Inflammatory Myofibroblastic Tumor of the Bladder: 2 Rare Cases Managed with Laparoscopic Partial Cystectomy.

Two cases of inflammatory myofibroblastic tumor (IMT) of the bladder are reported here. Both patients were male and presented with macroscopic hematuria; in the first case terminal hematuria was associated with irritative voiding symptoms. The second case was a smoker with hematuria unresponsive to medical treatment and anemia. Clinical presentation, pathological features, treatment, and prognosis are discussed. Due to rarity of this pathological condition, there are no guidelines concerning treatment and follow-up. We present our follow-up scheme and highlight the use of laparoscopic partial cystectomy as a successful treatment approach.

Sciatic nerve high division: two different anatomical variants.

INTRODUCTION: Sciatic nerve variations are relatively common. These variations are often very significant in several fields of Medicine. The purpose of this paper is to present two such variants and discuss their clinical implications. MATERIAL AND METHODS: Three Caucasian cadavers with no prior history of lower limb trauma or surgery were dissected and found to present anatomical variants of the sciatic nerve. RESULTS: In all cases the sciatic nerve divided above the popliteal fossa. In two cases (cadavers 1 and 2) it divided on both sides in the inferior portion of the gluteal region in its two terminal branches: the common fibular and the tibial nerves. In another case (cadaver 3) the sciatic nerve was found to divide inside the pelvis just before coursing the greater sciatic notch. The common fibular nerve exited the pelvis above the pyriformis muscle and then passed along its posterior aspect, while the tibial nerve coursed deep to the pyriformis muscle. DISCUSSION: According to the literature, the anatomical variant described in cadaver 3 is considered relatively rare. This variant can predispose to nerve entrapment and thus to the pyriformis syndrome, sciatica and coccygodynia. The high division of the sciatic nerve, as presented in cadavers 1 and 2, can make popliteal nerve blocks partially ineffective. CONCLUSION: The anatomical variants associated with a high division of the sciatic nerve, must always be born in mind, as they are relatively prevalent, and have important clinical implications, namely in Anesthesiology, Neurology, Sports Medicine and Surgery.

Introdução: As variações do nervo isquiático são relativamente comuns e frequentemente muito significativas clinicamente. O objetivo deste trabalho é apresentar duas destas variações e discutir algumas das suas implicações clínicas.Material e Métodos: Três cadáveres caucasianos sem história prévia de trauma ou cirurgia no membro inferior foram dissecados, apresentando variações anatómicas do nervo isquiático.Resultados: Em todos os casos o nervo isquiático dividia-se acima da fossa poplítea.Em dois casos (cadáveres1 e 2) a terminação deste nervo ocorria na porção inferior da região glútea nos seus dois ramos terminais: os nervos fibular comum e tibial. Num outro caso (cadáver 3), o nervo isquiático dividia-se ainda dentro da bacia antes de percorrer a incisura isquiática maior. Neste caso, o nervo fibular comum saía da pelve acima do músculo piriforme, passando em seguida ao longo de sua face posterior, enquanto que o nervo tibial corria profundamente ao músculo piriforme.Discussão: De acordo com a literatura, a variante anatómica descrita no cadáver 3 é considerada relativamente rara. Esta variante poderá predispor a síndromes compressivos do nervo isquiático. A divisão alta do nervo isquiático, de que são exemplos os cadáveres 1 e 2, pode comprometer a eficácia dos bloqueios anestésicos ao nível da fossa poplítea.Conclusão: As variantes anatómicas associadas à divisão alta do nervo isquiático devem sempre ser tidas em consideração porserem relativamente comuns e terem importantes implicações clínicas, nomeadamente nas áreas de Anestesiologia, Neurologia, Medicina do Desporto e Cirurgia.

[Giant cysts of seminal vesicles]. / Quistos gigantes das vesículas seminais.

We report a clinical case of a 60 year-old man, asymptomatic to whom was incidentally found two retrovesical cysts. Physical examination revealed hypogastric, elastic and painless masses; digital rectal examination documented a normal prostate gland. Computerized tomography confirmed the presence of two giant seminal vesicle cysts.

Relatamos o caso de um homem com 60 anos de idade, assintomático que é referenciado à consulta por achado acidental de dois quistos volumosos retro-vesicais. Ao exame objectivo identificaram-se massas hipogástricas, de consistência elástica, móveis e indolores; ao toque rectal caracterizou-se uma próstata elástica sem características suspeitas. A tomografia computorizada confirmou a presença de dois quistos gigantes das vesículas seminais.

Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization.

PURPOSE: To describe the anatomy and imaging findings of the prostatic arteries (PAs) on multirow-detector pelvic computed tomographic (CT) angiography and digital subtraction angiography (DSA) before embolization for symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: In a retrospective study from May 2010 to June 2011, 75 men (150 pelvic sides) underwent pelvic CT angiography and selective pelvic DSA before PA embolization for BPH. Each pelvic side was evaluated regarding the number of independent PAs and their origin, trajectory, termination, and anastomoses with adjacent arteries. RESULTS: A total of 57% of pelvic sides (n = 86) had only one PA, and 43% (n = 64) had two independent PAs identified (mean PA diameter, 1.6 mm ± 0.3). PAs originated from the internal pudendal artery in 34.1% of pelvic sides (n = 73), from a common trunk with the superior vesical artery in 20.1% (n = 43), from the anterior common gluteal-pudendal trunk in 17.8% (n = 38), from the obturator artery in 12.6% (n = 27), and from a common trunk with rectal branches in 8.4% (n = 18). In 57% of pelvic sides (n = 86), anastomoses to adjacent arteries were documented. There were 30 pelvic sides (20%) with accessory pudendal arteries in close relationship with the PAs. No correlations were found between PA diameter and patient age, prostate volume, or prostate-specific antigen values on multivariate analysis with logistic regression. CONCLUSIONS: PAs have highly variable origins between the left and right sides and between patients, and most frequently arise from the internal pudendal artery.

Branching patterns of the male internal iliac artery: imaging findings.

The aim of this study was to establish the imaging findings of the main branching patterns of the male internal iliac arteries, using different imaging modalities (angio MR, angio CT and digital angiography). Twenty-one males (mean age 73.2 years) underwent imaging evaluation with angio MR, angio CT and digital angiography to define the internal iliac artery anatomy before selective embolization of the pelvic arteries. All three modalities were used in 3 patients, angio MR and digital angiography in 17 patients, angio CT and digital angiography in 6 patients and only angio CT in 1 patient. Internal iliac arteries were classified into four groups using the Yamaki classification (modified from the Adachi's classification). Twenty-six pelvic sides were classified as Group A (61.9%), 13 as Group B (31%) and 3 as Group C (7.1%) with no cases of Group D found. Angio MR, angio CT and digital angiography were able to detect most branches of the internal iliac artery. Group A was the most frequent internal iliac artery branching pattern. Angio CT showed better detailed anatomy than angio MR and digital angiography was considered the gold-standard. Non-invasive vascular imaging with angio MR or angio CT is essential before invasive interventions, allowing better planning of the procedure.

Prostatic arterial supply: demonstration by multirow detector angio CT and catheter angiography.

OBJECTIVES: To evaluate the prostatic arterial supply with multidetector Angio CT and Digital Subtraction Angiography (DSA). METHODS: DSA was performed in 21 male patients (7 of these also underwent Pelvic Angio CT); a further 4 patients only underwent Angio CT. Prostatic arteries were classified according to their origin, direction, number of pedicles, termination and anastomoses with surrounding arteries in 50 pelvic sides. RESULTS: The most frequent origin was the internal pudendal artery (n = 28; 56%) with the common gluteal-pudendal trunk the next commonest (n = 14; 28%). Less frequent origins were the obturator artery (n = 6; 12%) or the inferior gluteal artery (n = 2; 4%). Two separate vascular pedicles were found in 12 pelvic sides (24%). There were anastomoses with the termination of the internal pudendal artery in 24% of cases (n = 12), with the contra-lateral prostatic arteries in 6 cases (12%), and to the superior vesical artery in 4 cases (8%). CONCLUSIONS: Defining prostatic artery origin and direction is paramount to allow selective catheterisation. Angio CT is very useful as a pre-intervention tool. The number of independent vascular pedicles and the presence of anastomoses with surrounding arteries should be taken into account when planning prostatic arterial embolisation.

Schwannoma, a rare tumor of the seminal vesicle.

We present a rare case of a schwannoma of the seminal vesicle that occurred in a 43-year-old male with symptoms of the lower urinary tract. Ultrasonography and magnetic resonance imaging documented a solid mass in the patient's left seminal vesicle. A transvesical approach with a transtrigonal midline incision was successfully performed. The microscopic aspect was compatible with schwannoma.