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A 54-year-old female underwent open left adrenalectomy for a left adrenal tumor in 2013. The pathology showed metastatic poorly differentiated adenocarcinoma. Despite a close examination, the primary tumor could not be identified. During the follow-up, a computed tomographic scan showed a hyper vascular tumor in the left breast in2015. A left mastectomy was performed for diagnosis and treatment. The pathology showed invasive ductal carcinoma of the breast. Comparing the histopathology and immunohistochemistry of the breast tumor with the adrenal tumor, the adrenal tumor was finally confirmed as metastatic invasive ductal carcinoma. Adrenal gland metastasis from invasive ductal carcinoma is said to be extremely rare. To our knowledge, there have been no reports of cases in which metastatic invasive ductal carcinoma of the adrenal gland was found before the primary site. We report this case with some literature review., 本論文の要旨は第232回日本泌尿器科学会関西地方会において報告した．

Background and Aim TL1A (TNFSF15) is a major Crohn's disease (CD) susceptibility gene, especially in the East Asian population, and is also known to be associated with some clinical phenotypes, such as stricturing and penetrating behavior. This study aims to investigate the association between TL1A genotype and the long‐term therapeutic outcomes of infliximab and adalimumab in Japanese CD patients. Methods We investigated 119 biologic‐naïve CD patients treated with infliximab or adalimumab. TL1A ‐358C/T (rs6478109) was genotyped as a tag single nucleotide polymorphism (SNP) for CD risk or nonrisk haplotype of TL1A (the ‐358C allele is a risk allele for CD development). We compared the long‐term therapeutic outcomes of anti‐tumor necrosis factor (TNF) antibodies between the TL1A ‐358C/C group and the C/T+T/T group. Results Sixty‐nine cases (58.0%) were homozygous for the risk allele (TL1A ‐358C/C group), and 50 cases (42.0%) were heterozygous for the risk allele or homozygous for the protective allele (TL1A ‐358C/T+T/T group). No significant differences were found in the cumulative retention rates and the relapse‐free survival between the TL1A genotypes. However, the surgery‐free survival was significantly lower in the TL1A ‐358C/C group than in the C/T+T/T group (log‐rank test, P, In this study, we investigated the association between TL1A genotype and the long‐term therapeutic outcomes of infliximab and adalimumab in Crohn's disease (CD) patients. We investigated 119 biologic‐naïve CD patients treated with infliximab or adalimumab and found an association between the TL1A genotype and surgery‐free survival during anti‐tumor necrosis factor (TNF) therapy. The patients whose genotypes are homozygous for the TL1A ‐358C (risk allele of CD development) show lower surgery‐free survival with anti‐TNF treatment.

We report a case of perivascular epithelioid cell tumor (PEComa) of the uterus associated with tuberous sclerosis complex discovered as a result of intraabdominal bleeding. A 54-year-old woman visited the department of obstetrics and gynecology with chief complaints of genital bleeding and abdominal pain lasting three weeks. Abdominal computed tomography (CT) revealed intraabdominal bleeding from the uterine corpus. She had a history of bilateral renal angiomyolipoma, which was treated with partial bilateral nephrectomy at age 25. Moreover, pulmonary lymphangioleiomyomatosis was diagnosed at age 43. Both conditions were detected by the CT scan during this hospitalization. Immediately after the CT scans, the patient entered a state of hemorrhagic shock, and we performed an emergency simple total hysterectomy. Histopathological examination on the resected specimen yielded a diagnosis of uterine perivascular epithelial cell tumor (PEComa). After making a definitive diagnosis of tuberous sclerosis complex (TSC), systemic evaluation was performed. As a result, multiple skin and intracranial lesions characteristic of TSC were identified and we stated administration of everolimus.

A 56- year-old man underwent a laparoscopic low anterior resection for rectal cancer (cT3bN0M0). Postoperatively, he was fairly well and started oral intake on postoperative day (POD) 9. On POD 14, he had an uncomfortable feeling during urination and noticed pneumaturia, and urinalysis revealed hematopyuria. Abdominal computed tomography (CT) showed air collection in the left seminal vesicle and bladder, and colonoscopy demonstrated a fistula at the anastomotic site. Abdominal CT following the fistulography under colonoscopy demonstrated fistulous communication between the rectum and left seminal vesicle. Under the diagnosis of seminal vesicle-rectal fistula, the patient was successfully treated by filling the fistula with fibrin glue by colonoscopy. No obvious recurrence of the fistula has been observed for 6 months after the treatment.

A 64-year-old male was referred to our hospital with a prostate tumor accompanying a huge prostatic cyst. He had been followed up for 10 years by another urologist, and received several prostate biopsies, which failed to make a definite diagnosis. We carefully reviewed the biopsy slides and diagnosed the lesion as prostatic stromal tumor of uncertain malignant potential (STUMP). We performed radical prostatectomy. From the excised specimen, we confirmed the diagnosis of prostatic STUMP. Eight months later, there was no sign of metastasis or recurrence.

A 79-year-old man was admitted to our hospital with a chief complaint of pollakisuria. He was diagnosed as having bladder tumors and bladder stone by cystoscopy. Transurethral resection of bladder tumors (TURBT) and transurethral cystolithotripsy were performed and histology revealed non-muscleinvasive hepatoid adenocarcinoma that produced alpha-fetoprotein (AFP) and urothelial carcinoma. The serum AFP level was present at a high level of 39.08 ng/ml. After five months’ follow up, recurrent tumor were detected in the bladder. TURBT was performed and the pathologic finding showed non-muscleinvasive (not hepatoid) adenocarcinoma that produced AFP. After eight months’ follow up, a recurrent tumor was detected in the bladder again. TURBT was performed and the pathologic finding showed nonmuscle- invasive urothelial carcinoma. However, the serum AFP level remained above 35 ng/ml. After the 3rd TURBT, intravesical intillations were performed, which led to a normalization of the serum AFP level. Nineteen months after his final hospitalization, the patient has had no evidence of recurrence.

症例1(69歳男性)。13年前に膀胱癌(CIS)に対するBCG膀胱内注入療法が施行され, 約9ヵ月前より前立腺癌に対し内分泌療法が開始されたが, 顕微鏡的血尿が出現した。症例2(83歳女性)。肉眼的血尿を主訴とした。症例3(84歳男性)。無症候性肉眼的血尿を主訴とした。いずれの症例も膀胱鏡にて膀胱左壁または右壁に非乳頭状広基性腫瘍が認められ, TURBTが行われた。その結果, 3症例とも病理組織学的に膀胱小細胞癌であった。症例1はpT2N0M0にてirinotecan+carboplatinによる化学療法を3コース施行し, CRが得られたが, 化学療法終了16ヵ月後に前立腺癌の悪化のため死亡となった。症例2はpT2N0M0にて膀胱部分切除術を施行し, 術後6ヵ月経過で再発転移はみられていない。症例3はcT3bN0M1にてetoposide+carboplatinによる化学療法を4コース施行したところ, 腫瘍は縮小し, 現在は経過観察中である。, We report three cases of small cell carcinoma of the urinary bladder. Case 1: A 69-year-old man showed microscopic hematuria during follow up of prostate cancer of stage D2. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage of pT2N0M0. Complete remission was achieved by three courses of chemotherapy consisting of irinotecan and carboplatin. The patient was died by prostate cancer 16 months after the chemotherapy. Case 2: An 83-year-old woman presented with macroscopic hematuria. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage of pT2N0M0 and partial cystectomy was performed. The patient has been alive without any evidence of tumor recurrence at 6 months after surgery. Case 3: An 84-year-old man presented with macroscopic hematuria. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage ofcT3bN0M1 with multiple liver metastases. Complete remission was achieved by three courses of chemotherapy consisting of etoposide and carboplatin.

症例1(69歳男性)。左鼠径部腫脹を主訴とした。左鼠径ヘルニアの診断で経過観察されていたが, 左鼠径部から陰嚢にかけて弾性軟・表面平滑・圧痛のない腫瘤が触知された。MRIを施行したところ, 左陰嚢内に精巣を圧迫する脂肪分に富んだ多房性の腫瘍が認められた。症例2(63歳男性)。排尿困難を主訴とした。触診で左陰嚢内に小鶏卵大の腫瘤を指摘され, MRIにて左鼠径部から陰嚢内に到る脂肪分に富んだ腫瘍が認められた。両症例ともリンパ節転移ならびに遠隔転移は認めず, 左精索腫瘍の診断のもとに, 左精巣・精索を一塊として摘除した。病理組織学的所見では脂肪滴の大小不同とクロマチン濃染の異型核をもつlipoblastの増殖がみられ, 高分化型脂肪肉腫と診断された。症例1は残存腫瘍が存在し追加切除術を施行し, 症例2には追加治療は行わなかった。いずれも目下, 術後3～5年経過で再発は認められていない。, Liposarcomas are most commonly found in the extremities, in the retroperitoneum and, less often, in the head and neck area. The spermatic cord is a rare site of origin, accounting for about 3-7% of all liposarcomas. We report two cases of liposarcoma of spermatic cord. Case 1. A 69-year-old male presented with complaints of a painless left inguinal mass. MRI showed a huge fatty mass in the left inguinal region. The mass was removed with left testis and spermatic cord. Histopathological examination revealed a well-differentiated and dedifferentiated liposarcoma. The surgical margin was positive, so re-resection was performed. Complete excision was achieved after re-resection. Case 2. A 63-year-old male with the difficulty urinating had a left scrotal mass. Left radical orchiectomy was performed. Histopathological examination revealed a well-differentiated liposarcoma. These are the 84th and 85th cases of liposarcoma of the spermatic cord reported in Japan.

66歳男。患者は肉眼的血尿, 咳嗽, 全身倦怠感を主訴とした。画像所見では左腎下極に突出するhypervascular tumorが認められ, 腎盂まで進展していた。また, 腫瘍塞栓が左腎静脈から下大静脈に進展し, 横隔膜からやや頭側にまで進展していた。一方, 左腎動脈造影では左腎全体に著明な腫瘍脈管増生像を認めたが, 左腎静脈本幹は造影されなかった。以上, これらの所見を含め, 他臓器への明らかな転移所見はなかったことから本症例は左腎細胞癌(stage III)と診断され, 全身状態の悪化より根治的手術は困難と考え, 天然型インターフェロンα(IFNα)を1日300万単位として週4回筋肉へ投与された。その結果, 投与22ヵ月後, 腫瘍の縮小は認められなかったものの, 左腎静脈から下大静脈にかけての腫瘍塞栓は消失した。更に下大静脈内腫瘍塞栓も縮小して器質化がみられた。以後, 投与開始25ヵ月経過で根治的左腎摘除術を施行したが, 術後5ヵ月で肝転移, 両肺転移, 脳転移を認め, 初診から3年6ヵ月後に患者は死亡となった。, We report a case of renal cell carcinoma in which interferon-a therapy was effective in reducing the tumor thrombus extending into the inferior vena cava. A 66-year-old man was referred to our hospital with a complaint of macroscopic hematuria, cough and general fatigue. We made a diagnosis of a left renal cell carcinoma with tumor thrombus by imaging examination. Because his performance status was 3, a radical operation was considered risky. Twenty-two months after the start of interferon-a therapy, the tumor thrombus was markedly reduced in size, and the clinical response was evaluated as partial response by the response criteria for urological cancer treatrment. Because of improvement of the performance status and downsizing of tumor thrombus, we performed radical nephrectomy. Pathological examinations revealed that viable renal cell carcinomas were found in the primary lesion and the tumor thrombus. In some cases, interferon-alpha therapy is useful and safe in the treatment of the tumor thrombus. Furthermore, radical nephrectomy and complete resection of the tumor thrombus prolongs postoperative survival.

77歳男。主訴は膀胱移行上皮癌術後の腫瘍の再発であった。MRIでは膀胱頸部から後壁にかけて広範囲に腫瘍を認め, 前立腺への浸潤も疑われ, 経尿道的膀胱腫瘍切除術を施行した。組織診断はsarcomatoid carcinomaで, 膀胱全摘除術および右尿管皮膚瘻造設術を施行した。病理組織学的に腫瘍は明らかな上皮性の像を示す部分と異型性の強い肉腫様成分で構成され, 免疫組織学的検査では肉腫様成分で, 同一細胞がサイトケラチンとビメンチンを発現していた。術翌月に肺転移が出現し急速に増悪して1ヵ月後に死亡した。病理解剖では肉腫様成分のみで占められる両側胸膜播種性多発性転移と, 上皮性成分と肉腫様成分が混在する骨盤内局所再発を認めた。, A 77-year-old man was admitted to our hospital for a scheduled examination after transurethral resection of transitional cell carcinoma of urinary bladder. Tumor reccurence was found in the bladder by cystoscopic examination. Total cystectomy and unilateral cutaneous ureterostomy were performed. Histologically the tumor was composed of epithelial and sarcomatous elements. Therefore, we diagnosed this tumor as sarcomatoid carcinoma. The patient died of lung metastasis three months after operation. Autopsy findings showed lung metastasis and local reccurence which were composed of carcinomatous and sarcomatous elements. About 64 cases of sarcomatoid carcinoma of the urinary bladder have been reported in the Japanese literature and are reviewed briefly here.

84歳女。患者は全身倦怠感、体重減少を主訴とした。膀胱鏡で三角部から後壁にかけて非乳頭状広基性の膀胱腫瘍を認め、膀胱癌(T3b)が疑われた。TU-Biopsyを施行したところ、病理組織学的所見によりmucosa-associated lymphoid tissue lymphoma(MALT リンパ腫)と診断された。一方、ガリウムシンチでは集積を認めず、胸腹部CTでも他のリンパ節腫大は認めなかった。また、ほか骨髄穿刺や生検でも腫瘍の浸潤はみられず、膀胱に限局したMALTリンパ腫と最終的な診断に至った。治療として従来のCHOP療法にリツキシマブを加えたR-CHOP療法を施行したところ、1コース終了後のMRIで膀胱内の病変は消失し、画像上で寛解と診断された。当初はR-CHOP療法6コースを予定していたが、嘔気・食欲不振等の副作用のため患者が治療を拒否し、1コースで終了となった。その後、外来での経過観察を行なっているが、6ヵ月経過現在、再発は認められていない。, Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the bladder is a rare disease, and the most effective therapeutic procedure remains unknown. We report a case of primary MALT lymphoma of the bladder regressed after rituximab in combination with CHOP chemotherapy (R-CHOP). The patient, a 84-year-old woman, presented with general fatigue and loss of weight. Computed tomography (CT) showed a solitary mass at the bladder. Histological diagnosis of the tissue obtained by transurethral biopsy was extranodal marginal zone B cell lymphoma of MALT. The patient was in complete remission after only one cycle of R-CHOP. This is the fourteenth case of MALT lymphoma of the bladder in Japan.

39歳男.全身倦怠感, 血痰を主訴とした.約半年後に近医を受診し, 左精巣腫瘍, 及び多発性肺転移の診断で左精巣高位摘除術を受けた.病理組織診断は絨毛癌であった.術後, 化学療法目的で来院した.頭皮・左頬部・前胸部には出血を伴う3cm大, 弾性硬, 黒色の皮膚腫瘤を認めた.胸部X線, 胸部CT, 頭部CT, 腹部CT, 上部消化管内視鏡検査では両肺の結節影, 左小脳半球の高濃度病変, 肝S7の低濃度域, 両腎の結節病変, 胃後壁の粘膜下腫瘤を認めた.BEP療法(ブレオマイシン・エトポシド・シスプラチン), EP療法(エトポシド・シスプラチン), TIP療法(パクリタキセル・イホスファミド・シスプラチン)などを行った.小脳転移に変化はなかったが, 肺転移は縮小傾向, 肝・腎・胃・皮膚転移は消失し, 腫瘍マーカーも正常化した.しかし, β-ヒト絨毛性性腺刺激ホルモンの再上昇がみられ, TIP療法, Nedaplatin+塩酸イリノテカン療法, γナイフ療法を行ったが, 脳転移巣の増大・出血による神経症状, 肺転移巣の増大を認め, 術後17ヵ月目に死亡した, A 39-year-old man whose chief complaints were general fatigue and bloody phlegm was diagnosed with testicular cancer and underwent left high orchiectomy at an affiliated hospital. The histopathologic diagnosis was chorio carcinoma. Several imaging examinations revealed the metastases in the lung, liver, brain, stomach, kidneys and skin. In spite of various chemotherapies, he died 17 months after the operation. Skin metastasis of testicular cancer is very rare and this is the twelfth case reported in the world, to our knowledge. The significance of skin metastasis in testicular cancer is discussed.

後腹膜原発の軟部組織肉腫3例を報告した.症例1は30歳男性, 症例2は31歳女性で, 左胸痛, 腹部膨満感を自覚した.CTで腫瘍を認め, 腫瘍摘出術を行った.腫瘍と左腎, 脾臓との癒着は強固であった.摘除標本の重量は症例1:3000g, 症例2:2000gで, 病理組織学的に後腹膜原発のfibrosarcoma, undifferential sarcomaと診断された.2例とも腫瘍断端陽性を一部に認め, その後再発した.症例1は再腫瘍摘出術を行ったが, 初回手術から約1年半後に, 症例2は術後約2ヵ月半後に死亡した.尚, 症例1は, 再腫瘍摘出術の病理組織像も原発巣と同様であった.症例3は73歳女性で, 心不全フォロー中に腫瘍を指摘され, 腫瘍摘出術を行った.重量は2420gで, 病理組織学的にwell-differentiated liposarcomaが一部で脱分化したものと診断された.一部に腫瘍細胞を認めた.術後1年2ヵ月後に局所再発が出現し, 2回目の腫瘍摘除術を行った.病理組織診断は初回同様differentiated liposarcomaであった, Soft tissue sarcomas (STS) are rare tumors that comprise only 1% of all malignancies. The retroperitoneum is an uncommon site of origin for them, accounting for about 10% of all STS. In case 1, a 30-year-old man complaining of chest pain was found to have a retroperitoneal tumor around the left kidney by computed tomography (CT). The tumor was removed along with the left kidney. Histologically, it was fibrosarcoma 3, 000 g in weight. In case 2, a 31-year-old woman complaining of abdominal distension was found to have a retroperitoneal tumor by CT. The tumor was removed in the same way. It was undifferentiated sarcoma 2, 000 g in weight. In case 3, a 73-year-old woman, who had no complaint was found to have mass in the left lateral region during follow up for cardiac failure. She was referred to our department for treatment of retroperitoneal tumor revealed by ultrasound and CT. The tumor was dedifferentiated liposarcoma 2, 420 g in weight. All three patients had local recurrences, and two of them underwent a second surgical procedure.

57歳男性.患者は頻尿を主訴に近医を受診, 直腸診にて前立腺腫瘤を指摘され, 著者らの施設へ紹介となった.入院時, 血清PSAの軽度上昇を認め, 経直腸エコーでは前立腺背側に精嚢へ突出する28×23×18mm大の内部不均一な腫瘤を認めた.経直腸エコーガイド下前立腺針生検の結果, leiomyosarcomaと診断し, 前立腺全摘術を施行したところ, 病理組織学的には前立腺原発のP-STUMPと診断され, 術後11ヵ月経過現在, 再発・転移は認められず, 経過も良好である, Sarcomas and related proliferative lesions of specialized prostatic stroma are rare. Lesions have been classified into prostatic stromal tumor of uncertain malignant potential (P-STUMP) and prostatic stromal sarcoma based on the degree of stromal cellularity, presence of mitotic figures, necrosis, and stromal overgrowth. STUMPs are considered neoplastic, based on the observations that they may diffusely infiltrate the prostate gland and extend into adjacent tissues, and often recur. Although most cases of STUMPs do not behave in an aggressive fashion, occasional cases have been documented to recur rapidly after resection and a minority have progressed to stromal sarcoma. Here we describe a case of P-STUMP. A 57-year-old male went to his family doctor because of pollakisuria. Digital examination revealed abnormal findings in the prostate, then he was referred to our medical center. The mass was palpable in the left lobe of the prostate; it was elastic hard, surface smooth, about 2 cm in diameter. Serum PSA was elevated slightly (5.42 mg /dl). We diagnosed firstly leiomyosarcoma by transrectal ultra sound guided needle biopsy of the prostate. Then we performed radical prostatectomy. Finally we made the pathological diagnosis of P-STUMP. After 11 months, there is no sign of metastasis or recurrence.

57歳女.2年前に右尿管癌を発症し摘出術を施行した.そのさい術前に尿管狭窄に対して一時的に右腎瘻を留置した.今回, 右腰背部皮下に腫瘤が出現し, 尿管癌の転移を疑い腫瘤切除術を施行した.切除標本の病理組織像は尿管癌と酷似しており, 腫瘍の部位が2年前の腎瘻穿刺ライン上にあることから尿管癌のneedle tract implantationと診断した, Malignant metastasis along the needle tract, called "needle tract implantation" (NTI), has been demonstrated for numerous carcinomas, including prostate, colon and liver. We report a case of NTI of ureteral carcinoma following percutaneous nephrostomy tube replacement. A 57-year-old woman was found to have a subcutaneous mass at the site of nephrostomy. She had a past history of right nephroureterectomy for ureteral carcinoma about one year earlier, and a nephrostomy tube had been inserted before diagnosis postoperatively. We resected the subcutaneous mass. Pathological diagnosis was urothelial carcinoma closely resembling right ureteral carcinoma. To our knowledge, this is the seventh reported case of NTI of upper urinary tract urothelial carcinoma. Percutaneous manipulation carries a potential risk of local tumor spillage and NTI in the nephrostomy tract.

36歳男性.患者は発熱が続き近医でCRP高値を指摘されたがNSAID投与で軽快したため放置していた.しかし今回, 38℃以上の不明熱の持続で著者らの施設へ受診となった.所見では, 左下腹部に表面平滑, 弾性硬, 可動性ある腫瘤を触知し, CTでは小骨盤左壁腹側に66×42mmの境界明瞭, 辺縁平滑な腫瘤を認めた.また, 造影CTでは均一な軽度の造影効果を認め, MRIでは内部はT1強調像で筋肉と等信号, T2強調像で高信号を呈し, 腫瘤の周囲に1～2cmのリンパ節の多発を認めた.更にMRアンギオグラフィーでは栄養動脈は左内腸骨動脈であり, 動脈相から濃染する充実性腫瘤と考えられ, 骨盤内腫瘍摘除術を施行することとなった.その結果, 病理所見で摘除組織は腫大したリンパ節で, 内部に大小不規則なリンパ濾胞の過形成と, 濾胞間に形質細胞の著明な浸潤を認め, Castleman diseaseのplasma cell typeと診断した.術後1年経過現在, 再発は認められていない, Although Castleman disease may occur in any lymph node of the body, it is the most commonly found in the thoracic cavity. Castleman disease rarely occurs in the pelvic cavity and only 8 such cases have been reported previously in Japan. In this report, we describe a case of Castleman disease in the pelvic cavity. A 36-year-old man complained of fever. Both serum c-reactive protein (CRP) and serum interleukin-6 (IL-6) were elevated. Computed tomography and magnetic resonance imaging showed a solid mass with calcification in the pelvic cavity. The pelvic mass was surgically excised. The removed mass was solid and 75 x 45 x 30 mm in size. The histological diagnosis was the plasma cell type of Castleman disease. Fever subsided and both serum CRP and serum IL-6 were normalized after the operation. No evidence of disease was detected one year post operation.

We experienced a rare case of 72-year-old woman with acute onset collagenous colitis (CC) induced by lansoprazole. The patient developed acute abdominal pain, watery diarrhea, and melena that are quite rare in usual CC. We could find the characteristic colonoscopic findings such as active long liner ulcers in the patient. We also observed the healing courses of these unique findings. Our case indicates two important points of view. (1) CC sometimes develops with acute onset symptoms which resemble those of ischemic colitis. (2) Colonoscopy would be useful and necessary to distinguish acute onset CC and ischemic colitis.

16歳男。左陰嚢内容腫大, 同部の疼痛が出現した。陰嚢内容は鵞卵大, 弾性硬で, 腹部CTでは左腎下極の高さで傍大動脈に径3cmのリンパ節腫大を複数認めた。精巣腫瘍の診断で左高位精巣摘除術を施行し, 腫瘍は傍精巣に存在していた。病理学的に腫瘍の精巣への浸潤は認めず, 高度の異型を示す紡錘形細胞が存在し, 紡錘形細胞の細胞質に明らかなstriationを確認した。傍精巣横紋肉腫の診断で, 後腹膜リンパ節転移の存在よりintergroup rhabdomyosarcoma study(IRS)のgroup IIと考えた。IRSのレジメンなどを参考に多剤併用化学療法を開始し, 3ヵ月後の腹部CTでは傍大動脈リンパ節の転移は縮小してPRと評価された。5ヵ月後に後腹膜リンパ節郭清術を施行し, 術中所見で傍大動脈領域に腫大したリンパ節を3個認め, 組織診断では残存腫瘍を認めるもののわずかであった。IRSレジメンに準じてVA療法を施行したが, 1年4ヵ月後に腹部に巨大な腫瘍を認めるようになった。トポテカン・シスプラチンなどによる化学療法を行うも無効であり, 死亡された。, We report a case of paratesticular rhabdomyosarcoma in a 16-year-old male. The patient with a mass in the right scrotum was at first diagnosed with testicular tumor. Right orchiectomy revealed paratesticular rhabdomyosarcoma. Para-aortic lymph node metastasis was pointed out by abdominal computed tomography. Although he received multidrug chemotherapy consisting of vincristine, adriamycin, cyclophosphamide, cisplatin, and actinomycin-D (IRS-III regimen 35 and IRS-IV regimen) without radiotherapy, he died twenty-one months after the operation.

78歳男。4年前に前立腺癌に対し前立腺全摘除術を施行し, その後放射線療法を行ったが, 4ヵ月前より肉眼的血尿を認め膀胱タンポナーデ状態に陥った。硬性膀胱鏡外筒による経尿道的圧迫止血および経尿道的電気凝固術(TUC)により一旦は止血したが, 2週間後膀胱出血による凝血塊のため尿閉をきたし入院した。尿道カテーテルを留置のうえ生理食塩水による膀胱内持続灌流を開始し, 2度にわたりTUCを行ったが肉眼的血尿の改善は見られなかった。水酸化アルミニウム・マグネシウム合剤(マーロックス)50～100mlによる膀胱内注入療法を計12日間施行した結果, 施行開始8日目には肉眼的血尿がほぼ消失し, 入院31日目に退院した。退院15日後に静脈性出血を再発したが, マーロックス注入療法を7日間施行し肉眼的血尿は消失した。その後12ヵ月経過して肉眼的血尿の再発は認めていない。, A 77-year-old man was admitted to our hospital due to macrohematuria and bladder tamponade. Bladder hemorrhage caused by radiation therapy had not improved after bladder lavage, intravesical drip infusion, medication of hemostatics, and transurethral coagulation. Bladder hemorrhage had completely disappeared 7 days after the intravesical instillation of 50-100 ml aluminium hydroxide gel and magnesium hydroxide for an hour per day. This method is easy and can be performed without complications. This method might be useful as first-line therapy in the case of severe bladder hemorrhage.

33歳男性。患者は血尿および失神を主訴に近医を受診, 救急入院となり, 膀胱鏡にて球部尿道に出血を伴うびらんを認め, 精査加療目的に著者らの施設へ紹介入院となった。静脈性腎盂造影・腹部CTおよび生検では異常所見は認められず, 陰茎MRIにて外因性による尿道損傷が疑われた。一方, 失神の原因検索を行うも明らかな異常所見は認めず, 入院後も尿道よりの出血を伴う失神発作を繰り返した。失神する場所が常に個室トイレであること, バルーンカテーテル留置中は尿道出血だけでなく失神発作も起こさないこと, 明らかな原因疾患がないことより, 自慰行為を含めた自傷行為が強く疑われた。確定診断には至らなかったが, 繰り返す出血に対し対症療法にて経過観察を行ったところ, 偶然ウエストポーチの中より血液の付着した塗り箸がみつかり, これによる自傷行為と判明した。精神科による検査の結果, ミュンヒハウゼン症候群の診断に至り, 患者は精神病院へ転院となった。, A 33-year-old man presented with urethral bleeding and syncope. Urethroscopy revealed erosive lesion with bleeding at bulbar urethra. Magnetic resonance imaging, biopsy, and blood examination were performed, but the cause of urethral bleeding was not identified. By accident, chopsticks with blood ware detected in his ward. It was revealed that urethral bleeding was caused by self-mutilation with chopsticks. He consulted a psychiatrist, and was diagnosed with 'munchausen's syndrome'.

75歳男.肉眼的血尿・膀胱刺激症状が出現した.尿細胞診はhigh grade TGGで, 経尿道的膀胱腫瘍切除術後, 患者・家族の希望により膀胱・前立腺・尿道全摘, 回腸導管造設術を行った.術後26ヵ月目, 回腸導管尿細胞診でurothelial carcinomaを認めた.IVP, 腹部CTでは, 両側とも水腎症を認めず, passage良好で, 両側上部尿路, 及び回腸導管内に異常所見はなかった.人工的に水腎症を発生させて腎瘻を留置し, 分腎尿細胞診を行った.その結果, 両側にurothelial carcinomaを認め, 両側上部尿路上皮内癌の診断で経皮的Basillus Calmatte-Guerin(BCG)灌流療法(左腎盂:計5回, 右腎盂:計6回)を行った.BCG灌流療法開始後4ヵ月目, 回腸導管尿細胞診は陰性化した.膀胱全摘・回腸導管造設後の導管尿細胞診陽性症例に対し, 人工的に水腎症を発生させて腎瘻を留置することは上部尿路再発の診断・治療に有用であると思われた, We report the diagnosis and treatment for carcinoma in situ of the bilateral upper urinary tracts after total cystectomy and ileal conduit by intentionally inducing hydronephrosis. A 75-year-old man whose chief complaints were macroscopic hematuria and bladder irritabilities was diagnosed carcinoma in situ of the bladder and underwent total cystectomy and ileal conduit. 26 months after the operation, the cytological examination of ileal conduit urine revealed urothelial carcinoma. Since the radiographic findings in the upper urinary tracts and ileal conduit were negative, we constructed bilateral percutaneous nephrostomies by intentionally inducing hydronephrosis. Since two serial cytological examinations of the urine sampling from the bilateral pyeloureteral systems revealed urothelial carcinoma, we performed the percutaneous Bacillus Calmatte-Guerin perfusion of the bilateral upper urinary tracts. The therapy was repeated at weekly intervals for a total of 11 perfusions and the cytological examination of ileal conduit urine became negative 4 months after the beginning of the therapy. Intentionally induced hydronephrosis is useful for the diagnosis and treatment for carcinoma in situ of the bilateral upper urinary tracts after total cystectomy and ileal conduit.

The upper gastrointestinal tract is not generally considered a target organ in ulcerative colitis (UC). However, several cases showing upper gastrointestinal involvement in UC have been reported. In this report, we present 2 rare cases of diffuse duodenitis accompanying pancolonic UC. Case patient 1 was a 44-year-old man who developed diffuse duodenitis shortly after colectomy and was successfully treated with mesalazine. Case patient 2 was a 25-year-old woman who developed diffuse duodenitis under a steroid-free condition and was successfully treated with prednisolone. The 2 patients had Helicobacter pylori-negative duodenitis that resembled colonic lesions of UC in both the endoscopic and histological findings. No evidence of Crohn’s disease was found in these cases. We diagnosed both cases as typical UC-associated diffuse duodenitis. The occurrence of gastrointestinal involvement in UC has been attracting attention because such lesions could potentially open a new window for studying the etiology and pathogenesis of UC. Further studies involving a large number of patients are needed to clarify whether the upper gastrointestinal tract is a target organ in UC.