Transitional cell carcinoma arising in a pyelocaliceal cyst. An unusual cystic renal lesion with cytologic and imaging findings.

The differentiation between benign and malignant cystic lesions of the kidney is a diagnostic challenge. Medical imaging aids in this task, but many cystic renal lesions require further work-up, frequently by computed tomography-guided fine needle aspiration. We report on the pathological findings in a case of moderately differentiated papillary transitional carcinoma, which arose in a pre-existing pyelocaliceal cyst in a 53-year-old man. In the case of this lesion, the distinction between a benign and a malignant renal cyst is blurred. To our knowledge, this is the third such occurrence to be reported and the first to be diagnosed by fine needle aspiration biopsy.

Repeat male genital self-mutilation precipitated by urinary complications of prior repair.

Male genital self-mutilation is uncommon, with repeat mutilation even more rare. Our case is unique in that a urological complication of the first mutilating act (meatal stenosis) helped to precipitate the second incident. This case underscores the need not only for immediate urological and psychiatric care at the time of initial mutilation but also for close, combined followup care as well. In the majority of cases, when properly monitored, the men do not repeat the mutilating act.

Prostate biopsy in patients after proctectomy.

Until the discovery of prostate specific antigen as a tool to detect prostate carcinoma, the rectum has always been necessary to allow the best evaluation and biopsy of the prostate, whether by digital examination or transrectal ultrasound. We describe a simple, accurate, computerized tomography-guided method to biopsy the prostate in men who have undergone proctectomy.