Primary or isolated adrenal melanoma is an exceptionally rare condition, with only a few cases reported in the literature. We report a case of a 30-year-old women patient, presented a left lumbar pain for 6 months. Abdominopelvic computed tomography revealed a left adrenal mass measuring 59×57×42 mm. The patient underwent an open left adrenalectomy. Histopathological examination of the resected specimen confirmed the diagnosis of primary melanoma of the left adrenal gland. The patient received adjuvant immunotherapy. At 16 months of follow-up, she developed local recurrence in the left adrenalectomy bed, associated with the development of hepatic metastases.
Primary renal Ewing sarcoma (PRES) is an exceptionally rare and aggressive malignancy with a poor prognosis. The optimal management strategy remains poorly defined due to its rarity. We report a case of a 39-year-old female with PRES. The patient received six cycles of neoadjuvant chemotherapy (VDC/IE regimen), followed by right radical nephrectomy. Histopathological examination revealed dense fibrocollagenous and inflammatory tissue with no viable tumor cells, confirming a pathological complete response (pCR). This case highlights the critical importance of a multimodal treatment approach integrating neoadjuvant chemotherapy and surgery.
Iatrogenic vesicovenous fistula creation via accidental implantation of the gonadal vein into the bladder with subsequent double J stent placement is an exceptionally rare complication of abdominopelvic surgery. We report the case of a 51-year-old woman who presented two years after hysterectomy and bilateral salpingo-oophorectomy in Mexico. She was found to have a double J ureteral stent passing from the bladder through the inferior vena cava into the right atrium of the heart complicated by E. coli bacteremia. Multidisciplinary management of this patient allowed for successful stent removal endoscopically without an open cardiac intervention.
Bicycle handlebar trauma rarely causes extensive perineogenital degloving in children. A 13-year-old boy sustained an 11 × 11 cm degloving injury involving the suprapubic, penile, and perineal regions, with narrow-based skin flaps and disruption of superficial penile vessels. He underwent wound exploration, washout, debridement, and layered closure. The suprapubic flap subsequently necrosed, while the penile skin remained viable, and the wound healed progressively by secondary intention. Follow-up revealed scar-related acquired cryptorchidism and mild dorsal chordee. Prompt surgical management and long-term follow-up are essential to identify and manage delayed complications.
Secondary bladder tumors are rare, and hematogenous bladder metastases from lung cancer are exceptionally uncommon. We report the first documented case of bladder metastasis from pulmonary hepatoid adenocarcinoma (HAC) in a 72-year-old man undergoing treatment for lung cancer. An asymptomatic bladder mass was detected during follow-up. Histopathology and immunohistochemistry confirmed metastatic pulmonary HAC and excluded primary urothelial and hepatic tumors. This case highlights the diagnostic value of comprehensive immunohistochemistry and clinicoradiological correlation in distinguishing secondary bladder tumors. Early recognition is essential to guide appropriate multidisciplinary management, although prognosis remains poor.
Renal angiomyolipomas (AMLs) may rupture and cause life-threatening hemorrhage. We report a man in his 40s with a ruptured giant renal AML who underwent emergent transarterial embolization after contrast-enhanced computed tomography demonstrated a pseudoaneurysm. Although initial hemostasis was achieved and he remained clinically stable, follow-up computed tomography performed 5 days later revealed a newly apparent 20-mm pseudoaneurysm arising from an alternative feeder, requiring repeat embolization. This case suggests that early postprocedural contrast-enhanced computed tomography may be useful in selected patients with ruptured giant or multifocal AMLs and high-risk vascular morphology.
A 68-year-old man with a history of ileocystoplasty performed 15 years prior presented with weakness and lethargy but no urinary symptoms. Despite the absence of typical complaints, imaging revealed a 10 × 9.8 cm giant bladder stone causing severe bilateral hydroureteronephrosis and renal failure. Following emergency dialysis, bilateral nephrostomy placement, and cystolithotomy, renal function recovered. This case highlights a giant stone within a bowel-segment urinary reservoir that caused silent obstruction and life-threatening renal failure, underscoring the need for lifelong follow-up after cystoplasty.
A 44-year-old man presented with bilateral flank pain, dysuria, and incomplete bladder emptying. Evaluation demonstrated a non-functioning atrophic left kidney, a markedly dilated tortuous ureter, and an ectopic ureter inserting into the left ejaculatory duct with an associated ejaculatory duct stone. Diagnosis was established using CT, MRI, DMSA scan, cystoscopy, and retrograde pyelography. Surgical findings confirmed the anomaly, and postoperative semen analysis showed hemato- and oligoasthenospermia. This rare congenital urological abnormality illustrates the importance of multimodal imaging and multidisciplinary management to achieve accurate diagnosis and guide appropriate treatment.
A hernia is the protrusion of an organ, such as the bowel, through the lining wall of the cavity in which it normally resides. Pediatric hernias are common developmental abnormalities which have different etiopathogenesis as well as management as compared to adults.Presence of persistent processus vaginalis is common mechanism in the etiopathogenesis of indirect inguinal hernia and hydrocele in children. Right sided hernias more common than left since, left processus vaginalis obliterates before the right.Author is reporting here a case recurrent inguinoscrotal hernia with hydrocele in a child and its management.
Renal cell carcinoma is the most common adult renal malignancy but is rare in children, where Wilms tumor predominates. A 10-year-old boy presented with intermittent gross hematuria for two years, worsening with clot retention. Imaging revealed a right renal solid mass without metastasis (cT1bN0M0). After cystoscopic clot evacuation, open radical nephrectomy was performed. Histopathology confirmed RCC with lymphovascular invasion and negative margins (pT2aN0Mx). Because clinical and radiologic findings overlap with other pediatric renal tumors, definitive diagnosis relies on histopathology. Surgical resection is the primary treatment, as pediatric RCC responds poorly to chemo-and radiotherapy. Early-stage disease generally has favorable outcomes.
A 20-year-old man presented with right flank pain and gross haematuria from a large right renal mass that enlarged rapidly over five months. Open radical nephrectomy with hilar node sampling revealed monophasic blastemal Wilms tumour with diffuse anaplasia; all nodes were negative. He later developed pulmonary metastases and, after treatment interruption, pulmonary relapse, managed with multi-agent chemotherapy, radiotherapy and salvage chemotherapy achieving complete response. Adult Wilms tumour is rare, mimics renal cell carcinoma and carries a poor prognosis. This case highlights its diagnostic difficulty, high-risk histology and the critical importance of sustained treatment adherence.
Adenoid cystic carcinoma is a rare malignant neoplasm characterized by slow growth, frequent perineural invasion, and a propensity for late distant metastasis, while renal involvement remains exceptionally uncommon. We report the case of a 48-year-old woman who presented renal lesion was diagnosed approximately three years after the initial treatment of the mandibular adenoid cystic carcinoma. The patient underwent right radical nephrectomy, and histopathological examination with immunohistochemical analysis confirmed secondary renal involvement by metastatic mandibular adenoid cystic carcinoma.
Anatomical variations may result from errors during embryologic development. Specifically, variations in gonadal vasculature can arise from atypical persistence of subcardinal -supracardinal anastomoses, which can result in duplicated gonadal veins. We present a rare case of a partially duplicated left ovarian vein bisected by the left renal artery that was discovered in a female anatomical donor during dissection of twenty human cadavers at Creighton University School of Medicine. To our understanding, the anteroposterior duplication with a bisecting renal artery has not been previously reported. Proper documentation of anatomical variations can help enhance clinician awareness, therefore mitigating procedural and clinical complications.
Renal aspergillosis is an uncommon complication of urological instrumentation. We report a 40-year-old immunocompetent male who developed upper ureteric Aspergillus flavus fungal ball obstruction one month following left partial nephrectomy for Papillary Renal Cell Carcinoma Type 1. Prior history included DJ stenting and ureteroscopic stone clearance. He presented with left loin pain, malaise, and decreased urine output. CT demonstrated left hydroureteronephrosis without a discrete calculus. Emergency ureteroscopy successfully extracted the fungal ball. The patient completed three months of oral itraconazole 200 mg twice daily, with therapeutic serum trough levels confirmed, achieving complete clinical and radiological resolution.
Adolescent retroperitoneal sarcoma (RPS) poses significant decision-making challenges due to complex subtypes and limited molecular diagnosis.A 16-year-old male with a 13.8 cm retroperitoneal mass underwent R0 en bloc resection (with left adrenal gland). Pathology favored high-grade fibrosarcoma. He completed 5 cycles of adjuvant Ifosfamide and Doxorubicin. At 17 months post-surgery, surveillance shows no disease recurrence.When molecular testing is unavailable for large, high-grade adolescent RPS, combining R0 en bloc resection with intensive adjuvant chemotherapy remains an effective strategy for favorable outcomes.
Neisseria meningitidis is an uncommon cause of genitourinary infection, and chronic prostatitis caused by this organism has rarely been reported. A 34-year-old man presented with recurrent dysuria and urethral discharge after oral sexual exposure. Initially misdiagnosed as gonococcal urethritis, the patient achieved only partial improvement after empirical therapy. Culture of midstream urine and expressed prostatic secretions, confirmed by biochemical testing,MALDI-TOF MS and 16S rDNA sequencing, identified N. meningitidis. Targeted antimicrobial therapy resulted in clinical and microbiological resolution. This case highlights the importance of accurate pathogen identification in recurrent urethritis and prostatitis.
A 70-year-old man with a 9.1 cm infiltrative right renal mass involving the inferior vena cava (IVC), with retroperitoneal lymphadenopathy and pulmonary nodules, received 27 months of lenvatinib and 6 months of pembrolizumab after biopsy confirmed metastatic clear cell renal cell carcinoma (ccRCC). Restaging imaging demonstrated a reduction of the renal mass to 3.6 cm, resolution of IVC thrombus, lymphadenopathy, and pulmonary metastases. He underwent right robotic cytoreductive radical nephrectomy. Final pathology was ypT0Nx. To our knowledge, this is the first reported case of complete pathologic and radiographic response of metastatic ccRCC predominantly on lenvatinib, with brief duration of pembrolizumab.
Horseshoe kidney (HSK) with a duplicated collecting system and a bifid ureter is a unique surgical challenge. We report the case of a 43-year-old male patient with a left HSK, duplicated collecting system, bifid ureter, staghorn calculus in the lower moiety, and proximal ureteral stone. The procedure of mini-endoscopic combined intrarenal surgery (mECIRS) with mini-percutaneous nephrolithotomy (mini-PCNL) was successfully performed, resulting in minimal blood loss and no intraoperative complications. This case exemplifies the feasibility of employing mECIRS with a single-tract, tubeless mini-PCNL, combined with flexible ureteroscopy, to achieve complete stone clearance in a rare and challenging anatomical context.
High-grade urothelial carcinoma of the bladder is exceptionally rare in children and optimal management remained undefined. We report a three-year-old boy who presented with painless gross hematuria and was found to have a papillary bladder mass. Complete transurethral resection of the bladder tumor with random bladder biopsies demonstrated high-grade urothelial carcinoma without carcinoma in situ, and metastatic evaluation was negative. Intravesical therapy was deferred and the patient underwent surveillance with cystoscopy, urine cytology, and ultrasonography. Eighteen years after diagnosis, he remains disease-free and asymptomatic. This case provides the longest reported disease-free follow-up in pediatric high-grade urothelial carcinoma.
Paragangliomas arising from the renal hilum are exceptionally rare and may mimic other retroperitoneal neoplasms on imaging. We report a 26-year-old normotensive man presenting with dull left flank pain. Biochemical evaluation showed elevated plasma free metanephrine and normetanephrine despite normal catecholamine levels. CT angiography demonstrated a thick-walled, multiseptated cystic hilar mass with renal vein encasement, while PET/CT showed low metabolic activity. Left nephrectomy with mass resection was performed, and histopathology with positive Synaptophysin, Chromogranin A, Vimentin, and S100 staining confirmed paraganglioma. This case highlights the diagnostic value of biochemical testing and histopathology in atypical renal hilar masses.
