IJU Case Reports最新文献_第8页

A case of testicular tumor and respiratory failure caused by choriocarcinoma syndrome managed through modified chemotherapy and extracorporeal membrane oxygenation 一例通过改良化疗和体外膜肺氧合治疗的绒毛膜癌综合征引起的睾丸肿瘤和呼吸衰竭病例

Q4 Medicine

IJU Case Reports

Pub Date : 2024-04-08 DOI: 10.1002/iju5.12725

Tetsuro Shiraiwa, Hiromichi Katayama, Yudai Iwasaki, Shingo Kimura, Yohei Satake, Takuma Sato, Yoshihide Kawasaki, Naoki Kawamorita, Shinichi Yamashita, Akihiro Ito

Introduction

Choriocarcinoma syndrome with multiple lung metastases has a poor prognosis and causes respiratory failure due to alveolar hemorrhage. We encountered a case where the introduction of extracorporeal membrane oxygenation effectively sustained oxygenation until chemotherapy took effect on lung metastases of testicular tumors.

Case presentation

A 35-year-old man with dyspnea was referred to our hospital. He showed left testicular tumor with multiple lung metastases. Serum human chorionic gonadotropin level was also elevated. Reduced chemotherapy was initiated and extracorporeal membrane oxygenation was administered because of low oxygen levels on the fourth day. Chemotherapy successfully reduced the size of the lung masses, and extracorporeal membrane oxygenation was discontinued. Respiratory status improved substantially, but the patient died of brain metastases 4 months later.

Conclusion

Extracorporeal membrane oxygenation may be a useful option for managing respiratory failure resulting from choriocarcinoma syndrome until the respiratory condition is improved by chemotherapy for testicular tumors.

伴有多发性肺转移的绒毛膜癌综合征预后不良，会因肺泡出血导致呼吸衰竭。我们遇到过这样一个病例，在化疗对睾丸肿瘤肺转移起效之前，采用体外膜肺氧合可有效维持氧合。他的左侧睾丸肿瘤伴有多发性肺转移。血清人类绒毛膜促性腺激素水平也升高。患者开始接受减量化疗，并在第四天因血氧过低而进行了体外膜肺氧合。化疗成功缩小了肺部肿块，体外膜氧合也停止了。在睾丸肿瘤化疗改善呼吸状况之前，体外膜肺氧合可能是治疗绒癌综合征导致的呼吸衰竭的有效方法。

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引用次数: 0

Durable response to nivolumab rechallenge in a patient with metastatic clear cell renal cell carcinoma 一名转移性透明细胞肾细胞癌患者对 nivolumab 再挑战的持久反应。

Q4 Medicine

IJU Case Reports

Pub Date : 2024-04-08 DOI: 10.1002/iju5.12727

Motohiro Fujiwara, Wataru Shimada, Minato Yokoyama, Anri Koyanagi, Hiroshi Shintaku, Shohei Fukuda, Yuma Waseda, Hajime Tanaka, Soichiro Yoshida, Yasuhisa Fujii

Introduction

While immune checkpoint inhibitors represent the mainstream treatment for metastatic renal cell carcinoma, a standardized approach following immune checkpoint inhibitors remains unclear. We report a case of metastatic renal cell carcinoma treated with nivolumab rechallenge.

Case presentation

A 60-year-old male with metastatic melanoma was referred to the urology division due to right renal cancer. He was undergoing nivolumab treatment for metastatic melanoma. Radical nephrectomy revealed clear cell renal cell carcinoma, pT3a. Two months post-surgery, multiple metastases were identified. Despite subsequent administration of interferon-α, axitinib, and temsirolimus, the metastases progressed. Consequently, nivolumab rechallenge and palliative radiotherapy were initiated, resulting in a durable response for 20 months. However, disease progression occurred, and he died of cancer 4 years after nephrectomy.

Conclusion

This is the first report of nivolumab rechallenge in metastatic renal cell carcinoma. Although the utility remains unclear, this case suggests that some patients may benefit from nivolumab rechallenge.

导言：虽然免疫检查点抑制剂是治疗转移性肾细胞癌的主流方法，但免疫检查点抑制剂后的标准化方法仍不明确。我们报告了一例接受 nivolumab 再挑战治疗的转移性肾细胞癌病例：一名患有转移性黑色素瘤的 60 岁男性因右肾癌转诊至泌尿科。他因转移性黑色素瘤正在接受 nivolumab 治疗。根治性肾切除术发现透明细胞肾细胞癌，pT3a。术后两个月，发现多处转移。尽管随后使用了干扰素-α、阿西替尼和替莫瑞莫司，但转移灶仍在发展。因此，他开始接受 nivolumab 再挑战和姑息性放疗，结果获得了长达 20 个月的持久应答。然而，疾病还是出现了进展，他在肾切除术 4 年后死于癌症：这是转移性肾细胞癌患者接受尼妥珠单抗再挑战治疗的首例报告。结论：这是首例 nivolumab 再挑战治疗转移性肾细胞癌的报告，尽管其效用尚不明确，但该病例表明，一些患者可能会从 nivolumab 再挑战中获益。

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引用次数: 0

Case in which percutaneous fibrin glue injection was useful for refractory urinary fistula following robot-assisted partial nephrectomy 经皮纤维蛋白胶注射治疗机器人辅助肾部分切除术后难治性尿瘘的病例

Q4 Medicine

IJU Case Reports

Pub Date : 2024-04-04 DOI: 10.1002/iju5.12724

Nao Yukimatsu, Takeshi Yamasaki, Keiko Iguchi, Taiyo Otoshi, Minoru Kato, Junji Uchida

Introduction

Urinary fistula is a rare complication following robot-assisted partial nephrectomy. For cases refractory to conservative treatment, only ureteral stent placement and percutaneous drainage are the established treatment alternatives.

Case presentation

A 44-year-old man presented with urinary fistula 3 weeks after robot-assisted partial nephrectomy for right renal cell carcinoma. Follow-up observations were conducted for 2 weeks; however, no improvements were observed. Additionally, the patient did not improve following percutaneous drainage and ureteral stent insertion. Subsequently, the patient received percutaneous injections of fibrin glue, with the urinary fistula showing significant improvements on the following day.

Conclusion

Our findings indicated that percutaneous fibrin glue injection can effectively treat refractory urinary fistula following partial nephrectomy.

尿瘘是机器人辅助肾部分切除术后的一种罕见并发症。一名 44 岁的男子因右肾细胞癌接受机器人辅助肾部分切除术 3 周后出现尿瘘。对该患者进行了 2 周的随访观察，但未发现任何好转。此外，患者在接受经皮引流术和输尿管支架植入术后病情也未见好转。我们的研究结果表明，经皮注射纤维蛋白胶能有效治疗肾部分切除术后的难治性尿瘘。

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引用次数: 0

A case of testicular cancer in a long-term hydranencephaly survivor with undescended testes 一例睾丸畸形长期存活且睾丸未降的患者罹患睾丸癌的病例

Q4 Medicine

IJU Case Reports

Pub Date : 2024-04-01 DOI: 10.1002/iju5.12720

Wataru Hirata, Toshiaki Shinojima, Kotaro Yokota, Rei Kin, Taketo Yamada, Hirotaka Asakura

Introduction

The development of malignant tumors in patients with hydranencephaly is extremely rare. We describe the first case of testicular cancer that developed in the undescended testes of a long-term survivor of hydranencephaly.

Case presentation

A 32-year-old man with severe cerebral palsy due to hydranencephaly was referred to our department for the evaluation of a subcutaneous lump in the lower right abdomen. He was a long-term survivor of hydranencephaly. After confirming the diagnosis of right testicular cancer originating in his undescended testes, surgical resection was performed. Pathological examination revealed a mixed-type germ cell tumor.

Conclusion

The decision-making process for treating malignant tumors, like testicular cancer, in adults with severe cerebral palsy can be challenging. Clinical ethics consultation could be helpful in avoiding treatment delays.

导言：无睾症患者发生恶性肿瘤的情况极为罕见。我们描述了首例睾丸癌病例，该病例发生在一名长期存活的无睾丸畸形患者的未降睾丸中。病例介绍一名因脑积水导致严重脑瘫的 32 岁男子因右下腹皮下肿块转诊至我科。他是水脑症的长期幸存者。经确诊，他的右侧睾丸癌源于未降睾丸，于是进行了手术切除。病理检查显示为混合型生殖细胞肿瘤。结论治疗重度脑瘫成人恶性肿瘤（如睾丸癌）的决策过程可能具有挑战性。临床伦理咨询有助于避免治疗延误。

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引用次数: 0

Editorial Comment to A rare case of a testicular lesion related to hand, foot, and mouth disease 编辑评论：一例罕见的睾丸病变与手足口病有关

Q4 Medicine

IJU Case Reports

Pub Date : 2024-04-01 DOI: 10.1002/iju5.12722

Kazuyoshi Johnin MD, PhD

This case report demonstrated that coxsackievirus viral orchitis showed an intratesticular mass, resembling testicular cancer.¹ After ruling out testicular cancer, the authors selected a watchful waiting policy for this situation. However, it is very difficult to make a diagnosis correctly without a biopsy or excision. Although viral particles can invade the testis parenchyma through the blood–testis barrier, viral orchitis shows different findings on ultrasound in the testis, as opposed to bacterial epididymo-orchitis. While mumps orchitis showed a homogeneous and or diffused pattern on the ultrasound exam, coxsackievirus orchitis showed a heterogeneous mass in the affected testicles. It is very difficult to tell the difference between malignant and benign conditions. If the wait-and-see policy is selected, both testicles should be monitored carefully. The authors showed the changes in the ultrasound findings over some time. The intratesticular mass finally disappeared after half a year of observation. Additionally, symptomatic therapy such as cooling is essential to prevent testis atrophy. This case report is very important for the readers of the IJU case report. Urologists should know and keep in mind the ultrasound findings of viral orchitis when ruling out testicular neoplasm.

The author declare no conflict of interest.

该病例报告显示，柯萨奇病毒性睾丸炎表现为睾丸内肿块，与睾丸癌相似。1 在排除了睾丸癌的可能性后，作者针对这种情况选择了观察等待政策。1 在排除了睾丸癌的可能性后，作者针对这种情况选择了观察等待政策。然而，如果不进行活检或切除，很难做出正确的诊断。虽然病毒颗粒可以通过血液-睾丸屏障侵入睾丸实质，但病毒性睾丸炎与细菌性附睾睾丸炎在睾丸超声波检查中的表现不同。腮腺炎性睾丸炎在超声波检查中表现为均匀的或弥漫性的形态，而柯萨奇病毒性睾丸炎则在受影响的睾丸中表现为异型肿块。要区分恶性和良性疾病非常困难。如果选择观望，则应仔细观察双侧睾丸。作者展示了一段时间后超声检查结果的变化。经过半年的观察，睾丸内肿块终于消失了。此外，降温等对症治疗对于防止睾丸萎缩也至关重要。本病例报告对《国际泌尿外科杂志》病例报告的读者非常重要。泌尿科医生在排除睾丸肿瘤时，应了解并牢记病毒性睾丸炎的超声检查结果。

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引用次数: 0

A rare case of a testicular lesion related to hand, foot, and mouth disease 与手足口病有关的睾丸病变罕见病例

Q4 Medicine

IJU Case Reports

Pub Date : 2024-04-01 DOI: 10.1002/iju5.12721

Ayaka Igarashi, Yutaka Takezawa, Yuki Ozawa, Tomomi Saito, Hiroshi Nakayama, Takeaki Makino, Toru Etsunaga, Yoshitaka Saito, Mikio Kobayashi

Introduction

Hand, foot, and mouth disease generally occurs in children. In rare cases, hand, foot, and mouth disease affects the testicles.

Case presentation

A 29-year-old man presented to our emergency department with testicular pain for several days after the onset of hand, foot, and mouth disease. Ultrasonography revealed hypoechoic mass-like areas in the right testis. A mild inflammatory response was noted, tumor markers and urinary data were normal, and tests for infection were all negative. Antibiotics were initiated and ultrasonography was performed in every subsequent examination. Testicular pain disappeared 6 months later.

Conclusion

We encountered a rare case of a testicular lesion related to hand, foot, and mouth disease that was successfully treated. The careful selection of treatment for testicular pain and scrotal enlargement in young adult males, such as surgery and symptomatic treatment, based on their medical history and laboratory findings, is important.

手足口病通常发生在儿童身上。一名 29 岁的男子在手足口病发病几天后因睾丸疼痛到我院急诊科就诊。超声波检查发现右侧睾丸有低回声肿块样区域。患者出现轻度炎症反应，肿瘤标志物和尿液数据正常，感染检测结果均为阴性。医生开始使用抗生素，并在以后的每次检查中都进行超声波检查。我们遇到了一例罕见的与手足口病有关的睾丸病变病例，该病例得到了成功治疗。根据病史和实验室检查结果，谨慎选择治疗青壮年男性睾丸疼痛和阴囊肿大的方法（如手术和对症治疗）非常重要。

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引用次数: 0

Retroperitoneal biloma—A rare differential diagnosis of perirenal fluid accumulation 腹膜后胆脂瘤--肾周积液的罕见鉴别诊断

Q4 Medicine

IJU Case Reports

Pub Date : 2024-03-23 DOI: 10.1002/iju5.12723

Kazushi Hanawa, Masanari Fukasawa, Tadashi Aoki, Munehiro Nozawa, Yoshio Takihana, Yuji Mishina, Hiroshi Nakagomi

Introduction

Nontraumatic biliary rupture and retroperitoneal biloma infrequently occur. Here, we report a case of retroperitoneal biloma due to spontaneous left hepatic duct perforation, which was difficult to differentiate from a perirenal abscess.

Case presentation

A 94-year-old female patient was hospitalized with symptoms of fatigue and right back pain that lasted for 5 days. Computed tomography revealed fluid accumulation in the retroperitoneum, and urinary extravasation and right perinephric abscess were suspected. Antimicrobial treatment and drainage with ureteral stents and urethral catheters demonstrated no symptom improvement. Ultrasound-guided puncture of the abscess revealed the presence of bile. Pigtail catheter drainage improved symptoms and inflammatory response. After diagnosis, endoscopic retrograde cholangiopancreatography revealed bile leakage, and a bile duct stent was inserted.

Conclusion

Biloma can cause perirenal fluid accumulation, and they should be considered an origin of perirenal fluid accumulation when urinary tract lesions are excluded.

非外伤性胆管破裂和腹膜后胆汁瘤很少发生。这里，我们报告了一例因自发性左肝管穿孔而导致的腹膜后胆汁瘤，该病例与肾周脓肿难以鉴别。一名 94 岁的女性患者因乏力和右背疼痛症状住院，症状持续了 5 天。计算机断层扫描显示腹膜后有积液，怀疑是尿外渗和右肾周脓肿。抗菌治疗以及使用输尿管支架和尿道导管引流均未改善症状。超声引导下的脓肿穿刺显示存在胆汁。尾纤导管引流改善了症状和炎症反应。确诊后，内镜逆行胰胆管造影检查发现有胆汁渗漏，于是植入了胆管支架。胆汁瘤可导致肾周积液，在排除泌尿道病变的情况下，应将胆汁瘤视为肾周积液的来源。

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引用次数: 0

Autologous rectus abdominis fascia sling surgery following unsuccessful synthetic midurethral sling 合成尿道中段吊带术失败后的自体腹直肌筋膜吊带手术

Q4 Medicine

IJU Case Reports

Pub Date : 2024-03-11 DOI: 10.1002/iju5.12719

Yoshitaka Kurano, Nobutaka Shimizu, Rie Yoshimura, Ryohei Iga, Kaya Atagi, Tomoya Nao, Hideo Fukuhara, Satoshi Fukata, Shingo Ashida, Keiji Inoue

Introduction

We performed autologous rectus abdominis fascia sling surgery using Advantage™ following an unsuccessful synthetic midurethral sling.

Case presentation

At the age of 76 years, the patient experienced stress urinary incontinence recurrence. A 1-h pad test resulted in 259 g of leakage. A pressure flow study verified urine leakage while coughing and straining without detrusor overactivity. Abdominal leak point pressure was 10 cmH₂O. Autologous rectus abdominis fascia sling surgery was performed using Advantage™. One month postoperatively, a 1-h pad test resulted in 0 g of leakage.

Conclusion

We believe that this method will allow the fascia sling procedure to be performed reliably even if one is unfamiliar with conventional autologous rectus abdominis fascia sling surgery.

在一次不成功的合成尿道中段吊带术后，我们使用 Advantage™ 进行了自体腹直肌筋膜吊带手术。患者 76 岁时压力性尿失禁复发。1 小时尿垫测试结果显示有 259 克漏尿。压力流量检查证实，患者在咳嗽和用力时有尿液渗漏，但无逼尿肌过度活动。腹漏点压力为 10 cmH2O。使用 Advantage™ 进行了自体腹直肌筋膜吊带手术。我们相信，即使不熟悉传统的自体腹直肌筋膜吊带手术，这种方法也能让筋膜吊带手术可靠地进行。

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引用次数: 0

Prostate brachytherapy seed migration to the right renal artery due to right-to-left shunting across a patent foramen ovale 前列腺近距离放射治疗种子因右向左分流穿过卵圆孔而移至右肾动脉

Q4 Medicine

IJU Case Reports

Pub Date : 2024-03-07 DOI: 10.1002/iju5.12707

Makoto Nakiri, Kosuke Ueda, Ryuji Hoshino, Naoki Ito, Hirofumi Kurose, Shoichiro Nohara, Koichiro Muraki, Chikayuki Hattori, Etsuyo Ogo, Tsukasa Igawa

Introduction

The seeds used in brachytherapy for prostate cancer may migrate through the surrounding venous plexus to other sites in the body, most commonly to the pulmonary vasculature.

Case presentation

A 78-year-old Japanese man received iodine-125 low-dose-rate prostate brachytherapy. Computed tomography revealed that one seed had migrated to the right kidney. No seed was observed in the ureter upon ureteroscopy. Transesophageal echocardiography confirmed a right-to-left shunt due to a patent foramen ovale, suggesting that the seed had migrated into the right renal artery. Three years after treatment, no recurrence of prostate cancer and no adverse events due to seed migration or due to the patent foramen ovale occurred.

Conclusion

Arteriovenous malformations and a right-to-left shunt should be suspected if a brachytherapy seed has migrated to an artery of the systemic circulatory system.

用于前列腺癌近距离放射治疗的粒子可能会通过周围的静脉丛转移到身体的其他部位，最常见的是转移到肺部血管。一名 78 岁的日本男子接受了碘-125 低剂量前列腺近距离放射治疗。计算机断层扫描显示，一粒种子移至右肾。输尿管镜检查时未在输尿管中发现种子。经食管超声心动图证实，由于卵圆孔未闭，存在右向左分流，这表明粒子已移入右肾动脉。治疗三年后，前列腺癌没有复发，也没有发生因种子移位或卵圆孔未闭引起的不良事件。

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引用次数: 0

Complete retroperitoneal cutaneous ureterostomy with robot-assisted radical cystectomy 完全腹膜后皮下输尿管造口术配合机器人辅助根治性膀胱切除术

Q4 Medicine

IJU Case Reports

Pub Date : 2024-03-05 DOI: 10.1002/iju5.12717

Shiori Tanaka, Goshi Kitano, Manabu Kato, Yuji Ogura, Takahiro Kojima

Introduction

Cutaneous ureterostomy is beneficial for older patients in a hypoalimentation state, providing less invasive options than intestinal tract reconstruction techniques. However, complications such as ileus and stoma site hernia still pose risks owing to the anatomical location of the ureter. We introduce a novel method, complete retroperitoneal cutaneous ureterostomy, performed simultaneously with robot-assisted radical cystectomy.

Case presentation

Our technique involves extending the retroperitoneal space to minimize complications and achieve stent-free outcomes. The median procedure time for complete retroperitoneal cutaneous ureterostomy was approximately 30 min. The stent-free rates at 1 and 4 months postoperatively were 66.7% and 100%, respectively; no case of stent reinsertion after stent removal was reported.

Conclusion

Our approach is promising for avoiding postoperative intestinal tract complications.

皮肤输尿管造口术对处于低营养状态的老年患者有益，与肠道重建技术相比，它提供了创伤较小的选择。然而，由于输尿管的解剖位置，回肠和造口部位疝气等并发症仍然存在风险。我们介绍了一种新方法--完全腹膜后皮下输尿管造口术，该手术与机器人辅助根治性膀胱切除术同时进行。完全腹膜后皮下输尿管造口术的中位手术时间约为30分钟。术后1个月和4个月的无支架率分别为66.7%和100%；未报告一例支架取出后重新植入的病例。

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引用次数: 0