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Nanoemulsions (NEs) comprising Labrafac WC® as an inner oil and Cremophor® ELP as an outer surfactant are promising organic nanoparticles for biomedical applications due to their characteristics, s...

We describe a 75-year-old man with undifferentiated prostate cancer that was treated with radiation therapy. He presented at a nearby general hospital with dysuria and pain upon micturition. He was diagnosed with undifferentiated prostate cancer by a needle biopsy and referred to our hospital for further examination and treatment. Enhanced computed tomography and magnetic resonance images showed prostate cancer and right obturator lymph node metastasis measuring 2.5 cm. Cystoscopy and colonoscopy revealed direct invasion of the urinary bladder and rectum. We constructed a vesical fistula and an artificial anus, and then treated the primary tumor and lymph node metastasis with radiation. Undifferentiated prostate cancer is extremely rare and to our knowledge only a few cases have been reported. We suggest that radiation might be effective for treating undifferentiated prostate cancer with or without local invasion and/or metastasis along with total body control.

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We report 12 renal cell carcinomas in 6 patients with Von Hippel-Lindau (VHL) disease treated with radiofrequency ablation (RFA). The mean age of the patients was 46 (range 38-53) years (male : 4, female : 2). Computed tomography (CT)-guided transcutaneous RFA was performed under conscious sedation with local anesthetics. The mean size of the tumors was 2.4 (range 0.7-8.1) cm. Nine of the 12 tumors (75%) were locally well controlled. However, 3 tumors in 2 patients developed visceral metastases after RFA. While minimal flank pain, nausea, perinephritic hematoma and lumbago were observed, there was no major complication during or after the procedure. The therapy with CT-guided transcutaneous RFA is efficient and minimal invasive for renal cell carcinoma in patients with VHL, leading to preservation of renal function.

Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) method and is considered potentially useful for detecting prostate cancer. We evaluated the clinical value of DWI with apparent diffusion coefficient (ADC) maps in addition to T2-weighted imaging (T2WI) using 3 tesla (3 T) MRI. Thirty-three patients with elevated prostate specific antigen were evaluated by MRI with T2WI and DWI prior to transperineal template-guided mapping biopsy. The MRI findings were compared with the pathology of biopsy specimens in six parts of prostate : both sides of outer peripheral zones, inner peripheral zones, and transition zones. The sensitivities, specificities and accuracies were 42.1, 84.4 and 76.3％ in T2WI, 57.1, 84.7 and 80.8% in T2WI/DWI, and 87.5, 85.2 and 85.4% in DWI/ADC using 0.951×10 −3 mm2/s as cutoff ADC value. The hazard ratio of patients whose ADC values were under the cutoff was 25.86 by multivariate analysis. Mean ADC values were significantly different between cancer positive and negative cores (p＜0.001). The ADC value showed a negative correlation with increasing tumor length (p＝0.0047). Although further study with a large number of patients is necessary, DWI/ADC using 3 T MRI is a useful tool for detecting prostate cancer.

We report a case of granulocyte-colony stimulating factor (G-CSF)-producing squamous cell carcinoma of the renal pelvis. A 71‒year-old woman presented with gross hematuria and leucocytosis of 21, 300/mm3 (neutrophil : 86%) in the peripheral blood, but with no focus of infection. Right renal pelvic mass was found at a nearby hospital and she was referred to our hospital for examination and treatment. We performed right nephroureterectomy for a right renal pelvic tumor. Hematoxylin-eosin staining revealed squamous cell carcinoma of the renal pelvis and tumor cells stained strongly positive for G-CSF. According to these histopathological findings, we diagnosed this case as G-CSF-producing squamous cell carcinoma of the renal pelvis. She is presently alive without any new recurrent lesions for 12 months.

We report a case of successful response of lung metastases of reccurent adult Wilms' tumor by multiagent chemotherapy. The patient was a 19-year-old woman who had undergone left radical nephrectomy and adjuvant chemotherapy (actinomycin D, vincristine) for stageⅠadult Wilms' tumor when she was 16 years old. Coputed tomography (CT) revealed multiple lung metastases (right parietal pleura, left S10, right S10). We treated the patient with thoracoscopic partial resection of inferior lobe of lung. Then she received multiagent chemotherapy (vincristine, adriamycin, etoposide, cyclophosphamide). CT scan showed complete response of the lung metastases at 8 months.

Carcinoid tumor of the kidney is an extremely rare neoplasm. We report a case of primary carcinoid tumor arising from a horseshoe kidney in a 31-year-old man. An abdominal bulky mass was found at a local hospital and he was referred to our hospital for examination and treatment. From the results of computed tomography, magnetic resonance imaging and angiography, we suspected renal tumor arising from a horseshoe kidney and performed left partial nephrectomy with isthmectomy. Pathological findings of hematoxylin eosin staining revealed tumor cells proliferating in a cord-like and ribbon-like structure and the tumor cells stained strongly for chromogranin A, grimelius and neuron specific enolase. According to these findings, we diagnosed carcinoid tumor arising from a horseshoe kidney.

腎細胞癌4症例(平均59歳, 男女各2例)の7腫瘍に対してCTガイド下に経皮的ラジオ波焼灼術(RFA)を行った.全例, imperative caseであった.2例はvon-Hippel Lindau(VHL)病に伴う遺伝性多発性腎細胞癌で, 他の2例は両側同時発生例, 原因不明の胸水に伴う呼吸機能障害例であった.腫瘍の平均径は4.5cmで, 最高出力は平均94W, 最高温度は平均82℃, 焼灼時間は平均11分, 手術時間は平均91分であった.平均観察期間6.3ヵ月における外方突出型3症例の局所制御率は42.9%(3/7腫瘍)であった.VHL病を持った2例には, 肺転移, 膵転移, 腫瘍の成長がみられた.合併症に重篤なものはなく, 疼痛, 嘔気, 腎被膜下血腫, 微熱などであった.腎細胞癌に対するRFAは, 症例によっては低侵襲, かつ良好な局所制御が可能であるが, 適応には慎重な検討が必要だと考えられた, We report 7 renal cell carcinomas in 4 patients treated by percutaneous image-guided radiofrequency ablation (RFA). The mean age of the patients was 59 years (male: 2, female: 2). All 4 were imperative cases. Two patients (5 tumor) had hereditary multiple renal cell carcinomas with von Hippel-Lindau (VHL) disease. The other two patients had sporadic renal cell carcinomas. RFA was performed guided by computed tomography under conscious sedation with local anesthetics. The mean size of the treated tumors was 4.5 (1.8-8.1) cm. Impedance-regulated RF energy from a generator at 94 (45-130) watts was applied at 11 (8-14) min intervals. The average procedure time was 91 (45-165) minutes. The maximum tissue temperature reached 82 (56-91) degrees C immediately after ablation. Three of the 7 lesions (42.9 %) were locally well controlled during the mean follow-up period of 6.3 (4-9) months. The two patients with VHL disease developed visceral metastasis after There were no major complications. Minor complications encountered included flank pain, nausea, perinephritic hematoma and fever. Although percutaneous image-guided RFA showed limited success in large or central renal tumors, the therapy against small exophytic renal tumors would be well tolerable and successful.

71歳男.尿道口からの出血と排尿困難を主訴に受診した.完全包茎を認めたため背面切開術を施行したところ, 亀頭部に有茎性充実性腫瘤を認めた.生検病理組織診断は非特異的肉芽腫で, 再生検を兼ねた腫瘤摘出術を施行した.病理組織学的診断及び画像診断は陰茎紡錘細胞癌で, 悪性度が高いため陰茎部分摘除術及び両側鼠径リンパ節郭清術を施行した.又, 抗cytokeratin抗体及び抗vimentin抗体を用いた免疫染色と, p53癌抑制遺伝子の免疫染色でも病理組織像と一致した診断であった.術後に軽度のリンパ管炎を認めたが全身状態は良好で, 術後18ヵ月経過現在, 再発を認めていない, Spindle cell carcinoma of the penis is extremely rare. The present case report is the nineth case in the world literature. A 71-year-old man was referred to our institution for examination of a penile tumor that showed non-specific granuloma histopathologically. We performed biopsy and total tumor resection. The histopathological finding showed squamous cell carcinoma with spindle type cells constituting the majority of the tumor, and the switching over from squamous cell carcinoma to spindle cell carcinoma was clearly visible in the histopathological examination. Therefore, we diagnosed this as spindle cell carcinoma of penis and performed partial penectomy with inguinal lymph node dissection. Spindle cell carcinoma is an uncommon variant of squamous cell carcinoma. We report the histopathological findings including the data of p53 immunohistochemical study, and reviewed the eight previous reports of spindle cell carcinoma of the penis.

Renal solitary fibrous tumor (SFT) is a rare, and a large scale study on this topic is lacking to date. In this article, we summarize the previously reported cases. The symptoms and signs resemble those of renal cell carcinoma, including hematuria, flank/abdominal/lumbar pain and palpable abdominal mass. Grossly, the tumor demonstrates a well-circumscribed solid mass. Microscopically, the tumor consists of fusiform or ovoid spindle cells and a various amounts of collagen bundles with patternless, storiform, or fascicular arrangements with an occasional hemangiopericytomatous pattern. Immunohistochemically, CD34, CD99 and bcl-2 are often detected. Ultrastructurally, tumor cells contain irregular nuclei, prominent Golgi apparatus, branching rough endoplasmic reticulum, variable numbers of mitochondria. Surgical resection is considered to be the gold standard therapy. Most of renal SFT are benign, but cases of approximately 10 to 15% behave in an aggressive fashion. All patients need to be on long-term follow-up because clinical behavior is rather unpredictable. As the molecular genetic study of renal SFTs is lacking, a large scale study will be desirable in the future.

マイクロ波組織凝固装置(OT-110M)を用いた腎腫瘍核出術を施行した5症例7腫瘍を対象に臨床的検討を行った.7腫瘍は全て偶発癌であり, CRP, 血沈等acute phase reactantも前例正常であったが, 1例のみ免疫抑制蛋白が高値を示していた.又, 腫瘍径は対側腎機能正常例では全例4cm以下であった.平均手術時間は241分, 平均出血量は788mlで1例のみ輸血を行った.術後合併症は, 尿漏1例, 術後イレウス1例を認めた.病理組織所見は全例腎細胞癌であった.予後は最長1年6ヵ月の経過観察中で全例に再発は認めず, 現在も経過観察中である.又, 術後腎機能も全例術前とほぼ変化なく良好である, We report our clinical findings on 7 tumors in 5 patients who underwent successful enucleation of renal tumor with a microwave tissue coagulator. All patients presented with incidentally-found renal tumor on ultrasonography or computed tomography. One patient had bilateral renal tumors. The mean size of the renal tumor was 2.5 cm (Range 1.0-5.2 cm). One patient had a tumor larger than 5 cm, and was found to have renal insufficiency preoperatively. Four cases were clinically diagnosed as T1aN0M0. In all patients, the renal tumor was enucleated with a microwave tissue coagulator successfully without renal pedicle clamping. The mean operative time and blood loss were 241 minutes and 788 ml, respectively. The pathological diagnosis was renal cell carcinoma in all cases. Although 2 patients had preoperative renal insufficiency, there were no serious postoperative complications and no evidence of loss of renal function as a result of this operation. Our findings suggest that renal tumors can be enucleated with a microwave tissue coagulator safely and successfully without damaging renal function.

症例は65歳男で, 肉眼的血尿及び右背部痛を主訴とした.排泄性腎盂造影では30分像で右腎盂に造影剤の排泄を認めず, 膀胱内に陰影欠損を認めた.CT及びMRIで膀胱右後壁に径3cmの腫瘍を認め, 筋層は全周性に消失し, 周囲脂肪組織への浸潤が疑われた.生検結果と併せてTCC, G3, pT3b, N0, M0と診断し, 化学療法を施行したが, 1クール終了後, 胸部CTで径1.5cmの気管前リンパ節腫大を認め, 生検で扁平上皮癌と診断した.原発巣検索における胃内視鏡で径2cmのBorrmann3型食道癌を認め, 放射線・化学療法を施行した.食道癌はCRとなったが, リンパ節はNCであった.膀胱癌に対しては放射線療法を行ったが評価はPDで, 以後急速に病態が悪化し, 入院5ヵ月後に死亡した.病理解剖で膀胱小細胞癌の多発転移を確認し, 原発性の潜在性肺癌も認めた, We present a case of triple primary cancers occurring synchronously in the urinary bladder, esophagus, and incidentally in the lung. A 65-year-old man with a chief complaint of gross hematuria was admitted to our hospital. Cystoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a non-papillary broad-based bladder tumor. Histological diagnosis was transitional cell carcinoma of the urinary bladder and he underwent one course of neoadjuvant chemotherapy (M-VAC) with the preoperative diagnosis of T3bN0M0. After one course of chemotherapy, chest CT, lymph node biopsy and esophagoscopy revealed squamous cell carcinoma of the esophagus. He first underwent radiochemotherapy (total 70 Gy, CDDP 5 mg x 41, 5-FU 250 mg x 24) for esophageal cancer and achieved complete remission. Then, he underwent radiotherapy for a total of 60 Gy for bladder cancer. However, his general condition gradually became worse and he died from metastatic cancer. The autopsy proved that he died from multiple metastases of small cell carcinoma of the urinary bladder and incidentally squamous cell carcinoma of the lung was identified.

42歳女.外尿道後部腫瘤を自覚し当科受診した.腫瘤の増大傾向を認め, 精査加療目的に入院となった.画像検査にて, 傍尿道部腫瘍と診断し, 経前庭的嚢腫部分切除術を施行した.術後経過良好で, 嚢腫の再発, 外陰部の変形もなく, 排尿痛, 排尿障害, 尿失禁等の自覚症状も認めていない, We experienced a case of paraurethral cyst in a 42-year-old woman. A paraurethral cyst, the diameter of which was about 2 cm, was observed in the septum between urethra and vagina. No communication between the cyst and urthra or vagina was detected. The resected cyst did not reveal malignant findings. Sixty-one cases of paraurethral cyst in the Japanese literature are also reviewed.

69歳男.横行結腸癌を同時性に重複した中等度腫瘍径の嚢胞状腎細胞癌を経験した.マイクロ波組織凝固装置を用いた腎保存手術を行い, 腫瘍核出に伴う腎盂欠損を術中修復しえた.腎保存手術の適応がさらに拡大しうることが示唆された, A 69-year-old man was referred to our department for a cystic tumor, 4.0 cm in diameter, in the lower portion of the right kidney, which was detected by computed tomography. The patient had been admitted to the department of surgery in our hospital for treatment of ileus caused by transverse colon cancer. With a diagnosis of cystic renal cell carcinoma. T2N0M0, in situ non-ischemic tumor enucleation was performed using a microwave tissue coagulator (Microtaze, Heiwa Electronics Industry Inc., Tokyo). The enucleation was accompanied by a defect of the renal pelvis, but it was easily repaired. The operation time was 120 minutes and blood loss was 110 cc. The histological diagnosis was renal cell carcinoma, pT2N0M0V1, expansive, alveolar type, clear cell subtype, G1 > G2. Diagnostic imaging done postoperatively showed no sign of damage to renal function. At the present time, the patient has been disease-free with interferon-alpha for 12 months and is being followed on an outpatient basis. In this report, the advantages of nephron-sparing surgery, especially in situ non-ischemic tumor enucleation using a microwave tissue coagulator for renal tumor are discussed. In particular, the technique of performing tumor enucleation with repair of the defect of renal pelvis used in this case may extend the indication of nephron-sparing surgery.