Primary Leiomyosarcoma of the Ovarian Vein Causing Obstructive Uropathy: A Case Report.

Retroperitoneal vascular leiomyosarcoma (RVLMS) are rare soft-tissue sarcomas that most commonly arise from large blood vessels and have a poor prognosis. We present the case of a 61-year-old woman who presented with isolated left flank pain. Abdominal computed tomography and magnetic resonance imaging revealed a 5 cm retroperitoneal soft-tissue mass that was contiguous with the left ovarian vein and connected to the proximal ureter, causing hydronephrosis. As ureteroscopy suggested extrinsic compression of the ureter, a percutaneous biopsy of the mass was obtained, whereupon diagnosis of leiomyosarcoma was made. Radical en-bloc excision of the tumor, including the involved upper urinary tract and the gonadal vein, was performed. The tumor proved to be a leiomyosarcoma arising from the ovarian vein wall. No adjuvant therapy was planned, and no recurrence was noticed at her 24-month follow-up. Primary RVLMS of the ovarian vein is an uncommon condition. To date, only a few sporadic cases have been reported in the literature. What makes the present case further interesting is the unusual tumor's relationship with the patient's ureter, raising both diagnostic and management challenges. To our best knowledge, this is so far the fourth reported case of its kind to cause ureteral obstruction.

Anteriorly Placed Midline Intraprostatic Cyst Resulting in Bothersome Lower Urinary Tract Symptoms: A Case Report.

Prostatic cysts are rare, usually asymptomatic and detected incidentally at imaging. Midline prostatic cysts are less common and mostly located posteriorly. We describe a case of a 51-year-old man with unknown comorbidities who presented with troublesome irritative and voiding symptoms. Transabdominal and transrectal ultrasound, abdominal computed tomography and pelvic magnetic resonance imaging revealed a midline intraprostatic cyst protruding into the bladder lumen, with no communication with the urethra on voiding cystourethrography. Uroflowmetry findings suggested an obstructed flow. The patient underwent transurethral marsupialization of the cyst, which was found to project on the bladder outlet causing urinary obstruction, with excellent outcomes. What makes this case further interesting is the unusual cyst's relationship with the patient's prostate and bladder neck. To our best knowledge, this is so far the seventh reported case in the literature to describe an anteriorly placed midline intraprostatic cyst projecting at the bladder neck region and causing bothersome lower urinary tract symptoms.

Abdominoscrotal Hydrocele With Intra-abdominal Undescended Testis in an Elderly: A Case Report.

Abdominoscrotal hydrocele (ASH) is an uncommon congenital anomaly in which a scrotal hydrocele extends to the abdomen through the inguinal canal in an hourglass fashion. Coexisting undescended testes (UDT) have mainly been reported in pediatric populations and are mostly located along the inguinal canal. We present a 66-year-old male with a history of neglected left cryptorchidism, who presented with a progressive ipsilateral inguino-scrotal swelling suggesting indirect inguinal hernia. On physical examination, inguino-scrotal hydrocele was suspected. Abdomen and pelvis computed tomography scan and magnetic resonance imaging revealed an abdominoscrotal cyst with a pathognomonic dumbbell appearance of an ASH, as well as an intra-abdominal testicle that proved to be intracystic, atrophic, and hypovascular. The patient underwent successful radical en-bloc excision of the ASH and testis via an extended inguinal approach. To our knowledge, this is the first case with this constellation of urogenital abnormalities to be reported in an aged man. What makes this case further unique and interesting is the unusual ASH's relationship with the patient's cryptorchid testicle and peritoneal sac.

Functional Bladder Paraganglioma as an Incidental Finding During Infertility Workup.

Bladder paragangliomas (PGLs) are extremely rare catecholamine-producing neuroendocrine tumors. They arise more frequently in the trigone and have unpredictable depth and behavior. Most cases typically present with a well-defined set of symptoms triggered by micturition or bladder overdistension. Besides long-term follow-up, they are usually managed by either transurethral resection (TUR) or partial cystectomy (PC). However, about 25% of all documented cases do not manifest clinically, raising both diagnosis and management challenges. This report describes an unusual case of a misdiagnosed, functional PGL arising on the bladder dome, which was fortuitously detected in a 21-year-old female during a fertility workup. Owing to its hypervascular nature and submucosal location, bladder PGL was suspected on ultrasound and CT findings and successfully diagnosed before surgery through biochemical confirmation. It was managed by cystoscopy-guided laparoscopic partial cystectomy (LPC) with good oncological and urinary outcomes, as well as no compromise of her fertility potential. To our best knowledge, this is the first case to be incidentally detected on transvaginal ultrasound during evaluation for infertility. This case also stresses the importance of considering PGL in the differential diagnosis of atypical bladder tumors, as well as conservative management through simultaneous laparoscopy and cystoscopy, when approaching young patients with large functional PGL.