Papillary Renal Cell Carcinoma As An Abdominal Cystic Mass.

Papillary renal cell carcinoma comprises around 15% of all renal cell carcinomas. Patients are usually asymptomatic, and 25 percent of individuals have advanced locoregional disease at presentation. Papillary renal cell carcinoma presenting as a huge abdominal cystic mass is uncommon and is reported rarely in literature. We present a case of renal cell carcinoma presenting with abdominal pain, distention, and constipation. A retroperitoneal cystic lesion measuring 23.4×23.8 cm cyst was reported on ultrasonography as potential cause of the symptoms. We now talk about the case of a 57- year-old male who presented to us with abdominal pain, distension, and constipation. He also had a history of on and off low-grade fever for the last seven months. A computed topography (CT scan) of the abdomen and pelvis with intravenous and oral contrast revealed a large retroperitoneal cystic mass extending from the left hypochondrium to the left kidney and into the pelvis crossing the midline. Internal calcific foci, enhancing septa, irregularly thickened walls and hyperdense nodules were also demonstrated. A radical left nephrectomy via a midline laparotomy was performed electively. The cystic mass was excised and the specimen was sent for histopathological evaluation which revealed papillary renal cell carcinoma with PAX-8 and CK-7 positivity. Patient made an uneventful recovery post-operatively and was discharged. Cystic tumors of renal origin can rarely present as a huge abdominal cystic mass confusing them for masses of intestinal or hepatic origin. Timely diagnosis can be made with a detailed history, examination, imaging studies and histopathology, and instigate timely intervention.

Intramedullary Spinal Tuberculoma: An Uncommon Presentation of a Common Disorder.

Intramedullary tuberculoma (IMT) is rare and usually indistinguishable from spinal cord tumors. Thus, the diagnosis of an IMT is challenging. Our case deals with an unusual presentation of a 55-year-old Asian man who had presented with lower limb weakness which was found to be caused by the dissemination of tuberculosis (TB) resulting in an IMT, a rare complication of tuberculosis. The patient also had a concurrent incidental hepatitis B infection. The treatment of IMT is anti-tuberculous medication. This case highlights the significance of the prompt diagnosis of an IMT, urgent intervention particularly in developing areas of the world where tuberculosis is still endemic, an increased probability of patients having an IMT, and their diagnoses being missed.

A Rare Facultative Anaerobe Causing Emphysematous Osteomyelitis of the Pubic Bone.

Emphysematous osteomyelitis is an uncommon and fatal disease that can only be confirmed with a contrast-enhanced CT scan showing characteristic features of air locules within the bone. It usually occurs in the setting of existing comorbidities and suppressed immune system resulting in widespread bacteremia which may be mono or poly-microbial. Presented here is a case of this disease caused by an unusual anaerobe affecting the pubic bone. This case emphasizes the importance of early imaging as it is crucial for the diagnosis and can facilitate early aggressive management. Moreover, it highlights the importance of early intravenous antibiotics and surgical intervention, which can be life-saving and result in a better outcome in the future.