Metastatic papillary renal cell carcinoma (PRCC) is associated with a poor prognosis. Many patients with PRCC respond to first- and second-line systemic chemotherapy treatments; however, few respond to late-sequence treatment. We describe a case of a long-term response to fourth-line axitinib after the use of tyrosine kinase inhibitor therapy for metastatic papillary renal cell carcinoma.
Case Presentation
A 37-year-old male presented with hematuria and left back pain. Following systemic examination, he was diagnosed with left renal cell carcinoma cT3aN0M1. He underwent left radical nephrectomy. The pathological diagnosis was PRCC type 2. After using sunitinib, cabozantinib, and nivolumab, axitinib was selected as fourth-line systemic therapy, resulting in a reduction in multiple liver metastases and 15 months of response.
Conclusion
Late-sequence treatment with axitinib following prior use of tyrosine kinase inhibitor therapy resulted in a long-term response in a patient with metastatic papillary renal cell carcinoma.
{"title":"A Case of a Durable Partial Response to Late-Line Axitinib Following Prior Use of Tyrosine Kinase Inhibitors in Metastatic Papillary Renal Cell Carcinoma","authors":"Naoto Hodotsuka, Yasutomo Suzuki, Shohei Yamaki, Yuichiro Honda, Kyota Suzuki, Shuma Endo, Eigo Kuribayashi, Yukihiro Kondo","doi":"10.1002/iju5.70115","DOIUrl":"10.1002/iju5.70115","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Metastatic papillary renal cell carcinoma (PRCC) is associated with a poor prognosis. Many patients with PRCC respond to first- and second-line systemic chemotherapy treatments; however, few respond to late-sequence treatment. We describe a case of a long-term response to fourth-line axitinib after the use of tyrosine kinase inhibitor therapy for metastatic papillary renal cell carcinoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 37-year-old male presented with hematuria and left back pain. Following systemic examination, he was diagnosed with left renal cell carcinoma cT3aN0M1. He underwent left radical nephrectomy. The pathological diagnosis was PRCC type 2. After using sunitinib, cabozantinib, and nivolumab, axitinib was selected as fourth-line systemic therapy, resulting in a reduction in multiple liver metastases and 15 months of response.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Late-sequence treatment with axitinib following prior use of tyrosine kinase inhibitor therapy resulted in a long-term response in a patient with metastatic papillary renal cell carcinoma.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SpaceOAR is a hydrogel spacer widely used to protect the rectum from radiation toxicity during prostate cancer treatment. Reported here is a case in which an abscess that developed following SpaceOAR placement was successfully treated with laparoscopic fenestration.
Case Presentation
A 70-year-old man with localized prostate cancer undergoing a radiation therapy course developed an abscess at the SpaceOAR placement site 76 days after implantation. Antibiotic therapy and percutaneous drainage were ineffective; thus laparoscopic abscess fenestration was performed. Abscess size reduction was noted, leading to clinical improvement and a favorable course.
Conclusion
This is the first known reported case of laparoscopic abscess fenestration for a SpaceOAR-related abscess and the findings highlight the need to include abscess formation as a differential diagnosis even after more than 2 months following placement. Furthermore, this case indicates laparoscopic fenestration as a viable treatment option for a rectal spacer-related abscess unresponsive to antibiotics or percutaneous drainage.
{"title":"Laparoscopic Fenestration for Abscess Following SpaceOAR Placement—Case Report","authors":"Yuki Matsuo, Kimihiro Shimatani, Toeki Yanagi, Yusuke Yamada, Xiu-Xian Wu, Akihiro Kanematsu, Masayuki Fujiwara, Hitomi Suzuki, Koichiro Yamakado, Shingo Yamamoto","doi":"10.1002/iju5.70109","DOIUrl":"10.1002/iju5.70109","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>SpaceOAR is a hydrogel spacer widely used to protect the rectum from radiation toxicity during prostate cancer treatment. Reported here is a case in which an abscess that developed following SpaceOAR placement was successfully treated with laparoscopic fenestration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 70-year-old man with localized prostate cancer undergoing a radiation therapy course developed an abscess at the SpaceOAR placement site 76 days after implantation. Antibiotic therapy and percutaneous drainage were ineffective; thus laparoscopic abscess fenestration was performed. Abscess size reduction was noted, leading to clinical improvement and a favorable course.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This is the first known reported case of laparoscopic abscess fenestration for a SpaceOAR-related abscess and the findings highlight the need to include abscess formation as a differential diagnosis even after more than 2 months following placement. Furthermore, this case indicates laparoscopic fenestration as a viable treatment option for a rectal spacer-related abscess unresponsive to antibiotics or percutaneous drainage.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ductal adenocarcinoma of the prostate is a rare and aggressive cancer that often presents with low prostate-specific antigen levels and nonspecific urinary symptoms, leading to a delayed diagnosis. Mutations in DNA repair genes such as BRCA2 may render these cancers susceptible to targeted treatments.
Case Presentation
A 78-year-old man developed acute urinary retention despite a prostate-specific antigen of 0.731 ng/mL. Histopathological examination after holmium laser enucleation of the prostate revealed a ductal adenocarcinoma. Imaging revealed multiple lung nodules, and partial lung resection confirmed metastasis. Genomic profiling of the lung metastases revealed a pathogenic BRCA2 mutation. The patient received androgen deprivation therapy, followed by a combination of talazoparib and enzalutamide. Six months later, imaging revealed fewer lung metastases.
Conclusion
This case illustrates the diagnostic challenges of low-prostate-specific antigen ductal adenocarcinoma and demonstrates the potential of molecular profiling to guide personalized treatment with targeted therapies for rare prostate cancer subtypes.
{"title":"Incidentally Detected Ductal Adenocarcinoma Presenting With Isolated Pulmonary Metastasis and a BRCA2 Mutation","authors":"Hiroyuki Karasawa, Takeo Kosaka, Akari Komatsuda, Yuto Baba, Kohei Nakamura, Hiroshi Nishihara, Mototsugu Oya","doi":"10.1002/iju5.70103","DOIUrl":"10.1002/iju5.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Ductal adenocarcinoma of the prostate is a rare and aggressive cancer that often presents with low prostate-specific antigen levels and nonspecific urinary symptoms, leading to a delayed diagnosis. Mutations in DNA repair genes such as BRCA2 may render these cancers susceptible to targeted treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 78-year-old man developed acute urinary retention despite a prostate-specific antigen of 0.731 ng/mL. Histopathological examination after holmium laser enucleation of the prostate revealed a ductal adenocarcinoma. Imaging revealed multiple lung nodules, and partial lung resection confirmed metastasis. Genomic profiling of the lung metastases revealed a pathogenic BRCA2 mutation. The patient received androgen deprivation therapy, followed by a combination of talazoparib and enzalutamide. Six months later, imaging revealed fewer lung metastases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case illustrates the diagnostic challenges of low-prostate-specific antigen ductal adenocarcinoma and demonstrates the potential of molecular profiling to guide personalized treatment with targeted therapies for rare prostate cancer subtypes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pheochromocytoma is a catecholamine-producing tumor arising from the adrenal medulla. When it coexists with a tumor of different origin within the same adrenal gland, it is classified as a collision tumor involving a pheochromocytoma.
Case Presentation
The left adrenal tumor was identified in an 84-year-old Japanese woman and initially considered pheochromocytoma; however, rapid growth, lymphadenopathy, reduced 123I-MIBG uptake, and intense FDG (Fluorodeoxyglucose) accumulation raised suspicion of another tumor component. The patient received cyclophosphamide, vincristine and dacarbazine (CVD) chemotherapy followed by surgical resection. Histopathology revealed extensive necrosis in the diffuse large B-cell lymphoma (DLBCL) component, suggesting a response to chemotherapy.
Conclusion
To the best of our knowledge, this is the fourth reported case of an adrenal collision tumor with pheochromocytoma and DLBCL, and the first treated with CVD followed by surgery. Collision tumors should be considered a differential diagnosis when adrenal masses present with atypical clinical or imaging features.
{"title":"Pheochromocytoma and Diffuse Large B-Cell Lymphoma in the Ipsilateral Adrenal Gland: A Case Report","authors":"Ken Maekawa, Toru Sakatani, Yuki Kita, Kimihiko Masui, Takayuki Goto, Yuki Teramoto, Taisuke Hosokai, Ichiro Yamauchi, Sho Koyasu, Takashi Kobayashi","doi":"10.1002/iju5.70118","DOIUrl":"10.1002/iju5.70118","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pheochromocytoma is a catecholamine-producing tumor arising from the adrenal medulla. When it coexists with a tumor of different origin within the same adrenal gland, it is classified as a collision tumor involving a pheochromocytoma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>The left adrenal tumor was identified in an 84-year-old Japanese woman and initially considered pheochromocytoma; however, rapid growth, lymphadenopathy, reduced <sup>123</sup>I-MIBG uptake, and intense FDG (Fluorodeoxyglucose) accumulation raised suspicion of another tumor component. The patient received cyclophosphamide, vincristine and dacarbazine (CVD) chemotherapy followed by surgical resection. Histopathology revealed extensive necrosis in the diffuse large B-cell lymphoma (DLBCL) component, suggesting a response to chemotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>To the best of our knowledge, this is the fourth reported case of an adrenal collision tumor with pheochromocytoma and DLBCL, and the first treated with CVD followed by surgery. Collision tumors should be considered a differential diagnosis when adrenal masses present with atypical clinical or imaging features.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daichi Hirata, Jun Kamei, Hotaka Matsui, Jimpei Miyakawa, Satoru Taguchi, Shigenori Kakutani, Aya Niimi, Yuta Yamada, Haruki Kume
Introduction
Hydrogel spacers are commonly used to minimize rectal toxicity during prostate cancer radiotherapy. We report a case of a periprostatic abscess extending to the perineum following hydrogel spacer placement.
Case Presentation
A 59-year-old man diagnosed with prostate cancer (serum prostate–specific antigen level, 6.71 ng/mL; Gleason score, 3 + 4; cT2aN0M0) underwent transperineal hydrogel spacer placement before stereotactic radiotherapy. Twenty-two days later, the patient developed urinary retention and painful perineal swelling. Computed tomography of pelvis revealed an abscess extending from the prostate to the perineum and scrotum. Broad-spectrum antibiotics were administered, followed by emergency perineal abscess drainage and percutaneous cystostomy. Residual abscesses required percutaneous drainage. The infection was cured, and the cystostomy successfully removed seven months after the onset of symptoms.
Conclusion
Although rare, severe infectious complications can occur following hydrogel spacer placement. Careful patient selection and perioperative management are essential to reduce risk and ensure patient safety.
{"title":"Periprostatic Abscess Extending to the Perineum Following Hydrogel Spacer Placement: A Case Report","authors":"Daichi Hirata, Jun Kamei, Hotaka Matsui, Jimpei Miyakawa, Satoru Taguchi, Shigenori Kakutani, Aya Niimi, Yuta Yamada, Haruki Kume","doi":"10.1002/iju5.70114","DOIUrl":"10.1002/iju5.70114","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hydrogel spacers are commonly used to minimize rectal toxicity during prostate cancer radiotherapy. We report a case of a periprostatic abscess extending to the perineum following hydrogel spacer placement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 59-year-old man diagnosed with prostate cancer (serum prostate–specific antigen level, 6.71 ng/mL; Gleason score, 3 + 4; cT2aN0M0) underwent transperineal hydrogel spacer placement before stereotactic radiotherapy. Twenty-two days later, the patient developed urinary retention and painful perineal swelling. Computed tomography of pelvis revealed an abscess extending from the prostate to the perineum and scrotum. Broad-spectrum antibiotics were administered, followed by emergency perineal abscess drainage and percutaneous cystostomy. Residual abscesses required percutaneous drainage. The infection was cured, and the cystostomy successfully removed seven months after the onset of symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although rare, severe infectious complications can occur following hydrogel spacer placement. Careful patient selection and perioperative management are essential to reduce risk and ensure patient safety.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a case where intraoperative indocyanine green (ICG) imaging was utilized to evaluate bladder perfusion, enabling successful bladder preservation and bilateral ureteral reimplantation.
Case Presentation
A 49-year-old woman underwent resection of a recurrent pelvic tumor. The tumor involved both ureters and bilateral vesical arteries, which were sacrificed during surgery. ICG fluorescence imaging demonstrated uniform bladder wall perfusion, guiding the decision to proceed with bladder preservation. Postoperatively, contrast-enhanced CT and cystoscopy confirmed preserved bladder perfusion and mucosal integrity. The patient voided spontaneously without dysfunction.
Conclusion
Real-time evaluation of bladder perfusion using ICG fluorescence enabled safe bladder preservation in a situation where major vascular supply was compromised. This technique may assist in intraoperative decision-making during complex pelvic surgeries.
{"title":"Real-Time Bladder Perfusion Assessment Using ICG Fluorescence Imaging Enables Successful Reconstruction","authors":"Kosuke Iwatani, Mahito Atsuta, Yuma Okamoto, Kazuhiro Takahashi, Yu Imai, Fumihiko Urabe, Takahiro Kimura, Jun Miki","doi":"10.1002/iju5.70116","DOIUrl":"10.1002/iju5.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We report a case where intraoperative indocyanine green (ICG) imaging was utilized to evaluate bladder perfusion, enabling successful bladder preservation and bilateral ureteral reimplantation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 49-year-old woman underwent resection of a recurrent pelvic tumor. The tumor involved both ureters and bilateral vesical arteries, which were sacrificed during surgery. ICG fluorescence imaging demonstrated uniform bladder wall perfusion, guiding the decision to proceed with bladder preservation. Postoperatively, contrast-enhanced CT and cystoscopy confirmed preserved bladder perfusion and mucosal integrity. The patient voided spontaneously without dysfunction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Real-time evaluation of bladder perfusion using ICG fluorescence enabled safe bladder preservation in a situation where major vascular supply was compromised. This technique may assist in intraoperative decision-making during complex pelvic surgeries.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
While established in pediatric urology, the laparoscopic use of appendiceal substitution of the ureter in adults is rare.
Case Presentation
An 83-year-old man developed a 2.5-cm right mid-ureteral stricture as a complication after endoscopic treatment for a ureteral stone. Preoperative imaging confirmed an adequate appendix length. A laparoscopic approach was selected due to its minimal invasiveness, which was considered particularly appropriate for an elderly patient. After isolation with a linear cutting stapler, both ends of the appendix were resected, and a guidewire was passed through. To prevent mesoappendix torsion, the cecal side was oriented cranially before ureteral anastomosis. The operative time was 336 min, with 10 mL blood loss. Postoperative ureteral stone formation resolved spontaneously, and renal function was preserved.
Conclusion
Laparoscopic appendiceal interposition is a viable and minimally invasive option for right mid-ureteral reconstruction in selected elderly patients.
{"title":"Laparoscopic Ureteral Substitution Using the Appendix for Complete Stenosis of the Middle Ureter due to Ureteral Stone in an Elderly Patient: A Case Report","authors":"Ryutaro Fukagai, Shuichi Shimabukuro, Masafumi Ie, Minoru Nakazono, Masashi Teramoto, Atsuhiko Ochi, Koichiro Suzuki, Akira Komiya, Hirokazu Abe","doi":"10.1002/iju5.70112","DOIUrl":"10.1002/iju5.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While established in pediatric urology, the laparoscopic use of appendiceal substitution of the ureter in adults is rare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>An 83-year-old man developed a 2.5-cm right mid-ureteral stricture as a complication after endoscopic treatment for a ureteral stone. Preoperative imaging confirmed an adequate appendix length. A laparoscopic approach was selected due to its minimal invasiveness, which was considered particularly appropriate for an elderly patient. After isolation with a linear cutting stapler, both ends of the appendix were resected, and a guidewire was passed through. To prevent mesoappendix torsion, the cecal side was oriented cranially before ureteral anastomosis. The operative time was 336 min, with 10 mL blood loss. Postoperative ureteral stone formation resolved spontaneously, and renal function was preserved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Laparoscopic appendiceal interposition is a viable and minimally invasive option for right mid-ureteral reconstruction in selected elderly patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cerebral air embolism accompanied by right-to-left shunt through the venous system during Robot-assisted partial nephrectomy (RAPN) is regarded as a rare occurrence, with a high mortality rate.
Case Presentation
A case of a 77-year-old man with renal cell carcinoma who developed cerebral air embolism during right retroperitoneal RAPN using AirSeal. Intraoperatively, a sudden drop in end-tidal CO2 was observed during tumor resection. Postoperatively, the patient developed seizures, and imaging revealed cerebral air embolization. Despite hyperbaric oxygen therapy and intensive care, he progressed to fatal cerebral infarction.
Conclusion
This case highlights the risk of serious brain stroke during RAPN. The pathways of air entry into the cerebral circulation occasionally remain unclear and are difficult to fully exclude preoperatively. Renal vein clamping and adequate insufflation pressure are recommended when the tumor is entirely endophytic or close to the renal vein, especially when performing a right retroperitoneal approach.
{"title":"A Case of Cerebral Air Embolization During Robot-Assisted Partial Nephrectomy via a Retroperitoneal Approach for the Patient With Renal Cell Carcinoma","authors":"Takashi Matsumoto, Masashi Kaitsumaru, Keiji Tsukino, Jun Mutaguchi, Shigehiro Tsukahara, Tokiyoshi Tanegashima, Shunsuke Goto, Satoshi Kobayashi, Masaki Shiota, Masatoshi Eto, Junichi Inokuchi","doi":"10.1002/iju5.70111","DOIUrl":"10.1002/iju5.70111","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Cerebral air embolism accompanied by right-to-left shunt through the venous system during Robot-assisted partial nephrectomy (RAPN) is regarded as a rare occurrence, with a high mortality rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A case of a 77-year-old man with renal cell carcinoma who developed cerebral air embolism during right retroperitoneal RAPN using AirSeal. Intraoperatively, a sudden drop in end-tidal CO<sup>2</sup> was observed during tumor resection. Postoperatively, the patient developed seizures, and imaging revealed cerebral air embolization. Despite hyperbaric oxygen therapy and intensive care, he progressed to fatal cerebral infarction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case highlights the risk of serious brain stroke during RAPN. The pathways of air entry into the cerebral circulation occasionally remain unclear and are difficult to fully exclude preoperatively. Renal vein clamping and adequate insufflation pressure are recommended when the tumor is entirely endophytic or close to the renal vein, especially when performing a right retroperitoneal approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12765818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Doege–Potter syndrome (DPS) is a rare paraneoplastic phenomenon of severe hypoglycemia associated with solitary fibrous tumors (SFT). We report a case of a giant pelvic SFT with DPS, which was managed with preoperative arterial embolization and complete excision.
Case Presentation
This report describes the case of a 77-year-old patient with persistent hypoglycemia and a giant pelvic mass. He required continuous total parenteral nutrition (TPN) for severe hypoglycemia. CT showed a giant hypervascular mass (20 × 18 × 15 cm) in the pelvic space. Tumor biopsy showed SFT. To avoid intraoperative brisk bleeding, transcatheter arterial embolization (TAE) of the main feeders was performed 1 day before surgery. The tumor was completely resected via midline abdominal incision. Hypoglycemia resolved postoperatively. He was recurrence-free for 11 months after surgery.
Conclusion
The combination of preoperative TAE and surgical resection appears to be an effective therapeutic strategy for DPS-associated SFT.
{"title":"Solitary Fibrous Tumor With Doege–Potter Syndrome Successfully Treated With Preoperative Transcatheter Arterial Embolization and Complete Excision; A Case Report","authors":"Rei Narimatsu, Ryuji Matsumoto, Haruka Miyata, Takahiro Osawa, Daisuke Abo, Kento Wakabayashi, Utano Tomaru, Hiraku Kameda, Izumi Fukuda, Takashige Abe","doi":"10.1002/iju5.70107","DOIUrl":"10.1002/iju5.70107","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Doege–Potter syndrome (DPS) is a rare paraneoplastic phenomenon of severe hypoglycemia associated with solitary fibrous tumors (SFT). We report a case of a giant pelvic SFT with DPS, which was managed with preoperative arterial embolization and complete excision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>This report describes the case of a 77-year-old patient with persistent hypoglycemia and a giant pelvic mass. He required continuous total parenteral nutrition (TPN) for severe hypoglycemia. CT showed a giant hypervascular mass (20 × 18 × 15 cm) in the pelvic space. Tumor biopsy showed SFT. To avoid intraoperative brisk bleeding, transcatheter arterial embolization (TAE) of the main feeders was performed 1 day before surgery. The tumor was completely resected via midline abdominal incision. Hypoglycemia resolved postoperatively. He was recurrence-free for 11 months after surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The combination of preoperative TAE and surgical resection appears to be an effective therapeutic strategy for DPS-associated SFT.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The frequency of granulocyte colony-stimulating factor-related aortitis is low. We report a case of successful corticosteroid treatment in a patient with prostate cancer who developed aortitis following pegfilgrastim administration.
Case Presentation
A 68-year-old male with castration-resistant prostate cancer initiated docetaxel therapy. During the second cycle, pegfilgrastim was administered for neutropenia prophylaxis. On Day 10, the patient developed a persistent fever and elevated inflammatory markers. Evaluation led to a diagnosis of granulocyte colony-stimulating factor-related aortitis, and corticosteroid therapy was started. After switching from pegfilgrastim to filgrastim, the patient completed eight treatment cycles without recurrence.
Conclusion
In patients who develop fever and elevated inflammatory markers following granulocyte colony-stimulating factor administration, granulocyte colony-stimulating factor-related aortitis should be considered in the differential diagnosis.
{"title":"Successful Treatment of Granulocyte Colony-Stimulating Factor-Related Aortitis in Prostate Cancer","authors":"Shota Yamada, Kota Amamoto, Nobuhide Maekawa, Kazusato Hara, Takahisa Iwata, Yushi Imasato, Tomohiro Matsuo, Masataka Furukawa, Ryoichi Imamura","doi":"10.1002/iju5.70110","DOIUrl":"10.1002/iju5.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The frequency of granulocyte colony-stimulating factor-related aortitis is low. We report a case of successful corticosteroid treatment in a patient with prostate cancer who developed aortitis following pegfilgrastim administration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 68-year-old male with castration-resistant prostate cancer initiated docetaxel therapy. During the second cycle, pegfilgrastim was administered for neutropenia prophylaxis. On Day 10, the patient developed a persistent fever and elevated inflammatory markers. Evaluation led to a diagnosis of granulocyte colony-stimulating factor-related aortitis, and corticosteroid therapy was started. After switching from pegfilgrastim to filgrastim, the patient completed eight treatment cycles without recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In patients who develop fever and elevated inflammatory markers following granulocyte colony-stimulating factor administration, granulocyte colony-stimulating factor-related aortitis should be considered in the differential diagnosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":52909,"journal":{"name":"IJU Case Reports","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145866430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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