IJU Case Reports最新文献

Introduction

Immunoglobulin G4-related disease is a systemic fibroinflammatory disorder that affects the kidney, presenting as an immunoglobulin G4-related inflammatory pseudotumor. These renal inflammatory pseudotumors are usually solid, and cystic presentations have not been previously described.

Case Presentation

We report a 77-year-old man who presented with a Bosniak category III renal cystic mass and periaortic fibrous thickening. Increased serum immunoglobulin G4 levels indicated immunoglobulin G4-related disease; however, a malignant process could not be definitively ruled out. The patient underwent robot-assisted radical nephrectomy, and histopathologic assessment confirmed a cystic immunoglobulin G4-related inflammatory pseudotumor.

Conclusion

This is the first report of a renal immunoglobulin G4-related inflammatory pseudotumor with cystic features. Increased knowledge of immunoglobulin G4-related disease as a potential cause of cystic renal lesions, particularly in patients with systemic findings, may improve preoperative diagnosis.

Introduction

Squamous differentiation (SD) occurs in up to 20% of muscle invasive bladder cancers.

Case Presentation

An 85-year-old man with an intrapelvic mass invading the bladder, small intestine, and rectus abdominis presented to our department. Cystoscopy showed a necrotic mass at the dome of the bladder. Histopathological examination of specimens from transurethral resection indicated squamous cell carcinoma. Radical cystectomy with resection of the small intestine and rectus abdominis, and reconstruction of the abdominal wall using a left short gracilis myocutaneous flap was performed. The histopathology showed squamous cell carcinoma and urothelial carcinoma (UC) components; findings consisted of UC with SD. The patient received appropriate flap management and treatment for postoperative complications and was discharged on postoperative Day 100.

Conclusion

To our knowledge, this is the first report of an invasive bladder cancer with SD treated with the use of a short gracilis myocutaneous flap.

Introduction

Enfortumab vedotin plus pembrolizumab (EV + P) shows high efficacy in metastatic urothelial carcinoma (mUC), potentially increasing tumor lysis syndrome (TLS) risk.

Case Presentation

A 64-year-old man with mUC underwent surgery and adjuvant nivolumab after neoadjuvant chemotherapy. Five months post-surgery, EV + P was initiated for recurrence with distant metastasis. Non-contrast computed tomography on Day 15 of therapy revealed marked regression of hepatic and pulmonary metastases and significant reduction of the iliac soft tissue mass, with no evidence of infection. The following day, however, laboratory findings were consistent with TLS, followed by hypotension and respiratory failure. He was transferred to the intensive care unit for multidisciplinary supportive management. After stabilization, he was discharged home, and the second cycle of EV + P was completed uneventfully under prophylactic hydration and uric acid–lowering therapy.

Conclusion

Early recognition and timely multidisciplinary management are essential for favorable outcomes in TLS following EV + P therapy in mUC patients.

Introduction

Despite the recent increase in applicable chemotherapy regimens for renal pelvic and ureteral cancer, patients with metastases still exhibit a poor prognosis. Here, we report a patient with renal pelvic cancer for whom long-term survival was achieved using chemoradiotherapy.

Case Presentation

A 62-year-old woman diagnosed with renal pelvic cancer showed indications of a right renal pelvic tumor with para-aortic and iliac lymph node metastasis on computed tomography. Radiotherapy doses of 55 and 66 Gy were administered to the primary lesion, para-aortic lymph node, and right iliac lymph nodes after chemotherapy with gemcitabine, cisplatin, and docetaxel. Five years after treatment, no recurrence was observed.

Conclusion

Chemoradiotherapy is a potential therapeutic option for patients with renal pelvic carcinoma in whom surgical intervention is challenging owing to complications or older age.

Introduction

Multiple synchronous renal tumors (MSRT) in unilateral kidney are clinically rare. Simultaneous resection for multiple tumors with RAPN is complicated and challenging. Herein, we report the successful resection of three synchronous renal tumors located in unilateral kidney with RAPN using the hinotori surgical robot system.

Case Presentation

A 75-year-old man was diagnosed with multiple left renal tumors (45 mm and 20 mm in diameter) that presented very close to each other. We performed RAPN using hinotori and excised the tumors simultaneously. Postoperative renal function was maintained. No complications were identified. The three histological types were distinct: ccRCC, pRCC, and small renal angiomyolipoma.

Conclusion

To the best of our knowledge, this is the first report of MSRT in unilateral kidney successfully treated with RAPN using hinotori.

Introduction

There are no previous reports of solitary renal metastases from urothelial carcinoma with trophoblastic differentiation, a rare bladder cancer subtype that is pathologically hCGβ positive.

Case Presentation

A 77-year-old male with urothelial carcinoma with trophoblastic differentiation underwent robot-assisted radical cystectomy following neoadjuvant chemotherapy. Pathological examination revealed urothelial carcinoma, classified as ypT2b and ypN0 with detection of focal hCGβ positivity. Postoperatively, serum hCGβ levels decreased from 1.6 to < 0.2 mIU/mL. At the 9-month follow-up, serum hCGβ was elevated to 20.1 mIU/mL with no recurrence on PET-CT. Gemcitabine–cisplatin chemotherapy was initiated; however, a solitary renal tumor was detected. Partial nephrectomy confirmed that the tumor was a renal metastasis of bladder cancer. Serum hCGβ levels decreased and remained < 0.2 mIU/mL, even 20 months after partial nephrectomy.

Conclusion

We report a case of urothelial carcinoma with trophoblastic differentiation and elevated serum hCGβ levels, in which a solitary renal metastasis was successfully resected by robot-assisted partial nephrectomy.

Introduction

Tumor development in the ileal conduit is rare. Herein, we present a case of metastatic malignant melanoma occurring within the ileal conduit 17 years after radical cystectomy.

Case Presentation

A 76-year-old Japanese man, with a history of bladder cancer treated with radical cystectomy and ileal conduit diversion, presented with gross hematuria. He had malignant melanoma diagnosed 10 years prior, with recurrent metastases managed through surgery and adjuvant therapy. During his recent admission, metastases to the subcutaneous tissue and retroperitoneum were noted. Contrast-enhanced computed tomography revealed bilateral hydronephrosis and a tumor in the ileal conduit. Endoscopic resection confirmed metastatic malignant melanoma. The patient's renal function stabilized postoperatively, and hematuria was controlled. A palliative care approach was adopted to treat the melanoma.

Conclusion

This rare case of metastatic malignant melanoma within an ileal conduit highlights the importance of histopathological examinations in patients with overlapping malignancies.

Trial Registration: 2016-0474

Introduction

We report a rare case of multiple spermatic cord angiolipomas.

Case Presentation

An 85-year-old man with a history of laparoscopic right nephrectomy for renal cell carcinoma was referred for evaluation of a palpable right scrotal mass. Ultrasonography showed a single solid mass. Computed tomography and magnetic resonance imaging revealed a solid nodule in contact with the right spermatic cord and a fatty mass below the nodule. Right inguinal orchiectomy was performed. Histopathological examination of the surgical specimen was consistent with angiolipoma. He was discharged 4 days postoperatively, and no recurrence has been observed during the subsequent 8 months.

Conclusion

Angiolipomas are benign and rarely occur in paratesticular tissue. They should be distinguished from liposarcomas, given the differences in treatment and prognosis. Diagnosis requires surgical resection and histopathological examination. Once resected, angiolipomas rarely recur, and the prognosis is good.