[Association between Proposed Cancer Foci from the Results of Systematic 12-Core Transrectal Needle Biopsies and Actual Cancer Foci from Radical Prostatectomy Specimens].

We investigated the diagnostic yield for systematic 12-core transrectal prostate needle biopsies. Subjects were 56 prostatic cancer patients who were diagnosed with transrectal ultrasound-guided 12 core prostate needle biopsies and who underwent open retropubic radical prostatectomy. Pathological findings were compared between needle biopsy specimens and total prostatectomy specimens in terms of the presence or absence of cancer foci. For the comparison, the prostate was divided into 5 regions : the apical, middle, basal, far lateral and transitional regions. Then, based on the pathological findings of the biopsies, the sensitivity, specificity, positive predictive value and negative predictive value were calculated for each region. As a result, the sensitivity and the specificity in the transitional region tended to be lower than in other regions, and six of ten false positive lesions were located in the transitional region on the biopsy specimens. Also, the negative predictive value tended to be lower in the apical and far lateral regions. In conclusion, thorough punctures in the apical, transitional, and far lateral regions of the prostate at the systematic transrectal biopsy were paramount important for improving the detection of cancer foci in these regions.

[A case of mixed epithelial and stromal tumor (MEST) of the kidney monitored as angiomyolipoma (AML) : a case report].

A 32-year-old woman presented with left abdominal pain. Intratumoral hemorrhage within a renal angiomyolipoma (AML) was suspected and embolization was performed. However, the patient declined surgery and was thus kept under observation. During the next 5 years, the tumor increased in size, and upper left abdominal pain appeared. Therefore, left radical nephrectomy was performed. The histopathological diagnosis was mixed epithelial and stromal tumor (MEST) of the kidney. A retrospective examination of imaging findings indicated that the fat which had been regarded as evidence of AML was actually either perinephric fat displaced by either the tumor or the renal sinus. In fact, the tumor consisted mainly of a cystic component containing a solid component. The possibility of MEST must be kept in mind when distinguishing renal tumors consisting mainly of cystic components in young to middle-aged women.

[In two patients with economic and social issues stage I giant seminoma].

The first case was in a 39-year-old man who complained of painless, left hemiscrotal swelling. The patient's serum ß human chorionic gonadotropin (ß-hCG) was elevated. A chest X-ray and computerized tomography (CT) did not reveal any abnormal findings. The patient underwent left high orchiectomy. The tumor weighed 440 g, and was pathologically diagnosed as a seminoma. The patient chose surveillance as the management strategy. Five months after the operation, the patient stopped attending his periodic checkups. After 21 months, the patient complained of abdominal distention. A CT showed a para-aortic lymph node mass. The patient achieved a complete response following chemotherapy with etoposide and cisplatin for 4 cycles. Three months after the adjuvant chemotherapy, hospital visits stopped again due to financial difficulties. The second case was in a 36-year-old man who complained of painless, right hemiscrotal swelling and difficulty in walking. Clinical examination revealed an adult-head-sized testicular tumor with elevation of serum lactic dehydrogenase (LDH) and ß-hCG. A chest X-ray and abdominal CT did not reveal any abnormal findings. Despite a recommendation that the patient undergo immediate orchiectomy, the patient did not undergo surgery due to his unstable lifestyle. After 1 month, the patient presented with more difficulty in walking. The patient underwent right high orchiectomy. The tumor weighed 1,926 g, and was pathologically diagnosed as a seminoma. The patient chose surveillance. There has been no recurrence for 19 months postoperatively.

[Hyaline vascula type Castleman's disease in the pelvic cavity : a case report].

A 48-year-old man was admitted to our hospital in order to treat a right lower abdominal tumor which was detected by ultrasonography in a general health check. The tumor was considered to be a pelvic sarcoma from computed tomography and magnetic resonance imaging findings, then, resection of the tumor was performed. Pathological diagnosis was a hyaline vascular type of Castleman's disease. The patient remained well without any evidence of local recurrence 12 months after surgery. The hyaline vascular type of Castleman' s disease is characterized by a solitary hypervascular tumor which is prone to adhere to neighboring great vessels. This tendency makes dissection from great vessels difficult and should be kept in mind when surgery is planned.

[A case of giant hemorrhagic adrenal pseudocystectomy with a flank incision].

The patient was a 43-year-old woman who underwent detailed examinations for a retroperitoneal cystic lesion that was incidentally found during orthopedic treatment. Although the tumor was a non-functioning tumor, and diagnostic imaging was negative for malignancy, the tumor was surgically resected with a flank incision. The histopathological diagnosis was adrenal pseudocyst.

Comparison of two-port and four-port irradiation in the bladder preservation therapy for locally invasive bladder cancer.

AIM: To ascertain therapeutic effectiveness and adverse reactions with radiochemotherapy for locally invasive bladder cancer, comparison was made between two-port and four-port irradiation with intravenous cisplatin administration. METHODS: In 86 patients who were diagnosed with locally invasive bladder cancer on the basis of imaging and biopsy findings, transurethral tumor resection was carried out initially to minimize tumor volume, and then radiochemotherapy was done. From 1985 to 1997, bilateral two-port irradiation was carried out, and after 1998, four-port irradiation was done. In regards to chemotherapy, cisplatin was administered intravenously. Therapeutic effects were assessed 1 month after the end of therapy. RESULTS: Fifty-five patients underwent two-port irradiation; complete response (CR) was achieved in 26 and partial response (PR) in 29 patients. Thirty-one patients underwent four-port irradiation; CR was achieved in 20 patients and PR in 11 patients. The cause-specific 5-year survival rate did not differ significantly between two-port and four-port irradiation (74%vs 79%), but there was a significant difference of survival between CR and PR patients. In the two-port irradiation group, 5-year bladder preservation rate was 89% in CR patients and 52% in PR patients. In the four-port irradiation group, 5-year bladder preservation rate was 90% in CR patients and 46% in PR patients. Of the various adverse reactions, no significant differences in leukopenia, thrombocytopenia or bladder symptoms were observed between two-port and four-port irradiation, but the incidence and severity of loss of appetite, nausea and/or vomiting, diarrhea and dermatitis were significantly greater for two-port irradiation. CONCLUSION: Radiochemotherapy are considered to be modest effective in the bladder preservation therapy for locally invasive bladder cancer. The four-port irradiation shows less adverse reactions than two-port irradiation.

[Retroperitoneal fibrosarcoma with myxoid matrix: a case report].

A 54-year-old male visited a local physician with right dorsolumbar pain as the chief complaint. Ultrasonography revealed a tumor mass 13 cm in diameter at the lower part of the liver, and the patient was referred to our hospital. On abdominal computed tomography, uneven contrast-enhanced effects were recognized in the tumor. On magnetic rescmance imaging studies, T1-weighted images showed a hypoechoic pattern from the kidney and a weak hyperechoic pattern from the muscle. T2-weighted images showed uneven hyperecoic patterns. Uneven contrast-enhanced effects were recognized inside and on the margin of the tumor. A diagnosis of retroperitoneal tumor was made, and surgery was performed. Histopathological examination revealed a fascicular alignment of spindle cells in the area in which the myxoid matrix is seen. On the immunological special test, only vimentin was positive, which led to the diagnosis of fibrosarcoma. Fibrosarcoma originating from retroperitoneal tumor is relatively rare.

[Sigmoid colovesical fistula associated with cancer of the sigmoid colon]. / Fístuia vesico-sigmoidea asociada con cancer de colon sigmoides.

OBJECTIVES: To report one case of colovesical fistula after the diagnosis of unresponsive urinary tract infection. METHODS: The 76-year-old patient underwent a diagnostic work up including cystography, cystoscopy and barium enema. RESULTS: Cystography revealed an image of the sigmoid colon, and cystoscopy showed a granuloma at the bladder dome. A fistula was identified underneath. A colovesical fistula was diagnosed and several intestinal germs grew on urine cultures. Partial cystectomy and end to end anastomosis of the sigmoid colon were carried out. Pathology report showed a well-differentiated adenocarcinoma which invaded down to the bladder mucosa. CONCLUSIONS: Inflammatory diseases are the main the etiology of colovesical fistula, followed by neoplasias. We reviewed around 170 cases reported in our country. It is important to identify the fistula by means of the gastro-intestinal series and the study of the lower urinary tract when treating patients with urinary tract infection difficult to control. We suggest the best radical therapy is surgery in a single procedure.

[Testicular malignant lymphoma: a case report].

We report a case of malignant lymphoma arising from the testicle in a patient who had been on chemotherapy for a long period after orchiectomy. A 54-year-old male presented with indolent swelling in the right scrotum. Diagnosed as having a testicular tumor by ultrasonography and MRI, he underwent orchiectomy. According to the histopathological diagnosis, the tumor was classified as non-Hodgkin's lymphoma, diffuse large cell type, B cell type. Diagnosis of Stage I eA was made by the Arr Arbor classification. Four courses of cycrophosphamide, adriamycin, vincristin and prednisolone (CHOP) therapy were administered. COP (CHOP minus adriamycin) therapy has been given every four months on an out-patient basis. At present, 28 months after the operation, no evident recurrence has been found.

[Clinical investigation of 6 cases of urachal carcinoma].

We have encountered 6 cases of urachal carcinoma in the past 7 years. They consisted of 4 females and 2 males, with the mean age of 48 years old. Of them, 2 cases were identified as gestational complications. Bladder irritating symptoms and extracystic symptoms other than hematuria were not observed as initial symptoms, and urinary cytology was positive in 2 cases. Cystoscopy is essential for diagnosis, but the spread of the tumor was clearly visualized by sagittal section patterns on magnetic resonance imaging. A correlation between the tumor and clinical course was suggested immunohistochemically with, carcinoembronic antigen and carbohydrate antigen 19-9. Cases of gestation concurrent with urachal carcinoma are very rare, but are expected to increase in the future. Thus appropriate medical treatment must be given to the maternal body. For the treatment, appropriateness of advanced surgery more than partial resection of the bladder combined with total urachoumbilical resection was recommended. However, an effective adjuvant chemotherapy after the first surgical resection needs to be established to improve the patient's quality of life.