Laparoscopic ureteroneocystostomy for iatrogenic ureterovaginal fistula after modified radical hysterectomy: A case report.

An unique laparoscopic ureteroneocystostomy technique was performed to treat an iatrogenic ureterovaginal fistula that was formed in a 69-year-old woman following open modified radical hysterectomy for endometrial cancer. Severe adhesions between the distal ureter and the surrounding tissues, including the iliac artery, were observed. Owing to difficulties in identifying the distal ureter, the proximal ureter was identified and dissected downward to free the ureter, thereby allowing anastomosis. This report shows that laparoscopic ureteroneocystostomy for ureterovaginal fistula repair may prove useful owing to its minimally invasive and broad approach.

Novel Technique for Hand-Assisted Laparoscopic Nephrectomy for Advanced Renal Cell Carcinoma with Renal Vein and Inferior Vena Cava Thrombi: Three Case Reports.

Introduction: The treatment of thrombi in the renal vein (RV) and inferior vena cava (IVC) requires advanced laparoscopic experience. We present three cases of hand-assisted laparoscopic nephrectomy (HALN) using a novel technique for treating advanced renal cell carcinoma (RCC) with thrombi in the RV and IVC. Case Presentation. Three patients with RCC with RV or IVC thrombus below level I underwent HALN. Two patients had right RCC with RV and IVC thrombi. One patient had left RCC with an RV thrombus. We hooked a vessel loop to the end of the thrombus and pulled it up manually to make space for vascular processing. The RV was narrowed and dissected using Hem-o-lok clips or an Endo GIA stapler. Conclusion: In carefully selected cases, renal vascular processing could be easily and safely performed using a vessel loop in HALN with thrombectomy.

[A case of dedifferentiated liposarcoma of the spermatic cord].

A 61-year-old man was referred to our department because of painless and stony hard mass beside the left testis. Serum levels of lactate dehydrogenase, alpha-fetoprotein and human chorionic gonadotropin were within normal ranges. The ultrasonography of the mass showed almost homogenous and relatively low intensity echogram. The mass which derived from the left spermatic cord and was partially surrounded by fat-like soft and yellow tissue, was removed with the left testis by usual orchiectomy. Histopathological diagnosis was liposarcoma, whose subtype was dedifferentiated type derived from well differentiated type. Postoperatively, a para-aortic mass, which resembled lymphnode metastasis, was pointed by computed tomographic scan and was removed surgically. However, it was histopathologically diagnosed as neurogenicganglioma irrelevant to liposarcoma. He has been free of disease for about 1 year without any adjuvant therapy.

[A case of primary mucinous adenocarcinoma of the scrotal contents].

A 48-year-old man consulted our hospital complaining of painless swelling of the left scrotal contents that had gradually increased for 5 years. Serum LDH, alpha-fetoprotein and HCG were within normal ranges. The ultrasonography showed heterogeneous echogram including high-echogenic spots and relatively a low-echogenic hydrocele. Left high orchiectomy was performed and the removed tissue was 24 x 16 x 15 cm in size, which had large cystic cavity filled with cloudy and deep-green mucin. Pathological diagnosis was mucinous adenocarcinoma. Postoperatively analyzed serum CEA, CA19-9 and PSA were within normal ranges. Systemic X-ray examinations, such as lung, abdominal and pelvic CT scan, upper GI series and barium enema, did not show any abnormal SOL suggesting carcinoma. Therefore, we diagnosed this case as a primary adenocarcinoma in the scrotal contents. The patient has been observed without any adjuvant therapy since operation, but no signs of recurrence have been identified for one year and six months.

[A case of anaphylactic shock induced by pirarubicin hydrochloride].

A 75-year-old man was admitted to our hospital for treatment of superficial bladder tumor. Transurethral resection (TUR) was performed and histopathological examination revealed a transitional cell carcinoma (G2). Despite one course of post-TUR bladder instillation therapy using pirarubicin hydrochloride, carcinoma in situ (CIS) was found 4 months later. CIS disappeared after another course of bladder instillation therapy using BCG; but, it recurred a month later. BCG bladder instillation therapy was performed again, and no malignant cells were detected in the urinary tract thereafter. Four months later, lung metastasis was diagnosed and an MVAC regimen (cisplatin, methotrexate, vinblastin adriamycin) was administered. However, anaphylactic shock was induced by intravenous injection of pirarubicin hydrochloride, so this therapy was stopped in the middle of the second course. Even though the lung metastasis disappeared once after the same MVAC treatment, it recurred the following year. At that time, 3 courses of a cisplatin-methotrexate-vinblastin regimen were administered, and a complete response was achieved.

Papillary renal cell carcinoma in a young adult: serial changes in diagnostic images.

In renal tumors, we often encounter cases in which accurate diagnosis before surgery is difficult. The serial changes in various diagnostic images were studied in a case of renal cell carcinoma in which definitive diagnosis could not be made by various imaging examinations and biopsies. We report on a case of renal cell carcinoma in a young adult. A 19-year old man complained of left flank pain and pyrexia. Computerized tomography (CT) scan and urography revealed a solid mass in the left kidney. Angiography revealed no abnormality, and CT scan after 3 months showed that the mass was decreasing in size, which suggested an inflammatory mass. CT scan and retorograde pyelography 12 months later showed that the tumor had enlarged and that much of the tumor had extended into the renal pelvis. Left nephrectomy was performed and histological examination revealed that the tumor was papillary renal cell carcinoma. When imaging results and clinical symptoms are atypical, pre-surgery diagnosis of renal cell carcinoma is extremely difficult. In such cases, we found that it was effective to observe the changes in various diagnostic images and to make an overall judgment based on these results.