BACKGROUNDCarcinoma prostate is one of the most common cancer in an elderly male. With the peak incidence between 70 and 74 years of age, less than 1% of patients with prostate cancer are younger than 50 years of age. Metastasis from prostate cancer occurs via local spread, lymphatic spread and haematogenously to the axial skeleton. Here, we present a case report of advanced prostate cancer presenting as cervical lymph node enlargement, which is a rare presentation.
Wilms' tumour also called as nephroblastoma is a malignant renal neoplasm of childhood that arises from remnant of immature kidney. About 80% of Wilms' tumour cases occur before age 5 with a median age of 3.5 years. But adult Wilms' tumour can occur at any age from 16 to 70 years, the median age in young adult is around 24. CASE REPORTA 16-year-old girl came with history of mass right abdomen, which she noticed for 1 week duration; no urinary symptoms. Her recent blood pressure was 140/90 mmHg. Per abdomen a 10 x 9 cm mass palpable in the right lumbar region, surface smooth, firmto-hard in consistency, non-tender, well defined, no bruit. Urine routine examination was normal; urine culture was sterile; renal and liver function tests were within normal limits; Sr. calcium 9.5 mg/dL. CT abdomen plain and contrast showed a 10 x 9 cm heterodense lesion equivocal with renal cell carcinoma and angiomyolipoma. MR angiogram was done. It showed well-defined encapsulated heterointense mass of size 12 x 8 x 7cm, IVC and bilateral renal vein normal. Since findings were inconclusive, we did a CT-guided biopsy and report came as feature positive for small round cell tumour. Hence, proceeded with right radical nephrectomy. The final histopathology report came as Wilms' tumour spindle cell variant. Margins clear and ureter not involved. She was then started on adjuvant chemotherapy Inj. Vincristine 2 mg weekly for 27 weeks. She is on regular followup now. CONCLUSIONWilms' tumour should be considered in a patient who presents with a renal mass with or without loin pain, haematuria especially in young adults. Every attempt should be made to differentiate it from renal cell carcinoma. The outcome for adult Wilms' tumour is steadily improving with current multimodality treatment approach.
The urachus is an embryological tubular structure extending from the umbilicus to the urinary bladder apex, which usually gets obliterated but may persist uncommonly in adults. Rarely, the urachus may be the primary site of benign and malignant neoplasms. Urachal malignancies are rare and represents less than 1% of all bladder neoplasms. CASE REPORT A 39-year-old female presented with pain and lump in the lower abdomen for 6 months' duration. No other symptoms. History of caesarean section 8 years back. On examination, a lower midline scar present. A vague swelling of size 6 x 5 cm present in the left lower abdomen adjacent to scar, surface smooth, firm, non-tender and non-reducible. Provisional diagnosed as irreducible, nonobstructing incisional hernia. Routine investigations were normal. Ultrasonogram abdomen was equivocal. CT abdomen plain and oral contrast confirmed a urachal cyst with subcutaneous component, so we planned for diagnostic laparoscopy and exploration. Intra-operatively, a 4x4 cm midline cystic mass infra-umbilical, well away from bladder dome. Abdominal component was mobilized laparoscopically using monopolar hook. A connecting component was identified entering the linea alba close to umbilicus into subcutaneous plane. Further laparoscopic dissection abandoned. A small mid-midline incision was made and both components excised in-toto. The final histopathology report came as fibrocollagenous, fibromyxoid, fibrofatty cyst wall lined by cuboidal to polygonal epithelial cells with focal atypia. Features consistent with urachal cystadenoma with focal atypia. CONCLUSION Rarely described in literature, it should be treated as mucinous cystadenoma of undetermined malignant potential which has the tendency for local recurrence should be completely excised. Followup of these tumours is mandatory, as it presents with focal atypia.
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