N. Rebai

Primary renal angiosarcoma: Case report and literature review

Angiosarcoma is a rare malignant tumour occurring in less than 2% of soft tissue sarcomas. Angiosarcoma involving the kidney usually represents metastasis from skin or visceral primary lesions, while angiosarcoma primarily occurring in the kidney is a very rare neoplasm. We report a case of angiosarcoma of the right kidney in a 59-year-old male. The computed tomography scan showed a solid tumour with a low increased density after administration of contrast medium. Histological examination of the piece of nephrectomy confirmed the diagnosis.

Cystic lymphangioma of the kidney: Diagnosis and management

INTRODUCTION Cystic lymphangioma is a rare benign vascular tumor that may arise in various sites, revealed at any age. Abdominal locations represent less than 10% of the cases preferentially involving the mesentery. We report a case of primary lymphangioma arising from the kidney. PRESENTATION OF CASE A 50-year-old woman was admitted for severe left lumbar pain. Abdominal ultrasonography and computed tomography revealed a 6×10 cm multiloculated cystic mass with hydronephrosis, extending along the left renal hilum. Surgical exploration revealed a retroperitoneal cystic tumor. Anatomopathologic examination concluded it to be a cystic lymphangioma. DISCUSSION The cystic lymphangioma is a benign malformative tumor of the lymphatic system. Surgery is the best curative treatment with complete excision, the prognosis is excellent. CONCLUSION Primary renal lymphangioma is exceedingly rare. Medical imaging has certain limits for the diagnosis which required histological confirmation. The treatment of choice is surgical.

Intérêt de l'abaissement du testicule non descendu chez l'adulte. Etude à propos de 259 patients

ResumeNous avons mené une étude rétrospective portant sur 259 patients âgés de plus de 18 ans, présentant des testicules non descendus (TND). L’objectif de cette étude est d’évaluer les résultats de l’abaissement du TND chez l’adulte du point de vue de l’amélioration de la fertilité et de la prévention de la dégénérescence maligne.L’âge moyen des patients était de 24 ans. La maladie a été découverte dans la majorité des cas lors d’un examen médical systématique (76,8% des cas) ou lors d’un bilan d’infertilité (12,7%). Le TND était unilatéral dans 80,7% des cas et bilatéral dans 19,3% des cas. Parmi 37 couples notifiés dans notre série, seuls 4 avaient déjà eu des enfants (10,8%). Le spermogramme, pratiqué chez les 33 patients consultant pour infertilité, était altéré dans tous les cas. Tous les patients ont eu un abaissement du testicule, sauf 36 patients (13,9%) chez qui on a été amené à sacrifier le testicule car il était atrophique (27 cas), tumoral (8 cas) ou nécrosé suite à une torsion (1 cas). L’étude histologique du TND a été pratiquée chez 53 patients, montrant des altérations histologiques dans tous les cas.L’évolution tardive a été marquée par la survenue d’une atrophie testiculaire après l’orchidopexie chez 6 patients (2,7% des cas), par une dégénérescence maligne opérée secondairement chez 3 patients (1,3%), et par une amélioration des paramètres spermatiques chez 16 patients, soit 48,5% des patients consultant pour infertilité. De plus, 4 patients ont eu des enfants après traitement.A notre sens, l’abaissement du TND chez l’adulte pourrait entraîner une amélioration de la spermatogenèse et de la fertilité. Il pourrait aussi s’associer à une baisse relative de l’incidence de la dégénérescence maligne. Mais surtout, il permet une surveillance clinique plus aisée à la recherche d’une éventuelle cancérisation.AbstractIntroductionUndescended testis is a frequent congenital disease, more often diagnosed and treated during childhood. However, due to ignorance or negligence, this disease can be seen even after puberty, when it raises a therapeutic problem: is orchidopexy still useful?This study was designed to evaluate the outcome of orchidopexy at adulthood in terms of improvement of fertility and prevention of malignant degeneration.Material and methodsRetrospective study performed over a 23-year period (1983–2005). We have found 259 patients with undescended testis diagnosed and treated after the age of 18 years.ResultsThe mean age of patients was 24 years (range: 18–63). In the majority of cases, undescended testis was diagnosed at a systemic medical examination in 199 patients (77% of cases), and in a context of infertility in 33 patients, testicular malignancy in 8 patients, testicular torsion in 2 patients and, in 17 cases, undescended testis had been known since birth but was neglected by the parents.Undescended testis was unilateral in 209 cases and bilateral in 50 cases. Out of 37 couples, only 4 gave birth to children (10.8% paternity rate). Sperm analysis was abnormal in all infertile patients. All patients were treated by orchidopexy, except for 36 patients in whom orchidectomy was performed due to testicular atrophy (27 cases), malignancy (8 cases) or necrosis (1 case). Biopsy of the intrascrotal testis was performed in 3 patients with unilateral cryptorchidism. Histological examination was normal in two cases and abnormal in one case. The long-term outcome was characterized by:1.Testicular atrophy in 6 patients (2.7% of cases).2.Progression to malignancy in 3 patients (1.3% of cases).3.Improvement of sperm parameters in 16 of 33 infertile patients (48.5%); 4 patients fathered children after treatment.ConclusionOrchidopexy at adulthood can lead to improvement of infertility. It can also decrease the incidence of malignancy and facilitate clinical examination looking for possible malignancy. However, the best treatment remains preventive, based on early diagnosis and orchidopexy.

Testicular torsion in older men: It must always be considered

Scrotal pain is a common presenting symptom among patients referred to emergency room. True urological emergency, such as testicular torsion, must be considered. Testicular torsion is exceedingly rare in the geriatric population, in whom infectious or even malignant etiologies are more common. There are reports of men in the sixth and seventh decades of life with torsion. The testicular salvage rate in adults with torsion is poor, because of the lack of recognition of this entity by physicians. We present the case of a 66-year-old man who presented to the emergency department with scrotal Pain and was eventually found to have testicular torsion after scrotal imaging and surgical exploration. This case highlights the need to consider torsion in the differential diagnosis of any man presenting with scrotal pain, regardless of his age.

Laparoscopic approach for retrocaval ureter: How to decrease surgical time?

A retrocaval ureter or circumcaval ureter is the result of an abnormality from the posterior cardinal vein persisting as a segment of the infrarenal vena cava (VC) during development. Open ureteroureterostomy has been the gold standard for many years. However, with the growth of minimally invasive surgery, which reduced postoperative pain, promotes less intraoperative bleeding with earlier return to daily activities and has excellent cosmetic results, laparoscopic procedures have almost replaced open Surgery. But the main limiting factor is increased the surgical time. Through this clinical case and literature review, we try to provide tips to overcome this problem.