Inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>It has been reported that immunoglobulin G4-related systemic disease can spread to nearly every organ, and often presents as an inflammatory mass or masses at those sites. In the kidney, this disease is often diagnosed after a radical or partial nephrectomy following the discovery of an inflammatory mass which is often suspected to be a malignant tumor. Here, we present a rare case of inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease, which were diagnosed by computed tomography-guided biopsies.</p> <p>Case presentation</p> <p>A 54-year-old Japanese man was referred to our hospital with suspected bilateral renal cancer, multiple lung metastases and autoimmune pancreatitis. His serum immunoglobulin G4 level was high. We used computed tomography-guided biopsies and histopathological examinations of the biopsied specimens to diagnose the tumors as immunoglobulin G4-related bilateral renal and lung inflammatory pseudotumors. Our patient was treated with oral prednisolone, and after one month of treatment, contrast-enhanced computed tomography demonstrated a general improvement, as noted by a reduction in size of the masses.</p> <p>Conclusion</p> <p>Renal masses that are formed due to immunoglobulin G4-related disease require comprehensive diagnosis to prevent unnecessary surgical resections from being performed. Further consideration should be paid to immunoglobulin G4-related diseases in the future.</p

Lung metastasis of ta bladder cancer: a case report and literature review.

A 66-year-old man with a history of multiple transurethral resections for recurrent bladder tumors, staged as Ta according to the International Union Against Cancer staging guidelines, presented with a complaint of dry cough. A round nodule with a diameter of 7.5 cm was detected in the lung by chest computed tomography, and a video-assisted thoracoscopic lobectomy was performed. Pulmonary metastasis of recurrent bladder cancer was diagnosed by immunohistochemistry staining for the urothelium-specific protein uroplakin Ia. Subsequently, 2 cycles of systemic chemotherapy were administered. Two and a half years after treatment, no recurrence of pulmonary lesions has been detected. A combination of complete resection of pulmonary lesions and systemic chemotherapy may result in a good prognosis for patients with non-muscle-invasive bladder cancer

Combination of deep learning and ensemble machine learning using intraoperative video images strongly predicts recovery of urinary continence after robot‐assisted radical prostatectomy

Abstract Background We recently reported the importance of deep learning (DL) of pelvic magnetic resonance imaging in predicting the degree of urinary incontinence (UI) following robot‐assisted radical prostatectomy (RARP). However, our results were limited because the prediction accuracy was approximately 70%. Aim To develop a more precise prediction model that can inform patients about UI recovery post‐RARP surgery using a DL model based on intraoperative video images. Methods and Results The study cohort comprised of 101 patients with localized prostate cancer undergoing RARP. Three snapshots from intraoperative video recordings showing the pelvic cavity (prior to bladder neck incision, immediately following prostate removal, and after vesicourethral anastomosis) were evaluated, including pre‐ and intraoperative parameters. We evaluated the DL model plus simple or ensemble machine learning (ML), and the area under the receiver operating characteristic curve (AUC) was analyzed through sensitivity and specificity. Of 101, 64 and 37 patients demonstrated “early continence (using 0 or 1 safety pad at 3 months post‐RARP)” and “late continence (others),” respectively, at 3 months postoperatively. The combination of DL and simple ML using intraoperative video snapshots with clinicopathological parameters had a notably high performance (AUC, 0.683–0.749) to predict early recovery from UI after surgery. Furthermore, combining DL with ensemble artificial neural network using intraoperative video snapshots had the highest performance (AUC, 0.882; sensitivity, 92.2%; specificity, 78.4%; overall accuracy, 85.3%) to predict early recovery from post‐RARP incontinence, with similar results by internal validation. The addition of clinicopathological parameters showed no additive effects for each analysis using DL, EL and simple ML. Conclusion Our findings suggest that the DL algorithm with intraoperative video imaging is a reliable method for informing patients about the severity of their recovery from UI after RARP, although it is not clear if our methods are reproducible for predicting long‐term UI and pad‐free continence

原発性尿管腺癌の1例: Primary adenocarcinoma of the ureter

The patient was a 66-year-old man who presented with asymptomatic hematuria. Left hydronephrosis was observed on drip infusion pyelography (DIP), and retrograde pyelography (RP) was performed because the image of the ureter was poor. On RP, stenosis was observed in the left ureter at the L5 vertebral level. The same findings were obtained by antegrade pyelography in combination with nephrostomy. A white-colored tumor was observed at the site ofstenosis by flexible pyeloscopy, and biopsy was performed. Adenocarcinoma was identified by histopathological examination. Total left renal nephroureterectomy was performed after its diagnosis as primary adenocarcinoma of the ureter (T2, NO, MO). To our knowledge, this is the 12th case reported in Japan.患者は66才, 男性。無症候性肉眼的血尿を主訴に受診, DIPでは左水腎症を認めたが尿管の抽出が不良であったため, retrograde pyelography(RP)を施行した。RPでは, 第5腰椎レベルで左尿管の狭窄を認め, 腎瘻増設を兼ねて行ったantegrade pyelographyではRPと同様に, 第5腰椎レベルで狭窄を示していた。同時に施行した軟性腎盂鏡では狭窄部位に一致して白色の腫瘍を認めたため, 生検を施行した。病理組織検査の結果はadenocarcinomaであった。原発性尿管腺癌(T2, N0, M0)の診断にて左腎尿管全摘除術を施行した。本症例はわれわれが調べえた限りでは本邦12例目であった。(著者抄録