Here we describe the first case of paratesticular epithelioid sarcoma in an adolescent male. Paratesticular epithelioid sarcoma is an exceedingly rare entity with an aggressive clinical course and poor prognosis. The patient underwent wide hemiscrotectomy with radical inguinal orchiectomy and adjuvant chemoradiotherapy for inguinal nodal metastasis. Subsequent retroperitoneal lymph node dissection revealed metastasis to the para-aortic lymph nodes. Paratesticular sarcomas can be challenging to diagnose and treat. This report outlines the pathology and management of the first pediatric paratesticular epithelioid sarcoma in the English literature and highlights the need for multidisciplinary collaboration.
Bladder hemangiomas are rare benign vascular tumors that may cause severe hematuria. We report a 66-year-old man with Glanzmann thrombasthenia who presented with life-threatening hematuria, clot retention, and severe anemia. Histopathological examination revealed multiple capillary bladder hemangiomas, while contrast-enhanced CT failed to clearly identify the lesions due to their small size. Despite intensive hematological support, including transfusions, recombinant activated factor VII, and transurethral electrocoagulation, bleeding recurred. Given the prohibitive hemorrhagic risk of repeat surgery, super selective vesical artery embolization was performed, achieving complete and durable hemostasis. No complications or recurrence occurred during six months of follow-up.
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.
Extramedullary hematopoiesis (EMH) is a compensatory process associated with chronic bone marrow failure and rarely involves the adrenal gland. We present a 63-year-old woman with abdominal pain and a large heterogeneous right suprarenal mass with calcifications and central necrosis raising suspicion for adrenocortical carcinoma. Laboratory evaluation revealed severe anemia and bone marrow examination confirmed primary myelofibrosis. Due to radiologic and core needle biopsy suspicion of malignancy, surgical resection was performed. Histopathological examination demonstrated extramedullary hematopoiesis composed of erythroid and myeloid precursors with scattered megakaryocytes. This case highlights adrenal EMH as a diagnostic pitfall mimicking adrenal malignancy clinically, radiologically, and histopathologically.
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.
