Search

A 38-year-old woman was referred to our hospital with a chief complaint of cyclic hematuria and amenorrhea after Caesarean section. Magnetic resonance imaging showed vesicouterine fistula. The patient was treated with luteinzing hormone-releasing hormone analog to stop menstruation for six months. We performed transperitoneal closure of the vesicouterine fistula. Normal menstruation resumed after 4 months, and the symptoms disappeared. This case was considered Youssef syndrome (cyclic hematuria without vasinal amenorrhea or urinary incontinence). We discuss the cause of this syndrome.

The first case was in a 73-year-old man with macrohematuria. The second case was in a 59-year-old man with pollakiuria. Their serum prostate specific antigen levels were slightly elevated and urinary cytology was negative. Histological examination by prostatic needle biopsy and biopsy from bladder neck showed prostatic ductal adenocarcinoma. Clinical stage on computed tomography and magnetic resonance imaging was T4N0M0 in both cases. After 10-month maximal androgen blockade(MAB) and arterial chemotherapy using reservoir system, radiation therapy was performed. After that, low dose FP-chemotherapy(5-fluorouracil 600 mg/day, cisplatinum 10 mg/day) was performed for 28 days in the first case. At present, there are no signs of recurrence or metastasis in either case.

A 72-year-old man and a 59-year-old man presented with painless hard swelling of left scrotal content. They underwent left high orchiectomy with clinical diagnosis of spermatic cord tumor. The pathological examination revealed leiomyosarcoma. The former had adjuvant radiation therapy locally. These are the 28th and 29th cases of spermatic cord leiomyosarcoma in Japan.

The patient was a 23-year-old-woman who was referred to our hospital with chief complaints of right flank pain and macroscopic hematuria. Right radical nephrectomy was performed with the diagnosis of right renal cancer. Histopathological examination revealed Wilms' tumor of favorable histology, stage I according to the National Wilms Tumor Study classification. She received adjuvant chemotherapy consisting of actinomycin D and vincristine at another hospital. One year and three months later, she developed lung metastasis. She underwent partial pulmonary resection, and then received chemotherapy. She is presently disease-free more than forty months after the initial operation. Wilms' tumor is rare in adults and has a poor prognosis compared with that in children. We analyzed 112 cases in the Japanese literature from 1981 to 2004. The mean age was 36.9 years, with males and females equally affected. No difference was found between the left and right sides in frequency of tumor. We also examined the relationship between histological features and prognosis based on 43 Japanese reports. Twenty-two of the 43 (51%) cases had unfavorable histology. The 2-year survival rate with unfavorable histology was 18%, while that with favorable histology was 87%. The 2-year survival rates for stages under II and over III were 67% and 27%, respectively. Based on these findings, we conclude that the prognosis of adult Wilms' tumor is very poor since many patients have unfavorable histology and no effective treatment guidelines have been established.

Approximately 70% of patients with advanced prostate cancer have bone metastases, which are associated with considerable skeletal morbidity, accompanied by severe bone pain that requires narcotics or palliative radiation therapy, pathological fractures, spinal cord compression and hypercalcemia of malignancy (HCM), which consequentiy lower the patient's quality of life. Bisphosphonates, potent inhibitors of osteoclast activity and survival, therefore inhibiting osteoclast-mediated bone absorption, transiently palliative bone pain and decrease analgesic usage in patients who have hormone-refractory prostate cancer (HRPC) with bone metastases. Recently, a randomized controlled trial showed that a third-generation bisphosphonate, zoledronic acid reduced bone pain and skeletal-related events (SREs). In this manuscript, we reviwed the efficacy of bisphosphonates in HRPC with bone metastases from several clinical studies and discuss treatment of advanced prostate cancer with bisphosphonates.

The shape of the uroflowmetrogram reflects voiding conditions. Using a voiding simulation, we examined whether the urethral loss coefficient (LC) calculated from the approximated uroflowmetrogram correlates with parameters that regulate the shape of the uroflowmetrogram. A total of 161 normal and abnormal uroflowmetrograms were used. Normal female subjects and patients before and after transurethral resection of the prostate (TURP) were also studied. The ratio of maximum flow rate (Q(max)) to flow time (T), a parameter expressing the shape of the uroflowmetrogram, was calculated. The uroflowmetrograms were approximated using a voiding model, and the urethral LC was calculated. As a result, a strong negative correlation was observed between the Q(max)-flow time ratio, Q(max)/ T, and LC. Q(max)/T is the vertical to horizontal ratio of the uroflowmetrogram and indicates the average degree of acceleration of flow rate during voiding. On the other hand, urethral LC, which can be estimated from the shape of the uroflowmetrogram, is considered a kind of urethral resistance. We concluded that when urethral resistance is high, the degree of acceleration of flow rate is low on average. Our study also indicated that Qmax/T was less affected by voided volume (VV) compared to Q(max). As Q(max)/T is not as dependent on VV, it is useful for comparing cases with different VV.

Prostatic neuroendocrine (NE) carcinoma is a rare disease with a poor prognosis because of its rapid progression and the androgen-independent characteristic, for which no successful therapy is available presently. We report a case of NE differentiated prostate cancer, which was diagnosed as adenocarcinoma initially and progressed with NE differentiation during the combined androgen blockade therapy.

A 85-year-old woman presented with macroscopic hematuria and miction pain. Cystoscopy revealed a wide-based submucosal mass, and biopsied specimens of the mass showed a B-cell lymphoma of the MALT type. Computed tomography (CT) showed a 7.5 x 3.0 cm solitary mass lesion situated from the anterior wall to the right lateral bladder wall, and magnetic resonance imaging (MRI) showed a low intensity in T1W1, high in T2W1 without invasion. After she was admitted to our hospital, TUR of the lesion was performed. The findings were consistent with extranodal marginal zone B-cell lymphoma of the MALT type. No evidence of lymphoma was found on the CT of the pelvis, chest X-ray and Gallium scintigraphy. The patient had stages I(AE) lymphoma. The patient was treated with radiation therapy to the bladder and pelvis (40 Gy in 20 fractions) and was followed with CT every 3 months. She had no evidence of recurrance.

We report a case of stage I malignant melanoma of the penis (confined to the penis). A 74-year-old uncircumcised man noticed a nonhealing, painless black lesion in penile foreskin and visited our institute. As the lesion was confined to the prepuce, the patient underwent circumcision for treatment and histological diagnosis. Histological examination revealed a malignant melanoma composed of epithelioid melanocytes. Ten months later, he is currently alive, without recurrence or metastasis.

A 67-year-old man, who had smoked heavily for many years, was found in 1997 to have bladder tumors, and transurethral resection of the bladder tumor (TUR-Bt) was performed. Histopathological diagnosis was urothelial carcinoma (G2G3, pTa, N0, M0, ly0, v0). In December, 1998, he noticed an oral cavity tumor. After preoperative radiation therapy (total 40 Gy, 17 times), surgical treatment was undertaken. Histopathological diagnosis was well differentiated squamous cell carcinoma (pT2, pN2b, M0). In February, 2000, gastric tumor was detected by endoscopic examination, and subtotal gastorectomy and Roux en Y operation were performed. Histopathological diagnosis was well differentiated adenocarcinoma (pT2, pN0, M0, P0, CY0). A chest computed tomographic (CT) scan revealed a solitary lung tumor in April, 2000. Partial peumonectomy was performed, and histopathological diagnosis was poorly differentiated adenocarcinoma (pT1, N0, M0, P0). In April, 2000, multiple lesions of bladder cancer in the neck of the urinary bladder and posterior urethra were found and radical cystoprostatourethrectomy combined with lymph node dissection and bilateral cutaneous ureterostomy were performed (urothelial carcinoma, G3, pT4a, pN2, M0, pL2, pV0, pR0). Since then, the patient has been followed carefully.

A case of renal cell carcinoma, found after skin metastasis is presented. A 79-year-old man visited Osaka JR hospital, complaining of a painless nodular mass on his right chest. The mass was resected and histopathological examination revealed a clear cell carcinoma (alveolar type, G1) with no involvement of the mammary gland. Abdominal ultrasound and magnetic resonance imaging revealed a heterogenous lower pole mass in the right kidney. Ultrasound-guided needle biopsy of the right renal mass was performed for histopathological diagnosis, which was clear cell carcinoma (alveolar type, G1). At that time, multiple metastases appeared in bilateral lung fields. The patient is currently receiving interferon-alpha therapy, without surgical treatment.

A 75-year-old man was admitted to our hospital for treatment of superficial bladder tumor. Transurethral resection (TUR) was performed and histopathological examination revealed a transitional cell carcinoma (G2). Despite one course of post-TUR bladder instillation therapy using pirarubicin hydrochloride, carcinoma in situ (CIS) was found 4 months later. CIS disappeared after another course of bladder instillation therapy using BCG; but, it recurred a month later. BCG bladder instillation therapy was performed again, and no malignant cells were detected in the urinary tract thereafter. Four months later, lung metastasis was diagnosed and an MVAC regimen (cisplatin, methotrexate, vinblastin adriamycin) was administered. However, anaphylactic shock was induced by intravenous injection of pirarubicin hydrochloride, so this therapy was stopped in the middle of the second course. Even though the lung metastasis disappeared once after the same MVAC treatment, it recurred the following year. At that time, 3 courses of a cisplatin-methotrexate-vinblastin regimen were administered, and a complete response was achieved.

A 67 year-old male consulted our department for examination a painless left scrotal mass accompanied by a continuously high serum carbohydrate antigen 19-9 level (CA19-9, 563.2 IU/ml). The patient underwent radical orchiectomy oof the mass. The histopathological diagnosis was an organized hematocele, and left testicular tissue was found in the cyst wall. There was no evidence of malignancy in the cyst wall or cyst contents, and immunohistochemical analysis showed no CA19-9-positive cells. However, the CA19-9 level lowered to the normal range immediately after surgery. The patient's CA19-9 level has remained normal, with no recurrence of tumor to date. Considering the clinical course, we suspected the resected mass to have been the cause of the high serum CA19-9 level, and to our knowledge, this is the first case report of organized hematocele in the scrotum with a high CA19-9 level.

Immunosuppressant-induced nephrotoxicity contributes to kidney graft loss in the long-term as one of the non-immunologic factors. We previously reported that correction of cyclosporine A (CsA)-induced hypomagnesemia reduced chronic CsA nephrotoxicity. This study was conducted to elucidate the mechanism of the beneficial effects of magnesium (Mg) on CsA nephrotoxicity and examine the role of the renin-angiotensin system in this mechanism. We particularly focused on CsA-induced interstitial mononuclear cell infiltration. CsA (15 mg/kg/day, s.c.) was administered daily to rats maintained on low sodium diets for 7, 14 and 28 days. The inhibitory effects of Mg supplementation and those of angiotensin converting enzyme inhibitor (ACEI) were compared for renal function, renal histology, mononuclear cell infiltration and gene expression profile. CsA lowered creatinine clearance and developed characteristic tubulointerstitial fibrosis that were mostly evident at day 28. CsA-induced impairment of renal function was ameliorated by Mg supplementation but not by ACEI. Monocyte/macrophage infiltration preceded the renal fibrosis and increased progressively with the duration of CsA administration. CsA markedly upregulated the expression of chemoattractant proteins, osteopontin and monocyte chemoattractant protein-1, concomitantly. These changes were markedly attenuated by Mg but only slightly by ACEI. CsA also promoted expression of fibrogenic molecules and extracellular matrices that were markedly attenuated by Mg but only slightly by ACEI. Similarly, CsA-induced tubulointestitial fibrosis was almost completely abolished by Mg supplementation but only partially attenuated by ACEI. These results suggested that Mg supplementation abolished CsA-induced precedent inflammatory cell influx possibly via inhibition of expression of chemoattractants and consequently suppressed tubulointerstitial fibrosis. In this beneficial mechanism, factors independent of renin-angiotensin system seem to be mainly involved.

Solitary fibrous retroperitoneal tumor is rare. We present a case with infiltrative growth in a 56-year-old female patient whose initial symptom was palpable tumor in the lower abdomen. Computed tomography and magnetic resonance imaging indicated a mass in the retroperitoneum under the left kidney with a poorly demarcated infiltrative growth. Surgical findings revealed a gelatinous tumor in the retroperitoneum, which had invaded up to the fatty tissue surrounding the Gerota's fascia and to the fatty tissue surrounding the descending colon. However, as there was no invasion into the Gerota's fascia, it was possible to preserve the left kidney. Pathohistological examination revealed increased cellularity in the tumor tissues as well as tissues with atypical nuclei of the tumor cells with some cell division. Due to these findings, it was diagnosed as malignant solitary fibrous tumor. Only surgical treatment was performed and the patient is alive without recurrence 2 years and 4 months after surgery.

In the two cases we report here, tumors were diagnosed as nephrogenic adenoma by pathohistological examination. Case 1 was a 72-year-old female presenting with a bladder tumor 8 months after receiving ureteral tumor surgery. Transurethral resection of bladder tumor (TUR-Bt) was performed. Case 2 was a 57-year-old female who had received intravesical bacillus Calmette-Guérin (BCG) treatment 6 times after her fifth TUR-Bt. Two tumors were found by cystoscopy, and TUR-Bt was performed. There have been 39 cases of nephrogenic adenoma of the bladder reported in Japan; 21 were male and 18 female with a mean age of 56.5 years. The main complaint was hematuria, which was seen in 16 cases followed by pollakisuria in 6 cases. Nephrogenic adenoma occurred after surgery of the urinary tract in 16 cases, followed by urinary tract infection in 9 cases and intravesical BCG treatment in 6 cases. The ratio of cases occurring after intravesical BCG treatment has increased since BCG approval for bladder carcinoma treatment in December 1996 in Japan, and an increase in the number of cases is expected in the future.