUCTION: Renal cell carcinoma (RCC) is a relatively rare malignancy often discovered incidentally. Approximately 15 % of cases are metastatic at diagnosis, commonly affecting the lungs, bones, lymph nodes, and liver. We present an exceptional case of RCC metastasizing to the eyelid. CASE PRESENTATION: A 67-year-old female with no prior cancer history exhibited rapidly progressing left blepharoptosis. Examination revealed a painless, solid eyelid mass. Immunohistochemistry of the eyelid mass biopsy identified a carcinoma potentially of renal origin. A thorax, abdomen, and pelvis CT scan confirmed the presence of a right renal mass. Following a multidisciplinary discussion, we decided to proceed with an upfront cytoreductive nephrectomy and surgical excision of the eyelid metastasis. DISCUSSION: Eyelid metastasis revealing a renal cell carcinoma is exceedingly rare. Immunohistochemistry plays a pivotal role in detecting primary renal tumors. Prognostic models, particularly the IMDC, guide therapeutic decisions. In the era of immune checkpoint inhibitors, cytoreductive nephrectomy remains a safe option for well-selected patients with favorable risk mRCC. CONCLUSION: Recognizing unusual metastatic sites of RCC is vital due to its asymptomatic nature and the potential impact of delayed diagnosis on prognosis. Immunohistochemistry plays a critical role in diagnosis. Multidisciplinary tumor board discussions are essential for tailored management of favorable risk mRCC patients.

Priapism associated with penile haematoma following a scorpion sting in a child: A rare case report.

Priapism is a rare condition in paediatrics. Although its association with scorpion envenomation has been documented, cases involving an associated penile haematoma are extremely rare. To the best of our knowledge, we hereby present the first documented case of this unique association in a nine-year-old boy following a scorpion sting. The purpose of this observation is to discuss the diagnostic difficulties, management strategies, and possible mechanisms associated with this unusual manifestation, and to highlight the importance of prompt recognition and appropriate management of priapism and penile haematoma in children, particularly those living in areas where scorpion stings are endemic.

Spontaneous Iliopsoas Hematoma in a Patient on Acenocoumarol: Report of a Rare Case.

Spontaneous hematoma of the iliopsoas is a rare pathological circumstance; in the majority of cases published in the literature, it is associated with disorders of hemostasis due to anticoagulant treatment or coagulopathies. We present a case of a 64-year-old man on acenocoumarol, an anticoagulant of the vitamin K antagonist family, for atrial fibrillation, who presented with a severe left hip and flank pain with a huge ecchymosis on the left flank and a partial inability to extend the left thigh. A CT scan confirmed the diagnosis of iliopsoas hematoma. Given the hemodynamic stability of the patient, he benefited from a conservative treatment with a favourable evolution. This case highlights the underlying conditions, diagnosis, and treatment of this uncommon complication.

Periurethral abscess in corpus spongiosum caused by urinary tract infection: A case report and review of literature.

Penile abscesses are rare and mainly interest the corpora cavernosa or soft tissue of the external genitalia, while involvement of the corpus spongiosum is unusual, with only a few cases published in the literature. We report the case of an abscess of the corpus spongiosum secondary to a documented urinary tract infection in a young immunocompetent patient with no particular pathological history. To our knowledge this is the first case reported in this context.

Secreting retroperitoneal latero-aortic paraganglioma revealed by acute abdominal pain: a case report.

We report the case of a retroperitoneal paraganglioma in a 35-year-old man discovered by abdominal pain. The abdomino-pelvic computed tomography (CT) showed a retro-peritoneal latero-aortic mass compatible with a paraganglioma, confirmed by the 24-hour urinary metanephrines and normetanephrines test. After an adequate pharmacological preparation, we decide to perform a laparoscopic resection of the paraganglioma. The surgery went without any complication. Blood pressure and urinary catecholamines were normal after the surgery. Our observation presents the particularity of the mode of discovery which is atypical, as well as the particularity of the therapeutic management, which is the laparoscopic resection of the mass.

Rudy and Borden technique for penile self-mutilation in Klingsor syndrome: a case report.

Penile self-mutilation is a challenging situation that often jeopardizes sexual and voiding functions. Surgical treatment is currently based on penile replantation, nevertheless its requirements of time, conservation, and quality of amputated phallus and microsurgical expertise are not constantly available. Here, we present a case of penile self-inflicted amputation in a 28-years-old patient suffering from a psychotic disorder, who did not preserve the amputated phallus. In the first clinical examination, we have attested a hemorrhagic total penile section, 6cm from the penoscrotal angle. We performed immediate surgical management. Rudy and Borden technique is a reconstructive surgery procedure with interesting functional results, by performing a dorsal vascularized split-thickness skin flap to cover the penile shaft. The aim of this technique is to avoid perineostomy which compounds significantly the quality of life.

Medullary Aplasia Revealing a Metastatic Prostatic Adenocarcinoma.

In this case report, we are reporting the case of a 68-year-old male patient who was admitted in our hospital for unintended weight loss, asthenia, and anorexia. Physical examination showed clinical signs of anemia such as pallor of skin and mucous membranes; hemodynamic parameters were normal. Complete blood count (CBC) analysis showed a pancytopenia with anemia, thrombocytopenia, and leukopenia. BM biopsy was performed, showing a malignant infiltration of bone marrow by a metastatic prostate cancer confirmed by immunohistochemistry. Prostate biopsy confirmed the diagnosis of acinar adenocarcinoma with Gleason score 8 (4 + 4), ISUP grade group 4. Our patient underwent chemical castration using LH-RH analogs in association with second-line hormone therapy by abiraterone acetate. The evolution was good on both the oncological and hematological levels.

Epididymo-testicular ischemia without torsion.

Epididymo-testicular infarction associated with ischemia of spermatic cord without torsion secondary to an orchiepididymitis is an extremely rare pathological entity, of little known etiopathogenesis and idiopathic in the majority of cases. The authors report an original observation of a 23-year-old young patient with a history of untreated orchiepididymitis, which presented to the emergency department for testicular pain. The ultrasound has showed an ischemic testicle and the exploratory scrototomy objectified an epididymo-testicular necrosis associated with ischemia of spermatic cord without torsion. This case highlighted the interest of early diagnosis and effective treatment of orchiepididymitis to prevent this rare serious complication.