Vesical metastasis of gastric adenocarcinoma

Metastatic vesical tumors are rare, and constitute approximately 1% of all neoplasias affecting this organ. The authors report the case of a 63-year old woman with vesical metastasis of gastric adenocarcinoma. Patient presented signs of cachexia and complained of left lumbar pain and dysuria unresponsive to antibiotic therapy for approximately 5 months. She reported a previous partial gastrectomy due to ulcerative undifferentiated gastric adenocarcinoma 1 year and 9 months before. Cystoscopy revealed an extensive vegetative lesion in bladder, occupying its entire mucosal surface. The biopsy revealed metastatic signet-ring cell adenocarcinoma.     

A case of lymphocytic hypophysitis successfully treated with steroid pulse therapy

Lymphocytic hypophysitis is an autoimmune disorder of the pituitary gland. We report a case of lymphocytic hypophysitis managed by high dose methylprednisolone pulse therapy and review the literature. A 61-year-old woman presented with severe headache. Magnetic resonance imaging (MRI) revealed a contrast enhancing pituitary mass. The patient underwent endonasal-transsphenoidal surgery of the pituitary lesion under the diagnosis of a non-secreting pituitary adenoma. Intraoperative histological findings suggested an inflammatory lesion and we performed subtotal resection of the mass. Histopathological examination confirmed the diagnosis of lymphocytic hypophysitis. Postoperatively, she received methylprednisolone pulse therapy and her severe headache resolved. This case report suggests that methylprednisolone pulse therapy may improve the clinical symptoms of lymphocytic hypophysitis.     

Fibrolipoma of the median nerve. A case report

The authors report a case of fibrolipoma of the median nerve in a 6-year old boy presenting as macrodactyly with clinodactyly. The causal relationship between the nerve lesion and the deformities is discussed. The difficulties of diagnosis of the condition are presented as are the difficulties of management where a balance has to be struck between conservative treatment and amputation.     

Surgical treatment of osteoid osteoma of the spine using intraoperative scintigraphy

The authors report a case of osteoid osteoma of the spine. The treatment, which consisted of surgical curettage of the lesion, was controlled by intra operative bone scanning. The authors present the advantages and difficulties of this technique. They also review the literature on the subject.     

A case of vesical varices as a complication of portal hypertension and manifested gross hematuria

We report a unique case of vesical varices in a patient who presented with an episode of serious gross hematuria. He also had cirrhosis of the liver and portal hypertension, and had undergone transection of the esophagus 10 years ago. A hemangiomatous mass was discovered on cystoscopic examination, and sonographic examination, computerized tomography and abdominal angiography revealed vesical varices. The genesis of vesical varices and possible treatment in this case are discussed.     

Chondrosarcoma of the cervical spine: A case report

Summary Among spinal bone tumors, chondrosarcoma occupies the third rank after myeloma and chordoma. Its location in the cervical spine is exceptional. The authors report a case of this lesion involving C7. This new case illustrates well the therapeutic and diagnostic difficulties of this tumor site at the cervico-thoracic level. The radiologic and histologic aspects do not differ from these of the other locations of this tumor. This insidious lesion is often voluminous at the time of discovery. This is why diagnostic delay does not always allow a wide carcinologically satisfactory excision. Despite the development of radiotherapy protocols, the only efficient treatment consists of total vertebrectomy. Surgical procedures are often carcinologically insufficient at the cervical level, which explains the poor prognosis of this tumor. However, results should improve with earlier diagnosis thanks to new radiologic imaging, especially with MRI. This will be then allow better surgical treatment.     

Bladder paraganglioma (pheochromocytoma): report of a new case

The authors report one case of vesical paraganglioma, not suspected in a 50-years-old female patient who presented gross hematuria as only symptom. The patient was not hypertensive. Radiologic and endoscopic investigations revealed a trigonal submucosal tumour. Complete transurethral resection of the tumor was performed with no intraoperative complications. The histopathological diagnosis indicated pheochromocytoma. Blood pressure was stable. There has been no recurrence for 18 months after transurethral resection.     

Primitive intracranial trigeminal nerve germinoma. Case report

A 22-year-old man presented headache, asthenia, body weight loss and trigeminal hypoesthesia worsening quickly. Radiological analysis showed an enhanced lesion that originated from the cavernous sinus and extended into the Meckel cave, owing to the fifth cranial nerve's course. The lesion was explored by a temporo-pterional approach and was partially removed. On the basis of histological analysis and negativity of tumor marker levels in serum and cerebrospinal fluid (alpha-fetoprotein alpha, human beta-chorionic gonadotropin), a primitive non-secreting intracranial germinoma was diagnosed. Under combined chemotherapy (carboplatine, ifosfamide, etoposide) followed by focal fractionated radiotherapy delivering 40 Gy to the initial tumor volume, the outcome was excellent. Five years later, the patient was in complete clinical and radiological remission. Primitive intracranial germinomas are rare malignant tumors involving mainly pineal and hypothalamic regions. We report a case of intracranial trigeminal nerve germinoma. To the best of our knowledge, no case of primitive germinoma was previously described in this location. Aspects of diagnosis and treatment are discussed in the light of previous publishing data.     

A case of ureteral and vesical malacoplakia

A case of ureteral and vesical malacoplakia is reported. A 58-year-old woman was admitted for non-papillary sessile bladder tumor. Ultrasound examination revealed bilateral hydronephrosis and renal function was deteriorated. Escherichia coli and beta-streptococcus were isolated from her urine. Antegrade pyelography demonstrated obstruction of the bilateral ureters. Percutaneous pyeloscopy revealed a bean-sized yellow nodule at the upper portion of the right ureter. Pathohistological the lesions of aggregates of macrophage in which typical Michaelis-Gutmann bodies were found at the punch biopsies of both vesical and ureteral lesions. She was treated successfully with the administration of bethanechol chloride and antibiotics. This case seems to be the second report of ureteral malacoplakia in the Japanese literature.     

Pseudo-tumoral xanthogranulomatous pyelonephritis. Apropos of a case

The authors report the case of a 20 year old patient in whom the clinical findings combined with the radiological signs, suggested the diagnosis of renal cancer. The histological findings after nephrectomy established the diagnosis of xanthogranulomatous pyelonephritis. This disease may rarely give the appearance of a renal tumor. This points out the importance of identifying this lesion in preoperative staging to avoid carcinologic surgery and all of its difficulties.     

Subarachnoid hemorrhage in the presence of a cerebral arteriovenous malformation and an intraventricular oligodendroglioma: case report

The authors report a case of a ventricular oligodendroglioma associated with a cortical arteriovenous malformation. The patient presented with subarachnoid hemorrhage. Computed tomographic scan showed an intraventricular hyperdense lesion, mimicking a hematoma. Angiography revealed a superficial arteriovenous malformation in the right parietal lobe, unrelated to ventricular cavities. Both lesions were treated during the same operation. The diagnostic difficulties and the significance of this uncommon association are discussed.     

A case of lymphocytic hypophysitis mimicking pituitary macroadenoma

Lymphocytic hypophysitis is a rare autoimmune disease of the pituitary gland mimicking pituitary macroadenoma on magnetic resonance imaging (MRI). We encountered a 32-year-old female who presented with a typical pituitary macroadenoma causing sudden on-set of visual disturbance during her second pregnancy. She underwent an endonasal-transsphenoidal resection of the mass diagnosed as a non-secreting pituitary macroadenoma after a cesarean operation. Intraoperatively, the lesion was found to be extremely tough and mucinous, and apparently differed from pituitary adenoma. The frozen section revealed hypophysitis and we performed only a biopsy of the mass. Histopathological examination showed diffuse infiltrate of non-specific lymphocytes. Postoperatively, prednisolone was given for two weeks, her visual disturbance improved with radiologically marked shrinking of the lesion. This case illustrates the difficulty of differentiation of lymphocytic hypophysitis from pituitary macroadenoma, and we discuss the clinical features and the management of this disease.     

Vesicocutaneous Fistula Caused by Giant Vesical Calculus

Vesicocutaneous fistula is an extremely rare complication of vesical calculus.To our knowledge only three cases have been reported in the World literature. Because of its rarity, here we report a case of vesicocutaneous fistula caused by giant vesical calculus. This is probably the fourth case of vesicocutaneous fistula caused by giant vesical calculus.     

Type A intradural spinal arteriovenous fistula. Case report

In this report, the authors present the case of a patient with a unique type of spinal arteriovenous fistula. Both the location and venous angioarchitecture of this variant are uncommon, making diagnosis of the lesion challenging and raising particular management issues. The authors discuss this unusual lesion and describe its imaging features and surgical findings, as well as highlight its pathological abnormalities.     

A sudden turner of events

The authors report the case of an 18‐year‐old woman with Turner Syndrome and aortic coarctation, who developed aortic dissection after percutaneous stenting. Surgical treatment was necessary as the lesion progressed. This case highlights both the importance of awareness as well as multidisciplinary management of this potential complication.     

A clunking knee with an unusual cause in an adolescent: a case report

The authors report an unusual case of a chondral lesion in the knee joint in an adolescent. The lesion produced a clunk in the knee joint on flexion. A low-resolution MRI scan failed to image the lesion. Arthroscopy revealed a unique shape of chondral flap from the weight bearing surface of the lateral femoral condyle, which resembled a meniscal bucket handle tear. Chondrectomy resolved all the symptoms. This case report highlights the point that special resolution MRI scan sequences are required to accurately assess these injuries and also that clunking in an adolescent can be produced by a chondral lesion.     

Bleeding small bowel angiodysplasia: unusual form of conservative treatment

The authors report a case of gastrointestinal bleeding caused by angiodysplasia of the small bowel. They stress the rarity of the lesion and consider the difficulties involved in obtaining a preoperative diagnosis. Intra- or pre-operative enteroscopy seems to be the most suitable method for identifying the source of occult small-bowel bleeding. The optimal management is uncertain and depends on the severity and rate of the bleeding. A conservative medical approach is indicated for many patients, while surgery constitutes definitive treatment in cases of massive haemorrhage or recurrent bleeding. The authors describe a case in which the diagnosis was reached only at intra-operative enteroscopy and an unusual conservative surgical treatment was performed based on ligation of the vascular elements of the angiodysplasia. This method makes it possible to avoid an intestinal resection and yields good results.     

Giant vesical diverticula with thrombophlebitis

An unusual case of giant vesical diverticula with deep vein thrombosis of the leg is presented. The lesion was acquired secondary to obstruction of bladder outlet from silent prostatic hyperplasia.     

A case of giant vesical diverticulum with malignant neoplasm

We experienced a case of giant vesical diverticulum with a malignant neoplasm in which the preoperative diagnosis was difficult. It simultaneously occurred with a vesical tumor. The patient, a 68-year-old man, visited our hospital complaining of pollakisuria, nycturia and microscopic hematuria. He had urinary retention and his vesical urine volume was 1,450 ml. X-ray examination and ultrasound examination revealed a giant vesical diverticulum and moderate hypertrophy of the prostate. A vesical tumor was suspected. Cystometrogram revealed a flaccid pattern with vesical capacity over 900 ml. Diverticulectomy and resection for a vesical tumor were performed. A malignant neoplasm in the vesical diverticulum was found during the operation. Transurethral resection of the prostate was performed after two months. There has been no evidence of recurrence for 3 years postoperatively.     

Cystoscopy-assisted laparoscopic resection of extramucosal bladder endometriosis

BACKGROUND AND PURPOSE: Involvement of the bladder is seen in only 1% to 2% of patients with endometriosis. The diagnosis of vesical endometriosis is difficult to formulate, and it should be confirmed by cystoscopy with biopsy. However, this examination is often insufficient because of the submucosal-transmural location of the lesion. Therefore, laparoscopic examination represents the gold standard for the diagnosis of pelvic endometriosis. We describe a case of recurrent bladder endometriosis treated by a combined endoscopy technique. Case Report: A 43-year-old woman presented with pelvic pain, dysmenorrhea, and persistent cystitis. The endometriotic lesion on the posterior wall of the bladder consisted in a 2.5-cm nodule growing into the vesical muscularis and raising the overlying peritoneum. We performed laparoscopic resection employing a cystoscopy-assisted technique in order to preserve the integrity of the vesical mucosa. Resection was carried out and monitored from inside the bladder with the cystoscope and laparoscope lights turned on during the whole procedure ("light-to-light" technique). CONCLUSION: This minimally invasive combined endoscopic procedure could represent a good alternative to partial cystectomy for muscle-infiltrating bladder endometriosis that does not involve the vesical mucosa.