Search

66歳男。便秘で下剤を服用したところ、10日間下痢が続き排尿時痛も現れたため受診した。腹部CTで長径約4cmの大きな膀胱結石を認め、血液検査で高度な炎症所見を示し、尿中白血球は100以上/HPFであり、膀胱結石、尿路感染症の診断で入院となった。膀胱造影で膀胱小腸瘻と診断し、瘻孔は大きく栄養状態が不良なので、保存的閉鎖は期待できないと判断し開腹手術を実施した。術中所見は膀胱頂部と回盲部から50cmに回腸とS状結腸が癒着し一塊になっており、瘻孔部はもろく周囲の腸間膜には腫大したリンパ節を認めた。小腸、S状結腸、膀胱部分切除により瘻孔部を摘除した後、両側尿管皮膚瘻による尿路変更を行った。摘出標本の病理所見は膀胱由来の扁平上皮化生を伴う浸潤性尿路上皮癌であった。術後2ヵ月目に残存膀胱の腫瘍腫大とそれに伴う疼痛が認められ、術後4ヵ月目には腹部・骨盤部のリンパ節腫大を認め、術後5ヵ月で癌性悪液質にて死亡した。, Enterovesical fistula is a very rare complication of primary urological malignancies. A case of ileovesical fistula caused by a bladder carcinoma is presented. A 66-year-old male was referred with complaints of urinary pain. On admission, fecaluria and urinary tract infection with bladder stone were detected. Cystography revealed the passage of contrast medium into the small bowel. Under the diagnosis ofileovesical fistula due to suspected inflammatory disease, sigmoidectomy and segmental small bowel resection with partial cystectomy were performed. Histological evaluation revealed a poorly differentiated urothelial carcinoma. Without further treatment, the patient died from cancer five months after operation. However, it is hard to assess the effect of fistulas on prognosis. Since it has been reported that about 40% of the patients with T4 bladder tumors could be potentially cured with radical resection, we recommend a thorough examination to confirm the diagnosis of primary disease to obtain the best results.

前立腺肥大症と診断された3294例に対しTUR-Pを実施した.stage Aは144例であり, このうちチップ数及び組織学的分化度の判明している136例について検討した.stage Aの患者数と亜分類の比は, PSA検査導入以後のT1c症例増加と関係がなかった.PSA測定開始後のA1の52例中24例, A2の32例中25%がPSA異常値, 生検陰性であり, TUR-Pによりstage Aと診断された.136例のA1及びA2症例をTNMで再分類を行い比較したところ, A1でT1aと一致したのは88例, A2でT1bと一致したのは39例で, 127例に両分類の一致をみた.不一致は9例であった.PSAの再上昇はA1T1aの7例, A2, T1aの1例, A2T1bの2例にみられた.癌死は2例であった.治療法はまちまちであるがA1T1aは良い予後であり, A2T1bはやや低い生存率を示した, Between 1980 and June, 2002, transurethral resection of prostate was performed against 3294 cases of benign prostatic hyperplasia, and 144 cases of stage A cancer were detected (4.4%). Among these cases, 136 cases which had complete records of examination were studied. Annual number of stage A and A1:A2 ratio were not influenced by introducing PSA determination from 1991, although the number of T1c has been increasing gradually. Since subclassification of stage A is different between Japanese rules (A1; 3 chips of cancer with well-differentiated adenocarcinoma, A2; others) and TNM (T1a; 5% of less number of chips with cancer, T1b; others), two criteria were compared. Coincidence was found with 93.7%, and disagreement was due to ratio of number of chips with cancer to whole number resected, or different grade. The former difference was caused by a larger or smaller prostate. Most cases of A1 and A2 were subjected to watchful waiting or subsequent therapy. PSA was elevated in 10 cases (7%), two of which died from progression of cancer. Other cases were disease-free. Individual pathological findings are important for subclassification of stage A.

A 66-year-old female was admitted to Chiba University Hospital for the evaluation of a left adrenal mass which was incidentally discovered by computerized tomography. The patient had no clinical signs of Cushing's syndrome. Although the plasma ACTH level was suppressed, serum cortisol and urinary 17-OHCS levels were normal. Serum cortisol was not suppressed by dexamethasone and loss of diurnal rhythm of cortisol was observed. Uptake of 131I-aldosterone in the left adrenal gland was noted, but no accumulation was observed in the right one. Left adrenalectomy was performed. The tumor resected was 20 x 22 x 26 mm in size. Pathological diagnosis was adreno-cortical adenoma. Whether slight abnormality of adrenocortical function without clinical symptoms observed in the present case would develop into a clinically typical Cushing's syndrome remains to be solved.

A case of retroperitoneal xanthogranuloma is reported. A 51-year-old man was referred to our hospital for the evaluation and treatment of right flank pain and hydronephrosis. Intravenous urography (DIP) and retrograde pyelography revealed the stricture in the middle portion of the right ureter. Ureteroscopy revealed no mucosal lesions. Computed tomography revealed the paraureteric mass lesion. Partial ureterectomy, mass resection and uretero-ureterostomy were performed. Then a double J stent was left in place for 6 weeks. The stricture was due to a yellowish mass adhered to the right side of the ureter. The resected mass measured 1.0 x 2.0 x 1.0 cm. The histopathological diagnosis was xanthogranuloma. The patient is in good health without recurrence 4 months after the surgery.

症例は41歳男性で, 1年ほど前から右陰嚢部の腫脹に気付き, それが増大傾向となったため来診した.超音波検査所見から右精巣腫瘍の診断で入院となり, 右高位精巣摘除術を施行した.摘出標本の病理組織学的所見では精巣カルチノイドと考えられたが, 術前術後を通して顔面の紅潮や下痢, 気管支喘息といったカルチノイド症候群および胸部X線・腹部CT上の転移所見は認められず, 外来にて経過観察中である.本症例の経験に文献的考察を加え報告した, This report describes a primary testicular carcinoid. A 41-year-old male was hospitalized with an asymptomatic right testicular mass. A high inguinal orchiectomy was done after the diagnosis of the testicular tumor. Pathologically, the tumor showed the typical appearance of a carcinoid tumor. A computed tomographic scan and other studies could not demonstrate any metastasis elsewhere. He has remained well and without any evidence of recurrence.

A 78-year-old man visited our department for macroscopic hematuria in June, 1989. On the basis of the diagnosis of tumor of the bladder and right afunctional kidney, total right nephro-uretero-cystectomy and skin grafting of the left ureter were performed on August 2. The patient continued to have fever of unknown origin postoperatively. Repeat laparotomy, which was performed for rectal fistula on August 25, revealed that the abdominal wall, colon, small intestine and mesenterium adhered to one another, producing a mass and that two sites in the rectum were perforated. A part of the small intestine was excised, the perforated sites were sutured, and an artificial anus was created at the transverse colon. Since the patient had intermittent fever and continued to complain of abdominal pain after creation of the artificial anus, nosotropic therapy was continued. However, the patient died from cardiac insufficiency on October 10. Erosion and ulcer were histologically observed over a wide range in the excised small intestine. In addition there was a defect in one area of the small intestine, penetrating the tunca muscularis propria, in which many cytomegalovirus (CMV) inclusion bodies were observed. CMV inclusion bodies were also detected in the bladder with re-examination of specimens from the excised bladder. From these findings, it appears that endogenetic CMV may have been reactivated in the present case.

1975年1月～1989年12月に根治的腎摘除術およびリンパ節郭清術をおこなった86例を集計した.1) 15例にリンパ節転移を認めた.2)リンパ節転移陽性率はpT, gradeと有意に相関し, またrapid typeに多かった.3) slow typeではリンパ節転移は局所に限局し, 予後も良好であったので, リンパ節郭清術の治療効果があったと考えられた.rapid typeでは静脈血栓や遠隔転移を有する症例が多く, このような症例ではリンパ節郭清術の意義を見出せない, Between January, 1975 and December, 1989, 86 patients with renal cell carcinoma received radical nephrectomy associated with lymphadenectomy at our institutions. Pathological examination revealed lymph node metastasis in 15 patients (17.4%). The incidence of lymph node metastasis increased in accordance with the aggravation of tumor stage (p less than 0.01) and grade (p less than 0.05). Patients with a rapidly growing tumor showed higher incidence of lymph node metastasis than patients with a slow growing tumor (p less than 0.01). Regional lymph node metastases were found in 3 of the 41 patients with a slow growing tumor. Since these 3 patients are surviving with no evidence of disease for 38.7 months on average, the regional lymphadenectomy was considered to have been effective for their survival. Nine of the 25 patients with a rapid growing tumor had progressive lymph node metastasis. Four of them had apparent tumor thrombi as well as lymph node metastasis, and 2 of them had distant metastasis. These patients showed poor prognosis even after operation. Lymphadenectomy was of no value to the patients with apparent tumor thrombi and/or distant metastasis.

腎及び腎盂腫瘍に伴う高Ca血症は, 26%, 13%出現する(真田).成因として腫瘍由来の液性因子による高Ca血症を呈するHHM (humoral hypercalcemia of malignancy)と思われる浸潤性非乳頭状移行上皮癌(73歳, 男性)を経験した, A 73-year-old man was admitted to our hospital with chief complaint of macrohematuria. Computerized tomography revealed enlargement of right kidney, tumor thrombi and lymph nodal involvement. Distant metastases were found in liver, lung and pelvis. We performed conservative therapy including right renal embolization. However, serum calcium levels continued to increase. Patient died from renal failure and pneumonia after 2 months, and autopsy was performed. Histological examination revealed infiltrative transitional cell carcinoma of the right kidney. PTH like peptide was measured 1 ng/gram wet tissue from the primary tumor and 16.6 ng/gram wet tissue from the metastatic liver tumor.

A 57-year-old male, with 1.5 cm tumor in his prepuce, was admitted to our institute in Feb. 1990. Circumcision and inguinal lymph node dissection was performed under the diagnosis of T1 disease of penile carcinoma. Pathological evaluation revealed well-differentiated squamous cell carcinoma (SCC). In April 1996, the patient revealed recurrence of the disease in the right inguinal lymph nodes and the lower abdomen, that was diagnosed to be poorly differentiated SCC. Laboratory findings showed elevation of serum calcium, parathyroid hormone-related protein (PTHrP) levels. Immunohistochemical staining confirmed production of PTHrP in the tumor tissue. This is the first case report of penile carcinoma that caused humoral hypercalcemia of malignancy in Japan.

A 54-year-old male visited our cancer center with the chief complaint of penile tumor in May, 1992. Magnetic resonance imaging (MRI) demonstrated a penile tumor and showed that this tumor invaded the submucosa but neither corpora cavernosa nor corpus spongiosum. Partial penectomy was performed in June, 1992. Histopathological examination of the resected tumor showed verrucous carcinoma. MRI was useful to investigate the degree of invasion of the penile tumor.

A 72-year-old female visited our hospital with the complaint of macroscopic hematuria on Jan. 29, 1990. Cystoscopic examination revealed hematuria flowing out from the left ureteral orifice. A 1 cm mass was found in the left upper calyx by retrograde pyelography (RP). Urine cytology obtained by RP was class IIIb. Later, the mass was found in the left middle calyx by CT. Repeated RP revealed no mass and the wall of the left upper calyx was irregular. Washing cytology from the left renal pelvis was class V. Left total nephroureterectomy was performed on Feb. 2, 1990. Macroscopically, no tumor mass was apparent. Microscopically, transitional cell carcinoma in situ was widely spread from the left renal pelvis to the middle ureter. The preoperative upper calyceal mass was thought to have been a blood clot. At twelve months after the operation, there has been no evidence of tumor recurrence.

Enterovesical fistula is a very rare complication of primary urological malignancies. A case of ileovesical fistula caused by a bladder carcinoma is presented. A 66-year-old male was referred with complaints of urinary pain. On admission, fecaluria and urinary tract infection with bladder stone were detected. Cystography revealed the passage of contrast medium into the small bowel. Under the diagnosis ofileovesical fistula due to suspected inflammatory disease, sigmoidectomy and segmental small bowel resection with partial cystectomy were performed. Histological evaluation revealed a poorly differentiated urothelial carcinoma. Without further treatment, the patient died from cancer five months after operation. However, it is hard to assess the effect of fistulas on prognosis. Since it has been reported that about 40% of the patients with T4 bladder tumors could be potentially cured with radical resection, we recommend a thorough examination to confirm the diagnosis of primary disease to obtain the best results.