Case Study in 2009

Although rare, life-threatening hemorrhage remains a challenging complication of transurethral resection of the prostate (TURP). In this Case Study, authors from Singapore present a 74-year-old man with benign prostatic hyperplasia who experienced post-TURP hemorrhage, complicated by TURP syndrome, which was ultimately successfully treated by bilateral selective arterial prostatic embolization.

A 32-year-old man, with a left-to-right crossed fused kidney containing a 25 mm stone, underwent laparoscopic nephrolithotomy for calculus removal. The authors provide a comprehensive description of the procedure, focusing on its role in patients with renal fusion anomalies where the stone burden is too large for extracorporeal shock wave lithotripsy.

Zakaria and colleagues describe the case of a previously healthy 29-year-old man with renal infarction. The nonspecific nature of his presenting symptoms caused a delay in diagnosis. The authors provide a comprehensive account of the presenting features, and of diagnostic tests that can distinguish renal infarction from more common conditions.

In this Case Study, El Madhoun and colleagues describe the diagnosis and management of a patient with bilateral renal hemorrhage caused by polyarteritis nodosa. The perirenal bleeding was at first attributed to trauma experienced 1 week before the initial presentation, but review of the case at a subsequent hospital admission identified the true cause of the bilateral hemorrhage.

Chung et al. describe the case of a 7-year-old girl diagnosed with complete avulsion of the left ureteropelvic junction 3 weeks after injury, and treated by creation of a ureteropelvic anastomosis with stent. The authors emphasize the necessity for delayed imaging to ensure the timely diagnosis of ureteral injuries in blunt trauma patients.

This Case Study discusses the management of a female neonate in whom a large pelvic mass had been detected 9 weeks before birth. She was diagnosed with botryoid rhabdomyosarcoma of the bladder. Tumor eradication was achieved with chemotherapy alone, and she remained free from recurrence during 24 months of follow-up.

The authors describe a 57-year-old man with paraneoplastic leukocytosis, caused by overexpression of granulocyte-colony stimulating factor from a suprarenal tumor with rhabdoid-like differentiation. This case presented several diagnostic and treatment challenges to the pathologists, surgeons, and oncologists involved, and illustrates the difficulties encountered when diagnosing and treating unusual malignancies.

In this Case Study, Sahai and colleagues report on a 15-year-old boy who sustained grade V renal trauma, with associated splenic injury and renal vein thrombosis. The authors use the case to illustrate that conservative management of grade V blunt renal trauma is possible in a hemodynamically stable patient.

Here, Ooi and co-workers present a 40-year-old man who developed acute-onset bilateral painless swelling of the scrotum, and was diagnosed with acute idiopathic scrotal edema. Although rare in adult males, this condition should be considered in the differential diagnosis of acute scrotal swellings, in order to avoid unnecessary surgery.

The authors present a 57-year-old woman with advanced renal cell carcinoma (RCC) and a tumor thrombus extending into the vena cava. She received neoadjuvant sunitinib, which shrank the tumor thrombus, and enabled laparoscopic radical nephrectomy to be performed. The case highlights the potential of targeted agents before surgery in RCC.

This Case Study describes a 48-year-old man who was referred to a specialist oncology center for management of presumed angiosarcoma. Further investigation revealed high-risk penile epithelioid hemangioendothelioma. This article highlights the spectrum of clinical behavior of this atypical epithelioid vascular tumor, and provides possible treatment options for low-risk and high-risk forms of this cancer.

In this Case Study, Henry and colleagues report on a 58-year-old man who was found to have a highly elevated serum PSA level, as a result of heterophilic antibody interference. The authors highlight that PSA test results should be interpreted in the context of a patient's clinical presentation to prevent potential overtreatment.

This article describes the case of a 17-year-old girl with tuberous sclerosis complex (TSC) and angiomyolipomas (AML), who presented with multiple bilateral renal masses—including a 6.0 cm mass—during routine follow-up. The case highlights the use of MRI for imaging, and nephron-sparing treatment for managing TSC-associated AML.

In this Case Study, Morris and Guimaraes present a 28-year-old man with left orchitis and an incidentally discovered right focal testicular mass. The authors suggest that, for a suspicious mass in the setting of contralateral orchitis, serum tumor markers and serial imaging might be preferred to urgent surgical intervention.

This article discusses the case of a 79-year-old woman with a history of chronic back pain and urinary urgency. Spinal imaging showed that she had spinal stenosis, and she was treated with an epidural steroid injection. Her back pain and urinary urgency improved immediately. This case demonstrates the potential for improving overactive bladder symptoms with a minimally invasive epidural steroid injection in patients with spinal stenosis.