Introduction Extragastrointestinal stromal tumors (EGIST) are rare mesenchymal tumor lesions located outside the gastrointestinal tract. A rare compressing tumor with difficult diagnosis is reported. Presentation of the Case A male patient, 63 years old, was admitted in the emergency room complaining of stretching and continuous abdominal pain for one day. He took Hyoscine, with partial improvement of symptoms, but got worse due to hyporexia, and the abdominal pain persisted. The patient also reported early satiety and ten-pound weight loss over the last month. Discussion EGIST could be assessed by CT-guided biopsy, leading to diagnosis and proper treatment with surgical resection or Imatinib. Conclusion This case report highlights the importance of considering EGIST an important differential diagnosis of compressing upper abdominal tumors.

The liver transplant patient was admitted to the hospital with hyperemic, granulomatous, ulcerated lesion in the anterior compartment of the right lower limb with report of local trauma. The agent Sporothrix schenckii was isolated from biopsy of the lesion and lymph nodes of the right lower limb. In this case, the treatment was difficult because the patient has severe pulmonary hypertension and took the following drugs: warfarin, sildenafil, and tacrolimus. These medicines interact with the antifungal, which made it difficult.

Varicocele is a dilation of the pampiniform venous plexus, mainly affecting the left side of the scrotum. In rare cases, however, the right side is affected. When this occurs, a retroperitoneal disease should be suspected, such as right-sided renal neoplasm. The present case report highlights the importance of right-sided varicocele in the diagnostic investigation of neoplasm of the right kidney.

Introduction: Percutaneous nephrolithotomy is the main type of surgery indicated for kidney stones larger than 2 cm. The present study describes a three-needle technique for percutaneous nephrolithotomy on two planes. Surgical technique: The patient is first placed in the lithotomy position for cystoscopy, which guides the ureteral and urethral catheter. Next, the patient is placed in ventral decubitus for the three-needle technique. With the aid of the nephroscope, the first needle is positioned in the projection of the renal pelvis, the second needle is placed in the most posterior of the inferior calyces and the third needle is aligned with the other two at the most depressible point determined by the surgeon’s index finger. After alignment in the topography of the third needle, an incision is made with the scalpel 1-2 cm perpendicular to the aponeurosis of the latissimus dorsi muscle. The second needle is replaced with a peridural needle, which is used to confirm the location of the inferior renal calyx and limit the depth of the Chiba needle inserted in the topography of the third needle, forming a 90° angle with the peridural needle. The Chiba needle enables the passage of the guidewire and subsequent dilatation until the 30F caliber for the passage of the Amplatz dilator, initiating the conventional procedure. Comments: The technique described has been used at our service for 15 years and has the advantages of less morbidity, fewer complications and less use of the nephrostomy tube. The technique is also easy to learn and highly reproducible.

Introdução: A doença renal policística é, em grande parte, um acometimento genético autossômico dominante com presença de cistos renais, podendo haver perda da função renal e outras manifestações, como cistos hepáticos, aneurisma cerebral e doenças cardiovasculares. O rim em ferradura é uma anomalia renal mais comum, ocasionada por um defeito na fusão durante a embriologia. É, em geral, assintomático, podendo estar associado com doença renal policística, nefrolitíase, hipertensão renovascular, entre outros. A associação entre as duas entidades é rara, sobretudo seu diagnóstico, quando na maioria dos casos, ocorre em exames de rotina. Objetivo: Relatar o caso raro de um paciente com rim em ferradura associado a doença renal policística. Materiais e Métodos: Revisão do prontuário, registro fotográfico dos métodos diagnósticos e revisão da literatura. Resultados: Paciente masculino, 76 anos, hipertenso e com hiperplasia prostática benigna foi admitido com oligúria, disúria, dor abdominal há cerca de uma semana com piora progressiva. Relatava ainda febre e uso de sonda vesical de demora para tratamento de retenção urinária há 9 meses. Após exames laboratoriais e tomografia de abdome, foi diagnosticado com pielonefrite aguda e doença renal e hepática policística associado com rim em ferradura. Conclusão: Obtivemos com o caso relatado e a revisão da literatura uma melhor caracterização dos sinais e sintomas do rim em ferradura em paciente com doença renal policística