Case Reports in Urology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Large Genital Cavernous Hemangioma: A Rare Surgically Correctable Entity Sun, 29 Nov 2015 12:15:48 +0000 We report a case of 24-year-old male presenting with painless penoscrotal swelling for 3 years. On examination, a large soft bag of worm-like, superficial, nonpulsatile swelling was present in scrotum and penis. Color Doppler showed dilated tortuous vessels and on angiography no connections to corpora or vessels were seen. So a diagnosis of hemangioma was made and a surgical excision was carried out by circumcoronal and scrotal incisions. Postop course was uneventful. At 6 months of follow-up, no recurrence was seen and wound had healed with excellent cosmetic appearance. Goto Gangkak, Anoop Mishra, Shivam Priyadarshi, and Vinay Tomar Copyright © 2015 Goto Gangkak et al. All rights reserved. “Rosary of Testes”: Splenogonadal Fusion in Association with Bilateral Abdominal Testes Presenting as Polyorchidism Sun, 29 Nov 2015 11:46:55 +0000 Polyorchidism is a rare anomaly where early segmentation in the gonadal ridge can lead to the development of three or less commonly four testes in one individual. Just over 150 reports of this phenomenon exist in English medical literature. However, once confronted by the clinical finding of supernumerary gonads, one must remain mindful of other likely diagnoses involving nontesticular origin. We report on a male patient with bilaterally impalpable testes in whom splenogonadal fusion mimicked polyorchidism. By keeping such differential diagnoses in mind, surgeons are more liable to take the appropriate intraoperative course of action. Pejman Shadpour and Behkam Rezaimehr Copyright © 2015 Pejman Shadpour and Behkam Rezaimehr. All rights reserved. Scrotal Lipomatosis Mimicking Varicocele: A Case Report and Review of the Literature Tue, 17 Nov 2015 11:11:04 +0000 Scrotal lipomatosis is a rarely seen disease with an etiology that is not fully understood. Some information suggests that this disease may be associated with infertility. It is characterized by pain-free scrotal swelling. In this study, we reported a scrotal lipomatosis case presenting due to infertility and pain-free scrotal swelling. It was operated on with the initial diagnosis of varicocele, but once fatty tissue was observed in the scrotum, the case was diagnosed as scrotal lipomatosis. Here, we present this rare case with a literature review. Sadi Turkan, Mehmet Kalkan, and Coşkun Şahin Copyright © 2015 Sadi Turkan et al. All rights reserved. Oncocytic Adrenocortical Neoplasm Diagnosed after Robot-Assisted Adrenalectomy Tue, 17 Nov 2015 06:32:08 +0000 Oncocytic tumors, composed of eosinophilic, mitochondria-rich cells, can occur in several locations throughout the body. These tumors can occur in the adrenal cortex and are rarely malignant. We report a case of a patient presenting with an incidental adrenal mass which was later diagnosed as a oncocytic adrenocortical neoplasm (OAN). The patient is a 53-year-old man found to have a 7.2 cm right adrenal mass, incidentally found by computed tomography (CT). After metabolic workup was negative, a right robotic adrenalectomy (RA) was performed. Pathologic analysis revealed clusters of large cells with abundant eosinophilic and granular cytoplasm, consistent with OAN. This pathology is rare, with only about 150 cases described in the literature. It occurs in females 2.5 times more frequently and more commonly on the left side. Diagnosis is usually made by imaging criteria, typically with CT or magnetic resonance imaging (MRI). Treatment is generally surgical, since OAN can be malignant in some cases. Differentiation between benign and malignant OAN is done based on the Lin-Weiss-Bisceglia criteria and can be difficult. If malignancy is diagnosed, recurrence is common and close surveillance should be performed. Andrew C. Harbin, Andrew Chen, Siddharth Bhattacharyya, Jasvir S. Khurana, Joshua R. Kaplan, and Daniel D. Eun Copyright © 2015 Andrew C. Harbin et al. All rights reserved. Adenocarcinoma at Anastomotic Site of Ureterosigmoidostomy Potentially of Urothelial Origin Spreading to the Upper Urinary Tract Sun, 15 Nov 2015 07:53:34 +0000 Ureterosigmoidostomy is associated with the risk of several late complications including cancer development at anastomotic sites. We present an unusual case with adenocarcinoma of the anastomotic site associated with multiple adenocarcinoma lesions in the upper urinary tract. A 69-year-old man complained of persistent melena and hematuria. He had undergone radical cystectomy for high-grade bladder cancer and ureterosigmoidostomy 30 years before. Colonoscopy showed a tumor at the right ureterocolonic anastomosis, which was endoscopically resected and histologically diagnosed as adenocarcinoma. Seven years later, a tumor of the left ureterocolonic anastomosis associated with hydronephrosis was found. He underwent temporal percutaneous nephrostomy followed by sigmoidectomy and left ureterocutaneostomy. Eighteen months after the operation, computed tomography (CT) detected left renal pelvic tumor with a mass along the former nephrostomy tract. Left nephroureterectomy and resection of the nephrostomy tract tumor revealed adenocarcinoma with multiple lesions of adenocarcinoma in the ureter. These tumors showed atypical immunohistochemistry as a colonic adenocarcinoma: positive for cytokeratin 7, negative for cytokeratin 20, and negative for β-catenin nuclear accumulation. Anastomotic site adenocarcinoma of the present case is potentially of urothelial origin because of unusual clinical manifestation and immunohistochemistry as a colon cancer. Katsuhiro Makino, Haruki Kume, Teppei Morikawa, Aya Niimi, Tetsuya Fujimura, Tohru Nakagawa, Hiroshi Fukuhara, and Yukio Homma Copyright © 2015 Katsuhiro Makino et al. All rights reserved. Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty Mon, 09 Nov 2015 10:00:38 +0000 Excision with primary anastomosis (EPA) urethroplasty is generally the preferred method for short strictures in the bulbar urethra, given its high success rate and low complication rate compared to other surgical interventions. Bleeding is a presumed risk factor for any surgical procedure but perioperative hemorrhage after an EPA requiring hospitalization and/or reintervention is unreported with no known consensus on the best course for management. Through our experience with three separate cases of significant postoperative urethral hemorrhage after EPA, we developed an algorithm for treatment beginning with conservative management and progressing through endoscopic and open techniques, as well as consideration of embolization by interventional radiology. All the three of these cases were managed successfully though they did require multiple interventions. We theorize that younger patients with more robust corpus spongiosum and more vigorous spontaneous erections, patients that have undergone fewer prior urethral procedures and therefore have more prominent vasculature, and those patients managed with a two-layer closure of the ventral urethra without ligation of the transected bulbar arteries are at a higher risk for this complication. L. A. Bertrand, S. P. Elliott, B. N. Breyer, and B. A. Erickson Copyright © 2015 L. A. Bertrand et al. All rights reserved. Laparoscopic Management of a Complex Adrenal Cyst Sun, 08 Nov 2015 08:32:32 +0000 Adrenal cysts are rare, and their clinical management remains controversial. We report a case involving an adrenal cyst with a complicated appearance on radiological studies. Unenhanced computed tomography revealed a unilocular, noncalcified, hypoattenuating mass with a thin wall in the left adrenal gland. The lesion gradually increased in size from 10 to 50 mm at two-year follow-up. On contrast-enhanced magnetic resonance imaging, a mural nodule with contrast enhancement was observed. The entire adrenal gland was excised en bloc via a lateral transperitoneal laparoscopic approach without violating the principles of surgical oncology. The pathological diagnosis was an adrenal pseudocyst. Laparoscopic adrenalectomy is a safe option for the treatment of complex adrenal cysts, while maintaining the benefits of minimal invasiveness. Koichi Kodama, Yasukazu Takase, Susumu Niikura, Akiko Shimizu, Hiroki Tatsu, and Katsuhiko Saito Copyright © 2015 Koichi Kodama et al. All rights reserved. Primary Desmoplastic Melanoma of the Penis Tue, 03 Nov 2015 10:18:48 +0000 Desmoplastic melanomas are rare amelanotic melanomas that usually occur on skin with sun exposure. In this report, we present a 72-year-old man who presented with a desmoplastic melanoma of the penis. To our knowledge this represents the first reported case of primary desmoplastic melanoma of the penis. We discuss the pathologic differential and histologic evaluation. Julia T. Chu, Michael A. Liss, William W. Wu, Atreya Dash, and Di Lu Copyright © 2015 Julia T. Chu et al. All rights reserved. Aggressive Angiomyxoma of the Bladder Neck Requiring Local Excision and Mitrofanoff Formation Wed, 28 Oct 2015 11:50:07 +0000 Aggressive angiomyxoma is a rare mesenchymal tumour predominantly affecting the female pelvis and perineum but has also been described in males. This tumour can often present a diagnostic challenge and has a propensity for local recurrence after surgical excision. We present an unusual case of aggressive angiomyxoma arising from the bladder of a female patient which required local excision and Mitrofanoff formation. M. Davari, B. W. Lamb, S. Chowdhury, C. Jameson, J. D. Kelly, and T. Greenwell Copyright © 2015 M. Davari et al. All rights reserved. Femoral Metastasis from Penile Carcinoma: Report of 2 Cases Thu, 22 Oct 2015 13:26:42 +0000 Purpose. Penile cancer rarely gives symptomatic skeletal metastases. Methods. We present 2 patients with squamous carcinoma of the penis who were surgically treated for metastases in the femur. Results. Both patients had pathological fractures and were operated on. In one case, the skeletal metastasis preceded any lymphatic spread of the disease, suggesting early haematogenous dissemination. Conclusions. Endoprosthetic reconstruction resulted in pain relief and restored the ambulatory capacity. Clinicians should be aware of the possibility for symptomatic bone metastases with a risk for pathological fracture in patients with penile cancer. Laura Braumann, Panagiotis Tsagozis, Rikard Wedin, and Otte Brosjö Copyright © 2015 Laura Braumann et al. All rights reserved. The Forgotten Complication of Recurrent Nephrolithiasis: “Squamous Cell Carcinoma of the Renal Pelvis”—A Case and Review of the Literature Thu, 22 Oct 2015 13:24:00 +0000 Squamous cell carcinoma (SCC) of the renal pelvis is an aggressive tumor with insidious onset of unspecific symptoms and advanced stages at diagnosis. It is a rare entity, accounting for 0.5–8% of renal tumors. In this paper, we describe the case of a patient with a history of recurrent nephrolithiasis that presented with an aggressive form of SCC of the renal pelvis with rapid relapse after resection. Tarek Assi, Elie El Rassy, Samah Naderi, Tania Moussa, Maroun Moukarzel, and Joseph Kattan Copyright © 2015 Tarek Assi et al. All rights reserved. Review of the Literature: Organ of Giraldes Epididymal Appendage Presenting as a Painless Scrotal Mass in a 19-Year-Old Male—A Rare Urologic Entity Wed, 21 Oct 2015 13:49:58 +0000 An incidental finding of a testicular mass in young male population is always a case of great concern for the patient and controversy for the physician. Differential diagnosis ranges from acute scrotum (notably testicular torsion), to acute inflammation and infection, all the way to testicular tumors. We present a case of an incidental finding of a painless testicular solid mass in a 19-year-old male patient, with an end pathological result of paradidymis (organ of Giraldes) following orchiectomy. To the best of our knowledge, this is the first case of its kind to be reported in the literature. Mohamad-Fadi Dalati, Tania Oliveira-e-Silva, and Kim Entezari Copyright © 2015 Mohamad-Fadi Dalati et al. All rights reserved. Prostatosymphyseal Fistula Treated by Robotic Assisted Radical Prostatectomy Tue, 20 Oct 2015 11:28:54 +0000 This case report documents a rare complication of prostate resection following a Greenlight laser procedure. The 75-year-old gentleman involved underwent photoselective vaporisation of the prostate (PVP) for clinically benign prostatic obstruction. Subsequent to PVP, the patient experienced recurrent macroscopic haematuria and pubic pain. Investigations confirmed the presence of a prostate-symphyseal fistula, a rare complication of PVP. We believe this to be the first reported case of successful treatment with robotic assisted radical prostatectomy. Lucy Whelan, Emma Mullarkey, and Henry H. Woo Copyright © 2015 Lucy Whelan et al. All rights reserved. Testicular Leydig Cell Tumor with Metachronous Lesions: Outcomes after Metastasis Resection and Cryoablation Wed, 07 Oct 2015 14:01:54 +0000 Leydig cell tumors represent 3% of testicular masses and usually occur in prepubertal boys and men between 30 and 60 years of age. Leydig cell tumors are benign in children but can be malignant in 10% of adults. This case report describes a 41-year-old patient who was diagnosed with a Leydig cell tumor that originated in his right testicle that subsequently metastasized to his liver, lungs, and retroperitoneum. We discuss the patient’s presentation and review the radiographic findings, surgical treatment, surgical pathology, chemotherapeutic treatment, and published literature on this rare pathology. Julio J. Geminiani, Stephen D. Marshall, Tammy S. Ho, and Steven B. Brandes Copyright © 2015 Julio J. Geminiani et al. All rights reserved. It Suddenly Occurred: Extensive Subcutaneous Emphysema after Bipolar Transurethral Resection of Prostate Mon, 28 Sep 2015 06:44:50 +0000 Subcutaneous emphysema is a very rare and good-natured complication after transurethral resection of prostate (TURP). It has been reported as colon perforation, diverticulitis, and bladder perforation associated complication previously. We report the first case of a wide subcutaneous emphysema due to microperforations of prostatic capsule, without a bladder perforation after TURP. Any sign of clinic situation should lead to ceasing of the procedure immediately; otherwise, it can cause a life-threatening problem of abdominal compartment syndrome. Murat Bagcioglu, Mert Ali Karadag, Ramazan Kocaaslan, Cafer Mutlu Sarikas, Mustafa Gok, and Omer Erkam Arslan Copyright © 2015 Murat Bagcioglu et al. All rights reserved. Urinary Incontinence due to Overactive Detrusor Muscle: A Rare Side Effect of Venlafaxine Sun, 27 Sep 2015 06:47:55 +0000 We report a case of reemergence of urinary incontinence (UI) in a patient with benign prostatic hyperplasia (BPH) after starting treatment with venlafaxine who was stabilized on tamsulosin and finasteride for about 6 years. A 66-year-old Caucasian male with prior history of major depressive disorder developed UI within a week of starting venlafaxine 75 mg per day. He described symptoms in the form of involuntary leakage of urine both during the day and at night. His symptoms of UI resolved after stopping the venlafaxine. To the best of our knowledge, there are only four case reports of venlafaxine induced urinary incontinence which have been published. Vithyalakshmi Selvaraj, Palanikumar Gunasekar, Suneel Kumar, and Imad Alsakaf Copyright © 2015 Vithyalakshmi Selvaraj et al. All rights reserved. Testicular Interposition Flap for Repair of Perineal Urinary Fistulae: A Novel Surgical Technique Mon, 21 Sep 2015 11:54:45 +0000 Rectourinary fistulae and urinary-cutaneous fistulae are a rare yet devastating complication. Current options for tissue interposition include rectus, gracilis, or gluteal muscle, omentum, or intestine for use in coloanal pull-through procedures. In elderly patients, testicular interposition flaps may be an excellent tissue option to use when vitalized tissue is necessary to supplement fistula repair. Elderly patients frequently have increased spermatic cord length, potentially offering a longer flap reach than use of a muscle flap. Additionally, mobilizing one of the testicles and developing it through the external inguinal ring may be a less morbid and less costly procedure than harvesting and tunneling a muscle flap. Longer follow-up and further studies are needed to determine the outcomes of this novel technique. Valary T. Raup, Jairam R. Eswara, Stephen D. Marshall, and Steven B. Brandes Copyright © 2015 Valary T. Raup et al. All rights reserved. Surgical Intervention for Penile Methamphetamine Injections Tue, 15 Sep 2015 12:10:24 +0000 Methamphetamine is a central nervous system stimulant and is the second most commonly used illicit drug after cannabis. Methamphetamine use for sexual pleasure is well documented. In this case report, we describe two cases presenting to our urban county hospital associated with complications related to penile injection of methamphetamine. Both patients developed penile abscesses and required urgent surgical incision and drainage. Penile abscesses represent a rare complication associated with IV drug administration into the penile corpora. Resultant penile abscesses require broad-spectrum antibiotics and surgical drainage. Further understanding of methamphetamine abuse along with the role it plays in sexual enhancement would be an invaluable addition to understanding of the rationale behind this self-administered stimulant. Drainage of penile abscesses associated with IV drug users may be hazardous to healthcare providers who are at risk from a needle stick injury. Thomas W. Gaither, E. Charles Osterberg, Mohannad A. Awad, and Benjamin N. Breyer Copyright © 2015 Thomas W. Gaither et al. All rights reserved. Pannus Is the New Prepuce? Penile Cancer in a Buried Phallus Sun, 13 Sep 2015 12:22:16 +0000 Two males presented to our urology department with complaints of bleeding and malodor from buried phallus within a suprapubic fat pad. Although both men had neonatal circumcisions, advanced penile carcinoma was found in both men. Formal penectomies showed high grade, poorly differentiated squamous cell carcinoma invading the corporal bodies and urethra. Buried penis represents a difficulty in early detection of suspicious lesions but may also provide an environment susceptible to poor hygiene and subsequent chronic inflammation. Patients with buried penis may be at a higher risk for development of invasive penile cancer and may benefit from regular and thorough genital exams. Jared Manwaring, Srinivas Vourganti, Dmitriy Nikolavsky, Alfredo L. Valente, and Timothy Byler Copyright © 2015 Jared Manwaring et al. All rights reserved. Stereotactic Body Radiotherapy for Localized Ureter Transitional Cell Carcinoma: Three Case Reports Wed, 09 Sep 2015 09:46:38 +0000 The gold standard management for ureter transitional cell carcinoma (UTCC) is radical nephroureterectomy with excision of the bladder cuff. However, some patients cannot undergo this procedure for several reasons. In the case reports described herein, we performed stereotactic body radiotherapy (SBRT) on three patients with inoperable or surgery-rejected localized UTCC. Two out of the three patients did not develop local recurrence or distant metastasis during the observation period. However, recurrence was detected in the bladder of one patient 22 months after the treatment. No acute or late adverse events occurred in any of the three patients. SBRT may become one of the treatment options for inoperable or surgery-rejected UTCC patients. Yoshiyasu Maehata, Kengo Kuriyama, Shinichi Aoki, Masayuki Araya, Kan Marino, and Hiroshi Onishi Copyright © 2015 Yoshiyasu Maehata et al. All rights reserved. Xanthogranulomatous Pyelonephritis of a Lower Pole Moiety in a Duplicated Collecting System Kidney Tue, 08 Sep 2015 09:04:18 +0000 Xanthogranulomatous pyelonephritis (XGP) is a destructive inflammatory process which is frequently caused by recurrent urinary tract infections or chronic obstruction by kidney stones. We present a 56-year-old female with an extensive retroperitoneal urinoma and xanthogranulomatous pyelonephritis of the lower pole moiety in a kidney with a duplicated collecting system due to obstructive nephrolithiasis. After drainage of the urinoma, the patient underwent a definitive lower pole heminephrectomy with preservation of the functional upper pole. We review important clinical features of xanthogranulomatous pyelonephritis and considerations for surgery on a duplicated kidney. Jean Paul Wuilleumier, Ariel Schulman, Antonio Montgomery, and Ervin Teper Copyright © 2015 Jean Paul Wuilleumier et al. All rights reserved. Palpable Penile Metastases: A Bizarre Presentation of Rectal Adenocarcinoma Tue, 08 Sep 2015 08:51:39 +0000 Metastasis to the penis is an uncommon occurrence, with only about 370 cases reported in the literature to date. The majority of the primary tumors are genitourinary in origin. We report on a patient with undiagnosed disseminated rectal adenocarcinoma, who first presented with lesions of the corporal bodies. A review of the literature indicates that corporeal metastasis as an initial presentation of malignancy is an extremely rare occurrence and carries a very poor prognosis. Liza Cholin, Sarah Perz, Furman Mahmood, and Saleem Zafar Copyright © 2015 Liza Cholin et al. All rights reserved. Mucinous Bladder Adenocarcinoma: Case Report and Literature Review Tue, 01 Sep 2015 09:13:02 +0000 Primary mucinous adenocarcinoma is an extremely rare type of bladder cancer, with aggressive behavior and poor response to chemotherapy and radiotherapy. The symptoms are similar to those of other bladder tumors. Surgery is the main treatment and remains the only curative option. There may be a progression from mucinous metaplasia to mucinous adenoma and then mucinous adenocarcinoma. We present the case of a 40-year-old woman with recurrent lower urinary tract infections, submitted to imaging tests, which showed a bladder tumor. After transurethral resection, pathology showed intestinal mucinous carcinoma. Metastatic work-up was negative. New surgical procedure showed metaplasia but no recurrence of the carcinoma. The patient is now using antibiotic prophylaxis and will undergo a cystoscopy every 3 months and computed tomography in one year. Bruno Mello R. Santos, Julia Duarte de Souza, Rachel Silviano Brandão Correa Lima, and Enaldo Melo de Lima Copyright © 2015 Bruno Mello R. Santos et al. All rights reserved. Extraperitoneally Ruptured, Everted, and Prolapsed Bladder: A Very Rare Complication of Pelvic Injury Mon, 31 Aug 2015 11:59:07 +0000 Traumatic rupture of the bladder with eversion and protrusion via the perineum is a rare complication of pelvic injury. We present a 36-year-old lady who sustained severe pelvic injury with a bleeding right-sided deep perineal laceration. She had closed reduction of pelvic fracture with pelvic banding and primary closure of perineal laceration at a private hospital. She subsequently had dehiscence of repaired perineal laceration with protrusion of fleshy mass from vulva and leakage of urine per perineum five weeks later. Examination revealed a fleshy mucosa-like mass protruding anteriorly with a bridge of tissue between it and right anterolateral vaginal wall. Upward pressure on this mass revealed the bladder neck and ureteric orifices. She had perineal and pelvic exploration with findings of prolapsed, completely everted bladder wall through a transverse anterior bladder wall rent via the perineum, and an unstable B1 pelvic disruption. She had repair of the ruptured, everted, and prolapsed bladder, double-plate and screw fixation of disrupted pelvis and repair of the pelvic/perineal defect. She commenced physiotherapy and ambulation a week after surgery. Patient now walks normally and is continent of urine. We conclude that the intrinsic urethral continent mechanism plays a significant role in maintaining continence in females. Rufus Wale Ojewola, Kehinde Habeeb Tijani, Olakunle Olaleke Badmus, Abisola Ekundayo Oliyide, and Chukwudi Emmanuel Osegbe Copyright © 2015 Rufus Wale Ojewola et al. All rights reserved. A Case of Giant Cowper’s Gland Syringocele in an Adult Male Patient Sun, 30 Aug 2015 11:00:29 +0000 Cowper’s gland syringocele is an uncommon, underdiagnosed cystic dilatation of Cowper’s gland ducts showing various radiological patterns. Herein we report a rare case of giant Cowper’s gland syringocele in an adult male patient, with description of MRI findings and management outcome. Santosh Surana, Mohamed Elshazly, Adel Allam, Sateesh Jayappa, and Deena AlRefai Copyright © 2015 Santosh Surana et al. All rights reserved. Abnormal Cystic Tumor in a Patient with Hereditary Leiomyomatosis and Renal Cell Cancer Syndrome: Evidence of a Precursor Lesion? Tue, 25 Aug 2015 11:54:38 +0000 The hereditary leiomyomatosis and renal cell cancer (HLRCC) association is a rare syndrome caused by mutation of the Kreb’s cycle enzyme, fumarate hydratase (FH). It is characterized by unusually aggressive type 2 papillary renal cell histology. FH is responsible for catalyzing the conversion of fumarate to malate. Its absence leads to a state of “pseudohypoxia,” inducing hypoxia inducible factor 1α (HIF-1α) and leading to increased growth factor transcription (e.g., vascular endothelial growth factor, VEGF; glucose transporter 1, GLUT1). Ultimately, this results in tumorigenesis. We present a patient who was diagnosed with HLRCC and underwent bilateral nephrectomies. One of the nephrectomy specimens was notable for benign cystic lesions that stained positive immunohistochemically for succinated proteins, a finding only noted in FH-deficient cells. Thus, we posit a potential precursor lesion to type 2 papillary renal cell carcinoma in the HLRCC syndrome. Benjamin T. Ristau, Sonal N. Kamat, and Tatum V. Tarin Copyright © 2015 Benjamin T. Ristau et al. All rights reserved. Comment on “Necrotizing Urethritis due to Aerococcus urinae” Tue, 18 Aug 2015 13:05:20 +0000 Magnus Rasmussen Copyright © 2015 Magnus Rasmussen. All rights reserved. Sneezing during Micturition: A Possible Trigger of Acute Bacterial Prostatitis Tue, 18 Aug 2015 11:07:25 +0000 A perfectly well 39-year-old man sneezed during micturition and developed classic features of acute bacterial prostatitis corroborated by laboratory evidence of prostatic inflammation/infection. The prostate-specific antigen level at presentation was 9.6 ng/mL and declined to 1.23 ng/mL one month later on levofloxacin. This is the first report in the medical literature of sneezing while voiding being a possible trigger of acute bacterial prostatitis. A biologically plausible mechanism is provided. William Derval Aiken Copyright © 2015 William Derval Aiken. All rights reserved. Mixed Germ Cell Tumor of Testis with Isolated Scapular Metastasis: A Case Report and Review of the Literature Sun, 16 Aug 2015 13:16:54 +0000 Bone metastasis is a rare entity in germ cell tumor of testis and is a poor prognostic site. It is usually associated with synchronous metastasis at other sites. Till now very few cases of isolated bone metastasis of germ cell tumor of testis have been reported but none have reported scapular metastasis. We are reporting a case of nonseminomatous germ cell tumor of right testis that was operated eight months ago and now presented with isolated scapular metastasis. Histopathology of the scapular tissue revealed rhabdomyosarcoma or poorly differentiated synovial sarcoma. Immunohistochemistry with serum markers concluded it to be metastatic germ cell tumor. To the best of our knowledge this is the first reported case of scapular metastasis of testicular germ cell tumor. This case is being reported here due to dilemmatic way of presentation and also to emphasize that histopathology may sometimes misguide and immunohistochemistry is necessary in such cases. Dipti Rani Samanta, Chaitali Bose, Roopesh Krishnappa, Saumyaranjan Mishra, Sulagna Mohanty, Ashish Upadhyay, and Surendra Nath Senapati Copyright © 2015 Dipti Rani Samanta et al. All rights reserved. Acute Respiratory Distress Syndrome after Treatment of Metastatic Prostate Cancer with Taxotere: A Case Report and Literature Review Thu, 13 Aug 2015 09:45:24 +0000 Prostate cancer is the most common cancer in men. Docetaxel is a common chemotherapeutic agent that has proven its efficacy in the treatment of patients with both castration sensitive and resistant metastatic prostate cancer. We report a case of acute respiratory distress syndrome (ARDS) in a patient with metastatic prostate cancer treated with docetaxel (Taxotere). ARDS is very rare but life threatening complication of docetaxel which requires aggressive supportive care and close monitoring. Better awareness and prompt diagnosis of this treatment related ARDS will improve the effectiveness and outcome of its management. Ali Raufi, Jennifer Dotson, and Mohamad Khasawneh Copyright © 2015 Ali Raufi et al. All rights reserved.