Genitourinary Involvement Research Articles

English

A 63-year-old male patient with diabetes mellitus, hypertension and chronic kidney disease who has been undergoing haemodialysis thrice weekly developed fever and shivering during haemodialysis for one week. He was doing haemodialysis from elsewhere and presented to nephrology department of our hospital with the same complaints. The patient had an intravenous catheter over left internal jugular vein, which was placed one month back from elsewhere for doing haemodialysis. He is a known case of diabetes mellitus and hypertension for the past ten years and on regular medications. On examination, the patient was moderately built and nourished, pallor was present and icterus, cyanosis, clubbing, lymphadenopathy, oedema were absent. His respiratory, cardiovascular, central nervous and gastro intestinal system examinations were within normal limit. The patient was febrile (101̊ F). pulse rate - 98/min, blood pressure – 150/80 mmHg, respiratory rate - 20 cycles per minute, fasting blood sugar - 140 mg/dl, Hb – 9 mg%, WBC count - 5600/μL. On local examination, mild erythema was noted over his neck on intravenous catheter site of left internal jugular vein. Other investigations were within normal limit. Human immunodeficiency virus (HIV), HBsAg and hepatitis C virus (HCV) antibodies were negative. The urine and sputum cultures were done to rule out any genitourinary or respiratory system involvement. Both cultures yielded no pathogens. The patient was treated with removal of internal jugular vein catheter, and a femoral vein catheter was placed. Blood and tip of intravenous catheter were sent to microbiology laboratory for culture and sensitivity testing. The patient was empirically started on intravenous antibiotic vancomycin.

Genitourinary involvement of immunoglobulin G4–related disease

Genitourinary involvement of immunoglobulin G4–related disease

Tip 1 Nörofibromatoziste Kliteromegali Olarak Gözlenen Ekstensif Plexiform Nörofibrom

Neurofibromatosis type 1 (NF1) is an autosomal-dominant disorder with multisystem involvement. Genitourinary involvement of neurofibromatosis type 1 is rare condition and involvement of plexiform neurofibroma can cause painful clitoromegaly. A 9-year-old girl with neurofibromatosis type-1 referred with clitoromegaly to our endocrinology clinic. Pelvic magnetic resonance imaging (T2W images) showed that plexiform neurofibroma was found on the pelvic floor and peripubic region, which was 8x7x13 cm in size, extending to the external genital region and progressing to subcutaneous soft tissue. Cranial and lumbosacral magnetic resonance imaging revealed two neurofibromas in the cerebellar region and the basal ganglia. We emphasize it should be kept in mind that suspicious genitalia may develop due to infiltration of space occupying formations such as neurofibromas.

EP18 Testicular sarcoidosis: a challenging diagnosis

EP18 Testicular sarcoidosis: a challenging diagnosis

Genitourinary involvement in pediatric patients with Klippel-Trenaunay Syndrome

BackgroundKlippel-Trenaunay Syndrome (KTS) is a genetic vascular malformation disorder which induces a variety of phenotypic expression in patients which differ in terms of severity/location. While previous studies have documented genitourinary (GU) complications in adult KTS patients, documentation of the scope and incidence of GU involvement in the pediatric population with imaging findings is currently limited. This study represents the largest KTS genitourinary review to date. ObjectiveTo assess the incidence, scope, clinical findings and imaging characteristics of GU pathology in pediatric KTS patients. Materials/MethodsUsing a retrospective data analysis design, the charts and imaging studies of pediatric KTS patients were reviewed. All patients received care at a specialized vascular clinic within a multicenter tertiary care system. Variables studied included age, age at KTS diagnosis, gender, urologic involvement, and age of urologic complication. Results58 patients were identified. 33 were male and 25 were female. 10 patients had GU findings. Three of these patients had multifocal GU involvement (greater than 1 finding). Urologic manifestations were diverse with 9 distinct diagnoses involving 6 unique organs. Renal, vesical and scrotal pathologies were most common. Hematuria was the most common presenting symptom in 30% (3/10). Previously unreported findings (labial swelling, renal lymphatic cysts) were identified. The average age of KTS diagnosis was 4.9 years. The average age of documented GU complication and involvement was 7.6 years. ConclusionSignificant GU complications due to KTS can occur in the pediatric population. Early clinical and imaging characterization of these conditions is important for management, family education and early intervention strategies.

Giresun ilindeki 106 Behçet hastasının retrospektif değerlendirilmesi

Background Behçet’s disease (BD) is a multisystem inflammatory disorder which is an important cause of morbidity in Turkey.Objective We aimed to investigate the demographical and clinical features of patients with BD followed up in our department in Faculty of Medicine in Giresun University Training and Research Hospital.Methods The hospital records of patients with BD who attended the dermatology department between 2006-2019 were retrospectively evaluated. One hundred and six patients who met the diagnostic criteria of International Study Group for BD were included in the study. The clinical and demographic characteristics, including the age of onset, disease duration, mucocutaneous findings and systemic involvements were recorded.Results Of the 106 patients in the study, 64 (60.4%) were female, 42 (39.6%) were male, and the female-to-male ratio was 1.52:1. The median age at the onset of the disease was 38 years, and the median disease duration was 9 years (range 1-40 years). The most common finding was recurrent oral ulcers (100%) followed by genital ulcers (86.6%), ocular involvement (52.8%), erythema nodosum (49.1%), articular involvement (45.3%), papulopustular lesions (34%), positive pathergy test (21.7%), vascular involvement (14.2%), gastrointestinal involvement (9.4%), neurologic (2.8%) and genitourinary involvement (2.8%). Papulopustular lesions were seen statistically significantly more frequent in men (P=0.047).Conclusion In our study, we presented the demographical and clinical features of patients with BD in a single center in Giresun. Major findings were mucocutaneous ones and most common extracutaneous involvements were eyes and joints.

A rare complication of brucella in adolescence: Epididymoorchitis

Brucellosis is a systemic infectious disease and one of the major public health problems in our country. Genitourinary system involvement is rarely seen in brucellosis, which can involve many organs and systems. A 15-year-old patient who presented with scrotal swelling and pain and subsequently diagnosed as brucella epididymoorchitis is described in this case report. Since brucella rarely presents with epididymoorchitis, it is necessary to keep in mind the differential diagnosis of scrotal diseases, especially in areas where the disease is endemic. Diagnosis can be made with a good anamnesis and laboratory tests and the disease can be controlled with appropriate treatment.

Brusella Epididimoorşitli 7 Vakanın Değerlendirmesi

Brucellosis is one of the most frequent zoonotic diseases in our country. Brucellosis, a systemic infection, can arise with various clinical involvements. Genitourinary involvement is seen at varying rates between 4-20%.Seven examinedepididymo-orchitis cases were diagnosed through anamnesis, physical examination and ultrasonography.All of our patients are provincials, in their anamnesis, there are histories regarding eating infected milk and dairy products and miscarriages in animals. Only in two of seven cases, diagnosis was made through coombs tube agglutination; in the other five of seven cases, standard tube agglutination test was sufficient for diagnosis. Blood culture positiveness was determined in three patients. Patients were healed by taking brucella treatment for six weeks. Combined modality therapy was administered to all patients. Treatment deficiency was not determined in any patients. In this article, we aim to provide taking into consideration also brucellosis in histories of patients having epididymo-orchitis treatment.\n

Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings.

Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.

34. An unusual presentation of a cervical mass

34. An unusual presentation of a cervical mass

Genital Neurofibromatosis Presenting as Painful Clitoromegaly

Neurofibromatosis type 1 (NF1) is a neurocutaneous disorder caused by a mutation on chromosome 17 of the gene for neurofibromin. Patients with this condition are prone to develop benign and malignant tumors of the central and peripheral nervous systems. Genitourinary involvement in children with NF1 is uncommon and primarily affects the bladder. External genital manifestations of NF1 are rare with sporadic reports of children presenting with enlargement of their penis, clitoris, or labia due to a neurofibroma. We present a case of painful clitoromegaly due to a plexiform neurofibroma in a child.

Common and uncommon imaging features of abdominal tuberculosis.

Despite the advances in the medical care, tuberculosis (TB) still remains an important health problem. This is particularly relevant to the developing countries as well as the immunocompromised population in the developed world. Multidrug resistance poses another challenge and may be responsible for increasing incidence of TB, to some extent. The respiratory system is the most commonly involved, although any organ system may be affected. Abdominal involvement occurs in 11-12% of the patients with extrapulmonary TB. The clinical features of abdominal TB are nonspecific. Imaging plays an important role in the diagnosis of abdominal TB. Although a few imaging features strongly favour the possibility of TB, abdominal TB is a greater masquerader. In this review, we highlight the entire spectrum of the manifestations of abdominal tuberculosis (excluding the genitourinary involvement) with an emphasis on imaging findings.

Brucellar epididymo-orchitis: a retrospective study of 25 cases

Objective: Brucellosis is a multisystemic disease which may affect all organs. Epididymo-orchitis is the most common form of genitourinary involvement. The aim of this study was to present our eight-year experience regarding the management of patients with brucellar epididymo-orchitis (BEO).Materials and method: The medical records of male brucellosis patients treated in two centers, between 2010 and 2018 were analyzed retrospectively. The diagnosis of epididymo-orchitis was made when the patients had scrotal pain, swelling, and enlarged tender testicles and/or epididymis on clinical examination. Brucellosis was diagnosed with a positive standard tube agglutination test or a positive blood culture.Results: Brucellosis was diagnosed in 996 male patients. Of these patients, 25 had a diagnosis of BEO (2.5%). All BEO patients suffered from enlarged painful testicles, however, testicular complaints were the only presentation symptoms in three of them. All patients received medical treatment alone except one patient with testicular abscess who underwent surgical drainage besides medical treatment. All patients recovered completely and no relapses have been detected during six-month follow-up.Conclusion: Patients with epididymo-orchitis should be investigated for brucellosis especially in endemic regions. To our knowledge, BEO patients may present with isolated testicular symptoms that make a diagnostic challenge.

Prenatal and postnatal presentation of PRMT7 related syndrome: Expanding the phenotypic manifestations.

Protein arginine methyltransferase 7 (PRMT7) is a member of a family of enzymes that catalyze the transfer of methyl groups from S-adenosyl-l-methionine to nitrogen atoms on arginine residues. Arginine methylation is involved in multiple biological processes, such as signal transduction, mRNA splicing, transcriptional control, DNA repair, and protein translocation. Currently, 10 patients have been described with mutations in PRMT7. The shared findings include: hypotonia, intellectual disability, short stature, brachydactyly, and mild dysmorphic features. We describe the prenatal, postnatal, and pathological findings in two male sibs homozygote for a mutation in PRMT7. Both had intrauterine growth restriction involving mainly the long bones. In addition, eye tumor was found in the first patient, and nonspecific brain calcifications and a systemic venous anomaly in the second. The pregnancy of the first child was terminated and we describe the autopsy findings. The second child had postnatal growth restriction of prenatal onset, hypotonia, strabismus, sensorineural hearing loss, genitourinary and skeletal involvement, and global developmental delay. He had dysmorphic features that included frontal bossing, upslanting palpebral fissures, small nose with depressed nasal bridge, and pectus excavatum. Our patients provide additional clinical and pathological data and expand the phenotypic manifestations associated with PRMT7 homozygote/compound heterozygote mutations to include brain calcifications and delayed myelination, and congenital orbital tumor.

18F-FDG PET/CT Findings of Non-Hodgkin Lymphoma Involving the Whole Genitourinary System

A sixty-two-year-old male patient underwent orchiectomy and was diagnosed with diffuse large B-cell lymphoma in the testicle and spermatic cord. 18F-FDG positron emission tomography/computed tomography (PET/CT) scanning was performed for initial staging. 18F-FDG PET/CT scan revealed multiple hyper-metabolic lymphadenopathies, lung lesions and mass lesions in the adrenal glands and kidneys. In addition, diffuse increased 18F-FDG uptake suggesting lymphomatous infiltration on the right testicle, prostate and left testicular veins were detected. The genitourinary system involvement is extremely rare in extra-nodal lymphomas and to the best of our knowledge this is the first case in the literature having 18F-FDG accumulating lesions in all genitourinary system structures.

Li-Fraumeni Syndrome-related Malignancies Involving the Genitourinary Tract: Review of a Single-institution Experience

ObjectiveTo report a case of pelvic angiosarcoma in a 27-year-old man with Li-Fraumeni Syndrome (LFS) and evaluate the presentation and timeline of genitourinary (GU) tract involvement in LFS patients. MethodsWe retrospectively identified 39 LFS patients treated at our institution between 2000 and 2014; 7 (18%) had experienced a GU malignancy or an LFS-related malignancy involving the GU tract. Clinical characteristics, including dates of onset of first GU tract malignancies; pathologic findings; multimodal management; and familial history of LFS were reviewed. ResultsMedian age at first malignancy was 14.0 years (interquartile range [IQR] 5.5-24.0). There was a slight male predominance (4 of 7). Median time between first malignancy and the malignancy involving the GU tract was 10.1 years (IQR 8.0-19.5). Six of the 7 patients (86%) had a form of sarcoma involving the GU tract; 1 developed adrenocortical carcinoma. The cancer pedigree of all patients showed LFS-associated malignancies in family members. Multimodal management included surgical resection in 6 patients with adjuvant chemotherapy or radiotherapy in 1 patient each. One patient received chemotherapy only. Following diagnosis of malignancy involving the GU tract, 5 of the 7 patients developed additional primary malignancies. At a median follow-up of 4.7 years (IQR 3.0-12.1), 2 patients are alive, 3 died of disease, and 1 died of unknown cause. One patient was lost at follow-up. ConclusionContinued follow-up of LFS cancer patients aimed at the determination of optimal screening, management, and surveillance protocols is recommended and may result in longer survival expectations.

Genitourinary involvement of lymphomas on FDG-PET.

Primary extranodal lymphomatous involvement of the genitourinary tract is rare and secondary extranodal involvement in disseminated disease occurs more frequently. Imaging of metabolic activity with 2-(fluorine-18) fluoro-2-deoxy-d-glucose (FDG) used in PET facilitates the identification of these extranodal sites of disease, particularly in the absence of structural lesions on conventional imaging modalities. Primary extranodal lymphoma affecting the genitourinary system is often caused by high-grade Non-Hodgkin's Lymphoma(NHL) with the most common subtype being diffuse large B-cell lymphoma(DLBCL). Although rare, the incidence of extranodal lymphoproliferative disease is increasing and a delay in diagnosis holds a poor prognosis. Familiarity with benign and physiological causes of FDG uptake, particularly due to the urinary tracer excretion is crucial in identifying sites of lymphomatous involvement in the genitourinary system. Additionally, non-lymphomatous malignancies are usually treated surgically, whereas lymphoma is primarily treated with chemotherapy and/or radiotherapy. Therefore, accurate identification and staging together with histological confirmation significantly impacts management of these patients.This article serves to review and illustrate the imaging findings on FDG-PET/CT of primary extranodal lymphoma affecting the genitourinary system.

Henoch-Schonlein Purpura in childhood: a tertiary care hospital experience in Turkey

Background: This study examines the clinical and laboratory features of children with Henoch-Schönlein purpura.Methods: A retrospective study was applied for the 32 Henoch-Schönlein purpura patients who were monitored between January 2014 and June 2017 at the Pediatric clinic of a tertiary care hospital. The diagnoses were made based on the HSP criteria of the American College of Rheumatology. Age, gender, clinical and laboratory findings of the patients were recorded.Results: The mean age of the 32 Henoch-Schönlein purpura patients was 9.29±3.29 years. Complaints at the time of admission were as follows: 93.8% of the patients (n=30) had rash; 40.6% (n=13) had abdominal pain; and 59.4% (n=19) had joint involvement and inability to walk. The results of fecal occult blood test examined during the admission were found as negative for the 75% (n=25) of patients and positive for the 19% (n=6) of patients. According to the urinary specimens, which were considered as the evidence of renal involvement at the applications, proteinuria was found negative for the 27 (8.4%) patients and positive for the 5 (1.6%) patients; hematuria was negative for the 29 (90.6%) children and positive for the 3 (%9.4) children. Antihistamine and non-steroidal anti-inflammatory were started as the treatment to the patients. During the follow-up, the 15.5% of patients had positive fecal blood tests although their test results were negative at the admission. During the clinical follow-up, the presence of proteinuria was found positive for the 6.3% of patients who had negative proteinuria test at their admissions.Conclusions: Henoch-Schönlein purpura is a childhood vasculitis that manifests itself with rash and joint findings. It can cause significant complications due to gastrointestinal and genitourinary system involvement.

Cutis laxa associated with monoclonal gammopathy: 14 new cases and review of the literature

Cutis laxa associated with monoclonal gammopathy: 14 new cases and review of the literature

81 - Genitourinary Involvement in Deep Infiltrating Endometriosis

81 - Genitourinary Involvement in Deep Infiltrating Endometriosis