RESUMO
INTRODUCTION AND IMPORTANCE: Rhabdomyosarcoma [RMS] is a malignant soft-tissue neoplasm characterized by skeletal muscle differentiation. It accounts for 7 % of childhood malignancies and is, by a wide margin, the most common sarcoma of childhood (Pappo, 1996). Approximately 20 % of cases of childhood rhabdomyosarcoma occur in the genitourinary tract (vagina, urinary bladder, prostate, paratestis, and uterus), and they are most commonly observed in the head and neck region. CASE PRESENTATION: We reviewed the case of a 42-year-old male who presented with a 2-week history of blood in the urine, which was painless, started on gradual onset, and progressively increased, involving the whole stream of urine. The blood clots were amorphous in shape but had no history of passed tissue shreds, childhood schistosomiasis, cigarette smoking, or working in chemical industries. On physical examination, the patient was anxious and conscious, with normal vital signs. The abdomen revealed distended abdomen shifting dullness, a palpable urinary bladder with suprapubic distension, and a tenderness on palpation, which disappeared upon catheterization 3-way 24F, with normal male genitalia and right lower limb edema. Other systems were essentially normal. On image KUB USS revealed a bladder mass, Cystoscopy showed a broad base bleeding tumor located at dome to the left lateral, fungating, with some necrotic tissue. TURBT was done into completion and histology revealed an embryonal rhabdomyosarcoma of urinary bladder, a botryoid subtype. After TURBT, the patient received adjuvant chemotherapy, the MAID protocol and underwent a 6-cycle cycle. The cycle was repeated every 21 days, and his height was 171.5 c, and his weight was 89 kg. Serial of check cystoscopy for one year revealed no recurrency of tumor. He repeated check CT scan, which showed a radiological improvement compared to the initial image. CLINICAL DISCUSSION: Rhabdomyosarcoma in adults is a rare type of urinary bladder carcinoma that is quite aggressive and is usually reported to be a pediatric malignant urinary bladder tumor. The modality of treatment is not universal because of its rarity. We used a combination of TURB and chemotherapy and performed strict follow-up, with no tumor recurrence occurring at least after one year of follow-up. These patients show significant improvement from the first presentation, both clinically and radiologically. CONCLUSION: The lack of a universal standard treatment approach for adult rhabdomyosarcoma indicates the need for more data on adult rhabdomyosarcoma, with a detailed description of its histological subtype.
RESUMO
INTRODUCTION AND IMPORTANCE: Leiomyomas are rare, benign mesenchymal tumors. They represent 1 to 5 % of all urinary bladder tumors. 20 % are asymptomatic, but most presentations are voiding and storage, followed by hematuria. Surgery has been reported to be a standard treatment, depending on the size of the tumor and its location in the bladder. The following case report, we discuss the case of a bladder leiomyoma presenting with storage and voiding symptoms and managed with dual approach of Transurethral resection of bladder tumor (TURBT) and open urethrotomy. CASE PRESENTATION: A 39-year-old female who presented with a one-year history of total hematuria and a blood clot that was ovoid in shape presented with urge incontinence, nocturia, strain during urination, and incomplete bladder emptying. She was mildly anemic, afebrile, with no palpable peripheral lymph node and no palpable mass. PVE revealed an anteriorly located cervix. The patient's Labs revealed to have moderate anemia of 8 g/dl, blood chemistry was uneventful, and ultrasound (USS) revealed that both kidneys were normal. The urinary bladder was well distended, with a mass located at the base, measuring 4.13 cm × 4.14 cm. MRI revealed a well-circumscribed intramural tumor on the left side measuring 4.3 cm × 4.2 cm, close to the bladder neck. A cystoscopy was used to visualize the tumor from the left lateral wall at 3 o'clock, extending to 5 o'clock, and part of the bladder neck. The tumor was solid, easily bled, and had an irregular margin, and the bladder mucosa was normal. The 1st TURBT was used for diagnosis; although she still persistent storage and voiding symptoms, she subsequently underwent 2nd TURBT, which was resected to completion with the aid of ventral urethrotomy. After the TURBT, tumor protruded into the urethra, complete excision was performed through the urethra due to extension of the tumor to the urethra. The patient's postoperative events were uneventful, and the patient was discharged with catheter care for 10 days. On follow-up, hematuria resolved, and there were no lower urinary tract symptoms. CLINICAL DISCUSSION: Leiomyoma of the urinary bladder is a rare, benign mesenchymal tumor. They are the most common type of tumor of the urinary bladder. The most common presentations are storage and voiding symptoms, and hematuria. The initial USS can be used, and CT IVU or MRI is necessary for surveillance of the upper tract, possibly with respect to the tumor location in relation to the ureteric orifice. Tumors can be endovesical, intramural or extravesical, resulting in different presentations. Some tumors are pedunculated and can move close to the bladder neck or even at the urethra and present with urinary retention. Leiomyomas are surgically excised, and sometimes via a dual approach, transurethral resection of bladder tumors is important. These patients have a very low recurrence rate and are symptom free, and they have a good prognosis. CONCLUSION: Leiomyomas are surgically excised, and sometimes via a dual approach, transurethral resection of bladder tumors is important. These patients have a very low recurrence rate and are symptom free, and they have a good prognosis.
RESUMO
INTRODUCTION AND IMPORTANCE: Circumcision is the most common surgical procedure done in boys. Its complication varies from minor to severe. In most of African countries circumcision is often performed by traditional circumcisers. The management of penile glans amputation depends on the duration before presentation with auto-transplantation being the favorable management in acute phase of presentation. The amputation of the glans is a serious complication of circumcision because it can derange the urinary and sexual functions of a patient and may lead into psychological instability and low self-esteem. CASE PRESENTATION: We report a case of total glansectomy in a 5-year old boy who presented 12 months after surgical circumcision which was done by inexperienced medical personnel at his house. Patient presented with a pinhole urethra opening, missing glans, buried phallus with remnants of corporal bodies. Penile exploration was done, with successful significant phallus stump of about 5 cm, phallus reconstruction and meatoplasty was achieved. Partial Skin thickness grafting of the phallus stump was performed. At six- month follow up, the patient had both satisfactory cosmetic and functional outcomes. CLINICAL DISCUSSION: Total glansectomy is a rare surgical emergency with auto transplantation being the best option in acute management however successful outcome for a delayed glansectomy depends on proficient surgical penile exploration and comprehensive post operative care. Based on the clinical presentation, the goals of management for our patient were to achieve a largely patent urethral opening in the long term and to prevent further urethral meatal stenosis as well as achieving adequate phallus stump for sexual function. CONCLUSION: The amputation of the glans is a serious complication of circumcision because it can derange the urinary and sexual functions of a patient if neglected. Findings on this case report highlight the importance of raising awareness among traditional health care workers to prevent urinary and sexual function disabilities. Prevention of penile amputation can be prevented by providing proper training for circumcisers and providing public education for hospital circumcision.