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A 47-year-old female presented to a clinic complaining of right back pain. A CT scan revealed a right retroperitoneal mass and she was referred to our department for further evaluation. Contrast-enhanced CT and MRI revealed a right retroperitoneal mass (6 cm) in the hilum of the right kidney that invaded the right renal vein and inferior vena cava (IVC). Suspecting a tumor arising from retroperitoneal tissues involving the right renal vein and IVC, the decision was made to excise the tumor with the right kidney, renal vein, and a portion of the IVC. The histologic findings indicated that the tumor was a leiomyosarcoma originating from the renal vein wall. The tumor cells were spindle-shaped and stained positive for desmin, caldesmon and HHF35. The post-operative course was uneventful and she was recurrence-free 20 months after surgery. In addition to presenting a case of a leiomyosarcoma of the renal vein, a short review of the literature is provided.

A 48-year-old married woman complaining of macroscopic hematuria and cystitis symptom was admitted to our institute. Flexible cystoscopy revealed many yellowish, nodular masses at the paries posterior of the urinary bladder, and cold-punch biopsy proved it to be amyloidosis. Serum amyloid protein A (SAA) was high, and suggested systemic amyloidosis. Renal biopsy and colon fiberscopy did not reveal any abnormalities. We therefore diagnosed a primary localized amyloidosis of the urinary bladder. Transurethral resection and dimethyl sulfoxide (DMSO) infusion therapy are used to treat amyloidosis of the urinary bladder. However there is no definite cure for amyloidosis of the urinary bladder. Therefore we selected DMSO occlusive dressing technique therapy. After 5 years of therapy, there was no evidence of a recurrence of amyloidosis.

The patient was a 74-year-old man. Computed tomography (CT) detected a right renal tumor with paraaortic lymph node swelling. Radical nephrectomy and left lymphadenectomy were performed in September 2008. Interferon-alpha (6 million international units three times per week) was administered as adjuvant therapy. Due to the development of side effects, including fatigue, the patient's immunotherapy was discontinued after 6 months. Radiofrequency ablation for pulmonary metastasis was performed 9 months after surgery. A nodular pedunculated tumor was detected on the posterior wall of the urinary bladder by CT, and transurethral resection was performed 18 months after nephrectomy/lymphadenectomy. Since the pathological diagnosis of the bladder tumor was clear cell carcinoma, that tumor was thought to have originated from the renal cell carcinoma. We have summarized 43 cases of bladder metastasis of renal cell carcinoma in Japanese patients, including ours.

A 58-year-old man, received polypectomy to evaluate the polyp of sigmoid colon. Pathological examination of the specimen revealed non-invasive adenocarcinoma. Systemic work up including abdominal computed tomography (CT) demonstrated a bladder tumor 11 x 18 mm in diameter associated with left obturator lymph node swelling (16 x 14 mm). In the preoperative staging, this nodule was suspected to be lymph node metastasis, even though both cancers were diagnosed to be early stage. Transurethral resection of bladder tumor (TUR-Bt) and lymph node open biopsy were performed. The final diagnosis of bladder tumor was pTa, urothelial cancer grade 2 and low grade. The nodule had originated from the obturator nerve itself, and pathological diagnosis demonstrated benign schwannoma. To the best of our knowledge, this is the 14th report of benign schwannoma of the obturator nerve in Japan.

A 33-year-old male complained of poor vision and visited the ophthalmology department of our hospital. Right iridoncus suspected as a metastatic nodule, was found. A systemic examination was done. Abdominal computed tomographic (CT) scan showed an enhanced mass in the right scrotum, 15 mm in diameter and enlargement of iliac lymph nodes. Chest CT scan demonstrated bilateral enlargement of mediastinal lymph nodes and enlargement of lymph nodes above the collarbone. Since malignant lymphoma or testicular malignancy was suspected, right orchiectomy was planned. A hard and nodular mass at the head of the epididymis, completely separated from the testis, was recognized. Only open biopsy was done, because no malignancy was found by the intraoperative biopsy. Pathological findings of the epididymal tissue revealed non-caseating epithelioid cell granulomas. Sarcoidosis was diagnosed based on pathological findings and systemic evaluations. Steroid ocular instillation therapy was started. To the best of our knowledge, this is the 18th report of epididymis sarcoidosis in Japan.

An 11-year-old female consulted our department with complaints of urinary incontinence and pyuria. She had had a cloacal repair 7 years ago. The radiograph showed four stones in the pelvis. Magnetic resonance imaging showed two diverticula next to the urethra and several low intensity masses in one diverticulum were regarded as stones. Voiding cystourethrography showed normal urinary bladder contraction, although there were residual urine in the diverticula. Preoperatively, these stones were thought to be formed as a result of the long-standing residual urine. Cystourethroscopy showed that the two diverticula existed within the proximal area of the urethral sphincter and four white stones were found in them. Transurethral cystolithotripsy was performed and a surgical staple was found in the core of each stone. The surgical staples had been used for the cloacal repair and they had migrated into the bladder resulted in stone formation. To the best of our knowledge, this is the first report of bladder stones caused by the migration of surgical staples into the bladder after cloacal repair.