An Adrift and Homeless Cyst within the Peritoneal Cavity

Introduction. Echinococcosis is a zoonotic infection caused by Echinococcus species. Iran is endemic for Echinococcus granulosus. Here, we present a case of hydatidosis in an 85-year-old man, presented with acute, dull, constant, and generalized abdominal pain. A computed tomography scan (CT scan) showed an intact hydatid cyst on the bladder dome and several hydatid cysts in the liver. Open surgery revealed a cyst with hepatic origin, confirmed with histopathological studies. Conclusion. Although a primary abdominal hydatid cyst is very rare, it can be transferred to the abdominal cavity without any rupture as secondary ones. In this case, rupture of the liver wall was the reason for this transfer. As a result, there should be a suspicion of hydatidosis in a patient with a similar presentation.

Non-functional urinary bladder paraganglioma with negative Ga-DOTA-NOC PET/CT uptake

Background Paraganglioma of the urinary bladder is a very rare benign tumor that constitutes less than 0.5% of all bladder tumors. It can be functional and non-functional. Functional tumors present with symptoms of catecholamine excess, and non-functional tumors usually remain asymptomatic. Case presentation Here, we present a case of non-functional urinary bladder paraganglioma in a 36-year-old female who presented to us with a history of intermittent hematuria. The routine hematological and biochemical parameters were within normal limits. Diagnostic computed tomography (CT) revealed a hypervascular lesion in the urinary bladder dome with no significant uptake in gallium-68-labelled-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid peptides-NaI3-octreotide positron emission tomography (DOTA-NOC PET/CT). Histopathology and immunohistochemistry confirmed the diagnosis of paraganglioma. Conclusion We present this case because of the rare location of paraganglioma in the urinary bladder and being non-functional with low/absent somatostatin receptor expression.

Robotic Partial Cystectomy for Urachal Carcinoma: A Case Report and Review of the Literature

Urachal carcinoma is a very rare tumor, commonly found in the urachal remnant connecting the bladder dome to the umbilicus. Diagnosis is often challenging due to the location of the tumor and its late presentation. We hereby report the case of a 49-year-old female where the diagnosis of urachal carcinoma was made and a robotic partial cystectomy associated with en bloc resection of the umbilicus was performed. We aim to present the clinical aspects, presentation, and diagnosis of this rare entity along with a review of the literature.

An Unusual Case of Meckel Diverticulitis Misdiagnosed as an Infected Urachal Cyst

Introduction: Meckel’s diverticulum (MD), a remnant of the omphaloenteric duct, is among the most frequent intestinal malformations. Another embryonic vestige is the urachus, which obliterates, becoming the median umbilical ligament; the failure of this process can lead to a urachal cyst formation. We present a case of Meckel diverticulitis misdiagnosed as an infected urachal cyst. Presentation of case: A 16-year-old girl presented with hypogastric pain, fever and vomiting. She had undergone an appendectomy 6 years prior and no digestive malformation had been documented. In the last 2 years, she had 3 events of urinary tract infections with Escherichia coli, and anabdominal ultrasound discovered a 28/21 mm hypoechogenic preperitoneal round tumor, anterosuperior to the bladder. We established the diagnosis of an infected urachal cyst, confirmed later by magnetic resonance imaging. Intraoperative, we found MD with necrotic diverticulitis attached to the bladder dome. Discussions: Meckel’s diverticulum and urachal cyst (UC) are embryonic remnants. Both conditions are usually asymptomatic, being incidentally discovered during imaging or surgery performed for other abdominal pathology. Imaging diagnosis is accurate for UC, but for MD they are low sensitivity and specificity. For UC treatment, there is a tendency to follow an algorithm related to age and symptoms, but there is no general consensus on whether to perform a routine resection of incidentally discovered MD. Conclusion: Preoperatory diagnosis of MD represents a challenge. We want to emphasize the necessity of a thorough inspection of the small bowel during all abdominal surgical interventions and MD surgical excision regardless of its macroscopic appearance. These two actions seem to be the best prophylaxis measures for MD complications and consequently to avoid emergency surgery, in which case more extensive surgical procedures on an unstable patient may be needed.

Inflammatory Myofibroblastic Tumor of the Urinary Bladder with Atypical Clinical and Pathological Features: a Case Report

Background: The inflammatory myofibroblastic tumor (IMT) of urinary bladder is very rare, this case and often misdiagnosed as bladder cancer. We report a patient with atypical clinical features with dysuria and lower abdominal pain. Case presentation: A 32-year-old man presented with dysuria and lower abdominal pain. Computed tomography (CT) demonstrated that a solitary non-papillary tumor was located at the wall of the bladder dome. Partial cystectomy was successfully managed. Immunohistochemically, positivity of the tumor cells for anaplastic lymphoma kinase (ALK), Actin (SM), vimentin, cytokine (CK), epithelial membrane antigen (EMA) and Ki-67. Based on the the above clinical features、histopathology and immunohistochemical, the tumor was definitively diagnosed as bladder’s IMT. After 24 months, there was no signs of recurrence and metastasis with CT and cystoscopy.Conclusion: A rare case of inflammatory myofibroblastic tumor of urinary bladder after partial cystectomy was reported. It is essential for urologists and scientists to entirely understand the characteristics of the inflammatory myofibroblastic tumor and make a better clinical guideline, to avoid over treatments.

The urachus revisited: multimodal imaging of benign & malignant urachal pathology

The urachus is a fibrous tube extending from the umbilicus to the anterosuperior bladder dome that usually obliterates at week 12 of gestation, becoming the median umbilical ligament. Urachal pathology occurs when there is incomplete obliteration of this channel during foetal development, resulting in the formation of a urachal cyst, patent urachus, urachal sinus or urachal diverticulum. Patients with persistent urachal remnants may be asymptomatic or present with lower abdominal or urinary tract symptoms and can develop complications. The purpose of this review is to describe imaging features of urachal remnant pathology and potential benign and malignant complications on ultrasound, CT, positron emission tomography CT and MRI.

Optimized Measurement Parameters of Sensory Evoked Cortical Potentials to Assess Human Bladder Afferents - A Randomized Study

Overactive bladder and voiding dysfunction are highly prevalent and often associated with malfunction of the bladder afferent pathways. Appropriate diagnostic tools for an objective assessment of afferent nerve function of the human bladder are currently missing. One promising possibility is the assessment of sensory evoked potentials (SEP) during repetitive electrical bladder stimulation, which proved feasible in healthy subjects. For an implementation into clinical practice, however, further refinements for efficient and reliable data acquisition are crucial. The aim of this randomized study was to find the optimal measurement settings regarding stimulation frequency, repetition number, and data acquisition. Forty healthy subjects underwent two visits of SEP (Cz-Fz) assessments using repetitive (500 stimuli) electrical stimulation of 0.5 Hz, 1.1 Hz, and 1.6 Hz and pulse width of 1 ms at the bladder dome or trigone. SEP analyses revealed higher amplitudes and better signal-to-noise ratio (SNR) with lower stimulation frequencies, while latencies remained unchanged. Decreasing amplitudes and SNR were observed with continuing stimulation accompanied by decreasing responder rate (RR). When applying stimuli at a frequency of 0.5 Hz, averaging across 200 stimuli revealed optimal reliability with best SNR, RR and sufficiently high amplitudes. This constitutes an optimal compromise between the duration of the assessment and SEP peak-to-peak amplitudes.