Tuberculous epididymitis： a case report and literature review

Tuberculous epididymitis is a rare urological disease difficult to diagnose. The conventional methods for diagnosis are often time-consuming and invasive. The combined use of scrotal magnetic resonance imaging （MRI） and urinary polymerase chain reaction （PCR）-based assay for mycobacterial DNA （the latter because of its high sensitivity and specificity to demonstrate mycobacterial DNA） is a valuable method for rapid diagnosis of tuberculous epididymitis. We report a 79-year-old man who was admitted with the chief complaints of bilateral scrotal swelling and pain. The combined use of scrotal MRI and urinary PCR allowed prompt diagnosis of tuberculous epididymitis and adequate antituberculous therapy. （Asian J Androl 2005 Sep; 7： 329-332）     

Case report – Prostatic carcinoma presenting as an epididymal nodule

International Urology and Nephrology -     

Primary leptomeningeal glioma mimicking an acoustic neuroma: case report with review of the literature

Primary leptomeningeal gliomas are rare. Historically, they have been found in the spinal canal more frequently; however, in the recent literature nearly all have been found within the cranium. In the only cadaveric study of leptomeningeal glial nests, the most frequent site was the medulla and pons. Until now, no leptomeningeal glioma has been found at this site. We report what we believe to be the first such case mimicking an acoustic neuroma.     

彩超诊断附睾腺瘤样瘤2例报告并文献复习

目的提高临床医生对超声诊断附睾腺瘤样瘤的认识。方法报告2例彩超诊断附睾腺瘤样瘤的患者,并结合文献复习其解剖、临床、病理和超声特征。首先2例患者术前使用二维超声观察记录肿块大小、形态、部位、边界、内部回声,并用彩色多普勒(CDFI)检查,记录其彩色血流信号分布,将取样容积置于血流信号最丰富处,获取频谱,使声束和血流的夹角<60°,测定收缩期血流速度、阻力指数等参数。后经手术顺利切除附睾肿瘤。结果2例附睾肿块均呈等回声、边界规则的肿块,内部回声均匀。1例位于右附睾头的肿块,内部未探及明显彩色血流信号;1例位于左附睾头的肿块,内部探及少量彩色血流信号,最大流速16cm/s,RI:0.62。术后病理诊断为附睾腺瘤样瘤。结论附睾腺瘤样瘤临床少见,超声检查可在附睾头或尾部见到等回声,形态规则,边界清晰完整,内部回声均匀,CDFI示无或有少量彩色血流信号的肿块,腺瘤样瘤可能性大。     

Multicystic adenomatoid pancreatic hamartoma in a child: Case report and literature review

INTRODUCTIONPancreatic tumor is a rare condition in children, but reasonably common in adults. Histopathology in children also differs from that in adults, with most cases being pancreatoblastoma, solid pseudopapillary tumor, or pancreatic endocrine tumors.PRESENTATION OF CASEA 14-month-old boy was noticed abdominal distension and referred to our hospital. Laboratory findings revealed leukocytosis and elevation of serum level of C-reactive protein and pancreatic enzymes. Radiological findings at admission were the huge abdominal cyst in abdominal computed tomography. As the levels of pancreatic enzyme elevated synchronous to oral feeding, total parenteral nutrition was needed. Besides radiographically the abdominal lesion changed from multiple large cystic type to multiple microcystic lesion including solid component over time. It was considered different diagnosis was pancreatic blastoma, pancreatic pseudo cyst, and lymphangioma and he was performed operation. The huge multicystic and partially solid tumor arising from the tail of pancreas existed from posterior of stomach to pelvic cavity. The tumor was completely resected without pancreatectomy and residual pancreas can be kept without tumor invasion. Histopathological finding was pancreatic hamartoma.DISCUSSIONPancreatic hamartoma was extremely rare, and only 17 cases were previously reported in the literature. This is the first case that the change of radiographic findings overtime was shown. We reviewed 17 cases (4 cases in children) of pancreatic hamartoma including our case.CONCLUSIONAlthough extremely rare, pancreatic hamartoma should be considered in the differential diagnosis of cystic abdominal mass in children.     

Basal cell carcinoma mimicking pilonidal sinus: A case report with literature review

IntroductionPilonidal sinus is a common benign disease that accounts for almost 15% of anal suppurations while basal cell carcinoma is the most common malignancy of the sun-exposed area occurring mainly on the head and neck. We report a case of basal cell carcinoma presented with signs and symptoms of PNS. A 40-year-old male presented with swelling of the lower back for 2 years. On examination, there was a round, mobile, soft 4 × 2.5 cm mass on the sacrococcygeal area. Ultrasound showed subcutaneous cystic lesion. Clinical diagnosis of PNS was done and excisional biopsy was performed under local anesthesia. The result of the histopathological examination was suggestive for basal cell carcinoma.ConclusionBasal cell carcinoma should not be forgotten in differential diagnosis of superficial mass and abscesses.     

A conus tuberculoma mimicking an intramedullary tumour: a case report and review of the literature

Tuberculomas of the spinal cord are rare. They usually present as mass lesions with little evidence of systemic illness. We report a case where the diagnosis was only made histologically, emphasising the need to consider infection as a cause of neurological illness in patients from under-developed countries.     

Chronic subdural hematoma associated with an intracapsular meningioma. Case report and short review of the literature

We describe a patient with a chronic subdural hematoma, associated with a intracapsular meningioma, who was successfully treated by operation. The development of chronic subdural hematoma and the possible relationship between the two lesions are discussed. A short review of the literature concerning this subject is included.     

Hydronephrotic obstructed kidney mimicking a congenital multicystic kidney: Case report with review of literature

Objective: To report a case of obstructed hydronephrotic kidney mimicking a multicystic kidney and to review the literature regarding differentiation of the hydronephrotic variant of multicystic kidney from the obstructed hydronephronic kidney. To suggest a possible algorithm in distinguishing them.Methods:We have reported a case of a 35-year-old male who presented with dull aching pain and a palpable right-sided cystic flank mass of several years duration. The initial workup suggested a nonfunctioning multicystic kidney while the operative findings and histopathology were suggestive of an obstructed hydroenphrotic kidney with pyelonephritic changes. We searched the literature using the key words hydronephrotic dysplastic kidney and multicystic kidney.Results:A detailed literature search did not reveal any such publication describing the differentiation of the hydronephrotic multicystic dysplastic kidney from the obstructed hydronephrotic kidney of pelviureteral obstruction. We reviewed the existing literature on this subject, on the basis of which, we have suggested a six-stepladder approach to distinguish such cases.Conclusion:By using the 6 step ladder protocol algorithm suggested by us one can attempt to distinguish the hydronephrotic variant of multicystic dysplastic kidney from the hydronephrotic kidney due to pelviureteral obstruction in patients presenting with a symptomatic cystic flank masses of renal origin. Differentiation between the two may be difficult at times due to the medial/central placement of cysts in the former. This is necessary since renal salvage may be possible in the latter while timely nephrectomy may be considered in the former to prevent against the hazards of leaving behind a dysplastic kidney in situ.     

Aggressive primary scalp lymphoma mimicking an acute epidural hematoma: Case report and review of the literature

BackgroundCutaneous Central Follicular Lymphoma (CCFL) is a type B cutaneous lymphoma with a usually indolent course. Scalp localization of CCFL is extremely rare, we report a new case mimicking an epidural hematoma, and showing a rapid progression with aggressive infiltration of skin, calvaria, dura and brain parenchyma.Case reportA 58-year-old patient with an unlabeled polymalformative syndrome was admitted to the Emergency department following a head injury secondary to a self-resolving tonic-clonic epileptic seizure. The initial CT-scan was interpreted as a minor subcutaneous and epidural hematoma initially deemed for conservative management. Within 4 days, the patient showed a progressive neurological deterioration culminating into a stuporous status which prompted a constrast-enhanced brain MRI. The scan revealed a multilayered solid lesion, extending from the subgaleal compartment to the subdural space, threatening the integrity of overlying skin and causing infiltration of the brain parenchyma. Following emergency neurosurgical excision a definitive histology diagnosis of central follicular lymphoma was made. A focused chemotherapy with high-dose Methotrexate with R-CHOP protocol led to disease control until the latest follow up at 2 years.ConclusionTo our knowledge, this case represents the first CCFL invading the brain parenchyma and the second extending to the dura. Although such tumor is usually indolent the aggressive behavior herein reported extend the differential diagnosis to high-grade meningiomas, sarcomas, and metastases. Prognostication and appropriate adjuvant treatment require prompt surgical excision and histological confirmation.     

Myositis ossificans mimicking parosteal osteosarcoma: a case report and literature review

Myossitis ossificans (MO) is an aberrant reparative process that causes benign heterotopic ossification in soft tissue. We report a case of MO presenting as a large mass located at the dorsal aspect of the distal thigh, with no history of trauma, with radiological and clinical features mimicking parosteal sarcoma. An incisional biopsy was performed and the mass was excised. The histological features identified the lesion as MO. In half of the cases, these ossifications may adhere to the periosteum. In these cases, the lesion is known as parosteal MO, which may be confused with a parosteal osteosarcoma. This parosteal MO seldom becomes malignant. We emphasize the importance of a differential diagnosis of MO, since these lesions may simulate tumours and lead to misdiagnosis.     

肾上腺功能性色素性皮质腺瘤1例报告并文献复习

目的：探讨肾上腺功能性色素性皮质腺瘤的临床及病理学特征。方法：回顾性分析1例肾上腺功能性色素性皮质腺瘤患者的诊治情况,并复习有关文献探讨其临床特征。结果：肾上腺功能性色素性皮质腺瘤临床上十分罕见,无特异性表现,影像学检查提示有肾上腺腺瘤病变,病理检查可见肿瘤细胞胞质内有特异性脂褐质存在。结论：肾上腺功能性色素性皮质腺瘤的诊断主要依靠病理检查,治疗以手术为主。     

Hepatic sarcoidosis mimicking cholangiocellular carcinoma: A case report and literature review

IntroductionSarcoidosis is a multisystem disease characterized by the presence of non-caseating granulomas in affected organs. Almost 70% of patients with a sarcoidosis reaction have hepatic involvement. However, evidence-based clinical management or treatment strategies for hepatic sarcoidosis are poorly defined. Here, we present a case of a resected hepatic sarcoidosis patient. Additionally, we review the relevant hepatic sarcoidosis literature and discuss the clinical management of hepatic sarcoidosis.Presentation of caseA 20-mm liver tumor of segment 8 was incidentally detected in a 64-year-old female. Radiological images resembled the enhancement pattern of cholangiocellular carcinoma. Thus, this lesion was assigned a preoperative classification of pT1N0M0 stage I according to the 7th Union for International Cancer Control guidelines. The patient underwent a partial liver resection. Histologically, the tumor contained sarcoidosis lesions indicated by a conglomerate of epithelioid granulomas with giant cells. These histopathological findings were consistent with the diagnosis of hepatic sarcoidosis.DiscussionHistopathological examination has been established as the definitive diagnostic tool for hepatic sarcoidosis. Therefore, liver biopsy or surgical resection of a liver tumor should be considered in cases that are difficult to preoperatively distinguish from malignant tumors.ConclusionWe present the case of a patient with surgically resected hepatic sarcoidosis that was difficult to preoperatively distinguish from cholangiocellular carcinoma.     

前列腺肉瘤样癌二例报告并文献复习

目的 探讨前列腺肉瘤样癌的临床表现、病理特点和诊治方法. 方法 前列腺肉瘤样癌患者2例.例1,51岁.因排尿困难、会阴部不适2个月,急性尿潴留入院.实验室检查PSA值2.31 ng/ml,CT检查示前列腺密度不均,左叶弥漫性增大、浸润膀胱.经直肠穿刺活检诊断为前列腺肉瘤样癌.行全膀胱、前列腺切除加尿流改道(Bricker手术),术后行局部放射治疗和内分泌治疗.例2,54岁,因排尿困难伴间歇性肉眼血尿1个月入院.实验室检查PSA 2.61 ng/ml.B超检查示低回声块.CT检查示前列腺密度不均.经直肠穿刺活检诊断为前列腺肉瘤.行全膀胱、前列腺切除加尿流改道(Bricker手术). 结果 2例术后病理均诊断为前列腺肉瘤样癌.镜下肿瘤组织由上皮癌细胞和肉瘤样间质2种成分组成,之间可见移行区过渡.免疫组化:2种成分中细胞角蛋白、上皮膜抗原均呈阳性表达.癌细胞波形蛋白阴性,肉瘤样细胞阳性.例1术后41个月出现广泛转移,2个月后死亡.实验室检查PSA正常.例2术后16个月出现骨转移并有局部复发,手术去势联合比卡鲁胺最大限度雄激素阻断治疗3个月无效,术后19个月死亡.实验室检查PSA<4.0 ng/ml.结论前列腺肉瘤样癌是一种罕见、高度恶性的肿瘤,预后不良,确诊需依赖病理表现及免疫组织化学检查.根治性切除辅以局部放射治疗和内分泌治疗可行.     

Etiopathology of camptodactyly (case report and literature review)

First, a review on the literature about camptodactyly and its pathogenesis is given. A case report is presented on a 13-year-old girl with a camptodactyly of both little fingers. Intraoperatively it was observed that the superficial flexor tendon of the right little finger ended in the palmar aponeurosis and was then found to be without function. It is our understanding that this type of anomaly of the superficial flexor tendon of the little finger as an aetiology of camptodactyly has not been reported yet in the previous literature.     

Thoracic splenosis mimicking thoracic schwannoma: case report and review of the literature

BACKGROUND: Thoracic splenosis is a rare entity. It occurs sometime after splenic and diaphragmatic injury, and it is rarely symptomatic. CASE DESCRIPTION: We report a case of left upper thoracic paraspinal splenosis 25 years after a thoracoabdominal penetrating trauma that required a splenectomy. The pathology was suspected on a routine chest x-ray and it mimicked a schwannoma on magnetic resonance imaging. Less than 40 cases of thoracic splenosis were described in the literature, but few were misinterpreted as schwannoma. CONCLUSION: Alertness to the possibility of thoracic splenosis can lead to confirmation of the diagnosis with technetium Tc 99m-tagged red blood cell radionuclide scanning based on a previous history of traumatic splenectomy.     

成人自发性椎间盘炎（附6例报告）

目的 探讨成人自发性椎间盘炎的诊治方法。方法 对本院自1993年至1999年诊治的6例成人原发性椎间盘炎患者的临床表现及诊治过程进行了分析总结。结果 6例证实为成人自发性椎间盘炎患者中,有3例发病前有慢性疾病史,另外3例则没有发现慢性疾病史,4例患者组织培养阳性,1例血培养阳性,其中金葡菌3例,大肠杆菌1例,链球菌培养阳性1例。2例患者进手术摘除椎间盘,排除脓液后治愈,另4例患者经抗菌素及氢化可的松治疗后痊愈。结论 成人自发性椎间盘炎一旦诊断明确,应早期应用大剂量广谱抗菌素治疗,如保守治疗无效,则可考虑手术治疗,手术能达到减压及清除病灶内的感染物质,所以能迅速解除症状、控制感染,促进愈合。