John Samuel Banerji

Multicentric small cell neuroendocrine neoplasm of the renal pelvis and ureter with concomitant focal high-grade urothelial carcinoma of the ureter: A case report

Malignant small cell neuroendocrine tumors of the pelvi-calyceal system are rare, and even more uncommon is their occurrence with concomitant transitional cell carcinoma, in the same renal unit. We present such a case for its unique presentation.

Cutaneous Fusarium infection in a renal transplant recipient: a case report

IntroductionFungal infections in the immunocompromised host are fairly common. Of the mycoses, Fusarium species are an emerging threat. Fusarium infections have been reported in solid organ transplants, with three reports of the infection in patients who had received renal transplants. To the best of our knowledge, this is the first case of an isolated cutaneous lesion as the only form of infection.Case presentationWe report the case of a 45-year-old South Indian man who presented with localized cutaneous Fusarium infection following a renal transplant.ConclusionIn an immunocompromised patient, even an innocuous lesion needs to be addressed with the initiation of prompt treatment.

Extramedullary hematopoiesis in the adrenal: Case report and review of literature

Extramedullary haematopoiesis (EMH) is common in the spleen, liver and lymph nodes, or in para osseus sites. EMH in the adrenal is rare, with fewer than 10 cases reported. We report the case of a 40-year-old male who underwent laparoscopic adrenalectomy for an incidentally detected adrenal mass. The histology showed extramedullary hematopoesis. In patients with a known history of haemolytic anaemia, an enlarged adrenal gland in an asymptomatic individual could represent extramedullary haematopoesis. A confirmatory biopsy would be all that is necessary to avoid adrenalectomy.

Fibroepithelial polyp of the prepuce: A rare complication of long-term condom catheter usage.

External urinary drainage devices are in wide clinical uses. There are only a few reports of complications from improper use of condom catheters. We present a case of fibroepithelial polyp of the penis, due to long-term usage of condom catheter. The lesion affected the ventral aspect of the penis. He was successfully treated with wide local excision. The histopathological diagnosis was a fibroepithelial polyp.

Early urinary diversion with ileal conduit and vesicovaginostomy in the treatment of radiation cystitis due to carcinoma cervix: a study from a tertiary care hospital in South India

To study the magnitude of radiation cystitis following radiation therapy for carcinoma cervix, and propose an algorithm to decide on early diversion, with or without vesicovaginostomy.

Total ureterectomy and ileal ureteric replacement for TCC ureter in a solitary kidney

Traditional treatment of upper tract transitional cell carcinoma (TCC) is nephroureterectomy with a bladder cuff. This is in keeping with the nature of the disease, in that TCC is a panurothelial disease. However, there are a few rare occasions when this would mean making a subject anephric, as in a TCC in a solitary kidney or bilateral synchronous/metachronous disease. We present a case of a patient with a dysplastic, poorly functioning left kidney and with a TCC of the ureter on the right side.

Spontaneous perinephric hemorrhage (Wunderlich syndrome) secondary to polyarteritis nodosa: Computed tomography and angiographic findings

We report the case of a young man who presented with spontaneous left perinephric hematoma and per-rectal bleeding. Evaluation revealed renal and superior mesenteric arterial aneurysms secondary to polyarteritis nodosa (PAN). Computed tomography and angiographic findings are presented. The aetiology of spontaneous perinephric hemorrhage along with relevant features of PAN are discussed.

Renal cell carcinoma in acquired renal cystic disease following renal transplantation.

A 50-year-old gentleman underwent renal transplantation 19 years ago. He was on triple immunosupression with cyclosporine, azathioprine and prednisolone initially, and later, on azathioprine and cyclosporine alone. The native kidney disease was unknown. He had been on maintenance haemodialysis for 11 months prior to transplant. Native kidney ultrasonography (USG) prior to transplantation revealed bilateral contracted kidneys, with grade 3 renal parenchymal changes (ultrasound grading: kidney hyperechoic, with no corticomedullary differentiation) and no cysts. He presented 19 years later to the Urology Department with progressive abdominal distension for 6 months and multiple episodes of gross painless haematuria. General clinical examination was non-contributory. The abdomen was distended and was occupied by large cystic masses in both flanks, which extended till the iliac fossae. His haematocrit was 36.7%; serum creatinine was 114.92 mmol/L. Urine microscopical examination revealed multiple red blood cells. Urine protein (24 h) was 195 mg/day. His liver function tests were normal. Urine cytology was not performed due to the gross haematuria present at that time, which would cloud its interpretation. Axial and coronal T2-weighted magnetic resonance imaging with gadolinium showed large multiloculated cystic masses in the region of both kidneys, with solid areas on the left (Figs 1,2). The graft kidney in the right iliac fossa appeared normal. He underwent bilateral native kidney nephrectomies. Histopathological examination revealed bilateral acquired renal cystic disease (ARCD) with a focus of clear cell renal cell carcinoma (RCC) on the left side. At 1-year follow-up post-native nephrectomies, he had no evidence of disease. Dunnill et al. first described the association of ARCD and RCC with haemodialysis. Previous studies suggest that the incidence of RCC among dialysis patients is three to six times greater than the general population. There are reports of up to a 50-fold increased risk of RCC in ARCD compared to the general population. ARCD-associated RCC is seen predominantly in men, occurs approximately 20 years earlier than in the general population, and is frequently bilateral (9%) and multicentric (50%). ARCD-associated RCC is generally asymptomatic (86%), but may be associated with bleeding, fever and flank pain or rarely with hypoglycaemia, hypercalcaemia or metastases at presentation. ARCD-associated RCC accounts for approximately 2% of deaths in renal transplant patients. Due to the fact that ARCD after renal transplantation seems to be less frequent (2–3%) than during dialysis treatment (30–90%), renal transplantation may inhibit RCC. Following renal transplantation, there is a possibility of regression of established ARCD. This would suggest that there might be a protective effect of transplantation against tumours in the native kidneys.

Brown Tumor and Staghorn Calculi in Primary Hyperparathyroidism

A case of primary hyperparathyroidism with bilateral renal staghorn calculi and brown tumor right thumb is reported in these images, along with the appropriate sequential management. Percutaneous nephrolithotomy (PCNL)was done after management of hypercalcemia and after parathyroidectomy. This case highlights the need for urologists and general practitioners to have a holistic approach in patient management.

Veiled Right Kidney Sign in Retroperitoneal Duodenal Perforation After Endoscopic Retrograde Cholangiopancreatography

Retropneumoperitoneum due to duodenal perforation after endoscopic retrograde cholangiopancreatography is rare. Recognizing the presence of free air, which outlines the right kidney, is essential for its early diagnosis and appropriate management.