IJU Case Reports最新文献_第6页

Dermatomyositis in a young patient: A rare paraneoplastic syndrome of renal cell carcinoma 一名年轻患者的皮肌炎：肾细胞癌的罕见副肿瘤综合征

Q4 Medicine

IJU Case Reports

Pub Date : 2024-07-15 DOI: 10.1002/iju5.12754

Margarida André, Alexandre Macedo, Vanessa Metrogos, Luísa Moreira, José Pereira, Nuno Figueira, João Paulo Rosa, Miguel Carvalho

Introduction

Paraneoplastic syndromes are frequent in patients with renal cell carcinoma. Dermatomyositis is an idiopathic inflammatory myopathy that may be associated with neoplasms. This case aims to describe the rare association of dermatomyositis with renal cell carcinoma and to increase clinical suspicion of this neoplasm when systemic rheumatologic symptoms are present.

Case presentation

A 35-year-old female developed severe rheumatologic symptoms (progressive muscle weakness, heliotrope rash, and Gottron's papules). Clinical and laboratory findings indicated dermatomyositis. During the investigation, computed tomography revealed a left kidney solid mass. She underwent a left radical nephrectomy, and histology confirmed renal cell carcinoma. After 3 months, dermatomyositis manifestations disappeared and the patient withdrawn steroid therapy.

Conclusion

Most paraneoplastic syndromes associated with renal cell carcinoma are only cured with nephrectomy. We highlight the potential role of surgery in dermatomyositis caused by renal cell carcinoma. The recurrence of symptoms related to the syndrome should alert for disease progression.

副肿瘤综合征在肾细胞癌患者中很常见。皮肌炎是一种特发性炎症性肌病，可能与肿瘤有关。本病例旨在描述皮肌炎与肾细胞癌的罕见关联，并在出现全身风湿症状时提高临床对这种肿瘤的怀疑。一名 35 岁女性出现了严重的风湿症状（进行性肌无力、日光疹和戈特龙丘疹）。临床和实验室检查结果显示患者患有皮肌炎。检查期间，计算机断层扫描发现左肾实性肿块。她接受了左肾根治术，组织学检查证实为肾细胞癌。3 个月后，皮肌炎症状消失，患者也停止了类固醇治疗。我们强调手术在肾细胞癌引起的皮肌炎中的潜在作用。与该综合征相关的症状复发应警惕疾病进展。

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引用次数: 0

A case of spontaneous bladder rupture successfully conservatively treated with transurethral debridement and hyperbaric oxygen therapy 一例自发性膀胱破裂病例，通过经尿道清创术和高压氧疗法成功保守治疗

Q4 Medicine

IJU Case Reports

Pub Date : 2024-07-11 DOI: 10.1002/iju5.12749

Heisuke Iijima, Rikuri Someya, Eriko Tanaka, Mami Yamazaki, Tomoya Yokoi, Takehiro Takahashi, Masakatsu Ueda, Yusuke Shiraishi, Koji Yoshimura

Introduction

Spontaneous bladder rupture is a potentially life-threatening condition. Its treatment often requires invasive strategies, mainly surgical closure, or cystectomy. We present a case where we successfully treated bladder rupture employing a less invasive technique of transurethral debridement and hyperbaric oxygen therapy.

Case presentation

A woman in her 80s presenting with lower abdominal pain was suspected of vesicoenteric fistula. Subsequent investigations confirmed bladder rupture to the abdominal wall, which eventually developed into a vesicocutaneous fistula. To minimize the invasiveness of treatment, a combined strategy of transurethral debridement of the fistula, and hyperbaric oxygen therapy was taken, resulting in successful outcome.

Conclusion

Our approach was unique for its tolerability in comparison to conventional surgical approaches taken towards this condition.

自发性膀胱破裂有可能危及生命。其治疗通常需要采取侵入性策略，主要是外科闭合术或膀胱切除术。我们介绍了一例采用经尿道清创和高压氧治疗的微创技术成功治疗膀胱破裂的病例。一名 80 多岁的妇女因下腹疼痛而被怀疑患有膀胱肠瘘。随后的检查证实膀胱破裂至腹壁，最终发展成膀胱肠瘘。为了尽量减少治疗的创伤性，我们采取了经尿道瘘管清创和高压氧治疗相结合的策略，最终取得了成功。与传统的手术方法相比，我们的方法具有独特的耐受性。

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引用次数: 0

Efficacy of trametinib in a metastatic urothelial carcinoma patient with a BRAF mutation 曲美替尼对一名 BRAF 基因突变的转移性尿路上皮癌患者的疗效

Q4 Medicine

IJU Case Reports

Pub Date : 2024-07-10 DOI: 10.1002/iju5.12759

Hiroyuki Karasawa, Yota Yasumizu, Takeo Kosaka, Tatsunori Shimoi, Mototsugu Oya

Introduction

BRAF mutations in bladder cancer are rare. MEK inhibitors have excellent clinical benefits in the treatment of melanoma.

Case presentation

A 60-year-old male was diagnosed with muscle-invasive bladder cancer and underwent total cystectomy and ileal conduit diversion. Despite 4 cycles of gemcitabine and cisplatin chemotherapy and 3 courses of pembrolizumab, the left obturator lymph node enlarged. Cancer multi-gene panel testing confirmed the BRAF G469A mutation and trametinib was recommended. Three months after the initiation of trametinib (2 mg, qd), the left obturator lymph node shrank by more than 50%. The disease has remained stable for more than 18 months.

Conclusion

The present case indicates the potential of trametinib to treat mBUC patients with the BRAF G469A mutation in this setting.

膀胱癌中的 BRAF 基因突变非常罕见。MEK抑制剂在治疗黑色素瘤方面有很好的临床疗效。一名60岁的男性被诊断为肌肉浸润性膀胱癌，接受了全膀胱切除术和回肠导流术。尽管接受了 4 个周期的吉西他滨和顺铂化疗以及 3 个疗程的 Pembrolizumab 治疗，但左侧钝器淋巴结肿大。癌症多基因面板检测证实了 BRAF G469A 突变，建议使用曲美替尼。开始服用曲美替尼（2 毫克，每天一次）三个月后，左侧闭孔淋巴结缩小了 50%。本病例表明，在这种情况下，曲美替尼具有治疗BRAF G469A突变的mBUC患者的潜力。

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引用次数: 0

Urinary tract fungal ball in a single kidney after total nephroureterocystectomy 全肾膀胱切除术后单个肾脏中的尿路真菌球

Q4 Medicine

IJU Case Reports

Pub Date : 2024-07-09 DOI: 10.1002/iju5.12757

Yoshinori Nakano, Yohei Sekino, Kenshiro Takemoto, Takeshi Ueno, Shogo Fujii, Hiroyuki Kitano, Keisuke Hieda, Shinya Ohara, Nobuyuki Hinata

Introduction

Fungal balls in the urinary tract are rare but dangerous complications of candiduria. Here, we report a case of a urinary tract fungal ball in a single kidney after total nephroureterocystectomy.

Case presentation

The patient was an 80-year-old male. He had a history of pyelonephritis, and his ureteral stent was regularly replaced. He was admitted to the hospital with a chief complaint of urinary tract obstruction, and a 50-mm-sized mass was found within the renal pelvis. Because the ureteral stent frequently became obstructed, the mass was removed percutaneously. Candida albicans was detected on the tissue culture results, and the mass was diagnosed as a fungal ball.

Conclusion

Appropriate urinary drainage methods for fungal balls vary among patients, and it is important to select an appropriate method based on the accumulated number of cases.

尿路真菌球是念珠菌尿的罕见但危险的并发症。在此，我们报告了一例在全肾输尿管囊肿切除术后在单肾中发现尿路真菌球的病例。他有肾盂肾炎病史，输尿管支架定期更换。他以尿路梗阻为主诉入院，在肾盂内发现了一个 50 毫米大小的肿块。由于输尿管支架经常发生阻塞，因此经皮切除了肿块。组织培养结果检测出白色念珠菌，肿块被诊断为真菌球。真菌球的适当排尿方法因人而异，重要的是要根据累计病例数选择适当的方法。

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引用次数: 0

A case of adrenal cavernous hemangioma resected due to tumor growth accompanied by intratumoral hemorrhage 一例因肿瘤生长伴瘤内出血而切除的肾上腺海绵状血管瘤病例

Q4 Medicine

IJU Case Reports

Pub Date : 2024-07-09 DOI: 10.1002/iju5.12760

Takayuki Ueda, Masato Yanagi, Takashi Kusakabe, Takeshi Shigihara, Mikio Shibasaki, Masato Nagasawa, Tsutomu Hamasaki, Yukihiro Kondo

Introduction

We describe a case of an adrenal cavernous hemangioma that was surgically resected because of tumor growth and intratumoral hemorrhage.

Case presentation

A 73-year-old woman presented with an enlarged adrenal tumor and intratumoral hemorrhage during the follow-up of an incidental adrenal tumor. A computed tomography showed that the left adrenal tumor had grown from 23 to 44 mm over 1 year. Blood tests revealed a normal metabolic profile. Paragangliomas and metastatic tumors were suspected on imaging. Laparoscopic adrenalectomy was performed to prevent tumor rupture due to further bleeding. No adhesions or bleeding were observed around the tumor during surgery. Pathological diagnosis was adrenal cavernous hemangioma.

Conclusion

Adrenal cavernous hemangioma is difficult to distinguish preoperatively from other adrenal tumors, including malignant tumors. The intraoperative findings of this case suggest that laparoscopic adrenalectomy is a safe treatment option for relatively small adrenal cavernous hemangioma.

我们描述了一例肾上腺海绵状血管瘤病例，该病例因肿瘤生长和瘤内出血而被手术切除。一名 73 岁的女性在随访偶然发现的肾上腺肿瘤期间，出现肾上腺肿瘤增大和瘤内出血。计算机断层扫描显示，左侧肾上腺肿瘤在一年内从23毫米增大到44毫米。血液检查显示代谢情况正常。影像学检查怀疑是副神经节瘤和转移性肿瘤。为防止进一步出血导致肿瘤破裂，患者接受了腹腔镜肾上腺切除术。手术中未发现肿瘤周围有粘连或出血。肾上腺海绵状血管瘤在术前很难与其他肾上腺肿瘤（包括恶性肿瘤）区分开来。本病例的术中发现表明，腹腔镜肾上腺切除术是治疗相对较小的肾上腺海绵状血管瘤的安全选择。

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引用次数: 0

Urethral caruncle causes acute urinary retention 尿道痈导致急性尿潴留

Q4 Medicine

IJU Case Reports

Pub Date : 2024-07-06 DOI: 10.1002/iju5.12756

Akifumi Katsu, Masato Yanagi, Norio Motoda, Hiroyoshi Kono, Ryoji Kimata, Tsutomu Hamasaki, Yukihiro Kondo

Introduction

We encountered a case of urinary retention caused by a urethral caruncle.

Case presentation

An 86-year-old woman presented to our hospital with urinary retention. When the urinary bladder catheter was placed, a smooth, well-defined mass 20 mm in diameter was detected on the posterior wall of the external urethral meatus. The patient was diagnosed with urinary retention due to a urethral caruncle, and the mass was resected. The mass was pathologically compatible with a urethral caruncle. The patient could urinate postoperatively. Ultrasound test after surgery showed residual urine volume was 100 mL.

Conclusion

Inspecting the urethral meatus is vital in the clinical examination of older women with voiding symptoms. A urethral caruncle is a rare cause of urinary retention. However, large urethral caruncles are at risk of causing urinary retention suggesting that resecting the urethral caruncles at an appropriate time is desirable.

我们遇到了一例由尿道痈引起的尿潴留病例。一名 86 岁的妇女因尿潴留来我院就诊。在放置膀胱导尿管时，发现尿道外口后壁上有一个直径 20 毫米的光滑、轮廓清晰的肿块。患者被诊断为尿道痈引起的尿潴留，肿块被切除。该肿块在病理学上与尿道海绵体吻合。术后患者可以排尿。术后超声检查显示残余尿量为 100 毫升。尿道肉阜是导致尿潴留的罕见原因。然而，大的尿道海绵体有引起尿潴留的风险，这表明在适当的时候切除尿道海绵体是可取的。

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引用次数: 0

Urethral catheter entrapped in vesicourethral anastomotic sutures after laparoscopic radical prostatectomy successfully removed by transurethral approach 腹腔镜前列腺癌根治术后尿道导管被膀胱尿道吻合缝合线夹住，经尿道方法成功取出。

Q4 Medicine

IJU Case Reports

Pub Date : 2024-06-19 DOI: 10.1002/iju5.12750

Kentaro Yoshihara, Kojiro Tashiro, Shoji Kimura, Keiji Yasue, Fumihiko Urabe, Hiroki Yamada, Takahiro Kimura

Introduction

Urethral catheter entrapped in vesicourethral anastomotic sutures after radical prostatectomy is a relatively common complication. We herein present a novel and safe technique to remove urethral catheter.

Case presentation

A 64-year-old man was diagnosed with prostate cancer. Subsequently he underwent laparoscopic radical prostatectomy. On postoperative Day 7, the patient experienced difficulty in removing the catheter, and entanglement of the suture with the urinary catheter was suspected. After conservative follow-up, a rigid endoscope was inserted into the urethra beside urethral catheter, identifying suture entanglement with the catheter. Finally, the suture was cut with scissor forceps.

Conclusion

To the best of our knowledge, this is the first reported case in which scissor forceps were used to cut the entangled thread in such a complication. This case highlights a novel but simple method for difficult removal of an entrapped catheter.

导言：根治性前列腺切除术后尿道导管卡在膀胱尿道吻合缝合线内是一种比较常见的并发症。我们在此介绍一种新颖、安全的尿道导管移除技术：病例介绍：一名 64 岁的男性被诊断出患有前列腺癌。随后，他接受了腹腔镜前列腺癌根治术。术后第 7 天，患者在移除导尿管时遇到困难，怀疑缝线与导尿管缠绕在一起。保守随访后，将硬质内窥镜插入导尿管旁的尿道，发现缝线与导尿管缠绕在一起。最后，用剪刀剪断了缝线：据我们所知，这是首例在此类并发症中使用剪刀剪断缠绕线的病例。本病例凸显了一种新颖而简单的方法，可轻松去除缠绕的导管。

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引用次数: 0

Report of case series: Correlation between pathological and radiological evaluation and clinical course of three cases of metastatic renal cell carcinoma with cytoreductive nephrectomy after combined immuno-oncology therapy 病例系列报告：三例转移性肾细胞癌患者在接受免疫肿瘤联合疗法后进行细胞切除肾切除术的病理和放射学评估与临床病程的相关性。

Q4 Medicine

IJU Case Reports

Pub Date : 2024-06-16 DOI: 10.1002/iju5.12752

Yuichiro Atagi, Kouki Tada, Reina Kouno, Ryoei Minato, Katsuyoshi Hashine

Introduction

The pathologic evaluation and clinical course of cytoreductive nephrectomy after combined immuno-oncology therapy were reviewed to understand the benefits of cytoreductive nephrectomy.

Case presentation

Three patients with clear cell carcinoma underwent tumor biopsy before combined immuno-oncology therapy. Case 1 was found to have a sarcomatoid component upon nephrectomy and continued with combined immuno-oncology therapy. Case 2 discontinued combined immuno-oncology therapy due to adverse events but maintained tumor shrinkage. The patient was found to have viable cells in most nephrectomy specimens but has had no recurrence after combined immuno-oncology therapy was discontinued. In case 3, the residual tumor was deemed resectable with combined immuno-oncology therapy, and nephrectomy and metastasectomy were performed. No viable cells were observed in either specimen, and the patient has had no recurrence.

Conclusion

Cytoreductive nephrectomy after combined immuno-oncology therapy may be useful to allow pathologic evaluation of treatment and provide an indicator for subsequent treatment.

简介：本文回顾了免疫肿瘤联合治疗后肾切除术的病理评估和临床过程：通过回顾性分析免疫肿瘤联合治疗后细胞肾切除术的病理评估和临床过程，了解细胞肾切除术的益处：三名透明细胞癌患者在接受免疫肿瘤学联合治疗前接受了肿瘤活检。病例 1 在肾切除术后发现有肉瘤成分，继续接受免疫肿瘤联合疗法。病例 2 因不良反应停止了免疫肿瘤联合疗法，但肿瘤继续缩小。患者在大部分肾切除标本中发现有存活细胞，但在停止联合免疫肿瘤疗法后没有复发。在病例 3 中，通过联合免疫肿瘤疗法，残余肿瘤被认为可以切除，于是进行了肾切除术和转移灶切除术。两例标本中均未观察到存活细胞，患者也没有复发：结论：免疫肿瘤学联合疗法后的肾切除术有助于对治疗进行病理评估，并为后续治疗提供指标。

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引用次数: 0

Vesicovaginal fistula and bladder calculus formation secondary to long-term retention of an intrauterine device 宫内节育器长期滞留导致膀胱阴道瘘和膀胱结石形成。

Q4 Medicine

IJU Case Reports

Pub Date : 2024-06-16 DOI: 10.1002/iju5.12753

Masahiro Goto, Tomoyuki Kaneko, Naoki Yamamine, Kazuki Yanagida, Michio Noda, Yuumi Tokura, Itsuki Yoshimura, Taketo Kawai, Tohru Nakagawa

Introduction

Although uterine perforation is a rare but serious complication, intrauterine devices are globally popular and effective contraceptive methods.

Case presentation

A 76-year-old female patient manifesting symptoms of vaginal leakage and lower abdominal discomfort was admitted to our hospital. Diagnostic imaging identified a vesicovaginal fistula and bladder calculi attributable to perforation of the bladder by an intrauterine device that had been inserted over four decades ago. The patient underwent open surgery for cystolith removal and vesicovaginal fistula repair.

Conclusions

If a patient with an intrauterine device complains of bladder stones or ongoing lower urinary tract symptoms, bladder perforation caused by the device should be considered in the differential diagnosis.

简介：子宫穿孔是一种罕见但严重的并发症，宫内节育器是全球流行的有效避孕方法：虽然子宫穿孔是一种罕见但严重的并发症，但宫内节育器是全球流行的有效避孕方法：本院收治了一名 76 岁的女性患者，她表现出阴道漏液和下腹不适的症状。影像诊断结果显示，患者患有膀胱阴道瘘和膀胱结石，原因是四十多年前放置的宫内节育器导致膀胱穿孔。患者接受了膀胱结石清除和膀胱阴道瘘修补的开腹手术：结论：如果宫内节育器患者主诉膀胱结石或持续的下尿路症状，在鉴别诊断时应考虑到节育器引起的膀胱穿孔。

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引用次数: 0

Myelodysplastic syndrome occurring after enfortumab vedotin treatment for metastatic urothelial carcinoma 恩福单抗维多汀治疗转移性尿路上皮癌后出现骨髓增生异常综合征

Q4 Medicine

IJU Case Reports

Pub Date : 2024-06-10 DOI: 10.1002/iju5.12734

Kazuki Yanagida, Taketo Kawai, Toyoshi Seito, Kensuke Matsumoto, Tomoyuki Kaneko, Tohru Nakagawa

Introduction

Enfortumab vedotin is an antibody-drug conjugate targeting Nectin-4 for the treatment of advanced urothelial carcinoma in patients previously treated with platinum-containing chemotherapy and immune checkpoint inhibitors. Common adverse events include rashes, peripheral neuropathy, and hyperglycemia. However, there are no reports on the development of myelodysplastic syndrome during enfortumab vedotin therapy in clinical settings.

Case presentation

A 72-year-old male patient experienced prolonged and severe thrombocytopenia 18 weeks after the start of enfortumab vedotin therapy for metastatic urothelial carcinoma, requiring daily platelet transfusions. Bone marrow examination and chromosomal analysis confirmed the diagnosis of myelodysplastic syndrome. Treatment with eltrombopag proved to be effective.

Conclusion

This is the first report of the development of myelodysplastic syndrome during enfortumab vedotin therapy in a clinical setting. Although rare, myelodysplastic syndrome can occur during enfortumab vedotin therapy.

Enfortumab vedotin是一种靶向Nectin-4的抗体药物共轭物，用于治疗既往接受过含铂化疗和免疫检查点抑制剂治疗的晚期尿路上皮癌患者。常见的不良反应包括皮疹、周围神经病变和高血糖。一位72岁的男性患者在开始使用恩福单抗维多汀治疗转移性尿路上皮癌18周后，出现了长时间的严重血小板减少，需要每天输注血小板。骨髓检查和染色体分析证实了骨髓增生异常综合征的诊断。这是在临床上首次报道恩福单抗维多汀治疗期间出现骨髓增生异常综合征。尽管罕见，但在恩福单抗维多汀治疗期间也可能发生骨髓增生异常综合征。

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引用次数: 0