Eosinophilic ureteritis (EU) is a rare inflammatory condition characterized by eosinophilic infiltration of the ureter, often presenting with flank pain, hematuria, or obstructive uropathy. Fewer than 30 cases have been reported in the literature, and no standardized treatment strategy currently exists. We report the case of a 54-year-old woman with a history of eosinophilic cystitis who developed progressive left-sided flank pain and hydronephrosis following radical cystectomy. Ureteroscopy with biopsy confirmed EU. A six-week course of corticosteroids resulted in partial radiographic improvement but persistent eosinophilic infiltration on repeat biopsy. Given ongoing biopsy-proven eosinophilic inflammation despite corticosteroid therapy, a multidisciplinary discussion between urology and rheumatology led to initiation of mepolizumab (300 mg administered as three 100-mg subcutaneous injections every four weeks) to target IL-5-mediated eosinophilic inflammation. Following initiation of therapy, the patient experienced progressive clinical improvement, with symptom relief beginning approximately three months after treatment initiation. Repeat imaging demonstrated decreased ureteral inflammation, and follow-up ureteral biopsy showed complete absence of eosinophils, consistent with remission of active disease. The patient has remained clinically stable for approximately 18 months of follow-up without the need for ureteral stenting or additional surgical intervention. This case suggests a potential therapeutic role for IL-5 pathway inhibition with mepolizumab in EU and highlights the biologic rationale for targeting eosinophil-mediated inflammation in this condition. However, because this report describes a single patient and off-label biologic therapy, these findings should be interpreted cautiously. Further investigation through additional case series, prospective studies, and rare-disease registries will be necessary to better define the role of IL-5-targeted therapies in EU, with potential for future clinical trials if sufficient evidence emerges.

Ewing's sarcoma (EWS) of the kidney is an extremely rare and aggressive malignancy, accounting for less than 1% of renal tumors. This report presents a 42-year-old male who initially presented with hematuria and intermittent fever, with imaging studies suggesting a renal cell carcinoma (RCC). However, histopathological and immunohistochemical analysis, including CD99 positivity and NKX2.2 nuclear expression, confirmed the diagnosis of primary renal EWS. The patient was promptly started on neoadjuvant chemotherapy (VAC + IE [vincristine, adriamycin, cyclophosphamide, ifosfamide, and etoposide]), which he tolerated well without significant adverse effects. Given its nonspecific clinical and [18] F-fluorodeoxyglucose positron emission tomography/computed tomography scan presentation, the case highlights the diagnostic challenges in distinguishing renal EWS from more common renal neoplasms such as RCC. Early diagnosis through histopathology and immunohistochemistry is crucial for guiding appropriate management. Given the aggressive nature of renal EWS, a multimodal treatment approach involving chemotherapy followed by radical nephrectomy is essential for improving prognosis. This case sheds light on the importance of considering renal EWS in the differential diagnosis of renal masses and emphasizes the role of early intervention in enhancing survival outcomes.

We report a case of delayed hemorrhage occurring four weeks after robotic-assisted partial nephrectomy for renal cell carcinoma. The patient, a 59-year-old lady, presented with gross hematuria and hemodynamic instability. Computed tomography (CT) angiography demonstrated a pseudoaneurysm arising from the resection site. As part of the major hemorrhage protocol, the patient received blood products and tranexamic acid (TXA) for hemorrhage control. Definitive hemostasis was achieved through the selective angioembolization of the pseudoaneurysm. Following embolization, the patient developed upper urinary tract obstruction secondary to extensive intraluminal clot formation. Endoscopic evaluation revealed a significant clot burden within the bladder and ureter, necessitating clot evacuation and ureteric stent placement to restore urinary drainage. The patient recovered fully, with stable renal function and no recurrence of bleeding following stent removal. This case highlights a potential association between tranexamic acid use and extensive intraluminal clot formation in the setting of upper urinary tract bleeding, particularly when bleeding communicates directly with the collecting system.

A 59-year-old female patient was admitted due to a vaginal mass detected one month ago. There is no family history of malignant tumors, nor any relevant complications. One month prior, she incidentally palpated a cystic mass on the anterior vaginal wall while bathing. She reported no dysuria, hematuria, abdominal pain, or vaginal bleeding. Over the past week, she developed dysuria with interrupted urine flow, but no frequency or urgency. Pelvic MRI revealed a cystic-solid mass in the anterior vaginal wall with indistinct borders from the urethra. Needle biopsy of the vaginal mass combined with immunohistochemistry initially suggested clear cell adenocarcinoma. Final diagnosis was confirmed as primary urethral clear cell carcinoma by pathological examination of the radical resection specimen. Cystic masses in the anterior vaginal wall should raise suspicion for urothelial origin clear cell carcinoma. Fine-needle aspiration biopsy combined with immunohistochemistry may still yield misdiagnosis; definitive diagnosis relies on pathological examination of resected specimens.

Tubular adenoma of the urinary bladder is an exceptionally rare intestinal-type glandular neoplasm that may mimic urothelial malignancy. Among approximately 82 reported enteric-type bladder adenomas, only four represent pure tubular adenomas. We report a case in a 78-year-old woman presenting with gross hematuria. Cystoscopy revealed a suspicious lesion, and transurethral resection was performed. Histopathologic examination showed tubular glands with intestinal differentiation without villous architecture. Immunohistochemistry supported intestinal differentiation. To our knowledge, this represents the fifth reported case. Recognition of this entity is essential to avoid misdiagnosis and overtreatment.