Recurrent paratesticular liposarcoma: a case report.

Introduction and importance: Paratesticular liposarcoma (PTL) is a rare condition, with fewer than 200 cases reported worldwide. It is a malignant tumor that originates from fat tissue with high risk of recurrence. Herein, the authors present a contralateral recurrence of a treated PTL. To the best of the authors' knowledge, in the current literature, there are few cases reported with recurrent PTL. Case presentation: The authors report the case of a 62-year-old man who presented with a rapidly growing painless right hemiscrotal swelling. Clinical and radiographic evidence suggested the presence of two paratesticular tumors. The patient underwent a radical orchidectomy with resection of the two tumors through an inguinal approach. The histologic examination revealed a sclerosing, well-differentiated liposarcoma. The decision of the multidisciplinary consultation meeting was not to do adjuvant treatment. A follow-up of 12 months showed recurrence of the contralateral scrotum revealed by an FDG-PET/scan. Clinical discussion: PTL, a rare spermatic cord tumor, affects adults aged 50-60, often presenting with scrotal swelling. Diagnosis involves ultrasound, computed tomography, and magnetic resonance imaging. Surgical intervention, including radical orchiectomy and adjuvant radiotherapy, is common for management, while the role of chemotherapy is inconclusive. High-grade subtypes carry a higher recurrence risk. Conclusion: PTL is often misdiagnosed preoperatively. It is typically managed through radical orchidectomy, which includes wide excision and high ligation to ensure free surgical margins and avoid recurrence. The role of adjuvant therapy remains debatable. Despite a generally favorable prognosis, long-term follow-up is crucial because of the elevated risk of recurrence.

Designing a Simple Electrochemical Genosensor for the Detection of Urinary PCA3, a Prostate Cancer Biomarker.

This study investigates the feasibility of a simple electrochemical detection of Prostate Cancer Antigen 3 (PCA3) fragments extracted from patients' urine, using a thiolated single-strand DNA probe immobilized on a gold surface without using a redox probe. To enhance the PCA3 recognition process, we conducted a comparative analysis of the hybridization location using two thiolated DNA probes: Probe 1 targets the first 40 bases, while Probe 2 targets the fragment from bases 47 to 86. Hybridization with PCA3 followed, using square wave voltammetry. The limit of detection of the designed genosenors were of the order of (2.2 ng/mL), and (1.6 ng/mL) for Probes 1 and 2, respectively, and the subsequent sensitivities were of the order of (0.09 ± 0.01) µA-1 · µg-1 · mL and (0.10 ± 0.01) µA-1 · µg-1 · mL. Specificity tests were then conducted with the sensor functionalized with Probe 2, as it presents better analytical performances. The electrochemical results indicate that the designed sensor can clearly discriminate a complementary target from a non-complementary one. A further modeling of the calibration curves with the Power Law/Hill model indicates that the dissociation constant increases by one order of magnitude, confirming the ability of the designed sensor to perfectly discriminate complementary targets from non-complementary ones.

Fournier's gangrene revealing an acute arterial occlusion: A case report.

INTRODUCTION AND IMPORTANCE: Fournier gangrene (FG) is a rare form of necrotizing fasciitis that affects both the deep and superficial layers of the perineal genital region. When left untreated, Fournier gangrene can rapidly advance, leading to substantial morbidity and mortality. Herein, we present a case of Fournier's gangrene, which revealed acute arterial occlusion. To the best of our knowledge, few cases of Fournier's gangrene secondary to arterial occlusion have been reported. CASE PRESENTATION: We report the case of a 37-year-old man with no known medical history who presented with fever and painful swelling of the scrotum. Physical examination revealed a large black spot on the scrotum surrounded by erythema, suggestive of Fournier's gangrene. We performed an extended debridement of the scrotal area. Three days later, the patient complained of severe pain in the left foot accompanied by numbness. Lower limb computed tomographic angiography (CTA) revealed multiple arterial occlusions. Thrombectomy and anticoagulation therapy were crucial in managing the vascular thrombosis and preventing the further extension of the gangrene. CLINICAL DISCUSSION: This case underscores the importance of recognizing diverse etiologies of Fournier's gangrene, including vascular involvement, and emphasizes the need for a multidisciplinary approach. Early identification, aggressive surgical debridement, and broad-spectrum antibiotics remain the cornerstone of management, with the added consideration of anticoagulation in cases involving vascular thrombosis. CONCLUSION: FG is a rare yet potentially life-threatening condition. Its multifaceted etiologies, including vascular factors, underscore the complexity of its presentation and challenges for timely diagnosis. The recognition of vascular involvement as a potential etiology of FG warrants further in-depth exploration.

Plasmacytoid bladder cancer: a rare case report.

Plasmacytoid carcinoma of the bladder is a rare histological variant of urothelial carcinoma associated with late presentation. This pattern of disease may portend an extremely poor prognosis and significant challenges for treatment with curative intent. Case presentation: The authors report a case of a patient with locally advanced plasmacytoid urothelial carcinoma (PUC) of the bladder. A 71-year-old man with a history of chronic obstructive pulmonary disease presented with gross hematuria. The rectal examination revealed a fixed bladder base. A computed tomography scan showed a pedunculated lesion arising from the anterior and left lateral bladder wall and extended to the perivesical fat. The patient underwent transurethral resection of the tumor. The histologic examination revealed the presence of muscle-invasive PUC of the bladder. The decision of the multidisciplinary consultation meeting was to do palliative chemotherapy. Thus, the patient could not receive systemic chemotherapy and died 6 weeks after transurethral resection of the bladder tumor. Clinical discussion: A plasmacytoid variant of urothelial carcinoma is a rare subtype of urothelial carcinoma that has a poor prognosis with a high mortality rate. The disease is usually diagnosed at an advanced stage. Given the rarity of plasmacytoid bladder cancer, treatment guidelines are not clear; therefore, more aggressive treatment may be required. Conclusion: PUC of the bladder is characterized by high aggressiveness, an advanced stage at the time of diagnosis, and a poor prognosis.

Primary extragastrointestinal stromal tumor of the prostate: review of the literature and case report.

The extragastrointestinal stromal tumor (EGIST) is defined as a mesenchymal neoplasm arising from soft tissues outside the gastrointestinal tract, and the prostate is a rare presentation site. Case presentation: A 58-year-old man was presented with lower urinary tract symptoms for 6 months. A digital rectal examination revealed a markedly enlarged prostate with a smooth, bulging surface. Prostate-specific antigen density was 0.5 ng/ml. MRI of the prostate showed an enlarged prostatic mass with hemorrhagic necrosis. Transrectal ultrasound-guided prostate biopsy was performed and pathological reports suggested a gastrointestinal stromal tumor. The patient refused radical prostatectomy and received only imatinib treatment. Clinical discussion: The diagnosis of EGIST of the prostate is extremely rare and depends on the histopathologic features with immunohistochemical results. The treatment is essentially based on radical prostatectomy, but there are other therapeutic modalities associating surgery with adjuvant or neoadjuvant chemotherapy. For patients refusing surgery, treatment with imatinib alone appears to be a therapeutic solution. Conclusion: Despite the rarity, EGIST of the prostate should be included in the differential diagnosis of patients presenting with lower urinary tract symptoms. There is no consensus regarding the treatment of EGIST, and the patients are treated as per the risk stratification.

Crossed-fused renal ectopia with renal calculi and its management, a case report.

INTRODUCTION AND IMPORTANCE: Crossed fused renal ectopia is a rare congenital anomaly characterized by both kidneys being fused together on one side of the spine. Herein, we present an atypical subtype of this disease. To our best knowledge, in the current literature, there is few cases reported with superior crossed fused renal ectopia of the right kidney. CASE PRESENTATION: A 40-year-old man with diabetes type 1 presented to our hospital with diabetic ketoacidosis and abdominal pain initially taken care of in an endocrinology department then transferred to our urology department after discovery on the CT scan of a staghorn calculus in the solitary right kidney is later discovered during the therapeutic management that it is a superior CFRE. CLINICAL DISCUSSION: Unilateral fused renal superior ectopia is extremely rare and the management of urinary calculi in this disease is technically challenging for urologists. The choice of treatment for urinary calculi in cases of crossed renal ectopia should be made depending on the size and position of the urinary calculi and the patient's anatomy. CONCLUSION: Before proceeding to surgery, a preoperative assessment with contrast computed tomography is necessary to explore a solitary kidney with calculi so as not to miss the diagnosis of crossed fused renal ectopia because the management of renal stone in this rare malformation is complicated.

Left paratesticular fibrous pseudotumor on the single testis and contribution of imaging in therapeutic management, a case report.

INTRODUCTION AND IMPORTANCE: Paratesticular fibrous pseudotumor is a rare benign tumor. Clinically, it can mimic testicular malignancy, but this lesion results from a reactive proliferation of inflammatory and fibrous tissue. CASE PRESENTATION: A 62-year-old man presented with left scrotal swelling dating back years. A left paratesticular mass is palpated, firm and painless. Ultrasound showed a heterogeneous and hypoechoic lesion in a single left testicle; the right testicle was not found in the scrotum or at the inguinal level. CT scan showed a hypodense left scrotal mass. The scrotal MRI showed the presence of a paraliquid left intrascrotal formation pushing back the left testicle. We performed a scrotal exploration with excision of the paratesticular mass, sparing the left testicle. The definitive pathological diagnosis was reported as paratesticular fibrous pseudotumor. CLINICAL DISCUSSION: Paratesticular Fibrous pseudotumors are a rare tumor with approximately 200 cases reported to date. These lesions constitute 6 % of all paratesticular lesions. Magnetic resonance imaging can give additional information when an ultrasound is inconclusive. The treatment of choice is a scrotal exploration of the mass and frozen section biopsy to avoid unnecessary orchiectomy. CONCLUSION: The diagnosis of paratesticular Fibrous pseudotumor is challenging. The contribution of scrotal MRI and intra-operative frozen section is essential for therapeutic management.

Renal cell carcinoma with atypical metastases sites revealed by diabetes mellitus: A case report.

Introduction and importance: Lung, bone, lymph nodes and liver are the most common metastatic sites. This observation presents a metastatic renal cell carcinoma (RCC) with atypical secondary sites and a rare mode of revelation corresponding to diabetes mellitus. Case presentation: We report the case of a 64-year-old woman recently diagnosed with diabetes mellitus. A thoracic parietal nodule was palpated. An uro-CT scan had shown a renal tumor with unusual metastatic sites: pleura, pancreas, and contralateral kidney. The patient underwent a biopsy of the pleural nodule. The pathology report concluded to the diagnosis of clear cell RCC. She had a targeted therapy. Three months after admission, the patient had altered general condition and total hematuria. Clinical discussion: RCC commonly metastasizes haematogenously via renal veins. Atypically, secondary lesions may involve pleura. Such a metastatic site may be of particular interest for percutaneous biopsy, as in our case. The rare metastatic invasion of the pancreas is most likely the cause of the inaugural diabetes in our patient. The controlateral kidney was involved in 1.4% of secondary lesions. For patients with poor prognosis, according to International Metastatic RCC Database Consortium classification, anti-angiogenic treatment is recommended. The median overall survival of patients with poor prognosis is 8 months. Conclusions: Pancreas and contralateral kidney are rare secondary sites of RCC. The clinical expression of pancreas metastatic invasion can rarely fit with diabetes. Metastatic dissemination to these organs is most often associated with an unfavorable prognosis.

Recurrent hematuria: A rare presentation of leiomyosarcoma of the prostate.

Introduction and Importance: Prostatic leiomyosarcoma is a rare aggressive tumor. The presentation came with non-specific signs and symptoms likewise other forms of prostatic pathology like benign prostatic hyperplasia. Case presentation: A 64 years old man presented to the emergency with a recurrent macroscopic hematuria, he was a heavy smoker and has reported lower urinary tract symptoms. On the physical examination, the patient was hemodynamically stable and afebrile. However, the digital rectal exam revealed an enlarged homogeneous prostate without any palpable nodule. Pelvic transabdominal ultrasound showed an enlarged prostate and a thickening of the bladder's left lateral wall. The CT-scan showed a large and heterogeneous mass arising from the left bladder wall measuring 100 mm, which extends through almost the entire bladder wall. Furthermore, the patient performed cystoscopy, performed by a Urology Professor, showing a normal urethra, a normal prostate gland, and a large solid bladder mass with multiple clots. Subsequently, multiple masses' biopsies were performed. The diagnosis of a primary protatic leomyosarcoma was based on the clinical findings and on the histopathological exam. The patient was prepared for a radical cystoprostatectomy, which would be performed by a Urology Professor, but he died of cardiac arrest before undergoing surgery. Clinical discussion: There are no specific clinical presentations of prostatic sarcoma, patients normally complain of urinary frequency and urinary urgency. Due to the lack of typical clinical symptoms, the tumor is easily overlooked or misdiagnosed as benign prostatic hyperplasia. In this case, the first symptom was a recurrent hematuria in a 64 years-old heavy smoker, which is a relatively rare obvious symptom according to literature. As showed in this case, recurrent hematuria may delay the diagnosis. Concerning the management of prostatic leiomyosarcoma, there are no standard recommendations. Multimodality combination treatments including surgery, pre or postoperative radiotherapy and neo or adjuvant chemotherapy have been used in the management of leiomyosarcoma of prostate. Conclusion: Prostatic leiomyosarcoma poses a unique diagnostic challenge, as clinical presentation alone may not always be suggestive, an unsual clinical presentation as recurrent hematuria must suggest a prostatic leimyosarcoma when associated with urinary frequency and urinary urgency. Histopathological examination and the FNCLCC grading system are essential for the definitive diagnosis. Multimodality treatment regimens including surgery, radiotherapy and chemotherapy are recommended.

The importance of surgical treatment in encrusted cystitis and pyelitis: A case report.

INTRODUCTION: Encrusted cystitis and Encrusted pyelitis are rare chronic inflammatory diseases. Those conditions are commonly caused by the Corynebacterium spp. especially the type D2 which is a gram positive, aerobic, slow-growing, and urea-sliting bacteria with a multi-antibiotic resistant profile. PRESENTATION OF CASE: We report the case of a 62-year-old man with a past history of chronic obstructive pulmonary disease. He was referred to the department of urology for urosepsis. Bacterial culture results were positive to Corynebacterium urealyticum. The diagnosis of encrusted cystitis and pyelitis were highly considered. An adapted antibiotherapy was undertaken using vancomycin during 3 weeks. The patient presented two acute peritonitis : the first was caused by a spontaneous bladder dome rupture which was surgically repaired and the second was caused by a total bladder rupture which required cysto-prostatectomy and bilateral ureterostomy. The post operative outcomes were uneventful. Bacterial urinalysis was negative and total recovery was obtained. DISCUSSION: In the majority of the reported cases, there were no sepsis or peritonitis conditions. Medical treatment by the glycopeptides and urine acidification was sufficient. However in this case, the sepsis condition and the bladder rupture with acute peritonitis made exclusively medical treatment by antibiotics insufficient. Therefore cystectomy associated to conventional antibiotics were able to limit the systemic dissemination of the bacteria and save the patient's life. CONCLUSION: Glycopeptides antibiotics are currently the preferential treatment of encrusted cystitis. In some complicated conditions such as bladder rupture and urosepsis as in this case, radical surgical treatment by cystectomy must be realized early to avoid peritonea and septic shock.

Significance of p53, p27, Ki-67, E-cadherin, and HER2 expression in upper urinary tract urothelial carcinoma.

BACKGROUND: The study investigated the expression and the clinicopathological significance of p53, p27, Ki-67, E-cadherin, and HER2 in upper urinary tract urothelial carcinomas (UTUC) from Tunisian patients. We performed a retrospective study of 66 UTUC. Main clinicopathological features were reported. The expression of p53, p27, Ki-67, E-cadherin, and HER2 was investigated by immunohistochemistry on whole tissue section. RESULTS: Expression of p53, Ki-67, p27, E-cadherin, and HERE2 was reported in 36.4%, 69.7%, 90.9%, 100%, and 0% of cases, respectively. p53 expression was associated with stage (p = 0.001), positive surgical margin (p = 0.005), and shorter recurrence-free survival (RFS; Log Rank test, p = 0.026). Ki-67 and p27 expression was associated with stage (p < 0.001 and p = 0.001, respectively) and grade (p < 0.001 and p = 0.001, respectively). Using Kaplan-Meier test, the positive surgical margin was associated with shorter RFS compared to free surgical margin (Log Rank test, p = 0.031). Moreover, in univariate Cox regression analysis, surgical margin (p = 0.041; HR 0.325, 95% CI 0.110-0.956) and p53 expression (p = 0.035; HR 0.328, 95% CI 0.116-0.925) were the significant factors associated with RFS. CONCLUSIONS: Together, our findings suggest that positive surgical margin and p53 expression were potential prognostic factors of UTUC since both were associated with shorter RFS in Tunisian patients.

Intratesticular leiomyoma: A case report and a literature review.

INTRODUCTION: Leiomyomas are benign tumors that originate from smooth muscles cells. Intratesticular leiomyoma is a very rare type of benign testicular masses. Through the literature, only 11 cases were reported. PRESENTATION OF CASE: A 36 years old man presented with painless right scrotal mass. Clinical examination showed right upper polar testicular mass, well circumscribed and highly vascularized on sonography. Serum tumor markers were normal. Patient was explained the possibility of an organ sparing surgery if frozen section shows no sign of malignancy. Midline incision with frozen section was performed, with wide local excision. Pathological examination of the specimen confirmed intratesticular leiomyoma. Two years after the surgery, patient showed no sign of recurrence. DISCUSSION: Intratesticular Leiomyoma is usually revealed as a non-tender firm scrotal mass that increases in size. Sonography is the imaging modality of choice for assessing intrascrotal pathology, and cannot distinguish benign from malignant tumor. Surgical management is subject of debate. While some authors recommend radical orchiectomy, others suggest the use of frozen section intraoperatively, and perform conservative treatment by mass excision in the absence of signs of malignancy. CONCLUSION: Intratesticular leiomyoma is a very rare finding. When suspected, conservative management using frozen section followed by mass excision can be done, but final diagnosis remains on pathological examination and immunohistochemistry of the specimen.

Metastatic renal clear cell carcinoma mimicking a gallbladder polyp: Case report and literature review.

INTRODUCTION: Metastatic tumors to the gallbladder are uncommon. Metastases from renal cell carcinoma (RCC) to the gallbladder are exceptional. Frequencies of less than 0.6% reported in large autopsy reviews and few cases have been reported in the literature. PRESENTATION OF CASE: Herein we present a case of a 50-year-old man that developed four years after radical nephrectomy for RCC, a gallbladder metastasis, discovered incidentally on Computed Tomography (CT) scan. It was described as an intraluminal gallbladder polyp. Radiological features were very suggestive of primary gallbladder carcinoma, thus the patient had a laparoscopic cholecystectomy. The pathological examination of the surgical specimen concluded to a RCC metastasis. Immunochemistry with vimentin and pancytokeratin were supportive of this diagnosis. The clinical course was uneventful after 18 months period of follow up. DISCUSSION: At the time of presentation, almost one-third of the patients with RCC are metastatic. Metastases to the gallbladder are extremely rare. Clinical presentation and physical examination are unspecific. Radiological findings can raise information and orient the diagnosis although the difference between both diagnoses remains difficult. Usually, it is a pedunculated and not associated with gallstones with enhancement on CT scan. The treatment remains surgical with R0 cholecystectomy, and prognosis is mainly related to disease free interval and single site metastasis. CONCLUSION: We highlight here the challenge to make the difference between a primary gallbladder carcinoma and metastasis from RCC. Diagnosis is made on pathological examination and immunochemistry.

Penile skin flap: a versatile substitute for anterior urethral stricture

ABSTRACT Purpose Penile skin flap uretroplasty is a useful technique for a long urethral stricture due to the ample length and surgical handling characteristics. We investigated the surgical technique and initial results of uretroplasty for anterior urethral strictures using a dorsal penile skin flap. Patients and methods From January 2003 to January 2018, a total of 77 patients underwent substitution urethroplasty using dorsal penile skin flap for bulbar urethral strictures in our institution. All patients were assessed preoperatively, and followed postoperatively by physical examination, urinalysis, retrograde and voiding urethrography, uroflowmetry and post-void residual urine measurement. Success was defined as no requirement of additional urethral instrumentation. Results The mean age was 45 years (10-87). The mean stricture length was 5cm (3-10cm). The mean flap length was 6cm. Urinary fistula was the most common postoperative complication. The mean follow-up was 60 months (6-120). The overall success rate was 88%. Recurrent strictures were found in 4 patients (5%) at 1 year. At 3 year follow-up, 5 (7%) more patients had recurrences. All recurrences were managed by internal urethrotomy. Conclusions Substitution urethroplasty using penile skin flap appear to be a safe and efficient technique for the treatment of a long and complex anterior urethral stricture. It provides encouraging cosmetic and functional results.

Penile skin flap: a versatile substitute for anterior urethral stricture.

PURPOSE: Penile skin flap uretroplasty is a useful technique for a long urethral stricture due to the ample length and surgical handling characteristics. We investigated the surgical technique and initial results of uretroplasty for anterior urethral strictures using a dorsal penile skin flap. PATIENTS AND METHODS: From January 2003 to January 2018, a total of 77 patients underwent substitution urethroplasty using dorsal penile skin flap for bulbar urethral strictures in our institution. All patients were assessed preoperatively, and followed postoperatively by physical examination, urinalysis, retrograde and voiding urethrography, uroflowmetry and post-void residual urine measurement. Success was defi ned as no requirement of additional urethral instrumentation. RESULTS: The mean age was 45 years (10-87). The mean stricture length was 5cm (3-10cm). The mean flap length was 6cm. Urinary fi stula was the most common postoperative complication. The mean follow-up was 60 months (6-120). The overall success rate was 88%. Recurrent strictures were found in 4 patients (5%) at 1 year. At 3 year follow-up, 5 (7%) more patients had recurrences. All recurrences were managed by internal urethrotomy. CONCLUSIONS: Substitution urethroplasty using penile skin fl ap appear to be a safe and effi cient technique for the treatment of a long and complex anterior urethral stricture. It provides encouraging cosmetic and functional results.

Mixed nutcracker syndrome with left renal vein duplication: A severe and exceptional presentation in an 18-year-old boy.

The nutcracker syndrome (NCS) is rare and often misdiagnosed because it embraces an extended non-pathognomonic spectrum of symptoms that imply a difficult diagnosis. Ultimately it may be associated with substantial morbidity and even life-threatening events. Mixed NCS with renal vein duplication is an exceptional variety, have previously been reported to the best of our knowledge. We report a rare case of an 18-year-old boy who presented with a long history of abdominal, pelvic and left flank pain, fatigue and higher bilateral varicocele. Computed tomographic angiography, Doppler ultrasonography and venography were performed revealed left renal vein duplication with dilated retroaortic and preaortic branchs, entrapped respectively between the aorta and the vertebral column and in the aortico-mesenteric space, with extensive and complex varices of the deep pelvic venous plexus; promoting the mixed renal NCS. Auto transplantation of the left kidney was suggested, but refused by the patient; and only the varicocele was managed. The patient is still suffering from his severe initial symptoms. Diagnosis is difficult and should be considered in patients with inexplicable flank or abdominal pain. Our purpose is to raise clinician's awareness for this condition so that they will be more likely to diagnose it. This will facilitate prompt diagnosis and treatment.

Modified medial nephropexy for treatment of the anterior nutcracker syndrome.

We report the case of a 15-year-old male, presenting with recurrent gross hematuria complicated by acute anemia. Cystoscopy showed little bleeding from the left ureteral orifice. Diagnosis of left renal vein compression at the aortomesenteric space was established through color Doppler ultrasonography and computed tomographic angiography. Therapeutic attitude was interventionist in our case, performing successful management with modified medial nephropexy, with a retroperitoneal approch. To the best of our knowledge, we report the second case of left medial nephropexy for treatment of the anterior nutcracker syndrome. The first case of modified medial nephropexy was done by lowering the left renal vein from its initial position in the aortomesenteric angle through a restrict retroperitoneal approach.

Nutcracker syndrome complicated by left renal vein thrombosis.

Isolated renal vein thrombosis is a rare entity. We present a patient whose complaint of flank pain led to the diagnosis of a renal vein thrombosis. In this case, abdominal computed tomography angiography was helpful in diagnosing the nutcracker syndrome complicated by the renal vein thrombosis. Anticoagulation was started and three weeks later, CTA showed complete disappearance of the renal vein thrombosis. To treat the Nutcracker syndrome, we proposed left renal vein transposition that the patient consented to.

Unexpected small urinary bladder pheochromocytoma: a nonspecific presentation.

Objectives. Pheochromocytoma of the urinary bladder is an extremely rare tumor that typically presents with a hypertensive crisis during micturition. Preoperatively, it may be misdiagnosed due to nonspecific symptomatology, physical, and radiologic findings. Method. We report a case of unsuspected small pheochromocytoma which was incidentally found by CT scan and confirmed by the histological aspects after transurethral resection in a 63-year-old woman. Here, we have described the clinical presentation, physical findings, laboratory investigations, and treatment provided in our case. We have also included radiological images and histopathology slides with input from both radiologists and pathologists. Surgical management and postoperative follow-up are discussed, as are details of previous published data. Results. After undergoing surgical treatment (transurethral resection), our patient is asymptomatic, with complete resolution of her pathology. Conclusion. Diagnosis is difficult before histopathological examination and should be considered in patients with no risk factors for usual bladder tumor. Our purpose is to raise clinician's awareness for this condition so that they will be more likely to diagnose it. This will facilitate prompt diagnosis and treatment and especially prevent complications due to pheochromocytoma which may be severe.

Bilateral renal infarction following atrial fibrillation and thromboembolism and presenting as acute abdominal pain: a case report.

INTRODUCTION: Renal infarct is rare and often misdiagnosed because the symptoms are misleading. The mechanisms are various, mainly thrombotic and embolic. CASE PRESENTATION: In this review, we report the case of a 61-year-old Tunisian woman presented to the emergency unit with a 4-hour history of abdominal pain diffused at both flanks, ultrasounds was performed to remove a surgical emergency, showed a peri-renal fluid collection with heterogeneous parenchyma.We followed by a CT scan, which confirmed the diagnosis of renal infarct. The patient was treated by heparin at a curative dose, and the outcome was favorable. CONCLUSION: Diagnosis is difficult and should be considered in patients with inexplicable flank or abdominal pain and with risk factors to this disease. Our purpose is to raise clinician's awareness for this condition so that they will be more likely to diagnose it. This will facilitate prompt diagnosis and treatment.A review of the literature was performed and the case is discussed in the context of the current knowledge of this condition.