A giant non-functional adrenocortical carcinoma presenting with acute kidney injury.

Hormonally inactive adrenocortical carcinoma (ACC) is a rare disease where abdominal discomfort and back pain are common presenting symptoms due to mass effect from a large tumor. Acute kidney injury (AKI) from retroperitoneal tumors has rarely been reported. The most common etiologies include venous thrombosis, ureteral compression, or both. Here, we described a man who presented with AKI from a large retroperitoneal tumor, which was finally diagnosed as a non-functional ACC. The inferior vena cava (IVC) was nearly completely compressed by the large retroperitoneal tumor leading to venous outflow obstruction and AKI. After surgical resection, his urine output increased and renal function recovered. Unfortunately, AKI recurred 2 months later due to recurrence of the tumor. Treatment with a tyrosine kinase inhibitor stabilized his tumor size, and hemodialysis was started. IVC-compression-associated AKI can be the presenting scenario for ACC, a rare but prognostically important aggressive neoplasm.

Multiple penile schwannomas and their magnetic resonance imaging characteristics.

Penile schwannoma is a rare encapsulated nerve sheath tumor of the peripheral nerve in the penis. Here, we report a case of multiple, painful, beadlike, nodular tumors in the penis of a 40-year-old man. The nodules showed well-defined margins and hypoechoic areas on gray-scale ultrasonograms. They showed high signal intensity on fat-saturated T2-weighted magnetic resonance imaging (MRI) and intense enhancement on gadolinium-enhanced T1-weighted MRI, compatible with their myxoid content. The nodules pressed against the tunica albuginea and some caused inward indentation, which we considered as indirect evidence of the tumor location. In conclusion, the MRI characteristics and location of the nodules together enable presurgical diagnosis of penile schwannomas, which is especially useful in asymptomatic patients and those unwilling to undergo surgery.

Desmoid tumor arising in the site of previous surgery in the left lower quadrant of the abdomen.

A desmoid tumor is a fibroblastic proliferation arising in musculoaponeurotic structures. The pathogenesis is still not clear. A 79-year-old woman who developed a desmoid tumor in the left lower abdomen after surgical resection of an abdominal lipoma seven years previously is presented. Preoperative computed tomography showed a large left lower abdominal mass. Pathology showed the spindle fibroblastic cell pattern typical of desmoids.

Congenital seminal vesicle cyst associated with ipsilateral renal agenesis mimicking bladder outlet obstruction: a case report and review of the literature.

Seminal vesicle cysts combined with genitourinary anomalies are uncommon. We present a 43-year-old married man who suffered from difficulty in urination and irritating voiding symptoms for 3 years. The symptoms worsened in the last 6 months. Digital rectal examination revealed a palpable large soft mass behind the prostate. Diagnostic imaging showed a left seminal vesicle cyst with an intravesical protrusion. The ipsilateral kidney and ureter were absent. Transrectal aspiration of the cyst was performed, which improved the clinical genitourinary symptoms. The maximal and mean urinary flow rates increased from 18 to 37 mL/s and from 6 to 16 mL/s, respectively.

Testicular microlithiasis in Taiwanese men.

Testicular microlithiasis (TM) is an unusual ultrasonographic manifestation in testicular parenchyma. Limited information is available about TM in Taiwanese men. We performed a retrospective analysis to investigate the characteristics of TM and its association with testicular cancer and infertility in Taiwan. Male patients who had received scrotal ultrasonography because of scrotal symptoms or infertility between January 2000 and December 2003 were recruited. The incidence of TM was 7.6%. Both testicular microlithiasis and testicular cancer occurred chiefly in the third decade. Patients with TM exhibit a higher chance of testicular cancer (6% vs. 0.9%). No local field effect between TM and testicular cancer was observed. Testicular microlithiasis severity is not positively correlated with sperm quality and sterility. Forty-eight patients (32%) were available at follow-up. No patient developed a testicular tumor or elevated tumor markers (AFP, beta-hCG) during follow-up. We suggest monthly self-examination, annual scrotal ultrasonography and tumor markers screening between the age of 20 and 30 years of patients with TM.

Computed tomographic features of circulatory arrest.

Although computed tomography (CT) is used widely in evaluating injuries from various kinds of trauma, the CT features of circulatory events are rarely reported. Recognizing these features is crucial to proper emergency management of patients when circulatory events occur during CT examination. We report two trauma patients who developed circulatory arrest during CT. Both patients had similar CT features of contrast distribution over the dependent portion of the right-sided venous system, a finding that has been previously reported only in patients with cardiac arrest. The quick paddle look feature may be useful to identify the condition and initiate proper resuscitation of patients without electrocardiographic monitoring in CT rooms.

Tuberculous epididymitis: a case report and literature review.

Tuberculous epididymitis is a rare urological disease difficult to diagnose. The conventional methods for diagnosis are often time-consuming and invasive. The combined use of scrotal magnetic resonance imaging (MRI) and urinary polymerase chain reaction (PCR)-based assay for mycobacterial DNA (the latter because of its high sensitivity and specificity to demonstrate mycobacterial DNA) is a valuable method for rapid diagnosis of tuberculous epididymitis. We report a 79-year-old man who was admitted with the chief complaints of bilateral scrotal swelling and pain. The combined use of scrotal MRI and urinary PCR allowed prompt diagnosis of tuberculous epididymitis and adequate antituberculous therapy.

MR imaging of pregnancy luteoma: a case report and correlation with the clinical features.

We report here on a 26-year-old pregnant female who developed hirsutism and virilization during her third trimester along with a significantly elevated serum testosterone level. Abdominal US and MR imaging studies were performed, and they showed unique imaging features that may suggest the diagnosis of pregnancy luteoma in the clinical context. After the delivery, the serum testosterone level continued to decrease, and it returned to normal three weeks postpartum. The follow-up imaging findings were closely correlated with the clinical presentation.