Cystadenome papillaire de l'epididyme: un nouveau cas

Le cystadenome papillaire de l'epididyme est une tumeur paratesticulaire benigne rare. Se presentant comme une masse epididymaire uni ou bilaterale. Son association avec le syndrome de Von Hippel-Lindau est frequente; en particulier dans les lesions bilaterales. Nous rapportons l'observation d'un patient age de 36 ans; qui presentait depuis un an des douleurs scrotales gauches; une grosse bourse chronique; sans fievre ni signes fonctionnels urinaires. L'examen avait mis en evidence une masse testiculaire dure; irreguliere et indolore sans adenopathies inguinales ni masse abdominale. L'echographie scrotale avait montre une masse testiculaire gauche solide hypoechogene bien limitee de 3 x 2;5 x 2;2 cm. Les marqueurs tumoraux etaient normaux (BetaHCG : 2 UI/j; AlphaFoetoProteine : 2;94 UI/l). La masse testiculaire a ete exploree a travers une incision inguinale gauche. A la palpation; c'etait une tumeur testiculaire dure. Une orchidectomie gauche a ete realisee. L'examen anatomopathologique de la piece d'exerese avait conclu a un aspect morphologique et immunohistochimique d'un cystadenome papillaire sereux borderline paratesticulaire sans signe d'invasion. A travers notre observation et les donnees de la litterature; nous proposons de mieux definir le diagnostic clinique et anatomopathologique ainsi que le traitement de ces tumeurs testiculaires rares

Successful Treatment of Homozygous Cystinuria with Captopril

Objective : Cystinuria is an autosomal recessive hereditary disorder associated with nephrolithiasis and its attendant complications. Traditional management using oral alkali; D-penicillamine; or mercaptopropionyglycine in an attempt to increase urinary cystine solubility is often unsuccessful due to intolerable side-effects. The aim of this study was to determine; if captopril could reduce urinary cystine excretion in homozygous cystinuric patients. Patients and methods : Three cystinuric patients with a history of multiple cystine stones despite previous traditional therapy were treated with 150 mg captopril daily for 3 years after determination of their baseline 24-hour urine cystine excretion. Cystine excretion studies were repeated subsequently at 6-month intervals. Results : The baseline 24-hour urine cystine excretion was within the expected limits for homozygous cystinuria in all patients (1072; 862 and 959 mg cystine per gm creatinine per 24 hours). After institution of captopril treatment; all patients had a significant decrease in urinary cystine levels (374; 313 and 451 mg cystine per gm creatinine per 24 hours). No patient experienced recurrent nephrolithiasis or adverse drug effects. Conclusion : We conclude that captopril can significantly decrease urinary cystine excretion in patients with homozygous cystinuria. Captopril should be considered an alternative to traditional drug management of cystinuria