Introduction and importance Xanthogranulomatous pyelonephritis is an extremely rare but known form of chronic pyelonephritis resulting from prolonged suppuration of the kidney. Pre-operatively, it may mimic renal tuberculosis or neoplastic lesions including renal cell carcinoma due to its vague clinical presentation, equivocal laboratory and radiological investigations. Due to its rarity and academic interest, herein we report such a rare case we recently encountered in our clinical practice. Case presentation An-eight-year old male child patient resented to our hospital with three months history of abdominal distension associated with progressive left flank pain. Preoperative investigations including CT-scan were suggestive of nephroblastoma with differential diagnosis of clear cell sarcoma. Radical nephrectomy was performed and histopathology of the specimen confirmed the diagnosis of Xanthogranulomatous pyelonephritis. The patient fared well postoperatively and he had no symptoms in the subsequent follow up visits. Clinical discussion Xanthogranulomatous pyelonephritis is a rare, severe and atypical form of chronic pyelonephritis due to infection ( E. coli , Proteus) or stones. The disease may resemble renal cell carcinoma preoperatively. Thus, high index of suspicion is necessary for preoperative diagnosis. Conclusion Preoperative diagnosis of Xanthogranulomatous pyelonephritis may be a daunting task related to the rarity of its presentation. Thus, scrupulous histopathological evaluation is essential for the definitive diagnosis. Radical nephrectomy is the mainstay treatment of choice especially in diffuse cases.

A 20-year-old man from Simanjiro district in northern Tanzania presented with a 3-year history of splenomegaly, fatigue, cachexia, skin maculae, and recent onset of watery diarrhea at Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania. Due to laboratory findings of pancytopenia, diagnostic workup included bone marrow aspiration cytology and biopsy. Although the rapid test (IT LEISH, rK39 RDT) was negative, blood smear showed amastigote forms of leishmaniasis in macrophages. Repeat bone marrow aspiration and PCR eventually confirmed visceral leishmaniasis (VL). The patient denied travel to known endemic areas of VL. Treatment was initiated with Amphotericin B, but the patient died on the fourth day of treatment from respiratory insufficiency. An autopsy revealed massive organ manifestations of VL. This is the first reported autochthonous case of VL in Tanzania. Clark and colleagues detected the vector Phlebotomus martini in Northern Tanzania in 2013, in a region bordering the district of our patient. The negative rapid test draws attention to the fact that sensitivity and specificity were found to be low in East African VL patients as displayed earlier by a Kenyan study. Therefore, tissue samples (spleen or bone marrow) remain necessary for diagnosis. The variety of symptoms in this presented case was remarkable, including the occurrence of post-kala-azar dermal leishmaniasis (PKDL) and VL at the same time. This has been described in East African VL cases before as well as the occurrence of chronic diarrhea. An elongated undiagnosed period likely led to a mixed clinical picture that included hepato-splenomegaly, PKDL, cachexia, and diarrhea.

Primary scrotal lipoma is a rare urological diagnosis. It is usually diagnosed incidentally as most of time initial diagnosis may be confused with other common etiology of scrotal masses. Here, we present a case a rare case of scrotal lipoma with initial misdiagnosis of hydrocele at primary health facility.

A 35-year-old man presented with a right lateral neck mass for 6 years. Thyroid function test was within normal limits. Computed tomography scan of the neck was suggestive of branchial cyst, tuberculous lymphadenopathy and normal thyroid gland. Fine needle aspiration cytology of cervical lymph node was suggestive of metastatic carcinoma. Branchial cystectomy spearing the thyroid gland was undertaken. Histopathology analysis of the resected specimen confirmed it to be papillary thyroid carcinoma originating from ectopic thyroid tissue in a branchial cyst. The patient was scheduled for total thyroidectomy and neck dissection. Unfortunately, he was lost to follow-up. A brief review of the literature regarding this unusual presentation of thyroid cancer has been provided.

Malignant mixed Müllerian tumor of the ovary is rare aggressive tumor that is histologically defined by the presence of malignant epithelial and stromal components. We report a 37-year-old woman who consulted our facility complaining of abdominal distention and a painful palpable mass over her lower abdomen. Physical examination including computerized tomography revealed a complex cystic mass lesion on the left ovary with extensive omental involvement. Ovarian cancer was suspected and the patient underwent debulking surgery. The histopathology of the specimen revealed a high-grade tumor composed of both malignant epithelial and sarcomatous elements. Both epithelial and stromal components stained positive for p53 immunostaining. Before the initiation of chemotherapy, on 5th day postoperation, the patient was found unresponsive. The stage of the disease seems to be the most important prognostic factor, thus emphasis should be made to identify it in earlier stages.