Myelolipomas are described as small tumors, with some authors referring to sizes less than 4 cm in diameter. However, when greater than 10 cm, myelolipomas are labeled as giant tumors and thus, have a definite indication for surgical resection. Myelolipomas represent a small percentage of adrenal tumors. Giant myelolipomas are usually discovered incidentally during imaging studies performed for other conditions. They are often slow-growing and may reach sizes that significantly distort the anatomy of the affected area. Despite their large size, they are usually benign and do not spread to other parts of the body. Adrenal myelolipoma is a benign tumor with a scarce number of detailed cases reported in literature. It is frequently discovered by chance, covering a variety of differential diagnoses. Imaging techniques and histopathological examinations are of great importance in the differential diagnosis of adrenal gland lesions, including retroperitoneal lipoma and liposarcoma, adrenal myelolipoma, adrenal lymphoma, adrenal adenoma, adrenocortical carcinoma, pheochromocytoma or metastasis. We performed a comprehensive review on PubMed of all cases of giant adrenal myelolipoma reported in literature with more than 10 cm in diameter, in order to estimate the incidence, diagnosis and treatment of giant myelolipoma. So far, only 15 cases of truly giant adrenal myelolipoma have been reported between 1981 and 2023.

Background: To diagnose prostate cancer, a prostate biopsy is required. Two methods are commonly used for biopsy: transrectal and transperineal. The transperineal approach, particularly the “freehand” technique under local anesthesia, offers better access to the anterior prostate, lower infection risk, and higher detection rates. Methods: This retrospective study examined the records of 1674 patients who underwent ultrasound-guided prostate biopsies between 2015 and 2022. Of these, 1161 patients had transperineal biopsy using the “freehand” method, and 513 had transrectal biopsy. All the biopsies were carried out under local anesthesia, with a combined systematic and targeted approach for patients with MRI-identified lesions. Results: This study demonstrates that the transperineal biopsy approach significantly increased the detection rate of clinically significant prostate cancer compared with the transrectal method, with detection rates of 65.7% and 59.4%, respectively. Notably, the transperineal technique also achieved superior detection of anteriorly located tumors (94.1% vs. 43.1%), supporting its use as the preferred biopsy strategy, particularly in anatomically challenging regions. Moreover, patients who underwent transperineal biopsy demonstrated more favorable diagnostic outcomes, characterized by a higher detection rate for clinically significant cancers and a reduced incidence of clinically insignificant cases. The transperineal method outperformed the transrectal approach, especially among younger patients and those presenting with lower PSA values. These results highlight the diagnostic superiority and broader clinical applicability of the transperineal biopsy technique across various patient subgroups.

Background and Objectives: Renal trauma is a significant consequence of both blunt and penetrating injuries, with management strategies having continuously evolved over recent years. This management requires careful clinical evaluation to balance the need for operative or non-operative treatment. This is especially critical in the context of the increasing trend of non-operative management for stable renal injuries, largely due to advances in imaging, improved hemodynamic stabilization, and better outcomes with conservative approaches. The main objectives of this study were to evaluate the epidemiology of renal trauma, the mechanism of injury, and the outcomes of management strategies in blunt renal trauma and determine their influence on morbidity and mortality rates. Materials and Methods: A retrospective review was conducted with patients diagnosed with renal trauma in the Emergency Clinical County Hospital in Brasov, Romania from 1.01.2018 to 31.12.2023. Data were collected from medical records. Results: A total of 89 patients with blunt renal trauma were identified. The most frequent renal injuries, according to AAST classification, were grade 2 in 34.83% of the patients and grade 1 in 26.97% of the patients. Most of them, 84.27%, were managed conservatively. The overall mortality rate was 12.36%. Conclusions: This review highlights the importance of personalized management strategies for renal trauma, especially emphasizing conservative treatment for hemodynamically stable patients. Our findings contribute to understanding renal trauma outcomes and should improve future clinical practices and guidelines in renal trauma management. Further studies should explore long-term outcomes and optimize treatment protocols.

Background: Renal trauma management has increasingly shifted toward non-operative treatment, particularly in hemodynamically stable patients. Advances in imaging, resuscitation, and monitoring have improved the outcomes of conservative management, even in high-grade injuries. Blunt trauma, most commonly from falls, is the leading cause, and renal injuries often occur within the context of polytrauma involving multiple organ systems. Management is primarily guided by hemodynamic stability, overall clinical condition, existing comorbidities, and the severity of injury as determined by the American Association for the Surgery of Trauma (AAST) grading system. This study aimed to describe the management strategies and clinical outcomes of patients with high-grade blunt renal trauma (AAST grades III–V), with particular emphasis on the use of conservative management in selected patients. Methods: This study is a retrospective analysis conducted in our department (Emergency Clinical County Hospital in Brasov, Romania) to identify the data of the patients admitted with high-grade blunt renal trauma from 1 January 2019 to 31 December 2025. Results: A total of 58 patients with blunt renal trauma (grade III or higher) were identified. According to the AAST classification, the most common injuries were grade III (35 patients), followed by grade IV (11 patients) and grade V (12 patients). The majority of cases (68.97%) were treated conservatively, and the overall mortality rate was 8.62%. Conclusions: This study highlights the importance of individualized management in renal trauma, supporting conservative treatment in hemodynamically stable patients. Hemodynamic stability, renal injury grade, and the extent of associated injuries should guide treatment decisions. Further research is needed to refine treatment protocols and assess long-term outcomes.

In case of a traumatic event, preservation of the injured renal and kidney function represents the goal of non-operative management (NOM) of renal trauma. The substantial benefits of non-operative management for minor blunt renal injury have already been clearly described in current literature, but its value for major blunt and penetrating renal injuries are still under debate and not clearly highlighted. We hereby fully report a case of a 64 years old male patient with a history of a thoraco-abdominal blunt trauma, victim of aggression caused by a blunt object, which resulted in grade IV injury of the right kidney and associated grade II hepatic injury and right adrenal injury – grading according to the American Association for the Surgery of Trauma (AAST) injury scale guidelines – evaluated through contrast enhanced emergency CT imaging. The patient was hemodynamically stable upon admission to the Emergency Department of Clinical Emergency County Hospital of Brașov, Romania. Non-operative management strategy was chosen, therefore constant and close monitorization and follow-up CT examinations were performed. The patient was subsequently discharged after 8 days, with no further complications reported.