Emphysematous cystitis and emphysematous pyelitis: A clinically misleading association

We present a rare case of emphysematous cystitis associated with an emphysematous pyelonephritis in a diabetic Arab man who was admitted ina confusional state. A 60-year-old man was admitted to the emergency department with confusion and hypogastric mass. The Clinical examinationfound comatose patient with a mass in the tympanic hypogastric percussion. The pelvic computed tomography (CT) demonstrated intramural gas in the urinarytract, which suggested a diagnosis of emphysematous cystitis and emphysematous pyelitis. The treatment was based on an antibiotics  associated with a bladder drainage and diabetes stabilization. The evolution was uneventful. Every diabetic patient with a urinary tract infection who seems to be severely ill should have an abdominal X-ray as a minimal screening tool to detect emphysematous complications. The rarity and the association with an emphysematous pyelitis, which is rarely reported in the literature, are two remarkable characteristics described in this case report

Primary malignant melanoma of prostate

Primary genitourinary melanoma accounts for less than one per cent of all cases of melanoma. Most cases attributed to the prostate actually originate from the prostatic urethra. Due to its infrequency, primary malignant melanoma of the genitourinary tract presents a difficult diagnostic and management challenge. We report a case of primary malignant melanoma of the prostate found during transurethral resection of the prostate

Primary malignant melanoma of prostate

Primary genitourinary melanoma accounts for less than one per cent of all cases of melanoma. Most cases attributed to the prostate actually originate from the prostatic urethra. Due to its infrequency, primary malignant melanoma of the genitourinary tract presents a difficult diagnostic and management challenge. We report a case of primary malignant melanoma of the prostate found during transurethral resection of the prostate

Existe-t-il une corrélation entre la taille tumorale au scanner et les caractéristiques anatomopathologiques du cancer du rein?

RésuméIntroductionLe stade tumoral, le grade nucléaire et le type histologique sont considérés comme les facteurs pronostiques les plus importants dans le carcinome à cellules rénales de sorte qu’il est devenu de plus en plus important d’obtenir les caractéristiques histopathologiques de la tumeur avant l’acte chirurgical.ObjectifL’intérêt de notre étude est de savoir jusqu’à quel point on peut se fier au scanner pour préciser la taille tumorale et l’intérêt de cette dernière pour prédire les caractéristiques anatomopathologiques du cancer du rein.Patients et méthodesNous avons réalisé une étude rétrospective au service hospitalier d’urologie du CHU Hassan II de Fès durant la période 2010-2012 de 35 dossiers de malades atteints du cancer du rein et ayant bénéficié d’une néphrectomie totale élargie ou d’une néphrectomie partielle.RésultatsL’âge moyen de nos malades était 56ans avec prédominance masculine (sex-ratio de 1,9/1). L’analyse anatomopathologique a montré que le carcinome à cellules claires était le type histologique le plus fréquent.La TDM a sous-estimé la taille tumorale sans que ce ne soit significatif (p=0,368). Elle avait tendance à surestimer la taille tumorale de façon significative (p=0,012) pour les tumeurs de moins de 4cm. Dans les tumeurs de taille supérieure à 4cm, la TDM sous-estimait ou surestimait la taille tumorale sans facteur déterminant et sans être significative Notre étude a montré que tant que la taille des tumeurs augmente, il y avait une probabilité significativement plus importante que celles-ci soient des carcinomes à cellules claires (p<0,0001). Aussi, il y avait une relation significative entre la taille tumorale et le grade nucléaire; les plus grandes tumeurs avait un grade nucléaire élevé et étaient potentiellement plus agressives.ConclusionLa présente étude réaffirme la précision de la TDM pour prédire la taille des tumeurs rénales mesurée à l’anatomopathologie, d’établir le renal score afin de mieux orienter le choix thérapeutique et de prédire les caractéristiques anatomopathologique du carcinome à cellules rénales.AbstractIntroductionRenal cell carcinoma (RCC) may vary in prognosis according to staging, histological subtype, and Fuhrman grade. Hence, accurate evaluation of the renal masses before surgery is essential to ensure an appropriate case management.PurposeTo evaluate the value of CT-scan in providing relatively sufficient information about pathologic characteristics of a renal mass and to determine the degree of correlation between radiographic size and true gross pathologic size.Patients and methodsWe retrospectively reviewed the records of 35 patients who underwent radical or partial nephrectomy for RCC at the department of urology, University Hospital Hassan II, Fez, between 2012 and 2013. Preoperative imaging was performed using CT-scan.ResultsThe mean patient age was 56 years with a male ascendancy, that is a sex ratio of 1.9: 1. The most common histopathological type was the clear-cell Renal Cell Carcinoma. Our study shows that in most instances, imaging by CT insignificantly underestimates true gross pathologic size of RCC (p=0.368). For tumours less than 4cm, the CT-scan significantly overestimate the tumor size (p=0.012). Furthermore, for tumors greater than 4cm, it insignificantly underestimated or overestimated the tumor size without any determining factor. In addition, as tumor size increased, there was a significant increase in the incidence of clear cell renal cell carcinoma (p<0.0001). Large tumor size was significantly associated with histological grading and high Fuhrman grade.ConclusionThe value of CT scan as a preoperative imaging in RCC is considered to be good for predicting the size of renal tumors to establish renal score and providing pathologic characteristics to direct the planning of the surgical approach and strategy

Pseudotumoral tuberculous ureteritis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Tuberculosis is still endemic in Morocco and the urogenital form is common. This form is characterized by clinical polymorphism. However, the isolated ureteric form is very rare. The differential diagnosis might be raised in tumoral cases while undertaking surgical excision which is the realistic choice. Hence, we report an isolated ureteric tuberculosis case, and we discuss the clinical, imaging, diagnostic and therapeutical features.</p> <p>Case presentation</p> <p>A 30-year-old Moroccan man consulted us for left back pain associated with urinary frequency and a few macroscopic episodes of hematuria for the past six months. A computed tomography urography revealed a left hydronephrosis and hydroureter secondary to focal wall thickening of the left lumbar ureter. Hence, we had diagnosed a ureteral tumor. However, a clinical examination showed irritative voiding symptoms and epididymal disorders associated with prostate infection suggesting a Koch’s bacillus assessment of the patient’s urine of which the results proved strongly positive. The treatment consisted of establishing a double-J ureteric stent to drain the left kidney, followed by antituberculous antibiotics.</p> <p>Conclusion</p> <p>Urogenital tuberculosis is common in endemic countries, however isolated ureter affection is rare. It is important to consider a ureteral tuberculosis diagnosis whenever ureteral thickening is revealed in a patient living in a country in which tuberculosis is endemic.</p