IJU Case Reports最新文献_第9页

Fatal tumoral hemorrhage from brain metastases of renal cell carcinoma after stereotactic radiotherapy and immune checkpoint inhibitor and vascular endothelial growth factor-targeted therapy combinations 立体定向放疗和免疫检查点抑制剂与血管内皮生长因子靶向疗法联合治疗后，肾细胞癌脑转移瘤引发致命性肿瘤出血

Q4 Medicine

IJU Case Reports

Pub Date : 2024-03-04 DOI: 10.1002/iju5.12708

Kaoruko Iwasa, Shigeaki Nakazawa, Taigo Kato, Koji Hatano, Atsunari Kawashima, Shinichiro Fukuhara, Norio Nonomura

Introduction

Brain metastasis in renal cell carcinoma, which is reported in 10% of cases, leads to significant morbidity and mortality. Establishment of appropriate and safe treatment for brain metastasis renal cell carcinoma remains a pressing need.

Case presentation

A 56-year-old female patient, presenting with anorexia, headache, and occipital swelling, was subsequently diagnosed with clear cell renal cell carcinoma with multiple metastases, including intracranial and epicranial tumors. The patient initially underwent stereotactic radiotherapy for metastatic brain tumors and then received combination therapy with pembrolizumab and lenvatinib. However, after 30 days of treatment, the patient experienced a sudden loss of consciousness due to massive multifocal intracranial hemorrhage, leading to her death the following day.

Conclusion

Although fatal tumoral hemorrhage during combined stereotactic radiotherapy and immune checkpoint inhibitor/VEGF-targeted therapy for patients with brain metastasis renal cell carcinoma is an extremely rare complication, it should always be considered a possibility.

据报道，10%的肾细胞癌会发生脑转移，导致严重的发病率和死亡率。一名 56 岁的女性患者出现厌食、头痛和枕部肿胀，随后被诊断为透明细胞肾细胞癌，并伴有多处转移，包括颅内和颅外肿瘤。患者最初接受了针对转移性脑肿瘤的立体定向放疗，然后接受了pembrolizumab和来伐替尼的联合治疗。虽然脑转移肾细胞癌患者在接受立体定向放疗和免疫检查点抑制剂/VEGF靶向治疗期间发生致命的肿瘤出血是一种极为罕见的并发症，但应始终将其视为一种可能性。

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引用次数: 0

Systemic amyloid A amyloidosis of the bladder after transurethral resection of urothelial carcinoma 经尿道膀胱癌切除术后的膀胱系统性淀粉样蛋白A淀粉样变性

Q4 Medicine

IJU Case Reports

Pub Date : 2024-03-04 DOI: 10.1002/iju5.12715

Kaori Yamashita, Keita Yoshida, Tadao Nakazawa, Satoshi Kubota, Takahiro Shiseki, Eri Sekido, Masashi Inui

Introduction

Amyloid A amyloidosis of the bladder is not a major disease. We report a patient with systemic amyloid A amyloidosis of the bladder after transurethral resection of urothelial carcinoma.

Case presentation

An 87-year-old Japanese man had bladder carcinoma. He was followed up regularly with cystoscopy. Cystoscopy revealed multiple polypoid tumors 6 months after the first transurethral resection of urothelial carcinoma. Pathologic specimens contained the amyloid A component. He had hypertrophic cardiomyopathy, valvular disorders, and arrhythmias. His cardiac disease may have resulted from amyloid A amyloidosis. We speculated the patient had systemic amyloid A amyloidosis of the heart and bladder.

Conclusion

We determined the type of amyloidosis via a biopsy of the bladder tumors. Our patient had cardiac disease. Therefore, systemic amyloid A amyloidosis could have caused his cardiac disease. The pathologic findings of bladder tumors can contribute to detecting systemic amyloid A amyloidosis.

膀胱淀粉样蛋白A淀粉样变性并不是一种主要疾病。我们报告了一名经尿道膀胱癌切除术后出现全身性淀粉样蛋白 A 淀粉样变性的患者。他定期接受膀胱镜检查。第一次经尿道膀胱癌切除术后 6 个月，膀胱镜检查发现多发性息肉状肿瘤。病理标本中含有淀粉样蛋白 A 成分。他患有肥厚型心肌病、瓣膜病和心律失常。他的心脏疾病可能是由淀粉样蛋白 A 淀粉样变性引起的。我们通过膀胱肿瘤活检确定了淀粉样变性的类型。我们通过膀胱肿瘤活检确定了淀粉样变性的类型。我们通过膀胱肿瘤活检确定了淀粉样变性的类型。膀胱肿瘤的病理检查结果有助于发现全身性淀粉样蛋白A淀粉样变性。

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引用次数: 0

Effectiveness of onabotulinumtoxin A for refractory overactive bladder with cough-associated detrusor overactivity 奥诺布林毒素 A 治疗难治性膀胱过度活动症合并咳嗽相关性逼尿肌过度活动症的效果

Q4 Medicine

IJU Case Reports

Pub Date : 2024-03-03 DOI: 10.1002/iju5.12716

Chie Nakai, Kosei Miwa, Akane Yamaguchi, Yasumichi Takeuchi, Masami Yamaguchi, Yasuhide Kitagawa, Takuya Koie

Introduction

We report a case of refractory overactive bladder with cough-associated detrusor overactivity treated by onabotulinumtoxin A.

Case presentation

A 79-year-old woman who underwent mid-urethral sling surgery 8 years ago complained mainly of urinary incontinence following abdominal pressure. Various medicines to treat overactive bladder symptoms were ineffective. Cystometry revealed cough-associated detrusor overactivity. Onabotulinumtoxin A injections in her bladder improved subjective symptoms, and cough-associated detrusor overactivity disappeared on cystometry.

Conclusions

Onabotulinumtoxin A injection effectively resolved refractory overactive bladder with urgency urinary incontinence due to cough-associated detrusor overactivity.

我们报告了一例采用奥博毒素A治疗的难治性膀胱过度活动症合并咳嗽相关性逼尿肌过度活动症病例。一位79岁的妇女在8年前接受了尿道中段吊带手术，主要主诉为腹压后尿失禁。治疗膀胱过度活动症状的各种药物均无效。膀胱造影显示她患有咳嗽引起的逼尿肌过度活动症。在她的膀胱中注射奥诺布林毒素A后，主观症状得到了改善，膀胱测量结果显示咳嗽相关性逼尿肌过度活动消失了。奥诺布林毒素A注射液有效解决了因咳嗽相关性逼尿肌过度活动导致的难治性膀胱过度活动症和尿急尿失禁。

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引用次数: 0

Retroperitoneal low-grade fibromyxoid sarcoma 腹膜后低度纤维瘤样肉瘤

Q4 Medicine

IJU Case Reports

Pub Date : 2024-03-03 DOI: 10.1002/iju5.12718

Takeaki Noguchi, Takahisa Suzuki, Yosuke Shibata, Mitsuyuki Koizumi, Kimito Osaka, Takeshi Kishida

Introduction

Low-grade fibromyxoid sarcoma is an uncommon deep-seated soft-tissue sarcoma that occurs rarely in young adults and children. Although surgical resection provides a long-term prognosis, late local recurrence and metastasis may occur.

Case presentation

A 44-year-old woman with no prior medical history presented with breathing and abdominal discomfort. Contrast-enhanced computed tomography scan revealed a retroperitoneal tumor protruding into the thoracic cavity and pleural effusion on the left side. Tumor biopsy revealed sarcoma. We performed complete resection of the tumor along with part of the diaphragm and replaced the diaphragm with a prosthetic patch. Histopathologic findings indicated low-grade fibromyxoid sarcoma. The patient experienced no postoperative complications and received no adjuvant therapy. Furthermore, she survived 4 years after surgery without recurrence.

Conclusion

Complete surgical resection is effective for low-grade fibromyxoid sarcoma; therefore, it is important to plan appropriately for complete resection when biopsy reveals malignant findings.

导言：低级别纤维肉瘤是一种不常见的深层软组织肉瘤，很少发生在青壮年和儿童身上。虽然手术切除可获得长期预后，但可能会出现晚期局部复发和转移。病例介绍一名 44 岁女性，无既往病史，因呼吸和腹部不适就诊。对比增强计算机断层扫描显示，腹膜后肿瘤突入胸腔，左侧胸腔积液。肿瘤活检显示为肉瘤。我们对肿瘤和部分横膈膜进行了完全切除，并用假体补片取代了横膈膜。组织病理结果显示为低级别纤维肉瘤。患者术后没有出现并发症，也没有接受辅助治疗。此外，她术后存活了 4 年，没有复发。结论对低级别纤维肌样肉瘤进行完全手术切除是有效的；因此，当活检发现恶性肿瘤时，制定适当的完全切除计划非常重要。

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引用次数: 0

A case of Legionella pneumonia after robot-assisted radical prostatectomy 一例机器人辅助前列腺癌根治术后军团菌肺炎病例

Q4 Medicine

IJU Case Reports

Pub Date : 2024-02-27 DOI: 10.1002/iju5.12705

Takuhisa Nukaya, Kiyohito Ishikawa, Kiyoshi Takahara, Masashi Takenaka, Kenji Zennami, Manabu Ichino, Hitomi Sasaki, Makoto Sumitomo, Ryoichi Shiroki

Introduction

Postoperative Legionella pneumonia is very rare.

Case presentation

A 71-year-old male patient with prostate cancer (cT2bN0M0) underwent a robotic-assisted radical prostatectomy. On the 5th postoperative day, the patient developed chills and a fever of 39.2°C. Chest radiography revealed decreased permeability in the right middle lung field, leading to the diagnosis of postoperative pneumonia. Antimicrobial therapy was initiated immediately. Blood tests on postoperative day 10 revealed mild liver function abnormalities, electrolyte abnormalities, and a markedly elevated inflammatory response. Legionella pneumonia was suspected based on blood sample results and systemic symptoms, such as diarrhea and nausea. Furthermore, Legionella antigens were detected in the patient's urine, prompting further administration of levofloxacin. The patient's subsequent clinical course was favorable.

Conclusion

When bacterial pneumonia fails to respond to antimicrobial therapy and systemic symptoms develop, atypical pneumonia, caused by pathogens such as Legionella pneumophila, should be considered even in cases of postoperative pneumonia.

一名 71 岁的男性前列腺癌患者（cT2bN0M0）接受了机器人辅助前列腺癌根治术。术后第 5 天，患者出现寒战和 39.2°C 发烧。胸片显示右肺中叶通透性降低，诊断为术后肺炎。随即开始了抗菌治疗。术后第 10 天的血液检查发现轻度肝功能异常、电解质异常和明显升高的炎症反应。根据血样结果和腹泻、恶心等全身症状，怀疑是军团菌肺炎。此外，患者尿液中检测到军团菌抗原，因此进一步使用了左氧氟沙星。当细菌性肺炎对抗菌治疗无效且出现全身症状时，即使是术后肺炎，也应考虑由嗜肺军团菌等病原体引起的非典型肺炎。

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引用次数: 0

Renal pseudoaneurysm after calculous pyelonephritis 结石性肾盂肾炎后的肾假性动脉瘤

Q4 Medicine

IJU Case Reports

Pub Date : 2024-02-27 DOI: 10.1002/iju5.12711

Yuri Koyama, Tetsuya Yumioka, Hirofumi Ohno

Introduction

Renal pseudoaneurysms reportedly occur after partial nephrectomy, renal trauma, or percutaneous procedures. Renal pseudoaneurysms can also occur after renal inflammation; however, such cases are rare and seldom reported.

Case presentation

A 53-year-old man presented to our emergency room with a 3-day history of fever and right back pain. A blood sample revealed severe inflammation and computed tomography showed an 8 mm diameter stone in the right middle ureter and hydronephrosis. The patient was diagnosed with calculous pyelonephritis and underwent emergency ureteral stenting and antibiotic therapy. On day 8 of hospitalization, hematuria and right back pain developed, and on day 9 bladder tamponade and anemia developed. Contrast-enhanced computed tomography revealed a ruptured pseudoaneurysm, and the patient underwent successful angioembolization. The patient was discharged on day 23.

Conclusion

We report a case of a renal pseudoaneurysm possibly caused by calculous pyelonephritis.

据报道，肾假性动脉瘤多发生在肾部分切除术、肾创伤或经皮手术后。肾脏炎症后也可能发生肾脏假性动脉瘤，但此类病例很少见，也很少有报道。一名 53 岁的男子因发烧和右背痛 3 天来我院急诊就诊。血液样本显示炎症严重，计算机断层扫描显示右侧输尿管中段有直径 8 毫米的结石，并伴有肾积水。患者被诊断为结石性肾盂肾炎，接受了急诊输尿管支架植入术和抗生素治疗。住院第 8 天出现血尿和右背痛，第 9 天出现膀胱填塞和贫血。对比增强计算机断层扫描显示假性动脉瘤破裂，患者成功接受了血管栓塞术。我们报告了一例可能由结石性肾盂肾炎引起的肾脏假性动脉瘤病例。

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引用次数: 0

Editorial Comment to CHARGE syndrome with both primary and secondary hypogonadism 对同时患有原发性和继发性性腺功能减退症的 CHARGE 综合征的编辑评论

Q4 Medicine

IJU Case Reports

Pub Date : 2024-02-25 DOI: 10.1002/iju5.12714

Shoichiro Iwatsuki MD, PhD, Yukihiro Umemoto MD, PhD, Takahiro Yasui MD, PhD

CHARGE syndrome, which is a disorder with a combination of malformations, rarely occurs and, however, is an important cause of congenital hypogonadism. Most often dysfunction of chromodomain-helicase-DNA-binding protein (CHD) 7 gene results in this disorder, causing multiple malformations and dysfunctions. CHD7 gene dysfunction impairs the function of the hypothalamus and pituitary gland which results in secondary hypogonadism.

Yoshida et al.¹ reported a case of CHARGE syndrome with secondary but also primary hypogonadism that occurred in a 15-year-old boy. After stimulation with human chorionic gonadotropin (hCG), the patient's serum testosterone level did not elevate, which suggested the presence of mixed hypogonadism. The author decided to perform bilateral orchidectomy, and pathological examination revealed germ cell neoplasia in situ (GCNIS). Thus, the author hypothesized that¹ dysfunction of the Leydig cell function was involved by decreased expression of steroid-synthesizing enzymes and² pathogenesis of GCNIS was involved in Sertoli cell degeneration associated with Leydig cell dysfunction.

CHD7 plays a role in the development of gonadotropin-releasing hormone (GnRH) neuron. On the contrary, Hadziselimovic et al. reported a decrease in the expression of CHD7 in testicular tissue in boys with high infertility risk, which was defined by decreased spermatogonia.² Additionally, overexpression of CHD7 in bladder cancer³ or mutation in the CHD7 gene in colorectal cancer⁴ has been reported, which suggests a hypothetical role of CHD7 on carcinogenesis. Thus, the direct effect of dysfunction of CHD7 in the testicular tissue should be considered. CHD7 is a member of the adenosine triphosphate (ATP)-dependent helicase family.⁵ It regulates the expression of several genes by binding to histone or interacting with various transcription factors. To date, there has been no report mentioning the role of CHD7 in spermatogenesis or steroidogenesis. Further study is required to clarify the function of CHD7 in the testis.

However, this case report contributes toward clarifying the molecular mechanisms of spermatogenic failure and endocrinal dysfunction of the testis.

The authors declare no conflict of interest.

CHARGE 综合征是一种合并畸形的疾病，很少发生，但却是导致先天性性腺功能低下的重要原因。大多数情况下，染色体结构域-螺旋酶-DNA 结合蛋白（CHD）7 基因的功能障碍会导致这种疾病，引起多种畸形和功能障碍。Yoshida 等人1 报告了一例继发性和原发性性腺功能减退的 CHARGE 综合征病例，该病例发生在一名 15 岁的男孩身上。在使用人绒毛膜促性腺激素（hCG）刺激后，患者的血清睾酮水平并未升高，这表明患者存在混合性性腺功能减退症。作者决定对患者进行双侧睾丸切除术，病理检查结果显示患者原位生殖细胞瘤（GCNIS）。因此，作者推测：1 Leydig 细胞功能障碍与类固醇合成酶表达减少有关；2 GCNIS 的发病机制与 Leydig 细胞功能障碍相关的 Sertoli 细胞变性有关。相反，Hadziselimovic 等人报告称，在不育症高风险男孩的睾丸组织中，CHD7 的表达量减少，表现为精原细胞减少。2 此外，CHD7 在膀胱癌中的过表达3 或 CHD7 基因在结直肠癌中的突变4 也有报道，这表明 CHD7 在致癌过程中具有假定的作用。因此，应考虑 CHD7 功能障碍对睾丸组织的直接影响。CHD7 是三磷酸腺苷（ATP）依赖性螺旋酶家族的成员5 ，它通过与组蛋白结合或与各种转录因子相互作用来调节多个基因的表达。迄今为止，尚未有报告提及 CHD7 在精子发生或类固醇生成中的作用。然而，本病例报告有助于阐明睾丸生精功能衰竭和内分泌功能障碍的分子机制。

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引用次数: 0

A novel treatment strategy for bladder hypoplasia: A case of megaureter in a functional solitary kidney 膀胱发育不良的新型治疗策略：功能性单肾巨输尿管病例

Q4 Medicine

IJU Case Reports

Pub Date : 2024-02-25 DOI: 10.1002/iju5.12713

Yutaro Sasaki, Masayuki Takahashi, Mitsuki Nishiyama, Saki Kobayashi, Yoshiteru Ueno, Junya Furukawa, Kenji Shimada

Introduction

We report a case of megaureter in a functional solitary kidney in which surgery was performed after bladder capacity was increased by home bladder cycling.

Case presentation

A 6-day-old girl with a left megaureter, a right multicystic dysplastic kidney, and bladder hypoplasia underwent percutaneous left nephrostomy for obstructive renal failure. At 8 months, home bladder cycling was initiated to increase bladder capacity before the planned ureterocystoneostomy. Surgery was performed after bladder capacity increased. The left ureter was compressed by the left umbilical ligament, so ureteral end-to-end anastomosis was performed at 1 year and 4 months. At 2 years and 8 months, cystometry showed age-appropriate bladder capacity and improved bladder compliance.

Conclusion

To the best of our knowledge, this is the first report of bladder hypoplasia treated by home bladder cycling.

我们报告了一例功能性单肾巨输尿管病例，该病例在通过家庭膀胱循环增加膀胱容量后进行了手术。一名出生仅 6 天的女孩因左侧巨输尿管、右侧多囊性肾发育不良和膀胱发育不良而接受了经皮左肾造口术，以治疗梗阻性肾衰竭。8 个月时，在计划进行输尿管膀胱造口术之前，她开始在家循环膀胱以增加膀胱容量。手术在膀胱容量增加后进行。左侧输尿管被左侧脐韧带压迫，因此在 1 岁 4 个月时进行了输尿管端对端吻合术。据我们所知，这是首例通过家庭膀胱循环治疗膀胱发育不良的报告。

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引用次数: 0

Lethal disseminated intravascular coagulation induced by primary and metastatic neuroendocrine prostate cancer 原发性和转移性神经内分泌前列腺癌诱发的致命性弥散性血管内凝血

Q4 Medicine

IJU Case Reports

Pub Date : 2024-02-25 DOI: 10.1002/iju5.12712

Takashi Ando, Taro Sasaki, Makoto Naito

Introduction

Neuroendocrine prostate cancer has a poor prognosis. Although disseminated intravascular coagulation associated with malignancy can be lethal, it very rarely occurs among patients with primary neuroendocrine prostate cancer.

Case presentation

An 80-year-old man presented to our hospital with bloody sputum. Blood examination indicated disseminated intravascular coagulation. Serum levels of prostate-specific antigen and neuron-specific enolase were 44.274 and 176 ng/mL, respectively. Core needle biopsies of an irregular mass in the prostate and a metastatic tumor in the left iliac bone showed similar neuroendocrine carcinoma cells. Hence, the patient was diagnosed with disseminated intravascular coagulation associated with primary and metastatic neuroendocrine prostate cancer. Unfortunately, he passed away 3 weeks after the biopsies.

Conclusion

Given the difficulty of effectively treating metastatic neuroendocrine prostate cancer among patients in poor physical condition due to disease progression, identifying a new well-tolerated treatment modality is imperative.

神经内分泌性前列腺癌的预后较差。虽然与恶性肿瘤相关的弥散性血管内凝血可导致死亡，但在原发性神经内分泌前列腺癌患者中却很少发生。血液检查显示存在弥散性血管内凝血。血清中前列腺特异性抗原和神经元特异性烯醇化酶的水平分别为 44.274 和 176 纳克/毫升。前列腺不规则肿块和左髂骨转移性肿瘤的核心针活检显示出类似的神经内分泌癌细胞。因此，患者被诊断为伴有原发性和转移性神经内分泌前列腺癌的弥散性血管内凝血。鉴于转移性神经内分泌前列腺癌患者因疾病进展而身体状况较差，很难对其进行有效治疗，因此找到一种耐受性良好的新治疗方式势在必行。

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引用次数: 0

Preoperative rapid growth of inferior vena cava tumor thrombus in renal cell carcinoma 肾细胞癌术前下腔静脉肿瘤血栓的快速生长

Q4 Medicine

IJU Case Reports

Pub Date : 2024-02-20 DOI: 10.1002/iju5.12709

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

Introduction

We present the case of a rapidly growing inferior vena cava tumor thrombus in renal cell carcinoma.

Case presentation

We present a case of a 66-year-old woman with right renal cell carcinoma with a tumor thrombus extending 2 cm into the inferior vena cava on an initial Imaging. Radical surgery was performed 6 weeks after the first visit. Intraoperatively, the tumor thrombus was confirmed to have grown near the diaphragm. The tumor was resected using an inferior vena cava clamping just below the diaphragm. The tumor thrombus and renal cell carcinoma were completely removed. There was no recurrence 6 months postoperatively.

Conclusion

Inferior vena cava tumor thrombus in renal cell carcinoma can grow in a short period, suggesting that preoperative imaging evaluation at the appropriate time is important. Once inferior vena cava tumor thrombus of renal cell carcinoma occurs, surgery should not be delayed unless there is an urgent reason.

我们介绍了一例肾细胞癌下腔静脉肿瘤血栓快速生长的病例。我们介绍了一例 66 岁女性患者的病例，她患有右肾细胞癌，初次造影时肿瘤血栓延伸至下腔静脉 2 厘米。首次就诊后 6 周，患者接受了根治手术。术中证实，肿瘤血栓生长在横膈膜附近。使用下腔静脉夹钳在膈肌下方切除了肿瘤。肿瘤血栓和肾细胞癌被完全切除。肾细胞癌的下腔静脉瘤栓可在短时间内生长，这表明术前适时进行影像学评估非常重要。肾细胞癌的下腔静脉瘤栓一旦形成，除非有紧急原因，否则不应延迟手术。

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引用次数: 0