Papillary Renal Cell Carcinoma with Sarcomatoid Differentiation in a Native Kidney of Transplant Recipient: A Case Report and Review of Literature.

Renal cell carcinoma (RCC) developing in a transplant recipient is about 5-20 times higher than the general population. It is more common in native kidneys than graft kidney, and incidence varies between 0.3% and 4.8%. Clear cell and papillary types are more frequently reported. Most RCC of allograft recipient is usually low-grade with favorable prognosis. We present a case of papillary RCC with sarcomatoid differentiation (SD) in a native kidney of renal transplant (RT) recipient. The coexistence of sarcomatoid variant with papillary RCC, as in our case, makes it a high grade (WHO/ISUP grade 4) and portends a poor prognosis. Relative aggressiveness and rarity of this variant histology in transplant recipients prompted us to report this case and carry out an extensive search of the available literature.

Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India.

OBJECTIVE: Paratesticular tumors (PTT) are rare and form a heterogenous group, ranging from benign to malignant high grade sarcomas. This study was undertaken to describe the clinicopathological spectrum of PTTs received over a 20-year period. METHODS: All primary and secondary PTTs diagnosed from 2000 to 2019 in the pathology department of a tertiary care hospital in North India were retrospectively reviewed. Gross, histopathological features and immunohistochemistry (IHC) findings were correlated with clinical details. RESULTS: A total of 169 intra-scrotal tumors were diagnosed during the study period, out of which there were 30 PTTs (in 27 patients) comprising 17.75%. Age range was 4 to 85 years (median 58 years). Benign PTTs were the commonest (n = 21, 70%), followed by metastasis to the paratesticular region (n = 6, 20%) and then primary malignant PTTs (n = 3, 10%). The commonest benign PTT was lipoma (n = 16, 76.19%), followed by adenomatoid tumor (n = 3, 14.28%) with one case each (4.76%) of cellular angiofibroma and hemangioma. Among primary malignant PTT, there were two cases of rhabdomyosarcoma, and one case of biphasic malignant mesothelioma. Metastatic tumors included four cases of prostatic adenocarcinoma, and one case each of pancreatic signet ring cell carcinoma and clear cell renal cell carcinoma. CONCLUSION: PTTs show a wide clinicopathological spectrum. Benign PTTs are commoner than malignant PTTs. Meticulous grossing and histopathological examination supplemented by IHC is essential for an accurate diagnosis of this heterogenous class of tumors, which influences the role of adjuvant therapy and patient prognosis.

Epistaxis presenting as sentinel feature of metastatic renal cell carcinoma: A case report and review of literature.

About 30% of all newly diagnosed renal cell carcinoma (RCC) patients present with synchronous metastatic disease. Usual organs of involvement are lung (75%), soft tissues (36%), bone (20%), liver (18%), cutaneous sites (8%), and central nervous system (8%). Metastases to the paranasal sinuses (PNS) are relatively common and may be a part of synchronous multiorgan involvement or present in follow-up after radical nephrectomy (metachronous); but primary presentation as isolated paranasal mass before the diagnosis of RCC is extremely rare. Here, we report a case of 74-year-old female presented with epistaxis and nasal obstruction. On evaluation by magnetic resonance imaging (MRI), a heterogeneously enhancing mass was found involving left PNS. Biopsy from mass revealed clear cell RCC. Later on, contrast-enhanced computed tomography (CECT) of chest, abdomen, and pelvis showed enhancing mass from the upper pole of the left kidney with no evidence of metastasis elsewhere. The patient was started on pazopanib 800 mg once a day. At 6 months follow-up scan, there was a partial response at both primary as well as metastatic site.

COVID-19 and its impact on genitourinary malignancies.

The severe acute respiratory syndrome coronavirus 2 has emerged as an alarming disease since December 2019, claiming the lives of thousands across the world to date. This pandemic has burdened healthcare systems all over the world due to its heavy death toll. Researchers are actively working on effective treatment strategies, the scope of vaccination and the production of more medical equipment to tackle this crisis. However, it is important to note that the management of patients with malignancy also needs to be prioritized during such times. Some urological malignancies need early diagnosis and treatment while the diagnosis and treatment of several others can be safely delayed. Hence, we searched MEDLINE for evidence on the optimal management of urological cancers during the coronavirus disease (COVID-19) pandemic. Studies published from December 2019 to April 2020 were included in the review. Guidelines formulated by international and national urological societies were also included. This review aims to summarize the present evidence on effective triage and safe management of urological cancers amid COVID-19 pandemic to ensure efficient usage of healthcare resources during these unprecedented times.

Trigonometric Concept of Fluoroscopy-Guided Percutaneous Renal Access.

Percutaneous nephrolithotomy is the standard surgical management of large renal calculi. Percutaneous renal access using the triangulation method has been an enigma for the endourologist to master and teach. This surgical conundrum is due to the uncertainty in the angle and depth required to puncture the target calyx. We describe a novel trigonometric method of renal access where both the angle and the depth of puncture are easily determined before the puncture.

Revascularisation of iatrogenic superior mesenteric artery injury by end to end anastomosis during robot assisted nephrectomy.

INTRODUCTION: Superior mesenteric artery (SMA) injury is very peculiar to left sided renal surgery. Although it is rare only, most of it is unreported. We report a case of SMA injury during robot assisted laparoscopic nephrectomy, which was managed successfully by end to end anastomosis. CASE PRESENTATION: A 19-year-old male patient was undergoing robot assisted laparoscopic simple nephrectomy for pyelonephritic kidney. Because of dense adhesion, SMA was inadvertently clipped and cut. It was recognised intraoperatively and an end to end anastomosis was done by laparotomy. DISCUSSION: SMA injury is rarely encountered in surgical practice. Most of it occurs following trauma. Iatrogenic SMA injury occurs in case of distorted local anatomy either due to adhesion or bulky tumor in left renal fossa and vicinity. CONCLUSION: One should be cautious about proximity of SMA and its possible injury during left nephrectomy and it should be repaired as soon as possible.

Massive Hematuria Due to Congenital Renal Arteriovenous Malformation Successfully Treated by Renal Artery Embolization.

Congenital renal arteriovenous malformations (AVMs) are rare benign vascular lesions and a rare cause of massive hematuria in females predominantly involving right kidney. Clinical presentation in a male with involvement of the left kidney is very rare. Only a few case series describing the outcome of congenital renal AVMs have been reported in the literature. We report a challenging case of a male patient with life threatening massive hematuria with congenital renal AVMs in left kidney. Successful embolization was performed using coils and gel foam.

Acute urinary retention and obstipation: a rare cause .

Tailgut cysts are rare congenital anomalies, believed to be remnants of the primitive embryonic hindgut. In addition to causing genitourinary and bowel obstructive symptoms, they have been reported to harbour occult adenocarcinoma. Varying positions of a tailgut cyst with respect to the rectum have also been reported in literature. We present a rare presentation of this disease vis a vis obstipation and acute urinary retention in a 70 year old man.

Influence of music on operation theatre staff.

BACKGROUND AND OBJECTIVE: The purpose of the study was to evaluate the perception of influence of music among surgeons, anesthesiologist and nurses in our hospital as well as to critically evaluate whether music can be used as an aid in improving the work efficiency of medical personnel in the operation theatre (OT). MATERIALS AND METHODS: A prospective, questionnaire-based cross-sectional study was conducted. A total of 100 randomly selected subjects were interviewed, which included 44 surgeons, 25 anesthesiologists and 31 nurses. Statistical package for social sciences (SPSS) Windows Version 16 software was used for statistical evaluation. RESULTS: Most of the OT medical personnel were found to be aware of the beneficial effects of music, with 87% consenting to the playing of music in the OT. It was also found that most participants agreed to have heard music on a regular basis in the OT, while 17% had heard it whenever they have been to the OT. CONCLUSIONS: Majority of the respondent's preferred playing music in the OT which helped them relax. It improved the cognitive function of the listeners and created a sense of well being among the people and elevated mood in them. Music helped in reducing the autonomic reactivity of theatre personnel in stressful surgeries allowing them to approach their surgeries in a more thoughtful and relaxed manner. Qualitative, objective and comprehensive effect of specific music types varied with different individuals. Music can aid in improving the work efficiency of medical personnel in the OT. The study has reinforced the beneficial effects of playing music in the OT outweighing its deleterious outcomes.

Penile gangrene and urethrocutaneous fistula following transurethral resection of prostatic carcinoma. A case report.

Channel transurethral resection of prostate (TURP) is an accepted treatment for advanced carcinoma of prostate (CaP) to improve quality of life. We are presenting a case of penile gangrene and urethrocutaneous fistula following TURP in a CaP. This is the first case in literature to our knowledge.

Hormone refractory carcinoma prostate with peritoneal metastases and malignant ascites without skeletal involvement: A case report and review of literature.

Peritoneal carcinomatosis is rare in prostate cancer especially in the absence of skeletal or other visceral metastases. We report a case of hormone refractory adenocarcinoma prostate presenting with only peritoneal metastases and massive malignant ascites. Palliation with docetaxel based cytotoxic chemotherapy resulted in clinical improvement of refractory ascites decreasing respiratory embarrassment and thereby improving the quality of life.

Schwannoma with concomitant tuberculosis in the adrenal gland.

Schwannoma is a rare primary tumor originating in the neural sheath with a good prognosis. The management is surgical. We present a case in which a retroperitoneal mass arising from the adrenal gland was excised and histopathology revealed a schwannoma with coexisting tuberculosis. This case report highlights the need to be aware of the potential coexistence of tuberculosis in any case of incidentaloma, especially due to resurgence of tuberculosis as a global epidemic with the increasing incidence of HIV and AIDS. To the best of our knowledge, this is the first reported case of a schwannoma and tuberculosis coexisting in the adrenal gland.