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Bone morphogenetic proteins (BMPs) comprise one of the largest subgroups in the TGF-β ligand superfamily. We have identified a functional BMP system equipped with the ligand (BMP4), receptors (BMP type II receptor, BMP type IA receptor, also called ALK3) and the signaling proteins, namely the mothers against decapentaplegic homologs 1, 4, and 5 in the human adrenal gland and the human adrenocortical cell line H295R. Microarray, quantitative RT-PCR, and immunohistochemistry confirmed that BMP4 expression was highest in the adrenal zona glomerulosa followed by the zona fasciculata and zona reticularis. Treatment of H295R cells with BMP4 caused phosphorylation of the mothers against decapentaplegic and a profound decrease in synthesis of the C19 steroids dehydroepiandrosterone (DHEA), DHEA sulfate, and androstenedione. Administration of BMP4 to cultures of H295R cells also caused a profound decrease in the mRNA and protein levels of 17α-hydroxylase/17,20-lyase (CYP17A1 and P450c17, respectively) but no significant effect on the mRNA levels of cholesterol side-chain cleavage cytochrome P450 (CYP11A1) or type 2 3β-hydroxysteroid dehydrogenase (HSD3B2). Furthermore, Noggin (a BMP inhibitor) was able to reverse the negative effects of BMP4 with respect to both CYP17A1 transcription and DHEA secretion in the H295R cell line. Collectively the present data suggest that BMP4 is an autocrine/paracrine negative regulator of C19 steroid synthesis in the human adrenal and works by suppressing P450c17.

Intrascrotal fibrous pseudotumor is rarely observed, and only 40 cases have been reported in Japan. A 65-year-old male patient visited this hospital due to a painless right scrotal mass. Computed tomography demonstrated a solid mass with a cystic component ; however, the exact location of the mass in relation to other scrotal contents was not determined. Intraoperative findings revealed a solid mass, 2 cm in diameter, in the tunica vaginalis. The mass could not be dissected from the epididymis ; therefore, high orchiectomy was indicated. A histopathological diagnosis of fibrous pseudotumor was made. The patient's postoperative course was uneventful, and no recurrence has been found. It is difficult to make a diagnosis of paratesticuler tumor based on preoperative radiological results and even macroscopic observation during surgery. We strongly recommend that it is necessary to undergo high orchiectomy for a fibrous pseudotumor in which dissection from the peripheral tissue is very difficult since it may involve various types which may lead to a diagnosis of malignancy.

Penile strangulation is one of the emergent urologic disorders, because immediate release is the critical treatment to prevent penile necrosis, urethral injury, erectile disorder, and other unfavorable events. A 66- year-old man was transferred to the emergency room of our hospital for the penile swelling and pain, occurring by penile insertion to the beverage bottle for masturbation. The penis was completely relieved using an electric plaster cutter without any injury. The strangulation time was four hours and a half, and there were no complications. We recommend an electric plaster cutter as a useful tool for this incident.

Pheochromocytoma occurs in 0.1 to 5.7% of patients with type 1 neurofibromatosis (NF1). Radiological findings of pheochromocytoma are often similar to those of neurofibroma; therefore, any pheochromocytoma should be excised in hypertensive patients with NF1. A 60-year-old male patient with NF1 was referred to this hospital for an incidentally discovered right adrenal mass, 7 x 6 mm in diameter. The patient had multiple benign tumors and suffered from hypertension for 4 years. Laboratory findings showed increased serum and urine catecholamine levels. Magnetic resonance imaging (MRI) revealed a high signal intensity on T2-weighted images, which was enhanced by gadolinium contrast. The mass was positive for 131 I-metaiodobenzylguanidine (MIBG) scintigraphy. A laparoscopic adrenalectomy was performed. A histopathological diagnosis of pheochromocytoma was made. The patient's post-operative course was uneventful, and blood pressure was normalized. Screening of the adrenal tumor is strongly recommended for NF1 patients with hypertension, since any unfavorable events due to catecholamine such as cardiomyopathy and fatal arrhythmia can be avoided by adequate surgical intervention.

A 67-year-old female patient had a cystic mass, 6 cm in diameter, which was incidentally detected on the dorsal side of the cecum in the retroperitoneum. A laparoscopic tumor excision was performed. Microscopically, the majority of the cystic wall consisted of Mullerian type serous epithelium, partially including the columnar epithelium containing round nuclei and mucin production. The columnar epithelium was similar to the uterocervical epithelium, and there was proliferation of dense collagen fibers resembling ovarian stroma under the epithelium. These microscopic findings were consistent with ovarian seromucinous cystadenoma. Therefore, the cyst was diagnosed to be a retroperitoneal Mullerian cyst. This is the 15th case of a cyst of this type reported and is the first case in which a laparoscopic excision was performed.

We encountered a case of lipomatous tumor in the left scrotum, which was clinically and radiologically quite similar to an inguinal hernia. A 75-year-old male patient visited a nearby hospital complaining of a painless left scrotal swelling. Palpation revealed an elastic firm mass 5 cm in diameter in the left scrotum. The tumor marker levels were within the normal range. The patient was referred to our hospital for further evaluation. A preoperative diagnosis of inguinal hernia containing the omentum was made. Although a solid mass was demonstrated in the scrotum, no inguinal hernia was found at the operation. Therefore, a left high inguinal orchiectomy was performed. Microscopically, most of the tumor consisted of mature adipocytes, some of which had different cellular sizes. Scattered lipoblasts and atypical mesenchymal spindle cells were also observed, suggesting potential malignancy. (

We encountered a case of seminoma arising from an intra-abdominal cryptorchidism associated with ipsilateral renal agenesis. A 42-year-old male patient was referred to this hospital with a complaint of right upper abdominal distention with pain. Radiologic examination demonstrated a right retroperitoneal mass, 12 cm in diameter, while the ipsilateral kidney was not detectable. Intra-aortocaval lymphnodes were swollen at the renal hilus level. The patient underwent tumor resection and lymphadenectomy. A histopathological diagnosis of seminoma with para-aortic lymphnode involvement was made. A definite diagnosis was seminoma (pT1 pN3M0) arising from cryptorchidism associated with right renal agenesis. The present case is the third of its kind reported in the literature.

A 30-year-old male, who underwent orchiopexy of left undescending testis in his childhood, presented with right hemiscrotal swelling without pain. Ultrasonography revealed a paratesticular tumor which showed enhancement on magnetic resonance imaging (MRI). Diffusion-weighted MRI showed decreased diffusion in the tumor, and malignant tumor could not be ruled out. High inguinal orchiectomy was carried out and pathological diagnosis was benign leiomyoma of the epididymis.

Recurrent urothelial carcinoma of the bladder is often a locally progressive disease. Invasive bladder cancers frequently show lymphatic or hematogenous metastasis. Regional lymph node metastasis is a frequent finding and may be the first sign of recurrence. Rectal involvement and obstruction is rare, but metastasis to the colon, small intestine, and stomach have been reported. Here, we report an unusual case of urothelial carcinoma of the bladder manifesting as an annular rectal obstruction.

A 79-year-old man had undergone radical cystourethrectomy for bladder carcinoma in January, 1989. Pathological report was Small cell carcinoma (SCC) >> transitional cell carcinoma (TCC), G2 > G3, pT4 (prostate), ew (-). Ten years later, follow-up computed tomography (CT) revealed swollen left inguinal lymph node in October 1998 and lymph node dissection was performed in January, 2000. The pathological report showed TCC, G2. Left inguinal lymph node metastases appeared again in January, 2001. Chest X-ray films showed multiple lung metastases in March, 2001. Three couses of MVAC (methotrexate, vinblastine, doxorubicin cisplatinum) chemotherapy had been performed since September, 2001 but were in effective. Papillary tumor was observed at external urethral meatus in September, 2002 and the biopsied specimens showed TCC, G1 > G2, pathologically. Finally he died of respiratory insufficiency in January, 2003. It is suggested that the recurrent TCC tumor in the urethral remnants might metastasize into the inguinal lymph nodes.