Case Reports in Urology The latest articles from Hindawi © 2018 , Hindawi Limited . All rights reserved. A Case of Fibrous Pseudotumor in the Scrotum: Challenge for Diagnosis and Testicular Preservation Wed, 17 Jan 2018 08:02:43 +0000 A paratesticular fibrous pseudotumor is a relatively rare benign disease. Preoperatively diagnosing a fibrous pseudotumor is challenging because distinguishing these masses from malignant tumors on the basis of clinical and radiological findings can be difficult. We present a case of a 28-year-old man who presented with a painless palpable mass in the right scrotum; the fibrous pseudotumor of the tunica vaginalis was treated with organ-sparing surgery. Computed tomography and magnetic resonance imaging revealed paratesticular tumors. Testicular tumor marker levels were within normal limits. We scheduled the patient to undergo tumor biopsy combined with intraoperative rapid diagnosis. Frozen section assessment suggested a fibrous pseudotumor without malignancy. We successfully performed organ-sparing surgery. Testicular-sparing surgery combined with frozen section assessment is primarily used for treating paratesticular fibrous pseudotumors. Hirotake Kodama, Shingo Hatakeyama, Teppei Matsumoto, Toshikazu Tanaka, Hirotaka Horiguchi, Yuka Kubota, Hayato Yamamoto, Atsushi Imai, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, and Chikara Ohyama Copyright © 2018 Hirotake Kodama et al. All rights reserved. A Case of Early Stage Bladder Carcinosarcoma in Late Recurrence of Urothelial Carcinoma after Transurethral Resection Mon, 15 Jan 2018 07:03:46 +0000 Carcinosarcomas of the urinary bladder are rare biphasic neoplasms, consisting of both malignant epithelial and malignant mesenchymal components, and the prognosis of this tumor is unfavorable in most patients with even possibility of resection of disease. A 77-year-old male with a history of transurethral resection (TUR) of urothelial carcinoma (UC) of the bladder and adjuvant intravesical chemotherapy with pirarubicin 10 years ago revisited our department with a gross hematuria. Cystoscopy demonstrated an approximately 2.5 cm nonpapillary tumor on the right wall of the bladder. Pelvic MRI showed the tumor without extending the base of the bladder wall. The tumor could be completely removed with TUR. The malignant epithelial elements consisted of high-grade UC and the majority of mesenchymal components were fibrosarcomatous differentiation based on immunohistochemical studies. The tumor could be pathologically also suspected to be an early stage on TUR specimens. Although he has received no additional intervention due to the occurrence of myocardial infarction at three weeks after the TUR, he has been alive with no evidence of recurrence of the disease 27 months after the TUR. Some early stages of bladder carcinosarcoma might have a favorable prognosis without aggressive treatments. Daisaku Hirano, Toshiyuki Yoshida, Daigo Funakoshi, Fuminori Sakurai, Shou Ohno, and Yoshiaki Kusumi Copyright © 2018 Daisaku Hirano et al. All rights reserved. Congenital Bladder Diverticulum in Adults: A Case Report and Review of the Literature Sun, 14 Jan 2018 00:00:00 +0000 A 37-year-old male patient presented to the emergency department with fever, gross hematuria, and irritative lower urinary tract symptoms. Investigations revealed the presence of a large left bladder diverticulum superior and lateral to the left ureteral orifice without bladder outlet obstruction. Bladder diverticula in adults almost always present in the setting of bladder outlet obstruction. The finding of a congenital bladder diverticulum in an adult represents a rare clinical entity. Rawad Abou Zahr, Khalil Chalhoub, Farah Ollaik, and Joe Nohra Copyright © 2018 Rawad Abou Zahr et al. All rights reserved. The Rare Togetherness of Bladder Leiomyoma and Neurofibromatosis Mon, 08 Jan 2018 00:00:00 +0000 Neurofibromatosis Type 1 (Von Recklinghausen disease) is a common, autosomal dominant hereditary disorder characterized by involvement of multiple tissues derived from the neural crest. Urinary system involvement in neurofibromatosis is a rare condition. Leiomyoma of the bladder is a rare benign mesenchymal tumor. In this case, our experience and approach regarding the bladder leiomyoma development in a patient diagnosed with neurofibromatosis are presented and the literature data has been reviewed. Cem Yucel, Salih Budak, Erdem Kisa, Orcun Celik, and Zafer Kozacioglu Copyright © 2018 Cem Yucel et al. All rights reserved. Testicular Inflammatory Myofibroblastic Tumor: A Known Entity at a Very Rare Site Thu, 21 Dec 2017 00:00:00 +0000 Inflammatory myofibroblastic tumors (IMT) are distinctive lesions of unknown etiology, composed of myofibroblastic spindle cells with an associated inflammatory background. They can occur in a wide age range and at all anatomic sites, but most frequently they can be observed in the lung (especially in pediatric cases), abdomen, or retroperitoneum. The urinary bladder is one of the most common sites in urological cases. We present a very rare case of IMT of the testis. Clinically, a 40-year-old patient showed a palpable painless lesion of the right testis. Ultrasound examination showed two solid intratesticular foci. During surgical intervention, the intraoperative frozen section revealed mesenchymal tumors admixed with an uncommon inflammatory infiltrate, consistent with a reorganized abscess. Despite the benign result, orchiectomy was performed due to the multifocal presentation and the large size of 3 cm. The final diagnosis was IMT without ALK-rearrangement. Incomplete resection increases the risk of local relapses to 30%. In this case, a complete resection could be achieved and the patient is free of tumor 15 months later. Hans-Ullrich Voelker, Daniel Kuehn, Annette Strehl, and Stefan Kircher Copyright © 2017 Hans-Ullrich Voelker et al. All rights reserved. Prostatic Utricle Cyst as the Most Likely Cause in a Case of Recurrent Episodes of Hematospermia Thu, 21 Dec 2017 00:00:00 +0000 Hematospermia is a clinical symptom that raises anxiety in patients and has various causes, benign and malignant. We report a case of hematospermia for which appropriate multidisciplinary expertise favored a conservative management of a benign prostatic cyst, namely, a prostatic utricle cyst. A cystic lesion found by transrectal ultrasound in the context of hematospermia related to masturbation in a young virgin male patient was investigated with a high-field magnetic resonance imaging (MRI) and an endorectal coil. The association of high-field MRI and endorectal coil leads to high quality images. Grégoire Feutry, Thomas De Perrot, Gregory J. Wirth, Xavier Montet, and Steve P. Martin Copyright © 2017 Grégoire Feutry et al. All rights reserved. Primary Signet-Ring Cell Adenocarcinoma of the Urinary Bladder Treated with Partial Cystectomy: A Case Report and Review of the Literature Mon, 11 Dec 2017 08:22:30 +0000 Primary signet-ring cell carcinoma is a variant of adenocarcinoma which is extremely rare, associated with poor prognosis and generally found to be resistant to chemotherapy and radiotherapy. We report a case of primary signet-ring cell carcinoma of the bladder which was successfully treated with partial cystectomy. A 71-year-old female with a history of type 2 diabetes, hypertension, and ischaemic heart disease presented with painless haematuria for 2 months’ duration. The abdominal ultrasonography showed a localised polypoidal vesical growth arising from the bladder dome. Cystoscopy revealed an exophytic solid tumour in the anterior fundal wall. A deep transurethral resection of bladder tumour was done and histology revealed an adenocarcinoma composed of mucinous and signet-ring cell components. Later, considering the patient’s age and the poor general condition, a partial cystectomy was done. Follow-up cystoscopy and ultrasonography were done at 12 months and there was no evidence of tumour recurrence and the patient is currently symptom-free. Partial cystectomy may be considered in patients with localised tumour without evidence of metastasis and poor general condition. Regular cystoscopies and ultrasound imaging are necessary for follow-up and early identification of recurrences. Umesh Jayarajah, D. M. Hilary Fernando, Kasun Bandara Herath, M. V. Chandu de Silva, and S. A. S. Goonewardena Copyright © 2017 Umesh Jayarajah et al. All rights reserved. Laparoscopic Dismembered Pyeloplasty in a Solitary Kidney with Intrarenal Pelvis: Two Challenges in One Case Sun, 26 Nov 2017 00:00:00 +0000 Laparoscopic pyeloplasty (LP) for ureteropelvic junction obstruction (UPJO) is one of the most appropriate surgical techniques to achieve the optimal goal of minimally invasive surgery. However, urologists hesitate to use the laparoscopic approach in UPJO with solitary kidney or intrarenal pelvis. There are a few published studies on laparoscopic pyeloplasty cases in intrarenal pelvis. However, to the best of our knowledge, the present case is the first in the literature in terms of intrarenal pelvis in a solitary kidney. Generally, YV plasty is the accepted technique instead of dismembered pyeloplasty in UPJO with small or intrarenal pelvis. However, in this report, we showed that dismembered LP can be performed with good results in intrarenal pelvis UPJO, even if it is in the solitary kidney. Akin Soner Amasyali, Erhan Ates, Hakan Görkem Kazici, Alper Nesip Manav, and Haluk Erol Copyright © 2017 Akin Soner Amasyali et al. All rights reserved. Nontraumatic Acute Elevation of Pancreatic Enzymes following Percutaneous Nephrolithotomy: A Rare Complication Wed, 15 Nov 2017 00:00:00 +0000 Herein, we report the case of a 48-year-old female who developed nontraumatic acute pancreatitis following left supracostal Percutaneous Nephrolithotomy. Three hours postoperatively, the patient developed fever with signs and symptoms consistent with hydrothorax, which was confirmed radiologically and was managed conservatively. The following days, the patient developed manifestations of Systemic Inflammatory Response Syndrome with epigastric pain, nausea, and vomiting. Blood, urine, and sputum cultures were negative. Serum amylase and lipase levels were elevated 3 and 13 times above the normal level, respectively. Imaging studies revealed no pathologic findings from pancreas. These findings were consistent with the diagnosis of acute pancreatitis. Nikolaos Ferakis, Antonios Katsimantas, Georgios Zervopoulos, Vasileios Klapsis, Spyridon Paparidis, Filippos Venetsanos, and Konstantinos Bouropoulos Copyright © 2017 Nikolaos Ferakis et al. All rights reserved. Mucin-Poor Mucinous Tubular and Spindle Cell Carcinoma of the Kidney Presented with Multiple Metastases Two Years after Nephrectomy: An Atypical Behaviour of a Rare, Indolent Tumour Tue, 14 Nov 2017 06:34:15 +0000 Background. Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare type of renal cell carcinoma, whose clinical behaviour and metastatic potential have not been fully elucidated to date. There are only a few metastatic cases in the literature, which all either featured sarcomatoid differentiation or were synchronously metastasised at diagnosis. Case Presentation. We report a case of a 49-year-old male with end-stage kidney disease on dialysis, presenting with multiple osseous metastases of a mucin-poor variant of MTSCC of the kidney, without sarcomatoid differentiation, two years after bilateral nephrectomy for papillary renal cell carcinoma (RCC) at a curable stage. After retrospectively reexamining the initial nephrectomy specimens, the tumour of the right kidney was also diagnosed as a mucin-poor variant of MTSCC, while the tumour of the left kidney was confirmed as a papillary RCC. Conclusions. It is proposed that MTSCC can be associated with end-stage renal disease and that particularly the mucin-poor variant is easily confused with papillary renal cell carcinoma, as happened in this case. Although it is considered as a relatively indolent malign entity, it can metastasise even years after successful primary surgical treatment. This implies, besides accurate diagnosis, that MTSCC patients should be monitored closely in the follow-up period. I. Sokolakis, C. Kalogirou, L. Frey, M. Oelschläger, M. Krebs, H. Riedmiller, H. Kübler, and D. Vergho Copyright © 2017 I. Sokolakis et al. All rights reserved. Squamous Cell Carcinoma of Suprapubic Cystostomy Site in a Patient with Long-Term Suprapubic Urinary Catheter Sun, 12 Nov 2017 07:04:00 +0000 Patients with long-term suprapubic cystostomy can rarely develop squamous cell carcinoma (SCC) of the suprapubic cystostomy tract. In addition to the few reported cases in the literature, this paper reports a case of suprapubic cystostomy SCC in an 88-year-old man without bladder involvement. Vigilance about any abnormal lesion at the site of suprapubic cystostomy is important among health providers and patients for early detection of SCC. Sasikumar Subramaniam, Gowribahan Thevarajah, Karunadasa Kolitha, and Nandasena Namantha Copyright © 2017 Sasikumar Subramaniam et al. All rights reserved. Primary Malignancy in a Supernumerary Testicle Presenting as a Large Pelvic Mass Sun, 22 Oct 2017 07:14:16 +0000 Supernumerary testis, also known as polyorchidism, is a condition characterized by the presence of more than two testes. Another condition of the testes is seminoma, a common cause of testicular germ cell tumor. A 35-year-old male was transferred to our hospital with a diagnosis of abdominal mass causing abdominal pain. On physical exam, he had a palpable undescended left testicle in the left inguinal canal, which was determined to be seminoma. The mass was surgically removed, and the patient underwent chemotherapy. The report discusses his workup, treatment, and outcome. This case illustrates an unusual presentation of supernumerary testis with the extra testis harboring a seminoma. When presented with a case of testicular cancer with no tumor noted in the palpable testes, malignancy in an extranumerary testicle should be considered in the differential. Justin Noroozian, Daniel Farishta, Daniel Ballow, Joseph Sonstein, Eduardo Orihuela, and Eduardo Eyzaguirre Copyright © 2017 Justin Noroozian et al. All rights reserved. A Unique Case of Testicular Compromise in a Patient with Ovotesticular Disorder of Sexual Development and a Solitary Testicle Sun, 08 Oct 2017 08:27:35 +0000 Ovotesticular disorder of sexual development (OT-DSD), previously true hermaphroditism, is a condition in which one or both gonads contain testicular and ovarian tissue. A 23-year-old OT-DSD male patient presented with continuous pain in his right testicle which had been previously intermittent over the past five days. The patient had a prior history of left ovotestis removal with prosthesis placement, a right undescended testicle with aberrant anatomy, and hypospadias repair, all of which were corrected shortly after birth. A lack of blood flow to the testicle on Doppler ultrasound warranted immediate surgical intervention. Intraoperatively, an aberrant tunica vaginalis space with a compressive hematoma secondary to epididymal abscess rupture was identified as the causation for testicular compromise. Return of vascular flow to the testicle was confirmed with intraoperative Doppler after hematoma and epididymis excision, and the testicle was left in situ. It is imperative to consider epididymal etiologies with acute testicular pain, especially in a patient with a medical history that carries an increased risk for gonadal anomalies. Ethan Vargo, Lillianne Stanitsas, and Mark Memo Copyright © 2017 Ethan Vargo et al. All rights reserved. Forty-Three-Year-Old Female with Dopamine Secreting Pheochromocytoma of the Adrenal Gland Thu, 31 Aug 2017 00:00:00 +0000 We report on a 43-year-old, asymptomatic female who presented with incidental finding of left adrenal mass. MRI gave concerns for possible pheochromocytoma but markers for pheochromocytoma were not elevated as expected. 24-hour urine dopamine levels (6988 μg/day) were significantly elevated. The patient successfully underwent robotic assisted radical left adrenalectomy and was diagnosed with a dopamine secreting pheochromocytoma. Pathology revealed increased malignant potential associated with the tumor. The patient underwent full metastatic workup, which was negative. At two years of follow-up there was no recurrence and normalization of lab values. Tyler Haden, Marcin Zuberek, and Naveen Pokala Copyright © 2017 Tyler Haden et al. All rights reserved. Chondroma of the Bladder: An Atypical Localization Thu, 24 Aug 2017 07:20:27 +0000 Chondroma is a benign tumour of mesenchymal origin that is composed of cartilage and rarely located in soft tissues, being described so far only in four cases, as located in the bladder, according to our knowledge. We describe the fifth case of a 67-year-old woman who consulted for microscopic haematuria, with an endoscopic finding of submucosal nodular image in the anterior wall of the bladder, which after resection and the histologic study shows cartilage and fibroconnective tissue, in part hyalinised, and positive immunohistochemical staining of cells with vimentin and S-100; this fact can support the diagnosis of bladder chondroma. M. Tamayo-Jover, A. Nazco-Deroy, R. González-Álvarez, H. Álvarez-Argüelles Cabrera, B. Padilla-Fernández, and T. Concepción-Masip Copyright © 2017 M. Tamayo-Jover et al. All rights reserved. Primitive Neuroectodermal Tumor and Wegener’s Granulomatosis of the Kidney: A Curious Combination of Two Rare Entities Tue, 01 Aug 2017 07:53:23 +0000 Wegener’s granulomatosis (WG) is characterized by necrotizing polyangiitis involving the respiratory tract and kidneys. It causes segmental necrotizing glomerulonephritis in the kidneys. In rare cases, a renal pseudotumor may be seen because of the granulomatous process. Association of WG with renal malignancy, however, is very uncommon. We report a case of a patient who presented several years after being treated for WG with malignant hypertension and an infiltrating mass in the right kidney. The histopathology of radical nephrectomy specimen showed presence of primitive neuroectodermal tumor (PNET). Association of renal cell carcinoma (RCC) with WG has been documented in a few cases, but PNET in such circumstances has not been reported. Long-term immunosuppressive treatment is a known risk factor in the development of malignancies, so it is proposed that the occurrence of RCC in WG may have been a side effect of cyclophosphamide treatment. It is not clear whether the same mechanism for PNET holds true in the present case. It is important to make a differential diagnosis between true malignancy and pseudotumors in WG as these entities cannot be distinguished based solely on imaging. We suggest a need to routinely screen the WG patients for increased risk of urologic malignancies. Rugvedita Parakh, Satyajeet Parakh, and Maria Tretiakova Copyright © 2017 Rugvedita Parakh et al. All rights reserved. Use of Diagnostic Laparoscopy for Identification of Bilateral Noncommunicating Hydroceles in an Infant with Right-Sided Abdominoscrotal Mass and Left-Sided Scrotal Mass Mon, 31 Jul 2017 00:00:00 +0000 Infantile abdominoscrotal hydrocele (ASH) is a rare condition characterized by a dumbbell-shaped cystic mass extending from the scrotum to the abdomen. We present the case of a 4-month-old infant who presented with progressively enlarging bilateral scrotal swelling and a tense, ballotable right-sided abdominal mass with extension into the scrotum. Scrotal ultrasound revealed bilateral hydroceles but exam and ultrasound could not rule out communication. At the time of planned hydrocelectomy, initial diagnostic laparoscopy was used to identify a massive right-sided ASH extending from the internal ring to the umbilicus and a large noncommunicating left-sided hydrocele that was visible with application of pressure to the left side of the scrotum. Following confirmation of anatomy with diagnostic laparoscopy, a scrotal approach to hydrocelectomy was performed as well as bilateral orchidopexy. Kian Asanad, Pooya Banapour, and Monica Metzdorf Copyright © 2017 Kian Asanad et al. All rights reserved. Scrotal Abscess Drained by Iatrogenic Urethral Fistula in an Adult Diabetic Male Mon, 17 Jul 2017 00:00:00 +0000 A 46-year-old Caucasian male has been transferred to our urology department with a history of septic fever, uncompensated diabetes, pain, and scrotal swelling. On clinical examination, the left inguinal and scrotal area was swollen, tender, and painful; scrotal MR had been performed, showing the catheter tip in scrotal cavity and presence of gas. The case was diagnosed as scrotal abscess with urethroscrotal fistula. He was successfully treated with scrotal incision, drainage, catheter repositioning under fluoroscopic control, antibiotics, and insulin. This patient developed an infection of scrotum, which led to subcutaneous abscess getting worse by a poorly controlled glycemia. In this case, an iatrogenic fistula, caused by wrong catheterization, stops the evolving to a Fournier’s Gangrene. Early detection and intervention provide opportunities to improve outcome of this disease. Marco Stizzo, Davide Arcaniolo, Carmelo Quattrone, Raffaele Balsamo, Marco Terribile, Celeste Manfredi, Vincenzo Mirone, Paolo Verze, and Marco De Sio Copyright © 2017 Marco Stizzo et al. All rights reserved. Multiple Acrometastases in a Patient with Renal Pelvic Urothelial Cancer Mon, 03 Jul 2017 06:34:09 +0000 Metastasis may occur in any bone but more commonly occurs in the spine, pelvis, or other axial bones. Metastasis in peripheral bones located distal to the elbow or knee, so-called acrometastasis, is rare. Although the mechanism of acrometastasis development is not completely understood, it is thought to be the result of a massive dissemination of cancer cells; thus the prognosis of patients with acrometastasis is relatively poor. Here, we report the case of renal pelvic cancer with multiple acrometastases in both the upper and lower extremities without axial bone metastasis in a 68-year-old man. After two regimens of chemotherapy, he suffered from pain on his wrist and ankle and swelling and hemorrhage of his toe. He had no axial bone metastasis by CT but was diagnosed with multiple acrometastases by plain radiographs. Radiation therapy and disarticulation of the left big toe at the metacarpal-phalangeal joint were performed and his pain and hemorrhage were successfully controlled. Although acrometastasis from renal pelvic cancer is very rare, we should recognize that acrometastasis might occur which exists outside of the CT scanning field. Ryoko Sawada, Yusuke Shinoda, Aya Niimi, Tohru Nakagawa, Masachika Ikegami, Hiroshi Kobayashi, Sakae Tanaka, Yukio Homma, and Nobuhiko Haga Copyright © 2017 Ryoko Sawada et al. All rights reserved. Marker-Negative Pheochromocytoma Associated with Inferior Vena Cava Thrombosis Thu, 15 Jun 2017 00:00:00 +0000 Pheochromocytoma associated with inferior vena cava (IVC) thrombosis is very rare. A 27-year-old female presented with right flank pain and hypertensive urgency. Contrast-enhanced CT abdomen and gadolinium-contrast MRI abdomen revealed right adrenal mass suspicious of malignancy with invasion and compression to the right IVC wall along with IVC thrombus extending from the level of renal veins to the level of confluence with hepatic veins. Her routine laboratory investigations including 24-hour urine fractionated metanephrines, vanillylmandelic acid, and cortisol were normal. Right adrenalectomy with IVC thrombectomy was done. Perioperative period was uneventful. Histopathology of the mass turned out to be pheochromocytoma with thrombus revealing fibroadipose tissue with fibrin. Pheochromocytoma may present with IVC thrombus as well as normal serum and urinary markers. Thus, clinical suspicion is imperative in perioperative management of adrenal mass. S. Poudyal, M. Pradhan, S. Chapagain, B. R. Luitel, P. R. Chalise, U. K. Sharma, and P. R. Gyawali Copyright © 2017 S. Poudyal et al. All rights reserved. Primary Signet-Ring Cell Carcinoma of the Urinary Bladder Successfully Managed with Radical Cystectomy in a Young Patient Mon, 05 Jun 2017 00:00:00 +0000 Primary signet-ring cell adenocarcinoma of bladder is a rare neoplasm, usually seen in middle age adults. We report the case of an 18-year-old man who presented with intermittent gross hematuria. Computed tomography imaging showed multifilling defects in the bladder. The patient underwent a transurethral resection of the bladder tumor. Histological findings were consistent with poorly differentiated mixed mucinous and signet-ring cell adenocarcinoma. We ruled out other possible origins of tumor by gastrointestinal endoscopy and colonoscopy. The patient was treated with radical cystectomy with prostate and seminal vesicle sparing technique and orthotopic diversion using “W” ileum pouch with pelvic lymphadenectomy to the bifurcation of the aorta was done. Six-month follow-up of patient showed normal conditions without metastatic spread or any recurrence. Farzad Allameh, Morteza Fallah Karkan, Yalda Nilipour, and Azadeh Rakhshan Copyright © 2017 Farzad Allameh et al. All rights reserved. Female Urethral Diverticulum Carcinoma: A Case Report and Literature Review Thu, 25 May 2017 07:08:02 +0000 A 48-year-old woman with a history of voiding difficulty visited our hospital. Magnetic resonance imaging revealed a periurethral tumor, which was pathologically diagnosed as an adenocarcinoma via transperineal needle biopsy. Radical cystectomy and urethrectomy were performed, and the urinary tract was reconstructed using an ileal conduit. Pathological examination of a resected specimen confirmed adenocarcinoma of the urethral diverticulum. The patient received adjuvant gemcitabine and cisplatin chemotherapy. She is alive at 5 months since the operation. Ryo Kasahara, Tadashi Tabei, Yukio Tsuura, and Kazuki Kobayashi Copyright © 2017 Ryo Kasahara et al. All rights reserved. Propionibacterium acnes Is an Unusual Cause of Acute Scrotal Abscess in a Preterm Infant Tue, 23 May 2017 10:02:26 +0000 Acute scrotal abscess is an extremely rare condition in neonates and may mimic testicular torsion. Most of these abscesses have reportedly been due to Staphylococcus and Salmonella spp. infections. We herein report a unilateral acute scrotal abscess in a preterm infant born at 26 weeks in whom Propionibacterium acnes was isolated from the collected scrotal fluid culture. To our knowledge, this is the first case report implicating P. acnes as a causative agent of neonatal scrotal abscess. Based on such findings, P. acnes infection should be considered in differential diagnosis of acute scrotal abscess in neonates, particularly in preterm infants. Naoto Nishizaki, Tadaharu Okazaki, Yu Adachi, Kaoru Obinata, Hiromichi Shoji, and Toshiaki Shimizu Copyright © 2017 Naoto Nishizaki et al. All rights reserved. Hyper IgE Syndrome and Renal Cell Carcinoma Thu, 18 May 2017 00:00:00 +0000 Hyper IgE Syndrome (HIES) is an immunodeficiency disorder characterized by increased serum levels of IgE, eczema, and recurrent cutaneous and pulmonary infections. In this report, we present, to our knowledge, the first documented case of renal cell carcinoma (RCC) found in a patient with HIES. The patient received infectious disease clearance prior to obtaining a partial nephrectomy which revealed clear cell histology. Both HIES and RCC have an immunological basis for their pathophysiology and may involve common pathways. Further studies may provide insight into any possible link and clinicians should be mindful of immunocompromised patients who present with risk factors for genitourinary malignancy. Neel H. Patel, Mark Ferretti, and John L. Phillips Copyright © 2017 Neel H. Patel et al. All rights reserved. Urothelial Carcinoma in a 22-Year-Old Female with Angelman Syndrome Tue, 11 Apr 2017 08:29:49 +0000 A 22-year-old nulligravid white female with Angelman syndrome was noted to have a 4-month history of premenstrual nausea, vomiting, and abdominal pain. She had an echogenic focus in her bladder noted on ultrasound. She was diagnosed with low grade urothelial carcinoma after cystoscopic evaluation with biopsy and was sent to urology for further treatment. Urothelial carcinoma is rare in individuals younger than age 40. Patients may present with gross hematuria. There is often a delay in diagnosis in younger individuals with different genetic mutations noted upon diagnosis. Jessica Pugh and R. Keith Huffaker Copyright © 2017 Jessica Pugh and R. Keith Huffaker. All rights reserved. Arterioureteral Fistula: Treatment of a Hemorrhagic Shock with Massive Hematuria by Placing a Balloon Catheter Wed, 29 Mar 2017 00:00:00 +0000 Arterioureteral fistulas (AUF) are serious diseases with increasing incidence. This case report relates the management of AUF in a patient with a history of abdominal oncological surgery, pelvic radiotherapy, and a double J stent in place. The fistula was discovered during a hemorrhagic shock with massive hematuria. The bleeding was controlled by a balloon catheter which led to endovascular treatment consisting of a covered stent. Nicolas Merzeau, Hervé Riquet, Ioannis Nicolacopoulos, Abbas Alame, and Stéphane Larré Copyright © 2017 Nicolas Merzeau et al. All rights reserved. Delayed Infection of a Lymphocele following RARP in a Patient with Nonspecific Symptoms Wed, 15 Mar 2017 07:11:02 +0000 Pelvic lymphoceles are an infrequent complication after pelvic surgery and develop shortly after the surgery in most cases. We experienced a case of delayed infection of a lymphocele 6 months after robot-assisted radical prostatectomy (RARP) and pelvic lymphadenectomy. In this case, antimicrobial chemotherapy and percutaneous drainage were effective, and there was no recurrence of the disease. Most urologists do not recognize that infected lymphoceles can develop a long time after surgery; thus, infected lymphoceles should be kept in mind in patients with nonspecific infectious symptoms, regardless of the length of time after surgery. Tomoki Taniguchi, Yoshito Takahashi, Mitsuhiro Taniguchi, Toru Yamada, and Kenichiro Ishida Copyright © 2017 Tomoki Taniguchi et al. All rights reserved. PSMA-PET/CT-Positive Paget Disease in a Patient with Newly Diagnosed Prostate Cancer: Imaging and Bone Biopsy Findings Wed, 15 Mar 2017 00:00:00 +0000 A 67-year-old man diagnosed with Gleason score clinically localized prostate cancer with 68Ga-labeled prostate-specific membrane antigen-targeted ligand positron emission tomography/computed tomography (PSMA-PET/CT) positive Paget bone disease is described. Immunohistochemical staining revealed weak PSMA positivity of the bone lesion supporting the hypothesis that neovasculature might explain positive PSMA-PET/CT findings in Paget disease. Michael Froehner, Marieta Toma, Klaus Zöphel, Vladimir Novotny, Michael Laniado, and Manfred P. Wirth Copyright © 2017 Michael Froehner et al. All rights reserved. Intraparenchymal Renal Artery Pseudoaneurysm and Arteriovenous Fistula on a Solitary Kidney Occurring 38 Years after Blunt Trauma Mon, 13 Mar 2017 00:00:00 +0000 Pseudoaneurysm and arteriovenous fistulae of the renal artery are rare complications of kidney trauma. They commonly result from open traumas and occur within days after the injury. Common symptoms include acute haematuria, pain, or hypertension. We report the case of a fifty-three-year-old man presenting with symptomatic complex chronic high flow kidney arteriovenous fistula with interposition of a pseudoaneurysmal pouch and arterial aneurysmal dilatation in a solitary left kidney 38 years after a blunt trauma. Those conditions were successfully treated by endovascular embolization followed by regular radiologic, biological, and clinical follow-up. To the best of our knowledge, few similar cases were reported more than 20 years after trauma. However, no case combining an arteriovenous fistula and a pseudoaneurysm revealing as late as 38 years after trauma was found. In addition, management of those conditions on a solitary kidney and outcomes has not been described. We believe that our case depicts the clinical presentation and management of this rare entity that should not be unrecognized due to its potential lethal implications. Daniel Benamran, Benedicte de Clippele, Frank Hammer, and Bertrand Tombal Copyright © 2017 Daniel Benamran et al. All rights reserved. Prostate Cancer Presenting with Parietal Bone Metastasis Thu, 09 Mar 2017 07:05:01 +0000 Bone metastases from prostate cancer are very common. They are usually located on the axial skeleton. However, cranial bone metastases especially to the parietal bone are rare. We report a case of metastatic prostate cancer presenting with left parietal bone metastasis in a patient with no urological symptoms or signs. We should consider prostate cancer in any man above 60 years presenting unusual bone lesions. Brahima Kirakoya, Abdoul Karim Pare, Babagana Mustapha Abubakar, and Moussa Kabore Copyright © 2017 Brahima Kirakoya et al. All rights reserved.