Aggressive non-Hodgkin's lymphoma mimicking unilateral transitional cell carcinoma of renal pelvis. The risk of making a diagnostic mistake.

A 78-year-old Caucasian man was referred to our department because of an incidental unilateral mass involving the right renal sinus. As the patient showed no urological disease at flexible ureterorenoscopy, a subsequent percutaneous CT-targeted biopsy was mandatory, confirming an aggressive non-Hodgkin disease involving the renal pelvis that is, to the best of our knowledge, the second reported case in literature. A whole body FDG-PET excluded multiple expression of this disease, and the patient underwent a chemotherapeutic scheme resulting in a stable marked reduction in tumor volume. To the date, the available experience on the management and outcome of such cases is extremely lean. In this scenario, our case can contribute to shorten the time-to-diagnosis by reporting a complete images overview comprising abdominal CT scan, MRI and FDG-PET-CT, hence making this clinical entity easier presumable in clinical daily practice and offering a possible suggestion for an effective treatment.

Giant scrotal lymphedema as unique onset sign of muscle-invasive bladder cancer. The risk of a misdiagnosis.

A 78-year-old male presented complaining voiding low urinary tract symptoms associated to genital weightiness over the past few years. Grossly the lesion was only interesting the scrotum, for an about 7.5 kg mass. The scrotum was minimally tender, with an intact skin bereft of erythema or inflammation, lower limb lymphedema, inguinal/crural lymphadenopathy. Despite repeated urinary cytologies were negative, an abdominal CT and urethrocystoscopy confirmed a muscle-invasive transitional cell carcinoma affecting the bladder. The surgical strategy included a direct excision of the giant scrotum with local tissue reconstruction and a radical cystectomy with ileal conduit. This is the first time it's noted a giant scrotal lymphedema as the unique onset sign of a muscle invasive transitional cell carcinoma of the bladder otherwise clinically silent. In this clinical setting, a differential diagnosis has always to be carried out, as bladder cancer is a life-threatening disease requiring an aggressive approach.

Determinism and liabilities in a complicated transrectal prostate biopsy: what is what.

We report the case of a 53-year-old man suffering from the contemporary onset of penile Mondor's disease and high-flow priapism 10 days after a transrectal prostate biopsy. We analyzed whether these pathological conditions were causally related to the biopsy, and the role of urologist regarding the onset of one or both the diseases. Critically evaluating the clinical picture and the procedure used for the biopsy, we were able to recognize a connection between the office procedure and the onset of the high-flow priapism, otherwise than for penile Mondor's disease. Our report is of value for urologists, making them aware of such possible complications, and for forensic experts that might have to deal with similar cases, as it demonstrates only a partial involvement of urologist in this clinical setting.