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A 51-year-old man who presented with gross hematuria and back pain was found to have a right renal mass accompanied with lung and osseous metastases. The patient underwent transabdominal right nephrectomy. The histopathological examination revealed the tumor to be tubulocystic carcinoma of the kidney. After the patient received sunitinib therapy, contrast enhanced computed tomography revealed that the metastatic tumor size was stable in the bone and decreased in the lung. Unfortunately, 9 months after nephrectomy, bone scintigraphy revealed an increase in the size of the metastatic tumor in the bone. The patient’s condition worsened gradually, and he died 15 months after the surgery.

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30歳, 男。右陰嚢内容腫脹で受診し, 右精巣は小手拳大で, alpha-fetoprotein(AFP)値, LDH値の上昇を認めた。右精巣腫瘍の診断で右高位精巣摘除術を施行した。病理学的にセミノーマ, 胎児性癌, 成熟奇形腫を認めた。AFP, LDHは低下し, stage Iと診断した。その後, 頭痛, 眩暈が出現し, MRIで右後頭部に腫瘍を認めた。AFPは上昇し, CTでは左肺野, 脾臓に腫瘍を認めた。再発性精巣腫瘍, 脳, 肺, 脾転移と診断し, シスプラチン, エトポシド, ブレオマイシンによるPEB療法を開始した。AFPは正常化しなかったため, エトポシド, イフォスファミド, シスプラチンによるVIP療法を施行したが, AFPは上昇した。肺, 脾, 脳転移の腫瘍が縮小したため, パクリタキセル, イフォスファミド, シスプラチンによるTIP療法を施行した。AFPは正常化し, 脾, 脳転移の消失, 肺転移の94%縮小を認めた。その後の腹腔鏡下肺腫瘍切除では残存腫瘍は認めず, 再発後約3年の現在, 再発は認めていない。, A 30-year-old man was diagnosed with testicular cancer, and underwent a radical orchiectomy. Pathological diagnosis was a mixed type nonseminomatous germ cell tumor. We diagnosed him as having stage I testicular cancer and decided to forgo adjuvant therapy. After 8 months of follow-up, he was admitted to our department because of brain, lung, and spleen metastases. Since the serum alpha-fetoprotein (AFP) level was present at a high level at 1, 297 ng/ml, he was given combination chemotherapy consisting of 3 cycles of PEB, cisplatin, etoposide and bleomycin and one cycle of PE, cisplatin and etoposide. Because of the decline in lung diffusing capacity, the administration of bleomycin was stopped in the final course. However, the AFP level remained above 14 ng/ml. Then he was given one more cycle of VIP therapy (etoposide, ifosfamide, cisplatin), but the serum AFP level was increased to 56 ng/ml. Then, two cycles of chemotherapy with paclitaxel, ifosfamide and cisplatin were administered as salvage chemotherapy, which led to a normalization of the serum AFP level, and disappearance of the brain and spleen metastases. Residual lung mass was resected at the surgical department, and microscopically no viable tumor cells remained. Three years after his final hospitalization, the patient has had no evidence of recurrence or metastasis.

放射線治療を行った骨転移を有する腎細胞癌22例(男18例, 女4例, 平均年齢61歳)を脊椎骨転移群と骨盤骨・長管骨転移群の2群に分類し, 再石灰化率, 再石灰化出現までの期間, 疼痛緩和効果, 効果持続期間について比較検討した。3～51ヵ月の経過観察期間で, 再石灰化率と再石灰化出現までの期間は両群で同等であったが, 骨盤骨・長管骨転移群の約60%で疼痛が完全消失したのに対し, 脊椎骨転移群で疼痛が完全消失したのは1例のみであった。また, 疼痛緩和持続時間は両群とも2～3ヵ月で差を認めなかったが, 治療線量による比較では35Gy以上照射した(10例)方がそれ未満(12例)より2倍以上長い効果持続期間であった。腫瘍縮小は3例に認め, 骨破壊の進行抑制も含めると奏功率は48%であった。骨転移の早期発見および放射線治療により疼痛管理を含めたQOL改善が示唆された。, If bone metastasis of renal cell carcinoma is neglected, pain, paralysis, and pathologic fracture develope; consequently, the patient's quality of life is significantly lowered. We investigated the local effect of the radiation therapy to the patients with metastasis. The investigation targeted 22 cases (27 parts) of renal cell carcinoma with bone metastasis that were treated with radiation therapy in our hospital during the last 6 years. We analyzed cell type, presence or absence of organ metastasis, irradiated site, therapeutic dose, treatment period, and combination therapy. The object was classified into 2 groups by metastatic site: the group with metastasis in the vertebra, and the group of metastasis in the pelvis or long bones. We examined re-calcification rate, length of time to recalcification emergence, pain relief and duration of effect as therapeutic effects. The irradiated site was vertebra in 14, pelvis in 7, and long bone in 6 patients. The therapeutic dose was 15 to 50 Gy, and the average was 35.7 Gy. No difference was found in the re-calcification rate and length of time to recalcification according to the metastatic site. The pain relief effect was significant in the pelvis and long bone group compared to the vertebra group. The effect lasted longer when the radiation dose was 35 Gy or more, compared with a lower dose. The radiation therapy for renal cell carcinoma with bone metastasis was effective to relieve pain and improve the patients' quality of life. The results showed that early detection and recognition of bone metastasis provide local control.

A 51-year-old man who presented with gross hematuria and back pain was found to have a right renal mass accompanied with lung and osseous metastases. The patient underwent transabdominal right nephrectomy. The histopathological examination revealed the tumor to be tubulocystic carcinoma of the kidney. After the patient received sunitinib therapy, contrast enhanced computed tomography revealed that the metastatic tumor size was stable in the bone and decreased in the lung. Unfortunately, 9 months after nephrectomy, bone scintigraphy revealed an increase in the size of the metastatic tumor in the bone. The patient’s condition worsened gradually, and he died 15 months after the surgery.

尿路系悪性腫瘍患者の主訴と受診契機を解析し, 都市部大学病院の癌患者の受診動向を検証した.腎細胞癌では検診と他疾患精査群が全体の半数を超え, 無症候例が約80%に達していた.腎盂尿管癌では肉眼的血尿が最も高く, 時には100%に達していた.膀胱癌でも肉眼的血尿が最も高く, 80%前後が肉眼的血尿を主訴としていた.前立腺癌では排尿困難, 頻尿などの排尿症状が最も高く, 比率は50-70%前後であった.PSAにより発見は1995年以降増え始めた.偶発癌は腎細胞癌で頻度および実数とも有意に高かった.膀胱癌と腎盂尿管癌は原発巣に基づく症状の主訴が大半であった.転移に基づく症状が主訴となった例は前立腺癌で有意に高かった, We analyzed the chief complaints of patients with four major urogenital malignancies (renal cancer, renal pelvis and ureter cancer, bladder cancer and prostatic cancer) over the past decade (1990-1999) at the Jikei University Hospital. Over the last 10 years, a high percentage of renal cancers were detected incidentally. By contrast, prostatic cancers were more likely (10.5%) than other cancers to be detected on the basis of symptoms of metastasis. However, since 1995 more prostatic cancers are being detected with prostatic-specific antigen screening at the health checkups. Gross hematuria is the chief complaint of most patients with uroepithelial cancers (cancers of the renal pelvis, ureter and bladder cancer). Additionally, renal pelvis and ureter cancers were diagnosed with screening in a few patients in the past five years.

A 39-year-old man with schizophrenia and suicide attempt was diagnosed with stage IIb testicular tumor. He was initially admitted to the psychiatry ward and underwent high orchiectomy. After schizophrenia became stable by administration of antipsychopathic drugs, he was transferred to the ordinary urology ward and treated with 3 courses of chemotherapy (bleomycin, etoposide, cisplatin) and retroperitoneal lymph noded dissection. The mental status of the patient remained under good control throughout the course of treatment. He has been free of recurrence for 8 months postoperatively. We discussed general medical issues concerning the treatment of malignant diseases in patients with psychosis.

1)THP-ADRを用いた化学療法, 放射線療法に奏効し根治的手術を施行したstage III陰茎癌の1例(60歳男)を報告した. 2)化学療法と放射線照射の併用療法は, 陰茎温存を可能にする有効な治療法と思われた, A 60-year-old [correction of 68] male was referred to our hospital because of a penile tumor with necrosis. Pathological examination of the penile tumor and superficial inguinal lymph nodes in biopsy revealed well differentiated squamous cell carcinoma (SCC) and the SCC tumor marker was elevated. TNM classification was T2, N2, M0 according to findings obtained by computed tomography (CT) and magnetic resonance imaging (MRI). We diagnosed the tumor inoperable radically and administered 10 mg peplomycin once a week for 10 weeks intravenously. The SCC marker level was not reduced and the tumor was not changed on MRI. Then, we performed combined pirarubicin treatment and radiotherapy. The patient received linac radiotherapy between 40 Gy/4 weeks/20 fractions. Pirarubicin, 10 mg/m2, was administered once a week for 4 weeks during irradiation intravenously. After the combined therapy, the SCC marked level was reduced to the normal range and the tumor was reduced. We performed radical operation. Pathological diagnosis revealed no viable tumor cells. The patient was alive with no evidence of disease a year later. This combined therapy is suggested to be useful.

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A 30-year-old man was diagnosed with testicular cancer, and underwent a radical orchiectomy. Pathological diagnosis was a mixed type nonseminomatous germ cell tumor. We diagnosed him as having stage I testicular cancer and decided to forgo adjuvant therapy. After 8 months of follow-up, he was admitted to our department because of brain, lung, and spleen metastases. Since the serum alpha-fetoprotein (AFP) level was present at a high level at 1, 297 ng/ml, he was given combination chemotherapy consisting of 3 cycles of PEB, cisplatin, etoposide and bleomycin and one cycle of PE, cisplatin and etoposide. Because of the decline in lung diffusing capacity, the administration of bleomycin was stopped in the final course. However, the AFP level remained above 14 ng/ml. Then he was given one more cycle of VIP therapy (etoposide, ifosfamide, cisplatin), but the serum AFP level was increased to 56 ng/ml. Then, two cycles of chemotherapy with paclitaxel, ifosfamide and cisplatin were administered as salvage chemotherapy, which led to a normalization of the serum AFP level, and disappearance of the brain and spleen metastases. Residual lung mass was resected at the surgical department, and microscopically no viable tumor cells remained. Three years after his final hospitalization, the patient has had no evidence of recurrence or metastasis.

If bone metastasis of renal cell carcinoma is neglected, pain, paralysis, and pathologic fracture develope; consequently, the patient's quality of life is significantly lowered. We investigated the local effect of the radiation therapy to the patients with metastasis. The investigation targeted 22 cases (27 parts) of renal cell carcinoma with bone metastasis that were treated with radiation therapy in our hospital during the last 6 years. We analyzed cell type, presence or absence of organ metastasis, irradiated site, therapeutic dose, treatment period, and combination therapy. The object was classified into 2 groups by metastatic site: the group with metastasis in the vertebra, and the group of metastasis in the pelvis or long bones. We examined re-calcification rate, length of time to recalcification emergence, pain relief and duration of effect as therapeutic effects. The irradiated site was vertebra in 14, pelvis in 7, and long bone in 6 patients. The therapeutic dose was 15 to 50 Gy, and the average was 35.7 Gy. No difference was found in the re-calcification rate and length of time to recalcification according to the metastatic site. The pain relief effect was significant in the pelvis and long bone group compared to the vertebra group. The effect lasted longer when the radiation dose was 35 Gy or more, compared with a lower dose. The radiation therapy for renal cell carcinoma with bone metastasis was effective to relieve pain and improve the patients' quality of life. The results showed that early detection and recognition of bone metastasis provide local control.

article

article

We analyzed the chief complaints of patients with four major urogenital malignancies (renal cancer, renal pelvis and ureter cancer, bladder cancer and prostatic cancer) over the past decade (1990-1999) at the Jikei University Hospital. Over the last 10 years, a high percentage of renal cancers were detected incidentally. By contrast, prostatic cancers were more likely (10.5%) than other cancers to be detected on the basis of symptoms of metastasis. However, since 1995 more prostatic cancers are being detected with prostatic-specific antigen screening at the health checkups. Gross hematuria is the chief complaint of most patients with uroepithelial cancers (cancers of the renal pelvis, ureter and bladder cancer). Additionally, renal pelvis and ureter cancers were diagnosed with screening in a few patients in the past five years.

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A 39-year-old man with schizophrenia and suicide attempt was diagnosed with stage IIb testicular tumor. He was initially admitted to the psychiatry ward and underwent high orchiectomy. After schizophrenia became stable by administration of antipsychopathic drugs, he was transferred to the ordinary urology ward and treated with 3 courses of chemotherapy (bleomycin, etoposide, cisplatin) and retroperitoneal lymph noded dissection. The mental status of the patient remained under good control throughout the course of treatment. He has been free of recurrence for 8 months postoperatively. We discussed general medical issues concerning the treatment of malignant diseases in patients with psychosis.

article

article

article

A 60-year-old [correction of 68] male was referred to our hospital because of a penile tumor with necrosis. Pathological examination of the penile tumor and superficial inguinal lymph nodes in biopsy revealed well differentiated squamous cell carcinoma (SCC) and the SCC tumor marker was elevated. TNM classification was T2, N2, M0 according to findings obtained by computed tomography (CT) and magnetic resonance imaging (MRI). We diagnosed the tumor inoperable radically and administered 10 mg peplomycin once a week for 10 weeks intravenously. The SCC marker level was not reduced and the tumor was not changed on MRI. Then, we performed combined pirarubicin treatment and radiotherapy. The patient received linac radiotherapy between 40 Gy/4 weeks/20 fractions. Pirarubicin, 10 mg/m2, was administered once a week for 4 weeks during irradiation intravenously. After the combined therapy, the SCC marked level was reduced to the normal range and the tumor was reduced. We performed radical operation. Pathological diagnosis revealed no viable tumor cells. The patient was alive with no evidence of disease a year later. This combined therapy is suggested to be useful.

Two cases of spontaneous rupture of the renal parenchyma caused by the renal pelvic and the ureteral cancer are reported. Case 1 was in a 53-year-old male who had left flank pain 2 weeks before admission to the hospital. In retrograde pyelography, the left upper ureter was visualized irregularly, but the left pelvis was not visualized. Computed tomography (CT) and magnetic resonance imaging (MRI) showed perirenal hematoma. Left nephroureterectomy with bladder cuff was performed under diagnosis of left renal pelvic and ureteral cancer. The rupture of the left renal parenchyma with extracapsular hematoma was identified. Pathological diagnosis was transitional cell carcinoma, grade 2 and pT1 of the left renal pelvis and the left ureter. Case 2 was in a 57-year-old male who had left flank pain 2 hours after he had enhanced CT study. MRI showed the left pelvic and the ureteral cancer with perirenal hematoma after 4 days. Left nephrourererctomy and partial cystectomy were performed. The rupture of the renal parenchyma with subcapsular hematoma was identified. Pathological diagnosis was transitional cell carcinoma, grade 2 and pT1 of the left renal pelvis and the left ureter.

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