Triple nostrils: a case report and review

In this paper we present a case of a "third nostril" situated below the left nostril and passing posteriorly into the nasal cavity. In all previously published cases the supernumerary nostril has been situated superior to the normal nostrils.     

Pheochromocytoma of the urinary bladder: a case report

We present a 66-year old female patient with pheochromocytoma of the urinary bladder. We performed transabdominal needle biopsy of the tumor without suspicion of pheochromocytoma because of her well-controlled blood pressure and no characteristic symptoms following administration of antihypertensive medication. Hypertensive crisis (260/130 mmHg) occurred just after the needle insertion. The diagnosis was pheochromocytoma. The norepinephrine level in the serum and her blood pressure normalized without antihypertensive medication after partial cystectomy. Pheochromocytoma should be suspected in cases of intramural bladder tumors, especially in a normotensive patients receiving antihypertensive medication.     

Paraganglioma of the urinary bladder: a case report

A patient with paraganglioma of the urinary bladder is reported. A 65-year-old woman was referred to our hospital with the chief complaint of postvoiding headache, palpitation, and cold sweat. She had has no episodes of hematuria. On laboratory data, mild elevation was found in plasma neuron specific enolase (NSE), urinary noradrenaline and urinary metanephrine. The patient showed hypertension after urination with the elevation of plasma noradrenaline. 131I-MIBG scintigraphy showed abnormal accumulation in the bladder, and no abnormal accumulation in the other lesion. Pelvic magnetic resonance imaging (MRI) revealed a solid tumor of the urinary bladder, measuring 2 cm in diameter. Paraganglioma of the urinary bladder was diagnosed and the tumor was extirpated. The tumor measured 2 x 2 x 1.5 cm, and histopathologically diagnosed as paraganglioma. After extirpation, the patient became free of the postvoiding symptoms, and showed normal catecholamine levels. She has been followed up for 4 months after operation without any evidence of recurrence.     

Pheochromocytoma of the urinary bladder: a case report

A 49-year-old man was hospitalized with the chief complaint of coagulation in urine. The patient was not hypertensive. Cystoscopic examination showed a submucosal tumor in the left lateral wall of the bladder. A transurethral sonogram revealed a low echoic nodule. Transurethral resection of the tumor in the urinary bladder was performed. The histopathological diagnosis indicated pheochromocytoma. Blood pressure was stable. After operation, the patient's course was uneventful, and there has been no recurrence for one year after surgery. This patient is the 52nd patient with pheochromocytoma of the urinary bladder reported in the Japanese literature.     

Curvularia urinary tract infection: a case report

A healthy 5-year-old child had recurrent symptomatic urinary tract infections, the last of which was accompanied by black specks in her urine. These specks were identified asCurvularia species, a dermatiaceous mold. Symptoms resolved and fungi disappeared with long-term hydration, without specific antifungal treatment.     

Localized amyloidosis of the urinary bladder: a case report

Amyloidosis is characterized by extracellular deposition of abnormal insoluble fibrils, which cause structural and functional disorders. Amyloidosis is classified into systemic and localized amyloidosis. Localized amyloidosis in individual organs is uncommon. We report a rare case of localized form of primary amyloidosis of the urinary bladder. A 76-year-old male visited our hospital with a complaint of macroscopic hematuria. Cystoscopy showed submucosal hematoma in the anterior wall and broad-based mass occupying the trigone without normal mucosa covered by calcification. Transurethral biopsy and resection were performed. Histopathological diagnosis was AL type amyloidosis occupying submucosal extracellular space. We gave the patient occlusive dressing with dimethyl sulfoxide. In 12 months, cystoscopy and magnetic resonance imaging revealed improvement of the mass-like lesion in the bladder wall.     

Impalement injury of the urinary bladder: a case report

Impalement injury of the urinary bladder, especially secondary to rectal impalement, is extremely rare. In this case, a 31-year-old man sustained a steel pipe impalement injury through his perirectal region. He presented with gross hematuria, abdominal defense, and a penetrating wound. On the basis of the computed tomography findings and abdominal defense, we suspected a through-and-through bladder perforation from the rectal space to the intraperitoneum. Laparotomy revealed a through-and-through bladder perforation as well as damage to the right ureter, 3 distinct ileal injuries, and rectal anterior, anal, and right seminal vesicle injuries. Surgical repair of each damaged site was undertaken. The prompt diagnosis and surgical repair ensured good postoperative recovery.     

Mesonephric adenocarcinoma of the urinary bladder: a case report

We report a very rare case of mesonephric adenocarcinoma of the urinary bladder, the origin of which is still uncertain. A non-papillary and broad-based tumor was located in the trigone and bladder neck on cystoscopic examination. Pelvic magnetic resonance imaging in T2-weighted images revealed a mass invading into the muscular layer of the bladder wall. Histologic examination of bladder cup-biopsy specimens showed adenocarcinoma. She underwent total cystectomy and pelvic lymph node dissection. Histologically, the tumor was chiefly composed of cells with eosinophilic cytoplasm and partly of cells with clear cytoplasm or hobnail-shaped cells, arranged in tubular or papillary structures, and infiltrated peri-vesical fat tissues. She died of metastatic disease 22 months after surgery. To the best of our knowledge, the present case is the 19th reported in the literature.     

Sarcomatoid carcinoma of the urinary bladder: a case report

A 63-year-old man was admitted to our hospital for a bladder tumor. Drip infusion pyelography, computerized tomography (CT) and magnetic resonance imaging suggested the presence of a large invasive tumor in the right wall of the bladder. Histopathological findings by transurethral resection of bladder tumor showed the presence of sarcomatous and carcinomatous elements. Immunohistochemical examination showed that the sarcomatous component did not stain for S-100 protein or for smooth muscle actin but it stained for epithelial markers. Under the diagnosis of sarcomatoid carcinoma, we performed a total cystectomy and ileal conduit without chemotherapy or radiation. A follow-up CT taken at four months postoperatively showed no evidence of recurrence.     

Inflammatory pseudotumor of the urinary bladder: a case report

A 65-year-old female was referred to our hospital with a complaint of urinary retention and macrohematuria. Ultrasongraphy, computed tomography, magnetic resonance imaging and cystoscopy revealed a 2 x 2 cm broad-based nonpapillary bladder tumor localized in the anterior wall of the urinary bladder. The clinical diagnosis was an invasive bladder tumor and transurethral resection of bladder tumor carried out for pathological investigation. Finally, we diagnosed it as inflammatory pseudotumor of urinary bladder. No local recurrence was seen 12 months after surgery. Inflammatory pseudotumor of urinary bladder is a relatively rare condition, and this is the 52nd case reported in the Japanese literature.     

Inflammatory pseudotumor of the urinary bladder: a case report

A 52-year-old man presented with gross hematuria. He had neither history of urinary tract infection nor trauma. Cystoscopy revealed a bladder tumor with ulcer on a left lateral wall. Computed tomography confirmed a round solid mass 3 cm in diameter invading deeply into the muscle layer of the urinary bladder. Transurethral biopsy revealed an inflammatory pseudotumor of the urinary bladder. Partial cystectomy was performed. This is the 38th reported case of inflammatory pseudotumor of the urinary bladder in Japan. No local recurrence was seen 3 months after surgery.     

Leiomyoma of urinary bladder: report of a case

A case of leiomyoma of the urinary bladder in a 46-year-old woman is reported. The patient was referred to us because of incidental finding of a mass in the bladder. Cystoscopy revealed a protruding tumor covered with normal-appearing urothelium on the right posterior wall of the bladder. The tumor was well-demarcated from adjacent organs on echography and computed tomographic scan. Transurethral biopsy revealed a bladder leiomyoma. Partial cystectomy was performed. The patient is now apparently free of disease 7 months after the operation.     

In utero urinary bladder rupture: a case report

We report a case of foetal urinary bladder rupture due to posterior urethral valves. A megacystis was diagnosed in a male foetus during routine second trimester ultrasound examination. The diagnosis of bladder rupture was made as, one week later, the bladder became undetectable with the appearance of ascites. During the follow-up, no oligohydramnios developed and intercurrent ascites resolved spontaneously. There are three described mechanisms releasing bladder hyperpressure: bladder diverticles, unilateral vesicoureteral reflux and bladder rupture. In this case, another mechanism might be involved: a patent urachus. The urethral valves were resected and no other surgical treatment was needed. The renal function remained normal. No long-term vesical follow-up of this pathology is available in the literature.     

Localized amyloidosis of urinary bladder: a case report

A case of localized amyloidosis of the urinary bladder is reported. A 82-year-old woman visited our hospital with the chief complaint of miction pain and residual urine sensation. Cystoscopic examination revealed a broad-based and nonpapillary tumor without bleeding on the right lateral wall. A transurethral biopsy of this tumor was performed. A histopathological examination with H.E. and Congo red stains demonstrated amyloid deposition in the submucosal layers of the vesical wall. Rectal biopsy and other findings suggested no deposition of amyloid in other organs. On the basis of these findings, we made a diagnosis of localized amyloidosis of the urinary bladder. To the best of our knowledge, the present case is the 23rd of localized amyloidosis of urinary bladder in Japan. The patient was asymptomatic after biopsy. We discuss the clinical features and management of this disease.     

Herpes zoster-associated acute urinary retention: a case report

An 87-year-old woman presents with a 4-week history of urinary incontinence during which she had been treated for disseminated herpes zoster virus (HZV). On physical exam painful vesicles involving the entire vulvar region with mainly right sacral distribution were found. A catheterized volume exceeded 600 ml of retained urine after the patient failed to void spontaneously. Multichannel voiding-pressure urodynamic studies revealed an acontractile neurogenic bladder with overflow incontinence. The patient was discharged on a conservative regimen with arrangement for visiting nurse services to perform intermittent self-catheterization twice daily. Urodynamic testing was repeated 10 weeks after initial symptoms. During voiding cystometry a biphasic increase in detrusor pressure of 15 cm H₂O was observed with no increase in abdominal pressure. The patient emptied 400 ml with a postvoid residual of 300 ml. Recovery from HZV-associated bladder emptying dysfunction can be achieved usually through conservative management, including intermittent self-catheterization. Complete recovery time ranges from 4 to 10 weeks.     

Bone formation in the urinary tract: case report

A case of osseous metaplasia of the ureter presenting as a small upper-ureteral calculus is reported. This rare phenomenon may represent an unusual nucleus for stone formation in the urinary tract. The etiology of this condition is uncertain; we speculate that trauma to the ureter may stimulate osseous metaplasia.     

Primary localized amyloidosis of the urinary bladder: a case report

A case of primary localized amyloidosis of the bladder during a twelve-year period is described. The initial symptom was miction pain when she was 43 years old. Cystoscopic examination revealed yellowish elevated lesion with hemorrhage at the right side of the bladder neck. Transurethral resection was performed, but two years later recurrence was found at the trigonum as well as the original site. The two lesions were apart. She remained asymptomatic for the following ten years until she returned to us with bladder symptoms. Cystoscopy showed the lesion was more diffuse and the posterior wall was involved in continuity with the trigonum. Complete transurethral resection was not possible because of generalized bladder involvement. Our case illustrates the clinically benign but slowly progressive nature of amyloidosis of the bladder. Multifocal recurrence is also to be noted. Our current treatment policy is conservative treatment with careful follow-up. She is asymptomatic three months postoperatively.