Primary bilateral non-Hodgkin's lymphoma (NHL) of the adrenal gland is a very rare entity. Indeed less than 60 cases have been reported in the literature. Hence, we report a case of high-grade lymphoma of both adrenal glands that was found in a young patient of 32 years of age. The patient was admitted in the emergency department of our hospital with a profile of hemorrhagic shock. After stabilization, the imaging investigations demonstrated large bilateral adrenal masses. The CT-scan guided biopsy of both adrenal glands allowed the diagnosis of primary bilateral adrenal NHL. The patient died after the first chemotherapy session. The presence of bilateral adrenal masses associated with a rapid increase of volume should raise the diagnosis of primary adrenal non-Hodgkin's lymphoma.
IntroductionSelf-insertion of foreign bodies into the urethra represents a heterogeneous group of cases concerning a wide variety of objects and involving multiple procedures and surgical techniques.Case presentationWe report a case of self-insertion of an electric cable into the urethra by a 36-year-old Caucasian man for erotic reasons. The patient, who has an ambiguous history of self-inflicted penile strangulation in childhood and self-insertion of foreign bodies into the urethra in recent years but no psychiatric history, presented to the emergency department to remove the object introduced one week previously. He was - strangely - asymptomatic and presented neither dysuria nor urinary incontinence or hematuria. A physical examination revealed a penile scar corresponding to the strangulation and a palpable hard, thin mass in the perineal urethra. The biologic findings were normal. Plain film of the urinary tract showed a hollow tubular object, whose size and shape corresponded to those of the urethra. Rigid cystoscopy was performed, which revealed urethral stricture at the projection of the scar. Laborious urethrotomy was performed before reaching the 25cm long cable, which was found in the urethra and removed with difficulty due to stenosis.ConclusionsWe encountered a particular case combining a self-introduced foreign body in the urethra and the sequelae of such manipulations, which is urethral stricture. We succeeded in treating both by endoscopy, which is not always possible in this situation.
IntroductionUrogenital tuberculosis is a frequent disease in endemic countries. It is characterized by clinical polymorphism. The isolated urethral form is exceptional, even in countries with endemic tuberculosis. We present a rare case of urogenital tuberculosis in a man revealed by urethral narrowing and multiple urethro-scrotal fistulas.Case presentationThe patient, a Moroccan man, was 40 years old. He visited our hospital for a urology consultation and presented with dysuria, purulent discharge and a meatic penoscrotal fistula. A retrograde and voiding urethrocystography was performed and revealed an extended narrowing of the whole anterior urethra associated with multiple fistulous portions toward the scrotum and perineum. At this stage, we reached a diagnosis of nonspecific sclero-inflammatory urethral stricture with complicating fistulas. We decided to perform a urethroplasty enlargement to clear the narrowing urethral sinus tracts. The evolution was marked by delayed wound healing associated with the persistence of fistulas extending into the corpus cavernosum with purulent discharge. It was at this point in the treatment that we suspected tuberculosis. Multiple biopsies were then performed on the periurethral tissue and fistula tracts. The histological examination confirmed urethral tuberculosis and showed the presence of giant cell epithelial lesions with caseous necrosis characteristic of tuberculosis. The treatment for tuberculosis was immediately established and the evolution was marked by a localized, rapid and significant improvement. A second-stage urethroplasty was scheduled for two months after the start of his antituberculous treatment.ConclusionsUrogenital tuberculosis is common, but isolated urethral involvement is very rare even in countries with endemic tuberculosis. We urge practitioners, and especially urologists, to consider the disease in their investigation whenever given clinical signs are declared.
IntroductionGenital self-mutilation is listed as a symptom of borderline personality disorder. The type of injury varies from simple skin laceration to total amputation of the penis and testicles. These injuries are urological and surgical emergencies.Case presentationWe report two cases of penile self-mutilation precipitated by erotic and religious bizarre delusions.Our first patient is a 24-year-old Moroccan man who visited our emergency room with a metallic ring at the root of his penis which had caused marked edema of his entire penis.Our second patient is a 26-year-old Moroccan man evaluated in our emergency unit. A clinical examination revealed a wound at the dorsal side of his penis with complete transection of the dorsal vein and imperfect hemostasis.The two patients were treated in our emergency unit after which a favorable clinical course was observed.ConclusionCases of genital self-mutilation are urological and psychiatric emergencies, therefore it is important that surgical and psychiatric teams collaborate closely while managing cases of genital self-mutilation.
IntroductionTuberculosis is still endemic in Morocco and the urogenital form is common. This form is characterized by clinical polymorphism. However, the isolated ureteric form is very rare. The differential diagnosis might be raised in tumoral cases while undertaking surgical excision which is the realistic choice. Hence, we report an isolated ureteric tuberculosis case, and we discuss the clinical, imaging, diagnostic and therapeutical features.Case presentationA 30-year-old Moroccan man consulted us for left back pain associated with urinary frequency and a few macroscopic episodes of hematuria for the past six months. A computed tomography urography revealed a left hydronephrosis and hydroureter secondary to focal wall thickening of the left lumbar ureter. Hence, we had diagnosed a ureteral tumor. However, a clinical examination showed irritative voiding symptoms and epididymal disorders associated with prostate infection suggesting a Koch’s bacillus assessment of the patient’s urine of which the results proved strongly positive. The treatment consisted of establishing a double-J ureteric stent to drain the left kidney, followed by antituberculous antibiotics.ConclusionUrogenital tuberculosis is common in endemic countries, however isolated ureter affection is rare. It is important to consider a ureteral tuberculosis diagnosis whenever ureteral thickening is revealed in a patient living in a country in which tuberculosis is endemic.
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