Herniation of bladder mucosa through the bladder wall muscle layer is known as bladder diverticulum. The incidence of bladder diverticulum is 1.7. About 0.8 to 10% of the urinary bladder diverticulum develops carcinoma. Transitional cell carcinoma is the most common. Painless hematuria is the most common clinical presentation. Different imaging modalities along with cystoscopy are the key to accurate diagnosis and staging. High grade multifocal urothelial carcinoma in the bladder diverticulum is better managed by radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Here we report a case of a 66-year old gentleman of high grade multifocal urothelial carcinoma in bladder diverticulum managed with radical cystectomy and standard pelvic lymph node dissection with an ileal conduit. Such cases have been addressed adequately in the literature, but we did not find such cases from our country.

Lymphadenopathy is most commonly encountered problems in clinical practice. Various etiological factors can cause lymphadenopathy. Cytomorphological study of lymphadenopathy is a window for diagnosis of many disease processes. Aspiration cytology provides a reliable, safe, rapid and economical method of screening the patients with accuracy. It can differentiate neoplastic from non-neoplastic lesions and therefore influences patient management preventing patient from being subjected to unnecessary surgery. Hospital based descriptive study was carried out in the Department of Pathology of a tertiary health care hospital in Kathmandu over a period of three years (1st June 2019 to 30th May 2022). A total of 331 cases of lymphadenopathy were included in the study. The aim of this study was to evaluate the cytomorphological findings of lymphadenopathy. Out of 331 cases of lymphadenopathy, 281 (84.9%) of the cases were non-neoplastic and 47 (14.2%) were neoplastic. Among non neoplastic lesions, reactive lymphadenitis 113 (34.1%) was the most common diagnosis followed by tubercular lymphadenitis, granulomatous lymphadenitis, suppurative lymphadenitis and necrotizing lymphadenitis. Among neoplastic, 40 (12%) were metastatic carcinoma and 7 (2.1%) were lymphoma. Among metastatic carcinoma the most common was squamous cell carcinoma followed by breast carcinoma, adenocarcinoma, papillary carcinoma of thyroid. Other metastatic carcinoma were small cell carcinoma of lung and melanoma. This study showed that cytomorphological study of lymph node is a convenient procedure for accurate assessment of patients with lymphadenopathy.

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Prostate cancer metastasis to the ureter is extremely rare because only 45 such cases have been reported worldwide in the last century. It accounts for 30% of ureteral metastasis. Neuroendocrine differentiation is approximately 1% of the entire primary prostate adenocarcinoma pathology. Metastatic prostate cancer may pose as upper tract urothelial carcinoma. Prostate may look normal on clinic-radiological examination in prostate cancer. Majority of such cases are managed with nephroureterectomy. Herein, we report a case of 62-year gentleman, who presented with refractory left flank pain with repeated imaging suggestive of neoplastic left ureteric stricture and normal prostate on clinic-radiological examinations. The case was later found with the diagnosis of metastatic prostate adenocarcinoma with neuroendocrine differentiation after left sided nephroureterectomy done for a provisional diagnosis of Upper Tract Urothelial Carcinoma (UTUC).

Renal calyceal diverticulum is a non-secretary urothelium cavity in the renal parenchyma communicating with calyx allowing for passive filling with urine. Calyceal diverticula are found incidentally in 0.21% to 0.6% of intravenous urograms in adults. Stone formation occurs in about 10-50% cases of renal calyceal diverticula. Symptomatic case needs treatment. Digital flexible ureteroscopy with Holmium laser infundibulotomy and laser lithotripsy is beneficial in terms of shorter hospital stay, better stone clearance and minimal complications in comparison with those of other modalities. Cases of stenotic infundibulum have been addressed adequately but infundibular atresia has been rarely reported. Therefore, we present a symptomatic case of calyceal diverticular stone with infundibular atresia managed by disposable flexible ureteroscopy with holimium laser infundibulotomy and laser lithotripsy.