[A case of Bellini collecting duct carcinoma with hypercalcemia in a young adult].

A 25-year-old man presented to a local clinic with right flank pain and gross hematuria. Computed tomography revealed the right renal tumor and he was referred to our hospital. Laparoscopic radical nephrectomy was performed and diagnosis of Bellini collecting duct carcinoma was made pathologically. Adjuvant therapy with interferon-α, followed by a gemcitabine and cisplatin-based regimen of chemotherapy was performed, but the disease progressed. Sunitinib was started 14 months after the operation. After one course of sunitinib, mental status was altered due to hypercalcemia (serum calcium level was 18.6 mg/dl and PTH-rP was 3.7 pmol/l). Level of consciousness recovered along with decreasing serum calcium level, but he died of multiple organ dysfunction 17 months after the operation. Autopsy showed liver, bone, lymph node, mediastinum and left adrenal tumor metastases.

[A case report of ureteropelvic junction obstruction and multiple renal stones associated with nutcracker syndrome].

A 20 year-old man presented to emergency room with severe left-sided flank pain. Urinalysis showed hematuria and he was referred to the urology department. KUB, DIP and retrograde pyelography (RP) revealed multiple renal stones, left hydronephrosis (grade 2) and ureteropelvic junction obstruction (UPJO). Abdominal CT revealed shortened nutcracker distance and renal angiography showed left renal vein hypertension. From these findings, diagnosis of nutcracker syndrome was made. Transposition of the left renal vein, dismembered pyeloplasty and left pyelolithotomy were performed simultaneously. 2 months after the procedure, his symptom and hematuria disappeared. 3 months after the procedure, DIP revealed improvement of hydronephrosis (grade 1) and CT showed elongation of nutcracker distance. In 12 months follow-up, there was no recurrence of symptom and hydonephrosis. To the best our knowledge, there has been no report of UPJO associated with nutcracker syndrome and the simultaneous treatment for the both diseases.

[A case of Candida parapsilosis fungal balls in the urinary tract associated with a retrocaval ureter].

A 70-year-old man with a medical history of diabetes mellitus presented to a local clinic with seven days history of right flank pain and fever. Because there was no symptomatic improvement after one-week antibiotic administration, abdominal ultrasonography and computed tomographic scans were performed to show mass lesions in the right hydropelvis, and he was transferred to our hospital. Retrograde pyelography revealed a retrocaval ureter and a ureteral stent was indwelt. After the symptoms improved, the lesions were removed by percutaneous nephrostomy and fungal balls were diagnosed as Candida parapsilosis after culture. After intermittent one-week irrigation of the renal pelvis with normal saline, the nephrostomy tube was removed. In six-month follow-up, mild hydronephrosis remains without fungal ball recurrence. To the best our knowledge, there has been no case report of Candida parapsilosis fungal balls in the urinary tract.