Search

The patient underwent laparoscopic left radical nephrectomy for clear cell renal cell carcinoma (ccRCC). After surgery, the patient had multiple lung metastases and underwent the combination therapy of radiofrequency ablation, interferon-alpha, and inteleukin-2. Thereafter, computed tomography showed multiple lymph node and brain metastases. The patient was administered targeted therapy and radiation. Eventually, the patient suddenly complained of dyspnea. An echocardiogram, coronary angiography and magnetic resonance imaging suggested acute heart failure and pericardial effusion due to a metastatic tumor in the cardiac anteroseptal and posterior wall. Nivolumab was administered for cardiac metastases. The patient has been in stable condition with no progression of cardiac metastases after the administration of nivolumab for 22 months.

A 45-year-old Japanese man visited a community hospital with the chief complaint of asymptomatic macrohematuria. He was diagnosed with muscle-invasive bladder cancer (MIBC), and he received intra-arterial chemotherapy followed by radiation therapy at another institution. Twenty-eight months after chemoradiotherapy, magnetic resonance imaging (MRI) revealed MIBC recurrence. After neoadjuvant chemotherapy, robot-assisted radical cystectomy was performed. Pathological examination indicated high-grade urothelial carcinoma with lymphovascular invasion, a positive surgical margin, and skip lesions of cancer cells in the perivesical adipose tissue. Three months after surgery, he was brought to our hospital in an ambulance with the chief complaint of rotatory vertigo and was speaking inarticulately. Head and whole spine MRI revealed meningeal metastasis along both the vestibulocochlear nerves and cauda equina. Analysis of the cerebrospinal fluid revealed malignant cells. The patient was diagnosed with leptomeningeal carcinomatosis originating from the MIBC. He received whole-brain radiotherapy followed by the administration of pembrolizumab. Unfortunately, the patient’s condition quickly deteriorated, and he died of cancer 4 months after surgery.

Sorafenib is a tyrosine kinase inhibitor (TKI) of the vascular endothelial growth factor receptor (VEGFR) used for advanced renal cell carcinoma. Treatment with sorafenib prolongs progression-free survival in patients with advanced clear-cell renal cell carcinoma. However, in spite of its therapeutic efficacy, sorafenib causes a wide range of adverse events. Cardiovascular adverse events have been observed when sorafenib was used with targeted agents. Although these adverse events like hypertension, reduced left ventricular ejection fraction, cardiac ischemia or infarction were manageable with standard medical therapies in most cases, some had a poor clinical outcome. We report three cases of acute myocardial infarction associated with sorafenib in patients with metastatic renal cell carcinoma.

Carcinoma of the penis is rare, and the prognosis of penile cancer with inguinal metastases is extremely poor. Standard chemotherapy for advanced penile cancer has not been established because of its rarity. A case of penile cancer with inguinal metastases that responded well to neoadjuvant chemotherapy with paclitaxel, ifosfamide and cisplatin (TIP) is described. A 55-year-old Japanese male visited our hospital for a penile tumor and fixed, 4 cm, right inguinal lymph nodes. Computed tomography and 18F-FDG-PET imaging showed not only right but also left inguinal lymphadenopathy. Penile cancer (clinical stage T3N3M0, 7th edition TNM classification) was diagnosed, and partial penectomy and right inguinal biopsy were performed. The pathological examination revealed squamous cell carcinoma of the penis with right inguinal lymph node metastasis. The inguinal metastases were judged to be unsuitable for radical resection ; and, paclitaxel 60 mg/m2 (day 1), ifosfamide 1, 200 mg/m2 (days 1-3), and cisplatin 60 mg/m2 (days 1-3) were given at 3-week intervals as neoadjuvant chemotherapy. After 4 courses of chemotherapy, the inguinal metastases were markedly reduced. He had neutropenia (grade 3) during each course and peripheral neuropathy after 2 courses, but there were no severe complications. The patient underwent bilateral inguinal and pelvic lymphadenectomy after neoadjuvant chemotherapy. Pathological examination revealed no viable cells in the resected specimens. The patient remains alive and well with no evidence of recurrence 8 months after this radical treatment. TIP chemotherapy appears to be effective for advanced penile cancer.

The management of urinoma after blunt renal trauma is still controversial, ranging from percutaneous drainage or ureteral stent placement for the symptomatic urinoma and waiting for spontaneous vanishment of the asymptomatic urinoma. We present two cases of symptomatic urinoma and a case of asymptomatic urinoma after renal laceration. All patients underwent selective renal arterial embolization for vascular complications, including active bleeding, pseudoaneurysm and arteriovenous fistula. Urinomas, which had been observed in all cases gradually reduced and vanished 1-24 months later. All cases were successfully managed without catheterization or percutaneous drainage for urinoma.

Patient characteristics. (PDF 77Â kb)

ROC curve analysis of PC and BPH patients. (PDF 30Â kb)

List of differentially expressed proteins. (PDF 97Â kb)

GGT activity in exosomes isolated by differential centrifugation from serum of PC patients. (PDF 40Â kb)

A 72-year-old Japanese man was referred to a hospital because of urinary retention. Digital rectal examination revealed a stony, hard nodule in the prostate. A high level of serum PSA was not detected. Prostatic biopsy was performed, and pathological examination indicated adenocarcinoma of the prostate. He was referred to our hospital for treatment. Imaging examinations revealed no metastases (T4N0M0), so we re-evaluated the biopsy specimens. Immunohistochemical examination revealed prostatic small cell carcinoma. His levels of neuron-specific enolase (NSE) and pro-gastrin-releasing peptide (Pro-GRP) were high. We treated him with combination chemotherapy comprising irinotecan and cisplatin, and the treatment waseffective. After four coursesof the chemotherapy, levelsof NSE and Pro-GRP had decreased, and the prostatic mass had decreased in size. Needle rebiopsy of the prostate demonstrated no evidence of malignancy. Adjuvant external beam radiation therapy wasals o performed. The patient iss till alive at 18 month after diagnosis with no evidence of relapse or metastasis of the disease.

A 58-year-old man from Brazil was followed as an outpatient with asymptomatic macroglobulinemia and idiopathic thrombocytopenic purpura (ITP). Abdominal enhanced computed tomographic (CT) scan for elevated liver enzymes revealed a left renal tumor. The tumor was in the middle outer left kidney, measured 18 mm in diameter, was discovered in its early phase, and appeared half exophytic. After investigations, the patient was diagnosed with left renal cell carcinoma associated with ITP. His preoperative platelet count was 10, 000/μl ; five days of intravenous gamma globulin therapy with high-dose dexamethasone increased the platelet count to 76, 000/μl just before operation. Laparoscopic left partial nephrectomy was performed successfully using the retroperitoneal approach. The renal artery was clamped and the tumor excised with an adequate margin. Renal parenchymal repair was completed using running sutures. Ischemia time was 16 minutes. There was no severe oozing of blood intraoperatively. The platelet count decreased to 15, 000/μl on postoperative day three (POD 3), and there was oozing of blood around the retroperitoneal drain tube. The bleeding stopped after administration of platelet transfusion. The patient was discharged on POD 9. The histopathological diagnosis was clear cell carcinoma, and surgical margins were negative.