Introduction:Zinner syndrome is a rare congenital urogenital anomaly characterized by seminal vesicle cysts, ejaculatory duct obstruction, and ipsilateral renal agenesis. Surgical treatment for prostate cancer in this setting has been reported in only 2 previous cases. Case Presentation:A 67-year-old man with congenital left renal agenesis presented with voiding dysfunction. Magnetic resonance imaging identified a 6-cm seminal vesicle cyst and a Prostate Imaging-Reporting and Data System category 4 prostatic lesion. Serum prostate-specific antigen was 1.3 ng/mL. Prostate biopsy revealed Gleason score 3 + 3 = 6 adenocarcinoma. Robot-assisted laparoscopic radical prostatectomy was performed using the posterior approach. Despite anatomical complexity and adhesions, the procedure was completed safely. Postoperative prostate-specific antigen became undetectable, and the patient achieved pad-free continence at 6 months. Conclusion:Robot-assisted laparoscopic radical prostatectomy was safely performed for prostate cancer arising in Zinner syndrome. Robot-assisted surgery is particularly valuable for complex anatomy caused by congenital anomalies.
ABSTRACT Introduction Although robot‐assisted surgery is widely used, there are few reports of robot‐assisted radical cystectomy in kidney transplant recipients. We report our experience with robot‐assisted radical cystectomy in a patient who had undergone three kidney transplants. Case Presentation The patient was a 57‐year‐old man who had undergone three kidney transplants. Robot‐assisted total cystectomy was performed for bladder CIS. Adhesions were observed in areas that had been operated on in previous surgeries, and although there were times when the surgery was difficult, it was performed safely. No major postoperative complications were observed, and the patient was discharged from the hospital on the 19th postoperative day. Conclusion Robot‐assisted surgery is one of the surgical techniques that many urologists are familiar with, and our findings suggest that it may be safe and effective even for such complex cases.
Introduction:Herein, we report a case of mesothelioma of the tunica vaginalis testis (MTVT), treated as a hydrocele. Case Presentation:A 65-year-old man was referred to our hospital after MTVT was incidentally diagnosed during hydrocelectomy performed for recurrent hydrocele. Left hemiscrotectomy was performed, and pathological examination revealed an epithelioid-type MTVT with invasion into the testis and spermatic cord. Immunohistochemistry was positive for D2-40 and calretinin, and negative for cytokeratin 5/6 and carcinoembryonic antigen. The patient remained disease-free for 12 months postoperatively without adjuvant treatment. Conclusion:MTVT should be considered in patients with long-standing or recurrent hydrocele. Wide surgical excision is essential for local control.
ABSTRACT Introduction Bullous pemphigoid is a rare cutaneous, immune‐related adverse event, and avelumab‐associated cases are extremely rare. Case Presentation A 76‐year‐old man receiving avelumab maintenance therapy for recurrent renal pelvic carcinoma developed pruritic erythema and tense blisters 20 days after the first dose. Laboratory examination showed eosinophilia, increased immunoglobulin E level, and markedly elevated anti‐BP180 antibodies. Moreover, skin biopsy revealed subepidermal blistering with eosinophilic infiltration, supporting drug‐associated bullous pemphigoid. Prednisolone (15 mg/day, increased to 25 mg/day) led to marked improvement. After the second course, avelumab was discontinued, and no recurrence occurred. Conclusion Immune‐checkpoint‐inhibitor‐related, drug‐associated bullous pemphigoid can present with nonspecific symptoms before blistering. Thus, urologists should monitor skin changes during immune checkpoint inhibitor therapy and promptly involve dermatology.
Introduction:Intravesical foreign bodies may remain silent until secondary complications occur. Rectovesical fistula caused by an intravesical foreign body is rare. Case Presentation:A 69-year-old man presented with urinary frequency and abdominal distension. Computed tomography revealed a 70.8-mm vesical calculus encasing an approximately 8-cm plastic object, with bilateral hydroureteronephrosis and suspected rectal involvement. Cystoscopic evaluation was limited by the massive calculus. Intravesical indigo carmine appeared from the rectum, and colonoscopy confirmed a foreign body protruding through the anterior rectal wall. Open cystotomy with removal of the foreign body and fragmented adherent stone, suprapubic cystostomy, and diverting transverse colostomy were performed. Delayed laparoscopic fistula closure and subsequent stoma closure were completed. Hydroureteronephrosis and renal function improved, with no recurrence. Conclusion:A long-retained intravesical foreign body can cause rectovesical fistula through stone-mediated fixation. Staged management may be appropriate when inflammation and contamination preclude immediate closure.
Introduction:Squamous cell carcinoma is a rare bladder cancer subtype with poor prognosis in advanced stages. Currently, there is no established systemic therapy, including immune checkpoint inhibitors, for this subtype. Case Presentation:A 49-year-old man with pure bladder squamous cell carcinoma arising from a diverticulum with pelvic lymph node involvement underwent neoadjuvant gemcitabine plus cisplatin followed by robot-assisted radical cystectomy. Six months later, pulmonary metastases developed, and platinum rechallenge led to rapid progression with pleural dissemination. Pembrolizumab produced a complete response despite programmed cell death ligand-1 negativity, microsatellite stability, and low tumor mutational burden. Isolated hilar lymph node progression during treatment was managed with radiotherapy, achieving temporary local control. The patient survived 41 months from diagnosis and 30 months after metastasis. Conclusion:Despite early and aggressive metastatic recurrence after robot-assisted radical cystectomy, the patient showed a remarkable and durable response to pembrolizumab.
ABSTRACT Introduction Pyelonephritis with contralateral vesicoureteral reflux (VUR) after robot‐assisted radical nephroureterectomy (RANU) in a solitary kidney has rarely been reported. Case Presentation A 73‐year‐old woman with preoperative lower urinary tract symptoms (LUTS; IPSS 15, OABSS 7) underwent right RANU for urothelial carcinoma of the renal pelvis (cT3N0M0). On postoperative day (POD) 12 she developed fever, and on POD 16 she was readmitted with left pyelonephritis and Escherichia coli bacteremia. Contrast‐enhanced computed tomography revealed multiple wedge‐shaped hypoenhancing areas in the left kidney, consistent with acute focal bacterial nephritis. Inflammatory markers improved promptly with antibiotics. Cystography on POD 21 demonstrated left grade 1 VUR limited to the storage phase, which resolved spontaneously 1 month after discharge. Conclusion Latent lower urinary tract dysfunction may unmask contralateral VUR in patients with a solitary kidney after RANU. Preoperative LUTS evaluation and prompt cystography during postoperative infection may help preserve contralateral renal function.
Introduction:Plasmacytoid urothelial carcinoma (PUC) is a rare, aggressive subtype of bladder cancer characterized by diffuse infiltrative growth and a propensity for peritoneal and retroperitoneal dissemination. Case Presentation:A patient with muscle-invasive bladder cancer (cT3N1M0) was diagnosed with conventional high-grade urothelial carcinoma without subtype histology on transurethral resection. After neoadjuvant gemcitabine-cisplatin chemotherapy, robot-assisted radical cystectomy with intracorporeal neobladder reconstruction was performed. Final pathological examination revealed PUC (pT4aN2). Within weeks after surgery, the patient developed sequential retroperitoneal fluid accumulation, bilateral hydronephrosis, duodenal obstruction, and biliary obstruction, suggesting rapid diffuse retroperitoneal progression. Enfortumab vedotin plus pembrolizumab was initiated; however, the disease progressed aggressively, and the patient died on postoperative day 80. Conclusion:PUC may evade detection on initial TUR and can progress rapidly through diffuse retroperitoneal dissemination even after radical cystectomy. Early postoperative, unexplained multiorgan obstructive findings should raise suspicion of occult progression and prompt timely initiation of systemic therapy.
ABSTRACT Introduction The coexistence of testicular cancer and hematopoietic disorders is rare, and reports on optimal treatment strategies are limited. Here, we present a case of metastatic testicular cancer associated with myelodysplastic syndrome. Case Presentation A 24‐year‐old man with pancytopenia underwent right orchiectomy for a right scrotal mass. Histopathological examination revealed embryonal carcinoma. Subsequent imaging demonstrated para‐aortic lymph node metastasis. Pancytopenia was diagnosed as myelodysplastic syndrome. The patient received chemotherapy with dose modifications and a prolonged treatment course, followed by retroperitoneal lymph node dissection; viable tumor cells were identified in the resected specimens. After adjuvant chemotherapy, allogenic hematopoietic stem cell transplantation was performed for myelodysplastic syndrome. The patient remained free of testicular cancer recurrence for 2 years post‐surgery. Conclusion This case suggests that durable disease control may be achievable in metastatic testicular cancer associated with myelodysplastic syndrome through carefully managed chemotherapy and surgery.
ABSTRACT Introduction Secondary malignancies arising in intestinal segments used for urinary diversion are rare, and reports of malignant lymphoma are extremely limited. We report a rare case of follicular lymphoma arising in an ileal neobladder 20 years after radical cystectomy. Case Presentation An 81‐year‐old man had undergone radical cystectomy with ileal neobladder reconstruction for muscle‐invasive bladder cancer (pT2bN0M0) 20 years earlier and had remained recurrence‐free. Follow‐up imaging incidentally revealed a large pelvic mass contiguous with the neobladder and multiple enlarged lymph nodes. Transurethral resection led to a diagnosis of follicular lymphoma. Treatment with bendamustine plus rituximab achieved marked tumor reduction without severe adverse events. Conclusion Malignant lymphoma arising in urinary diversion organs is extremely rare. This case highlights the potential for late‐onset lymphoid malignancies following urinary diversion and emphasizes the need for long‐term clinical awareness of secondary malignancies in such patients.
Introduction:Ileal conduit diversion is commonly performed after cystectomy and is considered the gold standard. However, late complications can occur. Case Presentation:A 74-year-old woman had undergone cystectomy with ileal conduit diversion for neurogenic bladder dysfunction 47 years earlier. She presented with recurrent urinary tract infections and bilateral hydroureteronephrosis. Imaging revealed conduit stenosis and impaired bilateral renal function. Endoscopy of ileal conduit revealed a pinhole-like stenosis on the proximal side. A 10-Fr catheter was advanced across the stenotic segment, resulting in pyelonephritis resolution and renal function improvement. After 1 month, the catheter was upsized to 16-Fr. Five months later, the catheter was spontaneously expelled, and good urine flow was maintained, with no recurrence over 2 years of follow-up. Conclusion:Ileal conduit stenosis can occur even decades after urinary diversion and can be managed effectively by stepwise dilation. The present case highlights the need for lifelong surveillance in ileal conduit patients.
Introduction:Periureteral IgG4-related disease (IgG4-RD) is rare and can mimic upper tract urothelial carcinoma (UTUC), sometimes leading to unnecessary nephroureterectomy. Diagnosis is challenging when endoscopic biopsy is inconclusive and percutaneous biopsy is unsafe. Case Presentation:A 58-year-old man presented with right-sided hydronephrosis. Imaging suggested right renal pelvic or ureteral carcinoma; however, ureteroscopic biopsy was nondiagnostic despite weak IgG4 positivity. Serum IgG4 was elevated to 684 mg/dL. Because percutaneous biopsy was unsafe owing to proximity to major vessels, retroperitoneoscopic biopsy was performed after placement of a fluorescent ureteral catheter. Near-infrared imaging identified the ureteral course, enabling safe biopsy. Frozen sections showed no malignancy, and histopathology revealed abundant IgG4-positive plasma cells, establishing IgG4-RD. Steroid therapy was initiated. Conclusion:Intraoperative frozen-section analysis ruled out malignancy and was the decisive factor in avoiding nephroureterectomy; the fluorescent ureteral catheter served as intraoperative navigation, enabling safe sampling of the periureteral lesion without ureteral injury.
ABSTRACT Introduction Penile metastasis from prostate cancer—generally associated with a poor prognosis—is rare and underreported. We report one relevant case. Case Presentation The patient was a 65‐year‐old male with metastatic hormone‐sensitive prostate cancer (prostate‐specific antigen [PSA]: 500 ng/mL) and lung, bone, and lymph node metastases. The patient received luteinizing hormone‐releasing hormone agonist monotherapy. The patient developed castration‐resistant prostate cancer and received androgen receptor signal inhibitor therapy and chemotherapy. As the disease progressed, a mass formed on his penis; biopsy revealed prostate cancer penile metastasis. The patient died 5 months later. Conclusion Penile metastasis is rare and typically observed in advanced prostate cancer stages. Awareness may aid in early recognition, guide palliative management, and support patient counseling.
ABSTRACT Introduction Cytokine release syndrome (CRS) is a systemic inflammatory response triggered by various factors, including infection and immunotherapy. Due to its nonspecific presentation, distinguishing CRS from other life‐threatening conditions remains challenging. Case Presentation A 79‐year‐old male receiving lenvatinib plus pembrolizumab for metastatic renal cell carcinoma presented with high‐grade fever, altered mental status, and respiratory failure on day 4 of treatment. After excluding infectious etiologies and endocrine dysfunction, CRS was suspected and confirmed by elevated interleukin‐6 levels. Lenvatinib and pembrolizumab were discontinued, and the patient was treated with tocilizumab and dexamethasone. Clinical improvement was achieved by day 7. Conclusion CRS should be considered a potential cause of unexplained shock in patients receiving immune checkpoint inhibitors. Early diagnostic consideration is vital for timely intervention.
ABSTRACT Introduction Accessory adrenal oncocytomas are rare. Consequently, the clinical characteristics and management of this entity remain poorly defined. Case Presentation A 65‐year‐old man presented with a retroperitoneal mass. Imaging revealed a 103 × 96 mm tumor adjacent to the left kidney. Hormonal evaluation indicated the tumor was nonfunctioning; however, dehydroepiandrosterone sulfate and neuron‐specific enolase levels were elevated, and malignancy could not be excluded. The tumor was resected laparoscopically. Histopathological examination revealed oncocytic features, and immunohistochemistry demonstrated positivity for steroidogenic factor 1. The tumor was anatomically separate from the normal adrenal gland, supporting the diagnosis of an accessory adrenal oncocytoma. Based on the Lin–Weiss–Bisceglia criteria, the tumor was classified as borderline malignant potential. No recurrence has been observed during 2 years of follow‐up. Conclusion Accessory adrenal oncocytomas are rare entities, and their accurate diagnosis requires a comprehensive, integrated approach incorporating clinical findings, imaging studies, and detailed pathological evaluation.
ABSTRACT Introduction Urethral metastasis of prostate cancer is exceptionally rare, particularly in castration‐resistant disease. Therapy‐induced neuroendocrine prostate cancer (t‐NEPC) is an aggressive variant with limited treatment options. Case Presentation A 72‐year‐old man, 14 years after diagnosis of prostate adenocarcinoma treated with androgen deprivation therapy, presented with hematuria and dysuria. Prostate‐specific antigen was 2.05 ng/mL and neuron‐specific enolase was 28.0 ng/mL. Urethroscopy revealed papillary tumors in the pendulous urethra. Histology showed high‐grade adenocarcinoma with a small cell carcinoma component, positive for synaptophysin and prostate‐specific antigen. Genomic profiling demonstrated PTEN loss, TP53 mutation, and androgen receptor amplification. Platinum‐based chemotherapy with external‐beam radiotherapy achieved durable urethral local control despite later distant progression; the patient survived 2 years 10 months. Conclusion Platinum‐based chemoradiotherapy may provide durable local control of urethral metastasis from t‐NEPC.
Introduction:Deferred cytoreductive nephrectomy may improve the prognosis of patients with metastatic renal cell carcinoma (RCC). However, reports of combined hepatic resection for RCC with liver invasion are limited, and treatment strategies remain insufficiently established. Case Presentation:A 75-year-old man presented with right RCC with liver invasion, lung metastases, and an inferior vena cava (IVC) tumor thrombus. Nivolumab plus cabozantinib reduced the lung metastases but not the primary tumor or thrombus. Three months after starting systemic therapy, he underwent open right nephrectomy, partial hepatectomy of segments 5, 6, 7, and part of 8, and tumor thrombus resection. Pathology revealed pT4, Grade 4 clear cell carcinoma. Although lung metastases recurred postoperatively, systemic therapy was resumed on day 51, resulting in complete remission. Conclusion:Appropriately early cytoreductive nephrectomy with partial hepatectomy after systemic therapy may have contributed to this favorable outcome.
Background:Cisplatin-based chemotherapy is the standard treatment for metastatic seminoma but may be unsuitable for elderly patients with comorbidities. We report a case of metastatic seminoma with chronic kidney disease (CKD) in an elderly patient successfully treated with carboplatin monotherapy. Case Presentation:A 70-year-old man presented with a left testicular tumor and para-aortic lymphadenopathy, causing left-sided hydronephrosis. Radical left high orchiectomy confirmed stage IIC pure seminoma pT1N3M0 with a favorable prognosis according to the International Germ Cell Cancer Collaborative Group classification. Because renal impairment and poor performance status precluded cisplatin-based chemotherapy, the patient received four cycles of carboplatin monotherapy (AUC 7). Grade 2-3 pancytopenia occurred but was manageable with pegfilgrastim and dose interval adjustment. Post-treatment PET-CT showed no residual uptake. Consolidation para-aortic radiotherapy was subsequently performed. The patient remains disease-free 1.5 years after treatment. Conclusion:Carboplatin monotherapy may be a feasible alternative for metastatic seminoma patients who are unsuitable for cisplatin-based chemotherapy.
ABSTRACT Introduction Primary urethral carcinoma (PUC) is a rare malignancy, particularly in females, with no established standard treatment. We herein examined the clinical outcomes of three female patients who underwent multimodal therapy with robot‐assisted radical cystectomy (RARC) and extended surgical resection. Case Presentation Three female patients (45, 65, and 71 years) were diagnosed with PUC (adenocarcinoma, cT3N0M0; clear cell carcinoma, cT3N2M0; and squamous cell carcinoma, cT4N0M0). Two patients received cisplatin‐based neoadjuvant chemotherapy. All patients underwent RARC with en bloc urethrectomy and extended resection of the anterior vaginal wall or pelvic fascia. One achieved a pathological complete response, one developed local recurrence due to a positive surgical margin, and two remained recurrence‐free. Conclusion Individualized multimodal strategies combining perioperative chemotherapy and extended surgical resection are crucial for managing locally advanced PUC in females.
