[A Case of Venous Malformation that Occurred in the Retroperitoneum].

A 70-year-old man complaining of pain in his right leg presented to the Department of Orthopedics in our hospital. X-ray findings revealed calcifications around the left kidney. He was referred to our department for further examination. Computed tomography revealed a tumor 3 cm in diameter with calcifications and an obscure border that was located on the caudal side of the pancreas, anterior to the left iliopsoas muscle and at the left side of the aorta. Magnetic resonance imaging showed that the tumor had comparatively low intensity in diffusion-weighted images and the cell density was not high. The contrast of the tumor by enhanced computed tomography was weak, and we had difficulty judging whether the tumor was benign or malignant. Each tumor marker, immunity factor, and hormone-like catecholamine were within the normal range. We considered the retroperitoneal tumor with calcifications as Castleman disease or tumor of nerve origin. It is believed that most retroperitoneal tumors are malignant. We performed laparoscopic surgery to resect the retroperitoneal tumor. Histopathological diagnosis was a primary retroperitoneal venous malformation. Vascular malformation derived from the retroperitoneum is rare. Furthermore, very few cases of venous malformation in the retroperitoneum have been reported.

[Investigation on Clinical Course of Patients after Cessation of Long-Term Successful Hormone Monotherapy for Prostate Cancer].

We investigated the clinical course of patients after cessation of long-term successful hormone monotherapyfor prostate cancer. Studysubjects were ten patients with prostate cancer (localized prostate cancer ; n＝8, prostate cancer with bone metastasis ; n＝2), who had hormone monotherapyfor over seven years, showed no signs of recurrence, and maintained prostatic-specific antigen (PSA) levels of less than the detection sensitivitylimit (＜0.01 ng/ml). The mean duration of hormone therapywas 101.1 months, and the mean duration of follow-up observation from cessation of the therapywas 31.1 months. PSA levels were maintained less than the detection sensitivitylimit in eight patients, and serum testosterone levels were equal to or less than the castration level in seven patients. This studydemonstrated that there were cases that maintained PSA levels of less than the detection sensitivitylimit even after cessation of long-term successful hormone monotherapyfor prostate cancer.

Improved Target Cell Selection and Counting Method for UroVysion Fluorescence in Situ Hybridization.

BACKGROUND: The UroVysion Bladder Cancer Kit requires morphological analysis of 4', 6-diamino-2-phenylindole (DAPI)-stained nuclei to identify target cells for fluorescence in situ hybridization (FISH) signals. Reproducibility and efficiency of target cell selection and counting was evaluated by combining immunofluorescence staining of cytokeratin 7 (CK7) and proliferating cell nuclear antigen (PCNA) with DAPI staining. METHODS: The reactivities to CK7, PCNA, and DAPI were compared between those for different ratios of T24 human bladder carcinoma cells and of cells from the urine of five healthy subjects. Two technicians independently performed five replicate cell counts of urine samples from four bladder cancer patients and one healthy subject. RESULTS: The positive staining rates for CK7 and PCNA were similar to DAPI, but our method showed enhanced inter-observer repeatability and reduced operating time for signal counting. CONCLUSIONS: Our proposed method showed better reproducibility and lesser operational time for signal counting than the DAPI method alone.

Detection of bladder cancer by measuring CD44v6 expression in urine with real-time quantitative reverse transcription polymerase chain reaction.

OBJECTIVE: To examine urinary CD44v6 total ribonucleic acid (RNA) expression in patients with bladder cancer using real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) and evaluate its potential as a novel marker of bladder cancer. METHODS: We used the bladder cancer cell line T24 and determined CD44v6 expression in cancer cells using in situ hybridization and immunohistochemistry. Subsequently, we obtained urine samples from 21 patients with bladder cancer and 25 patients without bladder cancer (controls). We extracted total RNA from the urine samples, measured CD44v6 total RNA expression in both groups using qRT-PCR, and compared the expression between groups. We also compared the sensitivity, specificity, and concordance rate between CD44v6 total RNA expression analysis by qRT-PCR and cytologic analysis, UroVysion fluorescent in situ hybridization, bladder tumor antigen identification, and nuclear matrix protein 22 measurements. RESULTS: We observed increased CD44v6 expression in bladder cancer cells using in situ hybridization and immunohistochemistry. CD44v6 total RNA expression was significantly higher in the urine samples of patients with bladder cancer than in those of controls. We calculated the cutoff value from the receiver operating characteristic curve and obtained sensitivity and specificity values of 85.7% and 72.0%, respectively, for qRT-PCR analysis. CONCLUSION: Our results suggest that CD44v6 total RNA levels in urine can serve as a potential noninvasive biomarker of bladder cancer.

[Clinical analysis of 35 cases of penile cancer].

We retrospectively reviewed the records of 35 patients with penile cancer, who had been treated at Gifu University Hospital and its affiliated hospitals between July 1994 and January 2009. The mean values of follow-up periods, ages, serum squamous cell carcinoma levels and maximum diameters of the tumor were 23.7±28.0 months, 72.3±10.5 year-old, 4.5±4.3 ng/ml, and 4.0±2.6 cm, respectively. Systemic chemotherapy and local radiotherapy were performed in six, and three cases, respectively. Ten patients died of penile cancer. By univariate analyses, maximum tumor diameter (＜- 4.3 cmvs ＞4.3 cm), T factor (＜T3 vs ＞- T3) and N factor (＜N2 vs ＞- N2) were significantly associated with cancer-specific survival. The five-year survival of stage N2 cases (28.6%) were significantly lower than that of stage N0 and N1 cases (68.4%) (p＝0.0003). By multivariate analyses N factor (＜N2 vs ＞- N2) was significantly associated with cancer specific survival (p＝0.020). We concluded that the development of effective systemic chemotherapy might be crucial to improve the prognosis of patients with metastatic diseases.

[Case report of inflammatory pseudotumor that occurred at the ureteropelvic junction].

A 60-year-old woman underwent detailed examinations for hepatic disorders and pancreatic tumor at the Department of Internal Medicine. A tumor mass in her left renal pelvis and a thickened wall in her left ureter were observed on computed tomography (CT) and magnetic resonance imaging (MRI) images. Retrograde ureteropyelography and drip infusion pyelography images showed a stenosis in 1 vertebral body from the left ureteropelvic junction. Urinary cytology finding was class III-a; however, malignancy could not be disregarded. Since the patient continued to experience severe dorsal pain, a left nephroureterectomy was subsequently performed at the patient's request. Pathological tests showed no malignant findings, and based on the chronic pyelonephritis, we diagnosed her condition as an inflammatory pseudotumor. Not many inflammatory pseudotumors are found in the urinary tract, and even fewer are manifest in the renal pelvis and ureter. Although inflammatory pseudotumors are generally benign, cases of repeated local recurrence exist. Therefore, a meticulous follow-up observation is required.

[Prostate cancer detected from pleural effusion: two case reports].

Prostate cancer is rarely detected from abnormal chest radiographs. We report two cases of prostate cancer detected from pleural effusion. Case 1 is a 76-year-old man who consulted the department of internal medicine of our hospital with dyspnea and abdominal fullness. Pleural effusion and multiple hepatic tumors of unknown origin were pointed out, but he refused any further investigation or treatment for them. Six months later, he consulted a family doctor with urinary frequency and lumbago. Increased serum prostate specific antigen (PSA) level to 864 ng/ml was recognized, then he was referred to our department. Under diagnosis of prostate cancer, T4NOM1c, maximal androgen blockade (MAB) was performed. Serum PSA level was decreased once to 8.1 ng/ml, but then rose gradually and he died 13 months after the beginning of the therapy. Case 2 was a 78-year-old man who was referred to our department to determine the origin of carcinomatous pleuritis detected in a routine general check up of hepatitis C. The serum PSA level was increased to 12,900 ng/ml, and the diagnosis was prostate cancer, T3aNOM1c. Although MAB was performed, the serum PSA level did not decrease markedly. He died 16 month after the beginning of the therapy.

[Bilateral recurrent laryngeal nerve paralysis in a child following a neurosurgical operation].

We experienced a case of 7-year-old boy who developed bilateral recurrent laryngeal nerve paralysis following an elective neurosurgical operation under oxygen-nitrous oxide-isoflurane anesthesia. He underwent a removal of brain tumor in the supratentorial region on supine position. After the removal of the endotracheal tube in the intensive care unit, he developed marked respiratory effort and inspiratory stridor. A diagnosis of bilateral recurrent laryngeal nerve paralysis was made by a direct diagnostic laryngoscopy. The patient needed continuous care for his airway patency with tracheotomy tube in place, and his normal vocal cord mobility recovered on the 23 rd postoperative day. Common cause of recurrent nerve injury following general anesthesia is either the procedure of endotracheal intubation itself or trauma due to surgical manipulation. In the present case, an endotracheal tube, a transesophageal stethoscope and a nasogastric tube inserted into the narrow laryngeal space might have been a cause of this complication. Moreover, accidental extreme flexion of his neck which occurred during the surgery might also be an additional cause. This case suggests that recurrent laryngeal nerve paralysis due to anesthetic instruments around the larynx is a possible cause of complications during general anesthesia in pediatric patients.

Clinical significance of enlarged perihepatic lymph node on ultrasonography.

OBJECTIVE: To determine the relation between enlarged perihepatic lymph node (PLN) and viraemia, and to find out whether there is a difference in PLN size between the healthy individuals and patients with hepatitis C virus (HCV) infection. METHOD: Seventy-four outpatients with HCV infection were primarily enrolled into the study. As controls, 283 individuals who had medical check-ups by ultrasonography without liver disease were also examined. The length and thickness of lymph node were measured. The lymph-node index (LN index) was calculated by multiplying the length and thickness of the lymph node. This index was then compared with serum HCV core antigen (HCV-Ag) levels. According to the level of HCV-Ag, we defined grade I as negative, grade II as minimal, grade III as medium and grade IV as extensive. RESULTS: LN index of 100 mm2 or more was found in 83.3% (50 of 60) of patients with hepatitis C, and LN index less than 100 mm2 in 90.9% (101 of 111) of controls. LN index showed a significant correlation with HCV-Ag level (r=0.436, P<0.05). No significant differences were found between LN index and HCV-Ag grade, but LN index increased in patients with grade IV [mean 160.0 mm2 (SD 50.86)] compared to grade I [57.0 mm2 (SD 98.73)], grade II [95.3 mm2 (SD 65.32)] and grade III [149.7 mm2 (SD 41.09)]. CONCLUSION: Perihepatic lymphadenopathy indicates viraemia, and LN index seems to be useful in estimating whether patients have hepatitis C infection or are healthy.