ABSTRACT
A 49-year-old male was admitted to Sendai Saiseikai Hospital with a complaint of upper abdominal pain. Perforative rectal cancer was diagnosed, and an emergency laparotomy was done. Transient colostomy and drainage for peritonitis were performed. Preoperatively rectal cancer was assessed to invade the sacral bone and prostate. A total of 50 Gy radiation therapy with low dose CDDP+5-FU chemotherapy was conducted for five weeks. Remarkable shrinkage of the tumor was found, and elective surgery for curative intent was done on April 2000. The tumor seemed to invade the adjacent tissues such as prostate and urine bladder, so extensive resection of the urine bladder and sacral bone was done in addition to abdominal perineal resection. Pathological exploration showed complete regression of the tumor and no tumor invasion to the prostate and sacral bone. He is well without tumor relapse. Once complete regression of the rectal cancer by chemo-radiation therapy has been achieved, relapse of the tumor was reported to be rare. Preoperative chemo-radiation therapy is an effective tool to control the advanced rectal cancer.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Pelvic Exenteration , Preoperative Care , Rectal Neoplasms/drug therapy , Rectal Neoplasms/radiotherapy , Rectum/surgery , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Cisplatin/administration & dosage , Colostomy , Combined Modality Therapy , Drug Administration Schedule , Fluorouracil/administration & dosage , Humans , Male , Middle Aged , Radiotherapy Dosage , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery , Remission InductionABSTRACT
We report a case of primary malignant melanoma of the male urethra in a patient whose penile shaft was successfully preserved, but who proceeded to acute renal failure (ARF) after interferon (IFN)-beta adjuvant immunotherapy. Primary malignant melanoma of the male urethra is rare and usually shows highly malignant potential. Therefore, urologists must often perform phallectomy, which impacts on the patient both sexually and mentally. A 64-year-old man presented at Saiseikai Sendai Hospital with asymptomatic gross hematuria and was diagnosed as distal urethral tumor. We predicted the highly malignant potential of this tumor from the urethroscopic finding and from urinary cytological examination. We did not select trans-urethral resection (TUR), but selected partial urethrectomy. This patient proceeded to ARF 1 month after natural IFN-beta treatment as an adjuvant immunotherapy. As IFN-beta rarely induces the delayed renal failure, urologists should be aware of renal dysfunction after IFN-beta therapy for the treatment of malignant melanoma.
