PURPOSE:The interaction between sources of industrial byproducts and environmental pollutants (IBP/EP) and the prevalence of urothelial carcinoma (UC) in surrounding communities has been infrequently explored. The purpose of this research is to identify microregional UC hotspots and associated industrial and environmental risk factors. MATERIALS AND METHODS:We retrospectively queried a multi-institutional database for UC patients diagnosed between 2008 and 2018. Addresses were geocoded and used to perform hotspot analysis on the census block level. Demographic and clinicopathological characteristics, census data and proximity to sources of IBP/EP were compared between patients who did vs did not reside in a hotspot. Associations were tested using multilevel logistic regression models using 95% confidence intervals. RESULTS:A total of 5,080 patients met inclusion criteria and 148 (2.9%) were identified as living in 1 of 3 UC hotspots. In univariate analyses, race, tobacco and alcohol use, household income, IBP/EP exposure and proximity to traffic, industrial discharge and airports were significantly associated with UC hotspots. Multivariable analysis demonstrated that polycyclic aromatic hydrocarbon exposure (OR: 48.09, p ≤0.001) and proximity to high-density traffic (OR: >999, p ≤0.001) increased the odds of living in a hotspot. Patients living in a hotspot were significantly less likely to be white (OR: 0.06, p ≤0.001) or tobacco users (OR: 0.39, p=0.031) on multivariate analysis. CONCLUSIONS:Spatially related clusters of UC may be associated with locoregional environmental exposures rather than tobacco exposure and may also be correlated with socioeconomic disparities. Geospatial analysis can help to identify at-risk populations, offering the opportunity to better focus preventive and diagnostic interventions.

ObjectiveTo study the effect of surgeon-administered Transversus Abdominis Plane block (sTAP) on opioid usage and length of stay (LOS).MethodsStarting in April 2018, two surgeons at our institution gradually introduced sTAP for radical cystectomy (RC) patients. We performed a retrospective observational cohort analysis of RC patients catalogued in a prospectively maintained database using the Enhanced Recovery After Surgery Interactive Auditing System. Two surgeons adopted the sTAP block technique in April 2018. We included patients undergoing RC for bladder malignancy under Enhanced Recovery After Surgery protocol between January 2017 and August 2020. Primary outcomes included LOS, and postoperative day (POD) 0-3 total opioids consumption measured by morphine milligram equivalents (MME). Multivariable linear or logistic models evaluated the association of TAP with outcomes while controlling for potential confounders.ResultsAmong 178 patients included in analysis, 84 patients underwent sTAP block and 94 did not. Multivariable analysis demonstrated significantly lower POD 0-3 total opioid usage (106.4 vs 192.2 MME, P = .004), and mean LOS (5.6 vs 7.7 days, P <.001) among the sTAP group.ConclusionsTAP appears to be an effective adjunct to RC care associated with improved LOS, and POD 0-3 opioid consumption. Further studies are needed to optimize TAP block technique and anesthetic composition.

A 53-year-old male with history of colon cancer status postneoadjuvant chemotherapy, radiation and colectomy, hyperlipidemia, non–insulin-dependent diabetes mellitus, obesity, hernia repair, and asthma presented to the urology clinic complaining of left inguinal swelling. Upon presentation, vital signs were unremarkable, but physical exam revealed a firm, palpable, nontender abnormality of the left inguinal region. Subsequent computed tomography (CT) scan with IV contrast revealed a large presacral fluid collection (7.0 × 2.4 cm) and complex cystic structure arising from the left tunica albuginea (3.8 × 3.0 cm) adjacent to the left corpora cavernosa.

Background: Nephroureterectomy (NU) remains the gold-standard for upper-tract urothelial carcinoma (UTUC). However, nephronsparing management (NSM), specifically segmental ureterectomy (SU) for urothelial tumors distal to the renal pelvis may offer decreased risk of renal insufficiency and equivalent cancer control. Objectives: To identify patient-specific and facility-related factors that are associated with the selection of SU vs. NU for patients with clinically localized, high-grade, ureteral UTUC. Design, setting, participants: We searched the National Cancer Database between 2004 and 2015 for patients with high-grade, clinically localized, primary ureteral UTUC managed by either NU or SU. Outcome measurements and statistical analysis: Univariate and multivariate analysis was performed to assess patient, disease-specific, facility and treatment-related factors associated with SU vs. NU. Since surgical approach was only indexed after 2010, separate multivariable logistic regressions were performed including and excluding surgical approach in order to capture patients treated between 2004 and 2009. Survival analysis utilized Kaplan-Meier methods and Cox proportional hazards regression. Results and limitations: Multivariate analysis including surgical approach demonstrated that among other factors, higher clinical stage (P = 0.034), larger tumor size (P < 0.001), the addition of neoadjuvant chemotherapy (P = 0.002), and the utilization of minimally invasive surgery (P < 0.05) decreased the likelihood of patients receiving SU. In this same cohort, institutions with larger facility volumes (P = 0.038) and performing intraoperative lymph node dissection (P < 0.001) were associated with a higher probability of SU. Excluding surgical approach, once again more advanced clinical stage (P = 0.005), larger tumor size (P < 0.001), and neoadjuvant chemotherapy (P = 0.003) decreased the probability of patients receiving SU, while increasing age (P = 0.049) and intraoperative lymph node dissection (P < 0.001) were more closely associated with SU compared to NU. No differences were noted in pathological T stage (P > 0.05), 30-day readmission (P = 0.7), 30-day mortality (P = 0.09), and 90-day mortality (P = 0.157) on multivariate analysis between SU and NU. Additionally, no significant differences were seen in median overall survival between patients receiving SU or NU (53 vs. 50 months; P = 0.143). Conclusions: Comparable outcomes suggest segmental ureterectomy for high-grade ureteral UTUC is appropriate in well-selected patients. Practice patterns appear consistent with guideline recommendations (decreased tumor size and lower clinical stage favor SU), but treatment disparities may exist based on a multitude of patient, pathologic- and facility-related factors. Improved dissemination of knowledge regarding practice patterns and outcomes of SU for UTUC of the ureter has the potential to improve delivery of NSM in appropriate patients. Patient summary: In this study, we examined factors associated with different surgical procedures for cancer of the ureter. We found that smaller tumor sizes, a less advanced clinical stage, intraoperative lymph dissection higher facility volumes tended to favor kidney-sparing treatment, while survival outcomes appear comparable to renal extirpation. (C) 2020 Elsevier Inc. All rights reserved.

Introduction Low-intensity shockwave therapy (LISWT) may improve erectile function in patients with mild to moderate erectile dysfunction (ED). Currently there is a paucity of research and prospective data on the utilization of LISWT in patients with ED. We present the results of our phase II clinical trial of LISWT with short-term follow-up in a cohort of patients with mild to moderate vasculogenic ED. Methods We obtained IRB approval and prospectively enrolled patients with mild to moderate vasculogenic ED. Baseline International Index of Erectile Function (IIEF) scores and peak systolic velocities (PSV) of cavernosal arteries measured on duplex penile ultrasound were obtained prior to treatment. Treatment included 6600 total shocks per session, for a total of six consecutive weekly treatment sessions. Baseline Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores were obtained at the completion of the treatment course. IIEF, EDITS and PSV were evaluated again at one-month follow- up. Clinical significance was defined as a median IIEF score increase of four points from baseline or an EDITS total score increase to greater than 65 or increase of greater than ten from baseline. Treatment success was evaluated on an individual basis and defined by a clinically significant improvement in questionnaire score. Results A total of 25 patients were enrolled in the trial, with 22 patients reporting for one-month follow-up. 68% (15/22) of patients demonstrated treatment success. In the cohort there was improvement in median EDITS from 61 (IQR 49-92) to 73 (IQR 43-49), which did meet criteria for clinical significance, but did not reach statistical significance (p = 0.74). IIEF improved from a median of 13 (IQR 12-19) to 18 (IQR 14-25), which did reach statistical significance (p = 0.011). On duplex ultrasound, mean cavernosal artery PSV increased from 34.3 cm/s (IQR 25.7-51.1) to 38.0 cm/s (IQR 31.6-45.1); however, these differences were statistically insignificant (p = 0.986). Of the 25 patients undergoing LISWT, two reported discomfort during treatment sessions, which subsided after repositioning the device without alterations in energy delivered. Conclusion LISWT may be a safe and potentially efficacious clinical modality for treatment of patients with mild to moderate vasculogenic ED demonstrating increases in cavernosal artery PSV and improvements in IIEF and EDITS scores in short-term follow-up. Longitudinal studies with increased power are needed to better evaluate the long-term efficacy and cost-efficiency of this therapy.

A 40-year-old male with presented to the clinic with the chief complaint of right inguinal pain radiating to his right testicle and right thigh with no history of trauma, fever, chills, dysuria, hematuria, or unprotected sexual activity. Physical exam revealed right testicular tenderness with no palpable abnormality of the bilateral testes or spermatic cords. Scrotal ultrasound was performed and was unremarkable for testicular or other intrascrotal pathology. Concurrently, chronic low back pain had prompted a lumbar CT to be performed, which was indeterminate, but subsequent lumbar MRI performed three months later revealed abnormal signals in the vertebral bodies of T12, L3, and L5, concerning for occult metastatic disease or multiple myeloma. PET-CT was performed revealing hypermetabolic lesions throughout the axial skeleton and, most notably, hypermetabolic lesions in the left inguinal and left upper scrotum. At this time, about 4 months after the original visit, physical exam revealed a palpable mobile mass in the left upper scrotum that was distinct from the left testicle, and another mass palpable near the left inguinal ring.

A 50-year-old Italian-American male with a past medical history of colon cancer presented to our urology clinic in Fall 2018 with an acute elevation in serum prostate specific antigen (PSA). In 2015, he had been diagnosed with stage III (T4a, pN1, cM0) cancer of the ascending colon and treated with right hemicolectomy followed by seven cycles of adjuvant combination of folinic acid, 5-fluorouracil, and oxaliplatin (FOLFox) therapy. Final pathology was consistent with signet ring cell carcinoma (SRCC) of the ascending colon with regional nodal metastasis. The patient responded well to treatment and demonstrated no evidence of disease on routine surveillance consisting of annual computed tomography of the chest, abdomen, and pelvis, yearly repeat colonoscopy, and follow-up office visits every 6 months.

Pure testicular choriocarcinoma is a rare histological subtype of germ cell tumor (GCT) and typically presents with distant metastases and aggressive features leading to a generally poor prognosis. Unique to choriocarcinoma among GCT histological subtypes is the propensity of spontaneous hemorrhage into metastatic lesions. We report a case of pure testicular choriocarcinoma in a 46-year-old male with postoperative acute pulmonary hemorrhage secondary to tumor invasion of the lungs, and the subsequent management of his disease with a discussion of relevant literature.

Low-Intensity Shockwave Lithotripsy (LISWT) may improve erectile function in patients with mild to moderate erectile dysfunction (ED). Currently there remains a paucity of research and prospective data on the utilization of LISWT in patients whom experience ED. The purpose of this Phase I clinical trial is to evaluate the safety and potential efficacy of this novel therapy. We present our Results with an initial cohort of patients. We obtained IRB approval and prospectively enrolled patients (n=17) with mild to moderate ED. Treatment consisted of the application of 3300 shocks (0.16mJ/mm2) each to the bilateral corpora cavernosa and the bilateral crura. Full treatment course included six weekly treatment sessions and a one-month post-treatment evaluation. IIEF and EDITS scores were obtained at baseline and one month after the treatment course concluded, along with GAQ and erectile hardness questionnaires. Duplex penile ultrasound assessed peak systolic velocity (PSV) of the cavernosal arteries at baseline and one-month post-treatment. Statistically significant differences in IIEF, EDITS and PSV pre and post-treatment were evaluated using Wilcoxon signed-ranks test, while categorical metrics were evaluated using logistic regression. Clinically-significant differences for IIEF-6 scores were defined by an increase of 2, 5, or 7 points based on baseline mild (>17), moderate (>8), or severe (<8) scores, respectively, while clinically-significant differences for EDITS was defined as an increase >9 points from initial to final score.

Introduction: There exist few reports of de novo tumors involving an allograft kidney, and to the best of our knowledge there are only two previous reports of angiomyxoma Case Presentation: A 53-year-old Caucasian male with end-stage renal disease (ESRD) on hemodialysis (HD) secondary to malakoplakia with three failed prior renal transplants presented for repeat transplant evaluation. Imaging demonstrated a mass of the transplanted kidney suggestive of posttransplant lymphoproliferative disease (PTLPD). A biopsy was obtained revealing a predominance of myxoid material. The patient became increasingly symptomatic from the mass and underwent a palliative right transplant nephrectomy. Final pathology revealed angiomyxoid tumor. Conclusions: Angiomyxomas are asymptomatic, appear as PTLD on imaging and should be considered in the differential diagnosis of masses occurring in renal transplant allografts.

Blunt trauma is the most common mechanism of injury to the scrotum and testicle. Surgical exploration with primary repair, hematoma evacuation, and de-torsion are common surgical interventions. A 20-year-old male with no previous medical history presented after a high-speed motor vehicle collision. Ultrasonography demonstrated heterogeneous changes of the tunica albuginea and decreased arterial flow to bilateral testicles. He was subsequently taken to the operating room for surgical exploration, which revealed bilateral mottled testes with questionable viability. Papaverine was injected into each testicle, which resulted in visibly increased perfusion and subsequent preservation of the testicles. Conclusion: Current evidence on the use of papaverine is isolated to testicular torsion. Additional research should be conducted on the use of papaverine in blunt testicular trauma. Papaverine injection may be a valuable treatment option when inadequate perfusion is observed intra-operatively.

Gross hematuria has several different etiologies, and as such, the process of working up a patient presenting with bleeding follows an outlined algorithm.The instillation of formalin, a caustic substance that hydrolyzes proteins and coagulates tissues, is a possible treatment option only when patients have failed previous preceding therapeutic steps.In our case, a 69-year-old African-American male presented with an acute episode of gross hematuria that did not resolve following several diagnostic and therapeutic steps.His hospital course was complicated by a steadily dropping hemoglobin, requiring many blood transfusions throughout his care.He was successfully treated with intravesical instillation of formalin following cystoscopy, transurethral resection of the prostate, and cystogram in the operating room.Thoughtful discussion regarding a treatment course in a patient with refractory gross hematuria deserves consideration.

An asymptomatic 64-year-old male with an elevated prostate specific antigen (PSA) of 28.0 ng/dL underwent transrectal ultrasound-guided prostate biopsy and was diagnosed with Gleason 8 (4+4) ductal adenocarcinoma in 8 of 12 cores sampled. Bone scan, chest x-ray, and abdominal CT scan were all radiographically negative for metastatic disease. He underwent curative intensity-modulated radiation therapy (IMRT) with 79.2 Gy in 44 fractions as well as adjuvant androgen deprivation (ADT) incorporating leuprolide, per American Urologic Assosciation (AUA) and National Comprehensive Cancer Network (NCCN) guidelines. Post IMRT and 3 months postdiagnosis, his PSA nadir was 5.0 ng/dL. Six months later, a repeat PSA had elevated to 9.4 ng/dL, but a repeat CT was negative for metastasis; therefore, ADT alone was continued.

641 Background: Weighing operative, oncologic and comorbid risks guide treatment recommendations for localized kidney cancers. We hypothesize that individualized surgical decision making may also be influenced by surgical center and volume. Methods: The National Cancer Database (NCDB) was queried for patients 18-80 years old with pT1a-T2bN0M0 RCC, treated by partial (PN) or radical nephrectomy (RN), or ablation (ABL) from 2004-2014. After adjusting for clinicopathologic characteristics, we evaluated the association of hospital volume (vol) and center classification with receipt of PN. High vol was defined as the top 10% in treatment volume. Results: 142,090 patients met inclusion criteria, where 58% (n = 82,498) and 41% (n = 58,873) were treated by RN and PN, respectively, and 1% (n = 719) by ABL. The utilization of PN increased over time (2004: 24% vs 2014: 53%; p < 0.001). Stratified by tumor stage, 60% (n = 47,484) of pT1a and 24% (n = 9,906) of pT1b tumors were treated by PN. On multivariate analysis, patients treated at a high-vol center (OR 1.89, 95% CI 1.57-2.28) had a greater likelihood of receiving a PN when compared to treatment elsewhere. Additionally, compared to a community cancer program, treatment at a comprehensive community cancer center (OR 1.39, 95%CI 1.23-1.57), academic/research (OR 1.67, 95%CI 1.47-1.90), or integrated network cancer program (OR 1.48, 95%CI 1.24-1.77) had a higher likelihood of receiving a PN. The median distance travelled was 9.8 and 18.1 miles, for treatment at non high vol and high vol centers, respectively. An inverse correlation was noted between increasing tumor stage and receipt of PN, compared to pT1a tumors (pT1b [OR 0.22, 95%CI 0.20-0.23], pT2a [OR 0.06, 95%CI 0.05-0.06], pT2b [OR 0.03, 95%CI 0.02-0.03]). Conclusions: In the NCDB, despite increased utilization of PN at higher vol centers, the majority of localized renal tumors are still treated with RN. Smaller tumor size, treatment at a higher vol centers, comprehensive community cancer centers, academic/research programs, or integrated network cancer programs increase the likelihood of receipt of PN. Evaluation of population based trends aid in understanding localized RCC surgical management and may help quality improvement efforts.

Introduction: Postoperative incisional hernias (PIH) are an established complication of abdominal surgery with rates after radical cystectomy (RC) poorly defined. The objective of this analysis is to compare rates and risk factors of PIH after open (ORC) and robotic-assisted (RARC) cystectomy at a tertiary-care referral center. Materials and methods: We performed a retrospective review of patients undergoing ORC and RARC from 2000-2015 with pre and postoperative cross-sectional imaging available. Images were evaluated for anthropometric measurements and presence of postoperative radiographic PIH (RPIH). Patient demographics, type of urinary diversion and postoperative hernia repair (PHR) were also assessed. Results: Of the patients that met inclusion criteria (n = 469), the incidence of RPIH and PHR were 14.3% and 9.0%, respectively. Between ORC and RARC, analysis revealed no statistically significant differences in rates of RPIH (13.6% versus 20.3%, p = 0.152) or PHR (8.2% versus 12.5%, p = 0.214). Body mass index was associated with a slightly increased likelihood of RPIH on univariate analysis alone (OR 1.08, p = 0.008). Ileal conduit was associated with a decreased likelihood of RPIH (OR 0.42, p = 0.034) and PHR (OR 0.36, p = 0.023). Supraumbilical rectus diastasis width (RDW) was an independent predictor of both RPIH (OR 1.52, p = 0.023) and PHR (OR 1.43, p = 0.039) on multivariate analysis. Conclusions: Patients undergoing RC are at significant risk of RPIH and PHR regardless of surgical approach. Anthropomorphic factors and urinary diversion type appear to be associated with PIH risk. Further research is needed to understand how risks of PIH can be reduced in patients undergoing cystectomy.

A 31-year-old man with no past medical or surgical history presented to the urology clinic with the primary complaint of purulent drainage from his umbilicus. He had 4 episodes of purulent drainage in the past 15 years during each of which the skin around his umbilicus became erythematous. He denied fever, chills, nausea, vomiting, hematuria, or dysuria. He denied urinary drainage from his umbilicus or urinary debris. Physical examination revealed an obese, well-appearing man with no obvious abdominal masses, skin lesions, or umbilical drainage. His external genitalia were normal. Laboratory evaluation revealed leukocyte count of 6.3 × 103/mm3, a creatinine of 1.06 ng/dL, and an unremarkable urinalysis. Computed tomography (CT) of the abdomen and pelvis with oral and intravenous contrast was performed, revealing no obvious collection or sinus tract to the umbilicus. However, within the inferior and left-lateral portion of the bladder, there was noted to be a 5.4-cm soft tissue lesion that appeared to be within the bladder wall itself.

Comparative effectiveness research (CER) is imperative for objective and balanced assessment of treatment outcomes. CER that uses administrative databases (AD-CER) affords unique opportunities for large scale data analyses that potentially transcend limitations of small institutional datasets. Prostate cancer has received much attention from the AD-CER research community, whereas non-prostate genitourinary malignancies are less well-studied. The objective of this article is to review the currently available AD-CER that has been published in the non-prostate genitourinary malignancies space.

RESULTS: Mean Tumor size was 4.3 (AE0.96)cm.The mean RENAL and PADUA scores were 9.9 and 10.6, respectively.There were 42 % of highly complex tumors, 53% of moderate complex tumors and 5% of low complexity tumors.NSS was pursued in all cases.Off-Clamp tumorectomy was achieved in 27% of cases.SRAC success, when attempted, was at 85% and mean superselective WIT was 34(AE19.6)min, mean EBL was 356(AE386) cc.There were two Clavien grade II medical complications, and two Clavien II surgical complications.Mean LOS was 2.3 (AE1.7)days.Pathology reported 7 benign tumors.The surgical margins were all negative.Mean POD-1 eGFR preservation was -15,6%(AE26)% (49 data sets) and at -9.5%(AE21.5)%at POM-3(47 data sets).No local relapse was observed at the 3-months follow-up (55 data sets).We had a 48% achievement of NSS trifecta.. CONCLUSIONS: Our initial experience applied to complex RAPN showed a promising low complications rate with a satisfying 48% trifecta.The implementation of 3D models available to the surgeon during RAPN provides him with pre-operative planning and intraoperative surgical guidance.

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease I1 Apr 2018MP37-05 SURVIVAL OUTCOMES FOR PARTIAL VS RADICAL ORCHIECTOMY: ANALYSIS OF THE NATIONAL CANCER DATABASE (NCDB) Daniel Edwards, Jason Levy, Brian McGreen, Noah May, and Laurence Belkoff Daniel EdwardsDaniel Edwards More articles by this author , Jason LevyJason Levy More articles by this author , Brian McGreenBrian McGreen More articles by this author , Noah MayNoah May More articles by this author , and Laurence BelkoffLaurence Belkoff More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1211AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical orchiectomy (RO) is the standard of care for patients with suspicious testicular masses, while partial orchiectomy (PO) is primarily a consideration in patients with bilateral masses or a solitary testicle. Outcomes research has predominantly featured case reports and small case series, while the comparative effectiveness of PO vs RO remains poorly elucidated in contemporary literature. The current study seeks to compare outcomes between these treatment modalities. METHODS The NCDB was queried for all patients treated for testicular cancer between 2004 and 2015. Patients were selected if they obtained either PO or RO. Clinical tumor stage and margin status were noted. Statistical analysis was performed using Fisher’s Exact test for relationships among categorical variables, Kaplan-Meier Curves to evaluate overall survival (OS) and Cox Regression Analysis to compare OS and Hazard Ratios between treatment modalities. RESULTS Patients underwent either PO (n=176) or RO (n=49449) orchiectomy. Median followup for all patients queried was 64.1 months (IQR 39.0-96.1). Risk of positive margin status was increased in all patients undergoing PO, regardless of clinical stage (OR=5.77,95%CI 3.86-8.64; p<0.001). OS was significantly decreased in patients undergoing PO versus RO (132.9 months vs 147.6 months; HR 1.76; 95%CI 1.09-2.83). When stratified by margin status, patients with positive surgical margin had decreased OS compared to those with negative margins (128.7 months vs 148.3 months; HR 3.60; 95%CI 3.14-4.12). Patients were then stratified by those with clinical stage cT1 tumors undergoing PO (n=56) vs RO (15235), as these would be the most likely candidates for PO. Risk of positive margin status was increased in all patients undergoing PO with cT1 tumors (OR 13.5, 95%Ci 6.07-29.89; p<0.001). OS was decreased in patients with cT1 tumors undergoing PO, but this difference did not reach statistical significance (128.9 months vs 149.1 months; HR 1.76, 95%CI 0.66-4.70). When stratified by surgical margin status, patients with cT1 tumors and positive surgical margins had significantly decreased OS (124.2 months vs 149.3 months; HR 4.15, 95%CI 2.59-6.63). CONCLUSIONS PO had increased positive margins and positive margins were associated with significantly decreased OS. PO was associated with decreased OS, but insignificant for patients with cT1 disease. PO may have comparable survival outcomes compared to RO for cT1 tumors, but higher clinical stage is associated with a worse prognosis and PO should continue to be approached with caution in select patients. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e493 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniel Edwards More articles by this author Jason Levy More articles by this author Brian McGreen More articles by this author Noah May More articles by this author Laurence Belkoff More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A 71-year-old female presented with a large, protuberant abdominal mass, and was found to have both a left renal mass and a biopsy-proven neuroendocrine tumor of the ileocecal valve. Ultimately, right hemicolectomy revealed a well-differentiated and low-grade neuroendocrine tumor of the ileocecal valve, whereas left radical nephrectomy revealed a 23 cm x 22 cm x 15 cm renal cell carcinoma, chromophobe-type (RCC-CT) weighing 3564 g. RCC-CT represents a small portion of diagnosed RCC, and generally portends a more favorable prognosis than other variants. Modern reports of renal tumors exceeding 20 cm are exceedingly rare. In spite of massive size, favorable histology may allow for surgical cure.