Renal cell carcinoma in an ectopic pelvic kidney in a patient presenting with acute urinary retention.

The incidence of renal cell carcinoma in a pelvic kidney is rare, and has only been described in a very small number of cases. We describe a case where an incidental ectopic kidney with invasive renal cell carcinoma was diagnosed during a separate emergency admission for acute urinary retention.

A vesicocutaneous fistula secondary to bladder calculi in a patient with spina bifida.

We present a rare case of a vesicocutaneous fistula secondary to two large bladder calculi in a patient with spina bifida. A 62 year old lady presented with swelling of her right thigh and a calcified mass protruding through the subcutaneous tissues of her right groin. Urine was seen to be draining from around the area and plain radiographs and a computed topography (CT) scan confirmed the presence of two bladder calculi with a vesicocutaneous fistula. Vesicolithotomy was performed and the fistula tract left to close spontaneously. Worldwide this is only the fourth case of a bladder calculus causing a vesicocutaneous fistula.

Defining the clinical target volume for bladder cancer radiotherapy treatment planning.

PURPOSE: There are currently no data for the expansion margin required to define the clinical target volume (CTV) around bladder tumors. This information is particularly relevant when perivesical soft tissue changes are seen on the planning scan. While this appearance may reflect extravesical extension (EVE), it may also be an artifact of previous transurethral resection (TUR). METHODS AND MATERIALS: Eighty patients with muscle-invasive bladder cancer who had undergone radical cystectomy were studied. All patients underwent preoperative TUR and staging computed tomography (CT) scans. The presence and extent of tumor growth beyond the outer bladder wall was measured radiologically and histopathologically. RESULTS: Forty one (51%) patients had histologically confirmed tumor extension into perivesical fat. The median and mean extensions beyond the outer bladder wall were 1.7 and 3.1 mm, respectively. Thirty five (44%) patients had EVE, as seen on CT scans. The sensitivity and specificity of CT scans for EVE were 56% and 79%, respectively. False-positive results were infrequent and not affected by either the timing or the amount of tissue resected at TUR. CT scans consistently tended to overestimate the extent of EVE. Tumor size and the presence of either lymphovascular invasion or squamoid differentiation predict a greater extent of EVE. CONCLUSIONS: In patients with radiological evidence of extravesical disease, the CTV should comprise the outer bladder wall plus a 10-mm margin. In patients with no evidence of extravesical disease on CT scans, the CTV should be restricted to the outer bladder wall plus a 6-mm margin. These recommendations would encompass microscopic disease extension in 90% of cases.

Ectopic adrenocortical tissue found at groin exploration in children: incidence in relation to diagnosis, age and sex.

OBJECTIVE: To assess the incidence of ectopic adrenocortical tissue (EACT) in the groin in children, and examine the relationship between the incidence and the underlying diagnosis, age and sex. PATIENTS AND METHODS: From computer records, all groin explorations between 1988 and 2002 in patients < or = 15 years old were identified. Cases of EACT were identified from computer histology records, and the incidence in different groups compared. RESULTS: Of 935 groin explorations, EACT was identified in 25 (2.7%); there were no cases in girls. The incidence was 0.7% at inguinal herniotomy (IH), 4.1% at ligation of the patent processus vaginalis for communicating hydrocele (P = 0.03 vs IH), and 3.3% at exploration for undescended testes (P = 0.02 vs IH). In boys with undescended testes the incidence of EACT was similar in different age groups (0-7 years, 3.3%; 8-15 years 3.2%, P = 0.96). CONCLUSIONS: The overall incidence of EACT at groin exploration was 2.7%, with none detected in girls. There was no evidence of involution of EACT with increasing age. The incidence of EACT varied with the underlying diagnosis, but the reason for this is unknown.