ABSTRACT
A right adrenal tumor was incidentally discovered on abdominal computed tomography performed on a 53-year-old Japanese man, who had been hospitalized with diabetic ketoacidosis. Normal values were obtained for adrenal hormones in the morning after an overnight fast and urinary cortisol excretion after treatment of diabetic ketoacidosis with insulin. However, overnight dexamethasone administration with 1 mg or 8 mg did not completely suppress serum cortisol levels. There were no remarkable physical findings related to Cushing's syndrome. The patient was diagnosed as having preclinical Cushing's syndrome (PCS). Histological examination of the adrenalectomy specimen demonstrated adrenal black adenoma. Blood glucose levels subsequently improved after adrenalectomy, and the patient never developed adrenal insufficiency after hydrocortisone withdrawal. The patient was treated with diet therapy alone, and maintained good glycemic control. However, the patient still showed a diabetic pattern in an oral glucose tolerance test. It seems that the existence of PCS in addition to the underlying type 2 diabetes mellitus contributed to aggravation of blood glucose levels. Although there are many aspects of the natural course of PCS that have not been thoroughly elucidated, it is necessary to remain aware that a PCS patient with abnormal glucose metabolism may develop diabetic ketoacidosis by environmental agents.
Subject(s)
Adenoma/complications , Adrenal Gland Neoplasms/complications , Cushing Syndrome/etiology , Diabetes Mellitus, Type 2/etiology , Diabetic Ketoacidosis/etiology , Adenoma/pathology , Adenoma/surgery , Adrenal Gland Neoplasms/pathology , Adrenal Gland Neoplasms/surgery , Adrenalectomy , Blood Glucose , Cushing Syndrome/pathology , Diabetes Mellitus, Type 2/pathology , Diabetic Ketoacidosis/pathology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
We report a rare case of symptomatic cardiac metastasis from a transitional cell carcinoma of the renal pelvis. A 57-year-old man presented with severe anemia, inflammation, hypoxemia and disseminated intravascular coagulation. Computed tomography revealed a large tumor in the left renal pelvis with multiple lymph node metastases. Two-dimensional echocardiography revealed large tumors in the right ventricle. The patient suddenly died because of the obstructive mass of the right ventricular outflow tract. Histopathological examination showed high-grade transitional cell carcinoma in the left renal pelvis and the right ventricle. There are only three cases of cardiac metastases from a transitional cell carcinoma reported in the literature.
Subject(s)
Carcinoma, Transitional Cell/secondary , Echocardiography/methods , Heart Neoplasms/diagnostic imaging , Kidney Neoplasms/pathology , Carcinoma, Transitional Cell/diagnosis , Diagnosis, Differential , Fatal Outcome , Heart Neoplasms/secondary , Humans , Kidney Neoplasms/diagnostic imaging , Kidney Pelvis , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
A 62-year-old man consulted our hospital complaining of macroscopic hematuria. Intravenous urography showed a dilated terminal portion of the left ureter resembling a cobra head. Cystoscopy revealed multiple tumors on the ureterocele. There were no metastatic lesions on CT and MRI. Transurethral resection of the tumor and the ureterocele was performed and the pathological examination revealed transitional cell carcinoma on the ureterocele. This is the 4th case of urothelial cancer on a simple ureterocele reported in Japan.
