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A case of synchronous triple primary cancer occurring in the prostate, kidney and urinary bladder is reported. A 74-year-old man had been complaining of macroscopic hematuria, dysuria and residual sensation of urine since January 1994. Pathological analysis of prostate revealed poorly differentiated adenocarcinoma in March, 1994. Bone and Ga scintigraphy gave no evidence of metastasis. Computerized tomography (CT) revealed irregularity of a part of the margin of prostate (T2N0M0) and enhanced mass with a diameter of 3 cm localized at the hilus of the right kidney. Excretory urography showed a shadow defect in the right pelvis and elevation of the bladder base. In spite of the appearance of class 5 in urine cytology, no tumor was detected in the bladder by cystoscopy. Angiography confirmed the presence of a hypervascular tumor in the right kidney. He underwent right-sided nephroureterectomy in April, 1994, because not only right pelvic tumor but also right renal tumor was suspected. Histological examination of the renal tumor revealed clear cell carcinoma (T2N0M0). Then, he did not visit our hospital for 8 months. In January, 1995 a papillary broadbase tumor was found near the bladder neck by cystoscopy. Transurethral resection of the tumor (TUR-Bt) was performed in February, 1995. Pathological analysis of the tumor revealed TCC G1 pT1 (T1N0M0).

腎細胞癌の治癒的切除術施行例44例を対象にrIFNα-2b投与に関する臨床的検討を行った.1) 44例のstage分類(Robson)は1が29例, 2が15例であった.2)適格例42例中, 再発が認められた症例は5例であり, うち2例が死亡している.再発から死亡までの期間は2ヵ月と6ヵ月であった.3)適格例の42例中, 死亡例は3例であり, 累積生存率は1年生存率97.6%, 2年生存率89.7%であった.4) IFN初期治療終了後のIFNαおよびIFNγ産生能は前者においてすべて低下(4/4)し, 後者においては3例が上昇(3/4), 1例が正常値を示した.5) 2-5AS活性は評価できた4症例において, いずれもrIFNα-2b投与により上昇が認められた.6)副作用を認めたものは24例であり, 発熱が22例と最も多く, その他に白血球数減少, 肝機能障害などを認めたが, 多くは投与継続が可能であり副作用による中止例は5例であった.7)抗rIFNα-2b抗体について22例で継続的に測定したが, いずれも測定限界値未満であった, A clinical trial using interferon alpha 2b (IFN alpha-2b) for prophylactic therapy was done on 44 patients who had received nephrectomy for renal cell carcinoma. Principally, the daily intramuscular injection of 3 of 6 million units of IFN alpha-2b was done for 4 consecutive weeks after 2 weeks postoperatively and thereafter followed by injection once every 2 weeks. The clinical evaluation was done for the recurrence rate, the survival rate, the IFN alpha and IFN gamma producing ability, the activity of 2', 5' oligoadenylate synthetase (2-5AS) and the side effect. Out of 44 cases entered, 42 were completely evaluable and recurrence was observed in 5 (11.9%) of the 42 cases. The recurrence rate was 5.5% and 16.4%, at the first and second year, respectively. Three (7.1%) of the 42 patients died. The survival rate was 97.6% at the first year, 89.7% at the second year for the followup study. The IFN alpha producing capacity was low in all of the 4 evaluable cases. The IFN gamma producing capacity was high in 3 cases and normal in 1 case. 2-5AS, the enzyme produced by IFN, was activated by IFN alpha-2b administration in all of the 4 evaluable cases. Side effects were observed in 24 (54.5%) of the 44 cases. The main side effect was fever. Leucopenia, general fatigue, appetite loss, temporary elevation of liver transaminase were also observed. However, there were only 5 cases (11.4%) in which administration of IFN alpha-2b had to be discontinued.

The patient was a 56-year-old male. Renal cyst and intracystic mass were incidentally found in the right kidney by ultrasound sonography. Intracystic mass was enhanced. At operation, intracystic fluid was clear and yellow, and its cytology was negative. However, rapid histological examination of the intracystic mass showed malignancy. Accordingly, nephrectomy was performed. We then reviewed the characteristics of the intracystic fluid in renal cell carcinoma reported in Japan and found that 70% was bloody intracystic fluid and 30% showed positive cytology. These findings suggested that we should to be more careful when diagnosing renal cyst associated with renal cell carcinoma only by the examination of the intracystic fluid.

We report a 27-year-old male with renal cell carcinoma associated with von Hippel-Lindau disease. The patient was admitted to the department of internal medicine because of pneumothorax. At that time liver and pancreatic cyst, and renal tumor were found incidentally on the abdominal computerized tomography. He had a history of cerebellar hemangioblastoma, which had been removed in 1988. Angiography revealed multiple hypervascular tumors in the right kidney. We performed right radical nephrectomy, and histopathology showed clear cell type of renal cell carcinoma.