1324 Open Partial Nephrectomy for Renal Cell Carcinoma

Open partial nephrectomy, or nephron-sparing surgery (NSS), is now considered as the standard for small renal tumors treatment. The oncologic efficacy and safety of NSS for the treatment of stage-T1a renal tumors have been repeatedly demonstrated to be equivalent to radical nephrectomy. A 66-year-old gentleman chronic smoker was incidentally found to have a small mid pole lesion in the left kidney on routine ultrasound scan, CT finding was 2x2 cm mid pole tumor, no involvement or metastasis, the patient given the option of partial nephrectomy. In surgery, the left kidney was explored, and the tumor mass was seen to occupy the mid pole. The mid pole branch of the renal artery was clamped after cooling the kidney with ice slush following 300cc of 20% mannitol infusion. In-situ nephron-sparing left nephrectomy was done with a margin of 1cm minor upper calyceal injury repaired. The patient was discharged five days postoperative. Gross examination of the specimen revealed a wedge biopsy of the mid pole with attached perinephric fat with swelling part at the outer surface, pushing the capsule. Microscopic sections show a well-defined tumor mass in the renal parenchyma, surrounded by a fibrous capsule, composed of a multilocular cystic area lined by malignant cells. NSS initially was reserved for patients with solitary kidneys, tumors, and those with significant comorbidities predisposing to future renal failure; indications have expanded recently to allow elective partial nephrectomy in the setting of a normal contralateral kidney.

Giant cell tumors of the mobile spine with invasion of adjacent vertebrae: an unusual imaging finding

Background Giant cell tumors of the mobile spine invasion of the adjacent vertebrae are an ignored imaging finding. Methods Nine patients with giant cell tumors of the mobile spine with invasion of the adjacent vertebrae confirmed by pathology were enrolled. Eight patients had pure giant cell tumors (GCTs), while one patient also had an aneurysmal bone cyst. All patients underwent conventional computed tomography, three-dimensional reconstruction, and conventional magnetic resonance imaging, while seven patients also underwent post-contrast magnetic resonance imaging. Results All patients showed GCTs of the mobile spine that arose from the vertebral body and extended to the vertebral arch. The tumors showed soft-tissue attenuation with no evidence of a mineralized matrix. Pathological fracture was seen in five patients. The margin of the original tumor showed partial sclerosis in four patients and involved an adjacent vertebral body with a sclerotic rim in two patients. The tumors showed a homogeneous and similar signal intensity to the normal spinal cord on T1WI (T1-weighted image) in five patients. The cystic area of the tumors was hyperintense on T2WI in the remaining four patients, while one patient showed hemorrhage that was hyperintense on T1WI. The solid components of the GCTs show marked enhancement in all cases, while the cystic area of the tumors was observed without enhancement on contrast-enhanced images in four patients. Bone destruction of the adjacent vertebral body showed a homogeneous signal on T1WI and T2WI and marked enhancement on contrast-enhanced images. Conclusions Giant cell tumors of the mobile spine with invasion into adjacent vertebrae are an unusual imaging finding. Radiologists should be familiar with this imaging characteristic.

Effect of Femoral Head Necrosis Cystic Area on Femoral Head Collapse and Stress Distribution in Femoral Head

Objective:Osteonecrosis of the femoral head (ONFH) is a common and difficult disease. The effect of cystic area on femoral head mechanics in patients with ONFH is unknown. The purpose of this study was to investigate the effect of cystic areas of osteonecrosis of the femoral head on stress distribution and disease progression in the femoral head.Methods:A total of 85 patients (106 hips) diagnosed with ARCO stage II non-traumatic and non-surgical treatment of ONFH from February 2017 to November 2018 were retrospectively analyzed. All patients were followed up for an average of more than 2 years. According to whether the femoral head collapsed during the follow-up, they were divided into collapse group and non-collapse group. The age, gender, etiology, height, weight, BMI, JIC classification, presence of cystic areas and diameter of cystic areas were compared between the two groups. In addition, five spherical cystic areas of different diameters of 0, 5, 10, 15, and 20 mm were constructed to simulate the hip joint load of a person during standing by finite element methods, and the maximum stress, mean stress, and maximum stress values in the necrotic area of the femoral head without cystic areas and in the area 1 mm around the cystic areas with different diameters were observed and analyzed.Results:All 85 patients (106 hips) completed the follow-up, with an average age of 37.4 ± 8.12 years. The mean follow-up time was 2.8 ± 0.6 years. Forty-five patients (57 hips) with ONFH who had femoral head collapse were included in the collapse group, and the remaining 40 patients (49 hips) were included in the non-collapse group. There was significant difference in JIC classification between the two groups (P < 0.05), most of which were C2 type in the collapse group and B type in the non-collapse group. There was a difference between the two groups in whether cystic areas appeared in the femoral head, with 49.1% in the collapse group showing cystic areas, which was significantly higher than that in the non-collapse group (18.4%) (P < 0.05). In addition, the diameter of the cystic areas was significantly larger in the collapsed group than in the non-collapsed group (P < 0.05). The maximum von Mises stress value and mean von Mises stress value around the cortical bone, necrotic area and around the cystic area of the femoral head increased with the increase of the cystic diameter. Furthermore, linear regression analysis showed a linear positive correlation between the maximum stress, mean stress in the necrotic area in the femoral head, and the maximum stress value in the 1 mm area around the cystic area and the diameter of the cystic area.Conclusion:The maximum stress and average stress of necrotic area can be increased in cystic area, and the increase of stress in cystic area is more obvious. Stress concentration areas can be generated around the cystic areas. The presence and increased diameter of the cystic areas accelerates the collapse of the ONFH femoral head.

Effect of Femoral Head Necrosis Cystic Area on Femoral Head Collapse and Stress Distribution in Femoral Head

Objective: Osteonecrosis of the femoral head (ONFH) is a common and difficult disease. The effect of cystic area on femoral head mechanics in patients with ONFH is unknown. The purpose of this study was to investigate the effect of cystic areas of osteonecrosis of the femoral head on stress distribution and disease progression in the femoral head.Methods: A total of 85 patients (106 hips) diagnosed with ARCO stage II non-traumatic and non-surgical treatment of ONFH from February 2017 to November 2018 were retrospectively analyzed. All patients were followed up for an average of more than 2 years. According to whether the femoral head collapsed during the follow-up, they were divided into collapse group and non-collapse group. The age, gender, etiology, height, weight, BMI, JIC classification, presence of cystic areas and diameter of cystic areas were compared between the two groups. In addition, five spherical cystic areas of different diameters of 0, 5, 10, 15, and 20 mm were constructed to simulate the hip joint load of a person during standing by finite element methods, and the maximum stress, mean stress, and maximum stress values in the necrotic area of the femoral head without cystic areas and in the area 1 mm around the cystic areas with different diameters were observed and analyzed.Results: All 85 patients (106 hips) completed the follow-up, with an average age of 37.4 ± 8.12 years. The mean follow-up time was 2.8 ± 0.6 years. Forty-five patients (57 hips) with ONFH who had femoral head collapse were included in the collapse group, and the remaining 40 patients (49 hips) were included in the non-collapse group. There was significant difference in JIC classification between the two groups (P < 0.05), most of which were C2 type in the collapse group and B type in the non-collapse group. There was a difference between the two groups in whether cystic areas appeared in the femoral head, with 49.1% in the collapse group showing cystic areas, which was significantly higher than that in the non-collapse group (18.4%) (P < 0.05). In addition, the diameter of the cystic areas was significantly larger in the collapsed group than in the non-collapsed group (P < 0.05). The maximum von Mises stress value and mean von Mises stress value around the cortical bone, necrotic area and around the cystic area of the femoral head increased with the increase of the cystic diameter. Furthermore, linear regression analysis showed a linear positive correlation between the maximum stress, mean stress in the necrotic area in the femoral head, and the maximum stress value in the 1 mm area around the cystic area and the diameter of the cystic area.Conclusion: The maximum stress and average stress of necrotic area can be increased in cystic area, and the increase of stress in cystic area is more obvious. Stress concentration areas can be generated around the cystic areas. The presence and increased diameter of the cystic areas accelerates the collapse of the ONFH femoral head.

Castleman Disease of the Kidney in Computed Tomography Urography

Background: Castleman disease (CD) of the kidney is extremely rare. In this study, we presented a case of CD of the left kidney and comprehensively described the findings of computed tomography urography. Case Presentation: The case involved unusual imaging characteristics of the focal central cystic area. Conclusion: The small and regular cyst-like structures and the hyperdense mass relative to the renal parenchyma in plain scans might help distinguish the CD of the kidney from other hypervascular tumors.

EQUINE UNILATERAL HETEROTOPIC POLYODONTIA: A CASE REPORT

Heterotopic polyodontia have been described in most domestic species and human. Known as a dentigerous cyst but appropriately called heterotopic polyiodontics, it rarely occurs in horses, however it is easily recognized as a congenital defect. The cysts usually associated with this condition contain part or all of dental structures. The heterotopic tooth or dental structure is usually adhered to the temporal bone and surrounded by a secretory membrane, with a accumulation of exudate and draining tract along the proximal pinna or directly over the cyst. This case report describes in a 2.5-year-old female quarter horse, weighing 430 kg, with a heterotopic polyodontia that contained two easily small’s identifiable dental structures, presented for evaluation of a chronic intermittent mucopurulent exudate discharge from the right sub-auricular region in the mastoid process of the temporal bone and a drainage tract near the right pinna. The diagnosis is established with clinical, radiographic, ultrasound and confirmed by histopathological examination of the structures removed. The cystic capsule was surgically removed, measuring approximately 3.0 x 2.3 cm in diameter, filled with mucopurulent exudate and containing two dental structures within 0.5 cm in diameter and 0.2 cm in diameter. Microscopic examination revealed a cystic area covered by stratified squamous epithelium with a lympho-histio-plasmatic cell infiltrate in the dermis, which was compatible with heterotopic polyodontia. Postoperatively, there were no neuromotor sequelae and wound healing evolved positively.

A Giant Adrenal Pseudocyst Presenting With Right Hypochondralgia and Cachexia: A Case Report

Adrenal cysts are rare clinical condition that can present as abdominal swelling and chronic abdominal pain with weight loss. A 26 year old girl presented to our hospital with a 3 years history of right sided abdominal swelling and cachexia. Ultrasound of the abdomen reaveled a cystic area measuring 20x18 cm below the liver. Computed tomography scan showed a large cystic homogenous mass measuring 20x18x18.5cm in the right hypochondrium with most likely origin from the right adrenal gland. IVU showed left sided kidney was absent and left sided crossed ectopia was present. Both kidney on right side was pushed downwards. limited work up for hormone done. Hypersecretion was negative.A laparotomy with right adrenalectomy was performed. Final pathology showed a benign adrenal endothelial cyst.post operative period was unevenful. Surgical resection appears a safe and reasonable management strategy in a patient with adrenal cyst. Bangladesh Journal of Urology, Vol. 18, No. 1, Jan 2015 p.43-46

VOLUME OF SURGERY IN THE PRIMARY CLOSURE OF BLADDER IN CHILDREN WITH BLADDER EXSTROPHY

Introduction. Bladder exstrophy is one of the most complex malformations in pediatric urology. Material and methods. In 1996-2019, 112 children with bladder exstrophy, aged 2 -32 days, had a “primary bladder repair” in St Vladimir Children’s Municipal Clinical Hospital. All children (112) were divided into groups depending on dimensions of the cystic area: large bladder size (over 5 cm) - 39 (34.8%) patients; average size (35-50 mm) - 43 (38.9%); small size (less than 35mm) - 31 children (27.6%). Subgroup “A” - 77 patients (68.7%) were treated in 1996 - 2012, and the primary bladder closure was performed at their neonatal period regardless of the area size. Subgroup “B” - 35 children (31.2%), operated on in 2013-2019, had various volume surgeries depending on clinical manifestations. These groups are homogeneous and comparable in age and manifestations. Results. Complications after surgery were seen in 20 children (25%) from Subgroup “A”: exstrophy relapse - 14 (18%), divergence of bladder neck - 6 (7%). The outcome analysis has shown that the highest rate of exstrophy relapses and cervical divergence was observed in children with microcystis - 15 (57.4%) out of 21. In Subgroup “B”, exstrophy relapse was observed in 1 (2.8%) child with an average bladder size; cervical divergence - in 2 (5.6%) children with an average size and in 2 (5.6%) with microcystis. The number of complications in children with microcystis was reduced from 15 out of 21 children (71%) in Subgroup “A” to 2 out of 10 patients (20%) in Subgroup “B”. Conclusion. A differentiated approach to the choice of surgery volume and proposed additional measures lead to better bladder growth and better urine retention after the first surgery.

Delayed laparoscopic cholecystectomy in a case of acute cholecystitis and intestinal malrotation type I

In adults, intestinal malrotation is an oligosymptomatic entity that is occasionally discovered during the course of diagnostic studies for other causes. In the case described herein, intestinal malrotation was discovered during investigation for cholelithiasis and acute cholecystitis. Malrotation may occur due to alterations in the asymmetric cellular dynamics of the mesentery responsible for intestinal shortening and unilateral retraction, this may occur as a secondary event following alterations in the expression of homeodomain transcription factors. The incidental finding of asymptomatic intestinal malrotation in adults does not preclude its surgical treatment. However, when intestinal malrotation is associated with cholecystitis, due to cholelithiasis, it is advisable, to first treat the cholecystitis conservatively, in our case, and then perform partial adhesiolysis of the Ladd bands that hinder access to the cystic area and carry out cholecystectomy by elective laparoscopy.

A case report on an unusual degeneration of uterine leiomyoma: Myxoid degeneration

Background: Leiomyomas are benign smooth muscle neoplasm that typically occurs from the myometrium. Most of the women with uterine leiomyoma remain asymptomatic. Various degeneration including hyaline, cystic, myxoid and red degeneration and dystrophic calcification occur in leiomyoma, among them myxoid degeneration occurs rarely. Here is a case report of 40 years with one living child and two abortions who came with complaints of feeling of heaviness and pain at lower abdomen for six months, palpable lower abdominal mass for four months and difficulty in passing urine since 15 days. Multiple fibroids with cystic degeneration were suspected in Computed Tomography scan report. The patient underwent Total Abdominal Hysterectomy with Bilateral Salphingectomy. On cut section there was a cystic area on the body of uterus containing 1. 1 liter of straw coloured fluid. Final histopathological findings concluded multiple leiomyoma with myxoid degeneration.