Penile self-mutilation is predominantly associated with psychiatric disorders and rarely occurs during suicide attempts by men with depressive mood disorders. Herein, we have reported a case of penile self-mutilation by a patient with depression. Case presentation: A 63-year-old man with a 20-year treatment history of depression presented to our hospital an hour after cutting his penile shaft during a suicide attempt. Hemostasis was achieved by urologists, and his psychiatric condition was evaluated by psychiatrists. The patient and his family hoped for penile replantation. His mood disorders were controllable, and microscopic replantation was performed by plastic surgeons after multidisciplinary discussion. The patient recovered, urinated without any signs of urinary stricture, showed no progression of depression, and did not repeat the mutilation. Conclusion: Penile self-mutilation during suicide attempts is a rare urological emergency that requires multidisciplinary management involving urologists, psychiatrists, and plastic surgeons.
Introduction
We report two cases of renal cell carcinoma with brain metastases that showed remarkable responses to cabozantinib.
Case presentation
(Case 1) A 70‐year‐old man with cT3aN0M0 clear cell renal cell carcinoma underwent radical nephrectomy and developed multiple brain metastases 2 months postoperatively. The brain lesions regressed after stereotactic radiotherapy followed by ipilimumab plus nivolumab therapy, but a new brain metastasis that caused hemiplegia developed after 6 months and showed no response to stereotactic radiotherapy. However, complete remission was achieved, and hemiplegia ceased within 2 weeks of cabozantinib therapy. (Case 2) A 63‐year‐old man with cT3aN0M1 clear cell renal cell carcinoma and brain metastases underwent upfront cytoreductive nephrectomy. The brain lesions progressed rapidly 1 month postoperatively. The lesions disappeared 2 weeks after cabozantinib plus nivolumab therapy.
Conclusion
Cabozantinib, alone or in combination with immune checkpoint inhibitors, may be a viable option for clear cell renal cell carcinoma with brain metastases.
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