ABSTRACT Introduction Sarcomatoid urothelial carcinoma is a rare, highly aggressive bladder cancer subtype. We report the first case of abdominal wall implantation of sarcomatoid urothelial carcinoma after bladder perforation during transurethral resection of a bladder tumor, followed by recurrence at the open repair site requiring further resection. Case Presentation A 73‐year‐old woman underwent emergency transurethral resection for a rapidly enlarging bladder tumor complicated by full‐thickness perforation. Histopathology revealed sarcomatoid urothelial carcinoma. During intravesical bacillus Calmette–Guérin therapy, she developed a malignant right lower abdominal wall mass attributed to tumor implantation. Enfortumab vedotin plus pembrolizumab did not prevent progression. Preoperative radiotherapy was followed by en bloc resection with partial cystectomy and anterolateral thigh flap reconstruction. Pathology demonstrated extensive treatment‐related necrosis and negative margins. She remained recurrence‐free at 11 months. Conclusion For localized recurrence, aggressive multidisciplinary treatment incorporating radical local resection and reconstructive surgery may provide local disease control in selected patients without metastasis.
ABSTRACT Background Calcified intratesticular masses may mimic malignancy. Organized testicular hematomas are rare and may develop fibrosis and dystrophic calcification. Differential diagnoses include regressed (“burned‐out”) germ cell tumors, cavernous hemangiomas, and paratesticular fibrous pseudotumors (PFP). Case Presentation A 60‐year‐old man presented with progressive right testicular swelling and dull aching pain. Imaging revealed a 5 × 4 × 4 cm solid, focally calcified intratesticular mass suspicious for neoplasia. Radical inguinal orchiectomy was performed. Histopathological examination revealed dense fibrocollagenous tissue, dystrophic calcification, organized hemorrhage, hemosiderin deposition, cholesterol clefts, hyalinization, and chronic inflammation, without evidence of malignancy. Conclusion This case highlights a rare organized, calcified testicular hematoma mimicking neoplasia. Histopathological examination is essential for definitive diagnosis. Organized hematoma should be considered when evaluating calcified intratesticular masses with chronic hemorrhagic and fibrotic changes. Regressed germ cell tumors and cavernous hemangiomas are important alternatives, whereas PFP should be considered when paratesticular origin is uncertain.
ABSTRACT Introduction Pulmonary tumor thrombotic microangiopathy is a rare, fatal complication of malignancy, with few reports involving bladder cancer. Case Presentation An 81‐year‐old man with chronic obstructive pulmonary disease presented with hematuria and progressive exertional dyspnea. Imaging showed an invasive bladder tumor with lymph node metastases. Echocardiography suggested pulmonary hypertension, although invasive confirmation was unavailable. Recurrent perioperative oxygen desaturation preceded fatal deterioration 2 days after transurethral resection. Autopsy revealed primary bladder adenocarcinoma, signet ring cell subtype, and microscopic pulmonary tumor emboli with fibrin thrombi, fibrous intimal thickening, and recanalization. These findings supported pulmonary tumor thrombotic microangiopathy. Distinct gastrointestinal tumors and matching bladder and metastatic morphology supported a bladder origin. Conclusion Pulmonary tumor thrombotic microangiopathy should be considered in patients with bladder tumors and progressive dyspnea. Recurrent desaturation and right heart abnormalities warrant reassessment despite preserved oxygen saturation. Autopsy vascular findings were essential to distinguish this condition from simple pulmonary tumor embolism.
ABSTRACT Introduction Primary prostatic lymphoma is rare and may mimic prostate cancer clinically and radiologically. Case Presentation A 66‐year‐old man was referred for evaluation of suspected advanced prostate cancer. Despite a normal prostate‐specific antigen level of 0.573 ng/mL, imaging revealed a prostatic mass with suspected bladder invasion and bilateral hydronephrosis. Prostate needle biopsy showed atypical lymphocytic infiltration but could not distinguish lymphoma from inflammatory changes. Additional transurethral biopsy provided sufficient tissue for histopathological and immunohistochemical evaluation, establishing a diagnosis of primary prostatic diffuse large B‐cell lymphoma. Conclusion Primary prostatic lymphoma should be considered when clinical and imaging findings suggest prostate cancer despite a normal prostate‐specific antigen level. Additional tissue sampling should be considered when needle biopsy is inconclusive despite persistent clinical suspicion of lymphoma.
ABSTRACT Introduction Spontaneous renal hemorrhage (SRH) caused by renal infection is extremely rare. Furthermore, sepsis caused by methicillin‐resistant Staphylococcus aureus (MRSA) has a high mortality rate and requires prompt source control. Case Presentation A 63‐year‐old man with severe diabetes presented to the emergency department in shock. Computed tomography revealed a left renal subcapsular hematoma. Based on his clinical course and history, infection‐induced SRH was suspected. Blood and urine cultures yielded MRSA. Although percutaneous drainage was performed after the initial bleeding stabilized, persistent infection was followed by rebleeding, necessitating left nephrectomy. The patient recovered postoperatively. Histopathology confirmed abscess formation and chronic inflammation without malignancy. Conclusion For inadequately controlled infections following percutaneous drainage, particularly when recurrent hemorrhage is suspected, early nephrectomy may be considered for definitive source control.
