[Splenosis mimicking local recurrence after radical nephrectomy: a report of two cases].

Splenosis is autotransplantation of splenic tissue and usually follow traumatic or surgical rupture of the spleen. We report two cases of splenosis which presented as a local recurrence after radical nephrectomy for left renal cell carcinoma (RCC). The patients were a 65- and a 71-year-old male, who had been operated for RCC including splenectomy because of disrupture of the splenic capsule 8 and 9 years earlier respectively. In both cases, follow up computed tomographic scans showed small nodules under the left diaphragm. Although we initially suspected local recurrence, we considered the possibility of splenosis. Both patients underwent technetium-99m Sn colloid scans and were diagnosed with splenosis successfully. Therefore, we could avoid unnecessary surgical explorations.

Risk factors for ipsilateral adrenal involvement in renal cell carcinoma.

OBJECTIVES: We retrospectively review patients treated for renal cell carcinoma at 19 institutes in collaboration with the Japanese Society of Renal Cancer, to clarify the risk factors for ipsilateral adrenal involvement (IADI). METHODS: The clinicopathologic factors of the 30 patients with IADI were compared with those of the 926 control patients without IADI, and independent predictors for IADI were identified by multivariate analysis. RESULTS: Preoperative computed tomography (CT) could detect 83.3% of the instances of synchronous ipsilateral adrenal metastasis. Patients with IADI had significantly larger primary tumors, higher pT stages and histologic grades, and higher percentages of upper pole involvement, microvascular invasion, spindle-cell-type tumors, lymph node metastasis (LNM), and distant metastasis (DM) outside the ipsilateral adrenal gland (IAd) than in control patients. Multivariate logistic regression analysis of clinical factors revealed that tumor size greater than 5.5 cm, pT stage of 3 or higher, LNM, and DM outside IAd, but not upper pole involvement, were significant predictors of IADI. CONCLUSIONS: Tumor size greater than 5.5 cm, clinical T stage of 3 or higher (tumor for which pT stage of 3 or higher is suspected), LNM, and DM outside IAd seemed to be important preoperative indicators of IADI. These factors and CT findings would be useful preoperative indicators for ipsilateral adrenalectomy. Moreover, patients with renal cell carcinoma who have normal adrenal on CT, have a T1 tumor extending less than 5.5 cm, and have neither LNM nor DM are good candidates for adrenal-sparing nephrectomy.

[Clinical significance of pelvic lymph-node dissection for the patients with locally invasive bladder cancer--correlation between the number of retrieved lymph nodes and prognosis].

The objective of this study was to know the effects of pelvic lymph node dissection on the survival of the patients who received radical cystectomy without neoadjuvant chemotherapy or radiotherapy. Between 1984 and 2000, 104 patients underwent operation at our institution for tumors clinically diagnosed as locally invasive bladder cancer (T2-4NxM0). Survival rates and 8 prognostic factors (age, sex, size, multiplicity, type, pT, N, pv) were analyzed by uni- and multivariate analysis. The significant factors were size, type, pT, N, pv by univariate analysis. Of these 5 factors, N factor was the most significant by multivariate analysis. Patients (N-) who had more than 20 lymph nodes retrieved showed better survival than the others.

[Clinical analysis of double cancer involving bladder and prostate].

Between January 1989 and March 2002, we treated 299 male bladder cancer patients and 416 prostatic cancer patients. Of these, 17 patients (5.7% of the male bladder cancer patients and 4.1% of the prostatic cancer patients) had double cancer consisting of prostatic cancer and bladder cancer. The mean age at diagnosis of the first and second cancer was 71.6 years and 75.5 years, respectively. Of the 8 patients with synchronous tumors, 3 patients had latent prostate cancer when they underwent total cystoprostatectomy. The mean interval between the first and second cancer was 45.3 months. The mean follow-up period was 84.7 months (ranged from 5 to 324 months) and two patients died of cancer (bladder: 1, prostate: 1). In the literature, the coincidence of bladder cancer and prostatic cancer is the highest in the urological field. In follow up of either of these cancer patients, it is important to be aware of not only progression of the first cancer but also generation of a second cancer.

[Three cases of pulmonary hamartoma appearing after radical nephrectomy for renal cell carcinoma].

We report 3 patients with pulmonary hamartoma, all of whom had undergone nephrectomy for renal cell carcinoma. A lung tumor was detected 2 to 9-months following nephrectomy. Preoperative diagnosis was pulmonary metastasis from renal cell carcinoma and pulmonary tumor resection was performed in each case. There was a 9- to 12-month interval between the detection and resection of the lung tumor. The histological diagnosis of the lung tumor in all three patient was pulmonary hamartoma. Following the resection of the lung tumor, recurrence was not noted in any of the patients.

Tumor doubling time of renal cell carcinoma measured by CT: collaboration of Japanese Society of Renal Cancer.

OBJECTIVE: This study was conducted to examine the natural history of renal cell carcinoma (RCC). METHODS: Inclusion criteria were the following: (1) patients who received diagnostic imaging of the kidney (CT, MRI) at two points in time before the diagnosis of RCC or patients who were followed, without treatment, after a diagnosis of RCC; and (2) patients in whom changes in tumor size were followed by the same modality of diagnostic imaging and who did not receive any treatment which could exert anti-tumor activity on the primary or metastatic lesions. The tumor doubling time (DT) and the growth rate of maximum tumor diameter (R) were determined. DT was calculated using the equation DT = (T - T(0)) x log2/logV - logV(0) (where T - T(0) indicates the length of time between two measurements and V(0) and V denote the tumor volume at two points of measurement). R was calculated using the equation R = (phi - f(0))/(T - T(0)) x 100 (where phi(0) and f indicate the maximum diameter at two points). Fifty-six cases registered with the Japanese Society of Renal Cancer were included in the evaluation. RESULTS: DT was 603.1 +/- 510.1 days, which did not correlate with V(0). R was 0.263 +/- 0.346 cm/day x 100. In cases where the tumor diameter was >/=4 cm, a significant correlation was noted between f(0) and R. CONCLUSIONS: Elucidation of the natural history of RCC will contribute to facilitation of differential diagnosis and determination of optimum therapeutic strategy.