A case of retroperitoneal tumor presenting with gross hematuria

A case of retroperitoneal tumor presenting with gross hematuria is reported. A 62-year-old female consulted our clinic with the chief complaint of gross hematuria. On physical examination, a goose-egg sized tumor was palpable in the left flank region. Drip infusion pyelography and computerized tomographic scan showed left retroperitoneal tumor which deviated the left kidney upwards. Percutaneous needle biopsy of the tumor revealed no malignancy. Total resection of the tumor was performed subsequently. A yellowish solid tumor was macroscopically encapsulated by fibrous tissue, weighed 230 g and 6 x 7 x 10 cm. Histopathological diagnosis was malignant schwannoma. After operation, the hematuria stopped without any treatment and deviation of the left kidney was improved. Soft tissue tumor should be treated by adjuvant chemotherapy with irradiation because of its high frequency of recurrence and metastasis. Combined chemotherapy with VCR, ADR, CPM and DTIC (CYVADIC) was performed and she is in good health at 1 year after operation.     

A case of Churg-Strauss syndrome undergoing cesarean section

A 37-year-old woman with Churg-Strauss syndrome underwent cesarean section under combined spinal-epidural anesthesia. Churg-Strauss syndrome is a rare diffuse vasculitis accompanied by severe asthma. Anesthesia was performed uneventfully, but there were several issues of concern regarding the perioperative management of this syndrome.     

A case of sudden gross hematuria caused by an iliac artery-ureteral fistula

A 51-year-old male patient, who had been treated for nonspecific angitis with pulselessness in the upper extremities, was found to have stenosis of the left common iliac artery. Patch grafting was performed for the stenotic lesion of the artery. Sixteen months after the operation, the patient developed a sudden massive hematuria for which he was immediately admitted. He required blood transfusions and bed rest. Pyelography and arteriography revealed almost complete impairment of the left kidney function. During subsequent left retrograde ureterography , the patient again developed massive hematuria and fell in shock. The ureterogram revealed left hydronephrosis and the adhesive left ureter to the site of the patch graft. Extraluminal outflow of contrast medium into the artery was also noted. These findings were considered to indicate the hematuria being an extravasation of blood from an arterio-ureteral fistula formed in the patch graft region. An emergency operation was performed. Contamination was avoided by construction of the femoro-femoral arterial bypass graft to the left lower extremity, prior to the radical removal of the potentially infected fistula and left kidney. The surgical procedures have saved the patient and his lower extremities.     

Munchausen syndrome presenting as gross hematuria in two women

Munchausen syndrome is an uncommon disorder in which patients present with fictitious disorders and a self-destructive urge to undergo invasive procedures. We present 2 cases of nurses who presented with recurrent urinary tract infections, flank pain, and gross hematuria. One patient had such severe hematuria as to require transfusions of more than 1000 U of packed red cells during a 30-year period. Both patients underwent extensive investigations--all of which were normal. One patient even underwent nephrectomy, which showed normal pathologic findings. Both were found to be phlebotomizing themselves and infusing blood into their bladders.     

A case of cutaneous sensory neuropathy associated with Churg-Strauss syndrome

Cutaneous sensory neuropathy manifests as multiple, sharply demarcated areas of hypoesthesia with a variable degree of pain. This rare neuropathy is caused by a multifocal infection or inflammation of the small sensory nerves of the skin. We report a case in a patient with febrile arthritis and eosinophilia. Her chronic cough and the presence of extravascular infiltrates of eosinophils in a neuromuscular biopsy specimen suggested Churg-Strauss syndrome. The course was favorable under corticosteroid therapy.     

Glomerular lesions in adolescents with gross hematuria or the nephrotic syndrome

We report clinical and pathological data in 56 adolescents presenting with gross hematuria (GH) and 65 presenting with idiopathic nephrotic syndrome (INS). IgA nephropathy (present in 52%) and other mesangial lesions were found in the majority of the 56 patients with GH. Many of these patients had complex urological procedures prior to consideration of a nephrological problem. This often led to significant delays in making the appropriate diagnosis. Pathological lesions in the 65 patients with INS included minimal change NS (MCNS) in 31%, membranous glomerulonephritis (MGN) and focal segmental glomerulosclerosis (FSGS) in 18.5% each, and membranoproliferative GN (MPGN) in 12%. In 47 of the patients with INS, in whom no specific treatment had been given prior to renal biopsy, MCNS and MGN were observed with a similar frequency (26% and 23%, respectively), with FSGS and MPGN being found in 21% and 11%. These results indicate that the pathological lesions in adolescents with INS who undergo a renal biopsy more closely resemble those in adults, and are usually more severe than those in young children. However, it should be noted that our study was retrospective. Hence, there were probably some adolescents with INS who had a successful response to therapy and therefore did not have a renal biopsy performed. Southwest Pediatric Nephrology Study Group (Central Office, Baylor University Medical Center at Dallas, Tex., USA). Director, Ronald J. Hogg; Associate Directors, Fred G. Silva and F. Bruder Stapleton; Statistician, Joan S. Reisch; Administrative Assistant, Kaye Green. Participating Centers—Baylor College of Medicine, Houston, Tex.: Phillip L. Berry, L. Leighton Hill, Sami A, Sanjad, Edith Hawkins; Baylor University Medical Center, Dallas, Tex.: Ronald J. Hogg, Kaye Green; Tulane University Medical Center, New Orleans, La.: Frank Boineau, John E. Lewy, Radhakrishna Baliga, Patrick Walker; University of Arkansas, Little Rock, Ark.: Watson Arnold, Eileen Ellis, Edward Uthman; University of Colorado Health Science Center, Denver, Colo.: Gary M. Lum, Wiliam Hammond; University of Oklahoma Medical Center, Oklahoma City, Okla.: James Wenzl, James Matson, Geoffrey Altshuler, Sarah Johnson; University of Tennessee, Memphis, Tenn.: F. Bruder Stapleton, Shane Roy, III, Robert J. Wyatt, Charles McKay, William Murphy; University of Texas Health Science Center at Dallas, Tex.: Billy S. Arant Jr, Michel Baum, Fred G. Silva, Arthur Weinberg, Craig Argyle, Joseph Rutledge, Ed Eigenbrodt; University of Texas Medical School, Houston, Tex.: Susan B. Conley, Jacques Lemine, Ron Portman, Ann Ince, Regina Verani; University of Texas Health Science Center at San Antonio, Tex.: Michael Foulds, Sudesh Makker, Kanwal Kher, Melanie Sweet, Victor Saldivar, Fermin Tio; University of Texas Medical Branch, Galveston, Tex.: Ben H. Brouhard, Alok Kalia, Luther B. Travis, Lisa Hollander, Tito Cavallo, Srinivasan Rajaraman; University of Utah Medical Center, Salt Lake City; Utah: Eileen Brewer, Richard Siegler, Elizabeth Hammond, Theodore Pysher. Note that this list reflects the investigators' addresses and positions during the period of this study and not necessarily their current situations.     

A case report: Bilharzial schistosomiasis in the urinary bladder presented with gross hematuria

A 31-year-old Japanese man who had been in Africa for two years presented with gross hematuria. He had been swimming in Lake Malawi during this period. Urinary specimen consisted of hematuria and pyuria. Cystoscopy showed tumors resembling Bilharzial tubercles located in the trigone, left lateral and posterior wall and dome. Further urine examination demonstrated eggs of schistosome haematobium. The patient was highly suspected of having Bilharzial schistosomiasis in the urinary bladder. Transurethral resection of bladder tumors was performed for diagnosis. Pathological examination revealed granuloma with many eggs of schistosome haematobium. He was diagnosed with Bilharzial schistosomiasis and was treated with 3,600 mg of praziquantel daily for two days. There have been no signs of recurrence during the one-year follow up except for excretion of degenerated eggs of schistosome haematobium in the urine specimens.     

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.     

A case of glioblastoma in which early diagnosis was difficult by MRI

The authors report a case of glioblastoma in which MR images with Gd-DTPA enhancement changed rapidly during the early stage. A 61 year-old male presented with sudden right facial spasm and dysarthria. However, both a plain and an enhanced CT failed to demonstrate any abnormal lesions. On the other hand, T2 weighted MR image revealed a well circumscribed high intensity lesion in the left frontal lobe without mass effect. This lesion could not be differentiated from cerebral infarction, since no contrast enhanced lesion was able to be observed in T1 weighted MR image with Gd-DTPA. His symptoms gradually became aggravated and at 3 months from the onset, MR image with Gd-DTPA disclosed a small enhanced lesion in the left frontal lobe near the cortical surface. After 6 months from the onset, he suffered from right hemiparesis and motor aphasia. The MR image with Gd-DTPA at this time showed a large enhanced lesion in the left frontal lobe with mass effect. He was admitted to our hospital, and subtotal removal of the tumor and intraoperative radiation was carried out. The patient did well postoperatively without additional neurological deficit, and then he received additional radiation therapy. It should be noted that Gd-DTPA enhanced MR image might fail to reveal the lesion of glioblastoma in its early stage, while T1 weighted image discloses only the gyral swelling.