Migration of a bladder diverticulum stone into the rectum revealing an advanced rectal process.

Rectovesical fistulas are rare and typically result from inflammatory or neoplastic conditions in the small pelvis. They occur within a pelvic region that has been altered by local inflammatory or neoplastic processes. This explains the challenges in detecting these fistulas using conventional imaging techniques, despite the effectiveness of CT and MRI. Colonic diverticulosis is the primary cause of colovesical fistulas. To date, there have been no reported cases of a rectovesical fistula associated with a bladder diverticulum in the literature. We present a case of a patient who presented with a large stone within a bladder diverticulum. The migration of this stone into the rectum revealed an advanced rectal tumor. The unique aspect of our case is primarily the presence of a rectovesical fistula arising from a lateral bladder diverticulum. Additionally, we observed the migration of the diverticular calculus from the bladder to the rectum.

Cerebral Vasculitis Revealing Systemic Sarcoidosis: A Case Report and Review of the Literature.

Vasculitis in neurosarcoidosis is rare, with only a few cases reported in the literature. We report the clinical observation of a 51-year-old patient with no previous medical history, who was admitted to the emergency department due to sudden onset confusion, fever, sweating, weakness, and headaches. The first brain scan was normal, but a further biological exam with a lumbar puncture revealed lymphocytic meningitis. A complementary cerebral MRI revealed abnormalities in the white matter signal, suggestive of multiple sclerosis, with petechial hemorrhagic foci associated with leptomeningeal involvement and cerebral vasculitis. Thoraco-abdomino-pelvic computed tomography revealed hilar and mediastinal lymphadenopathy, as well as lymph nodes in the lower cervical region. A biopsy of the lymph nodes confirmed the presence of non-caseating granulomatous inflammation consistent with sarcoidosis. High-dose corticosteroid therapy was initiated with good clinical outcomes. Cerebral vasculitis in neurosarcoidosis is rare but can lead to neurological complications requiring long-term multidisciplinary management.

Anteriorly Placed Midline Intraprostatic Cyst Resulting in Bothersome Lower Urinary Tract Symptoms: A Case Report.

Prostatic cysts are rare, usually asymptomatic and detected incidentally at imaging. Midline prostatic cysts are less common and mostly located posteriorly. We describe a case of a 51-year-old man with unknown comorbidities who presented with troublesome irritative and voiding symptoms. Transabdominal and transrectal ultrasound, abdominal computed tomography and pelvic magnetic resonance imaging revealed a midline intraprostatic cyst protruding into the bladder lumen, with no communication with the urethra on voiding cystourethrography. Uroflowmetry findings suggested an obstructed flow. The patient underwent transurethral marsupialization of the cyst, which was found to project on the bladder outlet causing urinary obstruction, with excellent outcomes. What makes this case further interesting is the unusual cyst's relationship with the patient's prostate and bladder neck. To our best knowledge, this is so far the seventh reported case in the literature to describe an anteriorly placed midline intraprostatic cyst projecting at the bladder neck region and causing bothersome lower urinary tract symptoms.

Hepatic Metastasis Revealing a Melanoma of the Penis: Case Report.

Melanoma of the penis is a rare tumor with a poor prognosis. We report the case of a 73-year-old patient with no significant medical history, admitted for deterioration of the general condition and bilateral inguinal lymph nodes. An abdominal ultrasound and thoraco-abdomino-pelvic CT (computed tomography) scan revealed metastatic liver nodules, the tumoral nature of which was confirmed by an anatomopathological examination. Further clinical examination revealed papular and ulcerated lesions of the penis located at the urethral meatus and glans penis. These lesions were biopsied and histologically assessed as melanoma. The contribution of imaging in penile tumors is generally not useful for diagnosis as clinical examination is key. However, it has its place in the assessment of locoregional and distant extension. In our case, it was the distant lesions that helped orient the diagnosis. The patient underwent immunotherapical treatment and is still alive 19 months after the diagnosis.

Abdominoscrotal Hydrocele With Intra-abdominal Undescended Testis in an Elderly: A Case Report.

Abdominoscrotal hydrocele (ASH) is an uncommon congenital anomaly in which a scrotal hydrocele extends to the abdomen through the inguinal canal in an hourglass fashion. Coexisting undescended testes (UDT) have mainly been reported in pediatric populations and are mostly located along the inguinal canal. We present a 66-year-old male with a history of neglected left cryptorchidism, who presented with a progressive ipsilateral inguino-scrotal swelling suggesting indirect inguinal hernia. On physical examination, inguino-scrotal hydrocele was suspected. Abdomen and pelvis computed tomography scan and magnetic resonance imaging revealed an abdominoscrotal cyst with a pathognomonic dumbbell appearance of an ASH, as well as an intra-abdominal testicle that proved to be intracystic, atrophic, and hypovascular. The patient underwent successful radical en-bloc excision of the ASH and testis via an extended inguinal approach. To our knowledge, this is the first case with this constellation of urogenital abnormalities to be reported in an aged man. What makes this case further unique and interesting is the unusual ASH's relationship with the patient's cryptorchid testicle and peritoneal sac.

Functional Bladder Paraganglioma as an Incidental Finding During Infertility Workup.

Bladder paragangliomas (PGLs) are extremely rare catecholamine-producing neuroendocrine tumors. They arise more frequently in the trigone and have unpredictable depth and behavior. Most cases typically present with a well-defined set of symptoms triggered by micturition or bladder overdistension. Besides long-term follow-up, they are usually managed by either transurethral resection (TUR) or partial cystectomy (PC). However, about 25% of all documented cases do not manifest clinically, raising both diagnosis and management challenges. This report describes an unusual case of a misdiagnosed, functional PGL arising on the bladder dome, which was fortuitously detected in a 21-year-old female during a fertility workup. Owing to its hypervascular nature and submucosal location, bladder PGL was suspected on ultrasound and CT findings and successfully diagnosed before surgery through biochemical confirmation. It was managed by cystoscopy-guided laparoscopic partial cystectomy (LPC) with good oncological and urinary outcomes, as well as no compromise of her fertility potential. To our best knowledge, this is the first case to be incidentally detected on transvaginal ultrasound during evaluation for infertility. This case also stresses the importance of considering PGL in the differential diagnosis of atypical bladder tumors, as well as conservative management through simultaneous laparoscopy and cystoscopy, when approaching young patients with large functional PGL.

Unilateral blindness following superior laryngeal nerve block for awake tracheal intubation in a case of posterior cervical spine surgery.

BACKGROUND: Superior laryngeal nerve block (SUPLANEB) is a popular airway anesthesia technique utilized for successful awake endotracheal intubation in patients with significant cervical spine instability. If not performed by an expert, it carries the risk of general/neurologic complications that are typically minimal/transient. However, permanent blindness and/or upper cranial nerve neuropathies may occur. Here, we describe a case in which a young patient underwent an atlantoaxial fusion for a C2 nonunion (e.g., following a fracture) complicated by unilateral blindness due to a SUPLANEB. CASE DESCRIPTION: A 25-year-old neurologically intact male underwent a C1-C2 posterior arthrodesis to address a nonunion of a C2 fracture. To perform the awake nasotracheal intubation, a SUPLANEB was performed using a video laryngoscope. Although the operation was uneventful, postoperatively, the patient reported left visual loss accompanied by left-sided facial numbness and hearing loss. On examination of the left eye, the anterior segment and fundus examinations were normal, but the OCT (optical coherence tomography) and retinal angiography demonstrated left-sided postischemic retinal edema with permeability of the intraocular vessels. Although the cranio-orbital computed tomography scan showed only mild pneumocephalus, the CT angiogram scan revealed abnormal air in the left carotid sheath accompanied by diffuse subcutaneous emphysema. Further, brain and orbital magnetic resonance imaging scans were normal. The patient was treated with pure oxygen, systemic steroid therapy, and nimodipine. The pneumocephalus and subcutaneous emphysema resolved on day 3. At 2 months follow-up, the patient remained blind on the left side, but had no further neurological deficits. CONCLUSION: Blindness and upper cranial nerves neuropathies should be considered as potential complications of SUPLANEB. Notably, these deficits were not directly related to the operative positioning or neurosurgical spinal procedure.

A Rare Case of Malignant Tumor of the Larynx with Good Prognosis: Laryngeal Chondrosarcoma.

Laryngeal chondrosarcoma is a rare laryngeal tumor that most frequently originates from the cricoid cartilage. The majority of lesions are low grade and the distinction from benign chondromas must be made. We present a case of a laryngeal chondrosarcoma arising from the cricoid cartilage in a 75-year-old Arab man who presented with hoarseness, dysphonia, and dyspnea. Endoscopic and radiological examinations showed a mass of the wall of his larynx with displaced structures, airway obstruction, and destruction of the cartilage. The patient underwent total laryngectomy. Histological examination supported the diagnosis of low-grade chondrosarcoma. Five months later, the radiological and clinical findings showed no evidence of recurrence or metastases. Laryngeal chondrosarcomas remain a rare disease of unknown etiology, with slow and insidious symptoms. The treatment is surgical, given the importance of preserving the larynx to patients' quality of life. The prognosis is favorable and metastases rarely occur.

Lipoma with Agenesis of Corpus Callosum: 2 Case Reports and Literature Review.

BACKGROUND: Intracranial lipomas are extremely rare fat-containing lesions, comprising 0.1-0.5% of all primary brain tumors. Lipoma of corpus callosum, the commonest variety of all intracranial lipomas (40%-50%), is associated with varying degrees of dysgenesis of corpus callosum and generally remains asymptomatic. CASE DESCRIPTION: In this study, we report 2 cases of pericallosal lipomas admitted with seizures and discuss the clinical and radiologic findings in light of the literature. CONCLUSIONS: Lipomas of the corpus callosum are rare, fat-containing asymptomatic lesions, mostly associated with dysgenesis of the corpus callosum. Diagnosis accidentally occurs during diagnostic procedures in case of an encephalic disorder. Magnetic resonance imaging is the most useful modality for a differential diagnosis. Prognosis and symptoms depend on associated malformations. Surgical treatment is mostly not indicated and should be avoided.