Giant cystic pheochromocytoma: a case report

The patient, a 59-year-old woman, was referred to our University Hospital for evaluation of a left mass. Ultrasonography revealed a left adrenal cystic mass. On excretory urograms, the left kidney was pressed downward by a suprarenal mass, and computerized tomography (CT) and magnetic resonance imaging (MRI) confirmed an adrenal cyst. 131I-meta-iodo-benzylguanidine (MIBG) scintigraphy showed prominent accumulation in the left adrenal mass and the capsule. Considering the elevation of catecholamines in both blood and urine samples, we performed a left adrenalectomy with a presumptive diagnosis of pheochromocytoma (tumor size: 11.6 x 7.5 x 6.5 cm, tumor weight 720 g). The subsequent pathological examination confirmed a left giant cystic pheochromocytoma. 131I-MIBG scintigraphy was the most useful tool in the diagnosis of the cystic pheochromocytoma.     

A case of adrenal pheochromocytoma with contralateral adrenocortical adenoma

A case of a pheochromocytoma in the right adrenal gland and adrenocortical adenoma in the left adrenal gland of a 58-year-old male is reported. The patient was incidentally found to have a right adrenal tumor by ultrasonographic study. A computerized tomographic (CT) study and magnetic resonance image (MRI) study revealed bilateral adrenal tumors. The sizes of the right tumor and left tumor were 2.5 x 3.5 cm and 1.2 x 1.0 cm, respectively. The intensity of each tumor was different on T2-weighted MRI. 131I-MIBG scintigram showed the uptake of right adrenal gland. The existence of pheochromocytoma was confirmed by the elevated levels of catecholamines. We performed venous sampling to be certain whether the patient had unilateral or bilateral pheochromocytoma. As a result, bilateral adrenal pheochromocytoma was diagnosed. Therefore, we performed bilateral adrenalectomy. However, histopathological examination revealed right pheochromocytoma and left non-functioning adrenocortical adenoma.     

A case of dopamine-secreting pheochromocytoma

We report a case of a pheochromocytoma that exclusively secretes dopamine among a blend of catecholamines. A 66-year-old female was referred to our hospital for further examination of right adrenal tumor. She had no symptoms and no episodes of hypertension. Abdominal CT scan showed a large mass, 9 x 8 x 6 cm, in the right adrenal region. Plasma and urinary catecholamine measurements were repeatedly performed and showed normal adrenaline and noradrenaline but elevated dopamine levels. We performed right adrenalectomy. The tumor was completely removed surgically and histological examinations revealed it to be a pheochromocytoma.     

A case of fistula between the urinary bladder and an ovarian dermoid cyst

A 20-year-old woman was referred to our hospital for further evaluation on persistent pyuria. Physical examination showed a tender solid suprapubic mass. Computed tomography showed a right ovarian multilocular cystic tumor just above the urinary bladder. Cystoscopy showed pus leakage from an orifice in a hemisphere protrusion of the bladder wall. A small catheter could be inserted into the orifice. It revealed a fistula 4 cm in length between the right ovarian tumor and the vesical cavity. The tumor and the adjacent thickened bladder wall with an abscess and fistula were resected en bloc. Also a small left ovarian cyst was enucleated. Histopathological examination showed bilateral ovarian dermoid cysts, abscess formation, and marked inflammatory change around the fistula in the vesical wall. The fistula was thought to be the consequence of infection of the ovarian cyst.     

Dermoid cyst of the colon

Dermoid cysts are benign cystic teratomas lined by skin and epidermal appendages. We report a dermoid cyst occurring in a 26-year-old female whose chief complaint was irregular vaginal bleeding. Abdominal magnetic resonance image demonstrated a space-occupying lesion in the right lower abdomen. The mass showed hyperintensity on the T2 image and the signal was homogeneous for the interior. During abdominal surgery we made the diagnosis of subserous tumor of the colon and resected the ileocecal portion of the colon. The tumor measured 5.4 x 4.8 x 3.5 cm and was soft and elastic. On cross section, a unilocular cyst filled with atheromatous material was found. Pathological examination revealed a dermoid cyst. In the view of this diagnosis, a simple excision would have been an adequate treatment.     

Laparoscopic resection of large adrenal ganglioneuroma

We report on a 23-year-old woman with a right adrenal tumor 13 cm in diameter who was treated by laparoscopy. The patient was asymptomatic, and the tumor was incidentally diagnosed on abdominal ultrasonography. A subsequent computed tomography (CT) of the abdomen confirmed a 12 x 7 x 8-cm homogenous mass of the right adrenal. Magnetic resonance imaging (MRI) showed a solid mass measuring 13 x 7 x 7.5 cm arising from the right adrenal. Laparoscopic complete excision of the mass was accomplished through a transabdominal lateral approach. The postoperative period was uneventful, and the patient was discharged on the second postoperative day. Histology was consistent with an adrenal ganglioneuroma. Two years later, there is no evidence of recurrence on abdominal CT scan.     

Bladder fistula of an ovarian dermoid cyst

We report a case of right ovarian dermoid cyst fistulized in the bladder and revealed by recurrence urinary infections. The diagnostic has not been conformed but 5 years after the urinary first manifestations. The cystoscopy has been a cardinal importance but the right seat of the lesion has been determined only during laparotomy. This unusual complication of ovarian dermoid cyst must call the practitioner's attention to urinary symptoms with a pelvic tumour. Moreover, the left ovary agenesis and the young patient's age have constrained the surgeon to preservative method. The functional efficiency of this method has been proved by the periods recovery, 5 months later.     

Laparoscopic treatment of adrenal myelolipoma: case report and review of the literature

Adrenal myelolipoma is a rare benign, non-functioning tumor consisting of fat and hematopoietic tissues. In January 2005 we had observed an adrenal myelolipoma in 70 year old man. During the follow-up for bladder urothelioma, an abdominal CT revaled a well delineated 4x4 cm homogeneous fatty mass in the right suprarenal area with negative attenuation values. The functional study of adrenal gland was normal. The patient underwent videolaparoscopic right adrenalectomy (Gagner technique). Postoperative course was uneventful. The istological diagnosis showed adrenal myelolipoma. We conclude that videolaparoscopic adrenalectomy should be considered the gold standard treatment for benign adrenal lesions.     

Giant epidermal cyst in the perineum extending into the pelvic space in the patient with polycystic kidney disease: a case report]

A 75-year-old man with autosomal dominant polycystic kidney disease was admitted to our hospital with the chief complaint of a giant mass in the left side of the perineum that had gradually developed in size during the previous 20 years. Palpation revealed a neonatal head-sized cystic mass with no tenderness. Magnetic resonance imaging (MRI) demonstrated a well-circumscribed homogeneous mass extended to the dorsal side of the bladder. It was excised surgically without any injury of rectum or urinary tract. The resected specimen was 23 x 18 x 12 cm in size and 1.2 kg in weight. The pathological diagnosis was epidermal cyst. Cases with an epidermal cyst extending into the pelvic space are extremely rare with few cases having been reported in the world.     

Contralateral response in renal pelvic pressure and diuresis during increasing ipsilateral pelvic pressure and flow: a study of the normal and denervated upper urinary tract in pigs

OBJECTIVE: To examine, in young pigs, changes in baseline pelvic pressure and diuresis in the contralateral kidney during conditions of increasing pelvic pressure and perfusion with isotonic saline in the ipsilateral renal pelvis; the role of a reno-renal nervous mechanism was examined by denervating the kidneys, and the effect of bladder filling on these variables assessed. MATERIALS AND METHODS: Female pigs (37-40 kg) were assessed under general anaesthesia. Transparenchymally, one 6 F and two 6 F catheters were introduced into the right and left renal pelvis, respectively. Through a bladder incision an 8 F catheter was introduced 10 cm into the right ureter to collect urine and the orifice closed around the catheter. For bladder drainage and to measure bladder pressure a 10 F catheter was placed in the bladder and both the 8 F and 10 F catheters lead out through the urethra. In group A, five animals served as controls, with group B comprising eight with intact nerves and group C eight with denervated kidneys. In group B and C the left renal pelvis was perfused with isotonic saline at 2, 4, 6, 8, 10, 12 and 16 mL/min while the bilateral pelvic pressure and right renal diuresis were recorded; the bladder was kept empty and 0.5 h later the left pelvis was perfused with 10 mL/min while the bladder catheter was closed. Perfusion continued until micturition occurred. The bilateral pelvic pressure, bladder pressure and right renal diuresis were recorded. In group C the kidneys were surgically denervated, dividing all adhesions and all connective tissue around the pelvis and the vascular pedicle. The renal artery was freed to the aortic level. RESULTS: During the pressure-perfusion study the mean (sd) right pelvic pressure was 7.4 (0.2) mmHg in group B and 8.6 (0.2) mmHg in group C. The diuresis from the right kidney in both groups was similar and the same as that in group A. The perfusion rate and pressure on the left side had no influence on pelvic pressure and diuresis on the right side. During perfusion with a full bladder the right pelvic pressure was 8.6 mmHg in group B and 9.5 mmHg in group C. Diuresis in group B was approximately 0.6 mL/min and a little higher in group C, at approximately 1 mL/min, but identical to that in group A. CONCLUSION: These results indicate that a reno-renal reflex mechanism has no apparent role in young pigs during pressure-perfusion measurements with an empty or full bladder.     

后腹腔镜下右侧巨大肾上腺肿瘤切除的手术技巧

目的:探讨后腹腔镜下切除右侧巨大肾上腺肿瘤(最大径≥6cm)的可行性及手术技巧。方法:采用后腹腔镜下右侧巨大肾上腺肿瘤切除术治疗右侧巨大肾上腺肿瘤患者18例,肿瘤最大径为6~19(8.4±0.69)cm。术中按3个相对无血管平面分离,在腹侧平面游离时尽量将腔静脉与瘤体分开,并显露肾上腺中央静脉,在背侧平面分离时尽量向内侧中线分离,形成基于腔静脉与腰大肌之间的倒三角形肿瘤基底部。抬起瘤体,逐步向上离断汇入基底部的动脉血供,切除肿瘤。结果:除1例患者因粘连转为开放手术外,17例均顺利完成腹腔镜下肿瘤切除,手术时间80~210(147.9±7.6)min。术后病理检查报告为髓质脂肪瘤8例,嗜铬细胞瘤4例,节细胞神经纤维瘤3例,性索间质瘤1例,肾上腺囊肿伴囊壁钙化囊内出血1例。17例腹腔镜肿瘤切除手术均无术中术后输血。结论:后腹腔可以获得巨大的手术空间,术中妥善处理富含动脉血供的肿瘤基底部可以安全切除体积巨大的肿瘤。     

A case of ovarian dermoid cyst with bladder perforation

A 60-year-old female presented with the main complaints of hematuria, pain upon urination, and pollakiuria. Simple abdominal X-rays revealed a dumb bell-shaped calculus shadow, and a calculus was detected in the right posterior wall by cystoscopy. At surgery, a left ovarian dermoid cyst accompanied by a calculus that was adhesive and perforating in the right posterior wall of bladder was detected. Twenty-eight cases of ovarian dermoid cyst with bladder perforation including this case are reported.     

Adrenal tumors discovered incidentally on ultrasonography: three case reports

A series of three adrenal tumors is reported. They were discovered incidentally on ultrasonography for screening. One case was a benign pheochromocytoma and the others were non-functioning adrenocortical adenomas. They were hypoechoic on ultrasonography and were 4.5 x 3.5 x 4.0, 3.0 x 2.5 x 2.5 and 3.5 x 2.5 x 2.0 cm. Non-functioning adrenal tumors of a diameter smaller than 3.0 cm generally tended not to require surgery. Ultrasonography is useful for screening and evaluating patients with an adrenal mass without surgery as well as is computed tomographic scan.     

Adrenal cyst: report of a case

This is a case report of an adrenal pseudocyst which developed in a 46-year-old man. The patient experienced dull headache, vertigo and palpitation. The diagnosis of the right adrenal cyst was established by echography and CT scan. The fluid of the cyst obtained preoperatively by percutaneous needle aspiration under ultrasonic guidance was 30 ml of a white, cloudy fluid and contained higher concentrations of cortisol and aldosterone than those in the plasma. The adrenal cyst was removed surgically: it measured 4 x 4 x 4 cm and contained yellow and serous fluid. Histological study revealed that the wall of the cyst consisted of thick collagen fibrous tissue without endothelial cell lining and so this adrenal cyst was classified to pseudocyst of the adrenal grand. The percutaneous needle aspiration under ultrasonic guidance is useful in the diagnosis and treatment of adrenal cyst. This is the 81st case of adrenal cyst reported in the Japanese literature.     

Huge pelvic mass secondary to wear debris causing ureteral obstruction

We report an unusual granulomatous reaction of wear debris that produced a huge pelvic mass causing ureteral obstruction. A 72-year-old woman, who received a cemented total hip arthroplasty 30 years ago, was referred to the department of gynecology for examination of a pelvic mass. A computed tomography scan revealed a huge homogenous mass, measuring approximately 20 x 16 x 12 cm, including extensive osteolysis of the left pelvis around the acetabular component. Intravenous pyelogram revealed complete obstruction of the left ureter resulting in hydronephrosis of the left kidney. Histological examination from the biopsy specimen detected polyethylene wear debris in the mass.     

Solitary fibrous tumor of renal pelvis

A 70-year-old Japanese man was referred because of a right renal mass of 2 years in duration. Imaging studies, including magnetic resonance imaging, revealed an ovoid mass, with relatively abundant vascularity, in the right renal pelvis. Right radical nephrectomy was done and a tumor measuring 6.0 x 4.5 x 4.0 cm was found in the renal pelvis. Solitary fibrous tumor (SFT) was highly suspected by histology. Immunohistochemical study using a monoclonal antibody directed against the human hematopoietic progenitor cell antigen (CD34) stain confirmed SFT. This is the first case of SFT of the renal pelvis. Although SFT is extremely rare in urogenital organs, this tumor must be included in the differential diagnosis when we encounter urogenital tumors consisting of mesenchymal elements.     

Large dermoid cyst of the spermatic cord presenting as an incarcerated hernia: a rare presentation and literature review

Dermoid cyst of the spermatic cord is a very rare clinical entity with only a few cases reported in the literature so far. We herein describe an extremely rare case of a large dermoid cyst of the spermatic cord measuring 8.5 × 5 × 5 cm in a young patient who presented with clinical manifestations of an incarcerated inguinal hernia. After the cyst excision, a diffuse direct hernia became apparent and a Lichtenstein polypropylene mesh repair was performed. Direct hernia was likely the result of chronic pressure on the inguinal floor maintained by the large cyst. We conclude that although very rare, dermoid cyst of the spermatic cord should be considered as a part of the differential diagnosis in patients presenting with an irreducible inguinal mass of a long course.     

Pre-pubertal presentation of peritoneal inclusion cyst associated with congenital lower extremity venous valve agenesis

Peritoneal inclusion cysts are uncommon lesions that usually occur in the pelvis of reproductive-age females. The case of a 7-year-old girl with an inflamed peritoneal inclusion cyst with unusual right paracolic localization and congenital lower extremity superficial and deep venous valve agenesis is presented. Inflammation of the peritoneal inclusion cyst was responsible for the signs of acute abdomen and subsequent presentation at our center. The cystic structure was initially diagnosed using ultrasonography, and its complete extent (8cm x 6.5cm x 4cm) was evident after magnetic resonance imaging. The minimal access approach was opted for to resect the entire cyst from the lateral border of the ascending colon. Afterwards, the cyst was punctured to reduce its size and to retrieve the cyst wall using an endoscopic specimen retrieval bag. Minimal access surgery precautions in this patient with congenital lower extremity venous valve agenesis are discussed.     

Uncommon calcification of a pheochromocytoma: a case report

A 62-year-old man with a 2-year history of hypertension was referred for evaluation of severe back pain, but his blood pressure was normal during his hospital stay. Plain radiography and excretory urography demonstrated central and eggshell-like calcification in the left suprarenal area. Computed tomographic scan confirmed similar shapes for the left adrenal calcifications. Laboratory examination revealed that the urinary normetanephrine was elevated. Left adrenal venography showed that the mass was in the middle to lower portion of the left adrenal gland. The most likely diagnosis was, calcified pheochromocytoma. The left adrenal tumor was removed surgically through a thoracolumbar incision on September 19, 1985. The blood pressure rose to 186/102 mmHg at the time of tumor manipulation. The tumor was a markedly hard mass, which was 3.5 x 3.5 x 3.0 cm and weighed 20 g. The histopathologic diagnosis was calcified pheochromocytoma. The patient remained symptomless after the operation.