ABSTRACT
The patient was a 38-year-old man. A cystostomy catheter had been inserted when he was 23 years of age for neuropathic bladder due to cervical spinal cord injury at 20 years of age. Purulent discharge from around the cystotomy had continued for approximately 4 months. Examination revealed the formation of a subcutaneous tumor around the cystostomy, with elevated carcinoembryonic antigen (CEA) levels (459.4 ng/ml) in the blood. Urothelial carcinoma was detected using open biopsy. It was considered that primary urothelial carcinoma of the bladder had progressed along the cystostomy, and clinical stage 4 cT4N2M0 was diagnosed, with intrapelvic lymph node metastasis evident on imaging. Four courses of gemcitabine-cisplatin chemotherapy were administered; a partial response was obtained, after which cystectomy and ileal conduit formation were performed with the main aim of improving difficulty in urination. However, retroperitoneal lymph node and liver metastases were observed 1 month postoperation with rapid enlargement; the patient died approximately 2 months after the surgery. The CEA level was observed to be 18,998 ng/ml before he died. Here, we have reported this case with a discussion of the literature concerning the association between long-term indwelling catheter in patients with spinal cord injury and the development of bladder cancer.
Subject(s)
Carcinoma/etiology , Cystostomy , Postoperative Complications , Spinal Cord Injuries/surgery , Urinary Bladder Neoplasms/etiology , Adult , Carcinoma/pathology , Humans , Male , Urinary Bladder Neoplasms/pathologyABSTRACT
A 39-year-old woman was referred to our hospital due to left abdominal mass which was incidentally pointed out by computed tomographic (CT) scan. She had no symptoms. Abdominal enhanced CT showed an 85 mm solid mass, which had clustered calcifications and was enhanced weakly. Magnetic resonance imaging showed a relatively well-circumscribed mass 125 mm in maximum diameter, in the left kidney. The left adrenal gland could not be identified. An endocrinological examination was done. In the 24-hour specimen of urine, dopamine and vanillylmandelicacid levels were abnormally high. We surgically removed the tumor, because malignancy including adrenal carcinoma was not completely excluded. An additional 1cm tumor which mimics lymph node metastasis along the aorta was found during the operation and removed. Postoperative histopathological findings revealed the tumor clearly distinguished from the adrenal gland and was composed of mature nerve fibers and ganglion cells. The other tumor had the same histology without any lymph node tissue. On the basis of this finding, it was diagnosed as multifocal retroperitoneal ganglioneuroma.
Subject(s)
Ganglioneuroma/pathology , Retroperitoneal Neoplasms/pathology , Adult , Female , Humans , Lymphatic MetastasisABSTRACT
We report a case of bilateral adrenal metastasis from renal cell carcinoma. A 65-year-old man was referred to our hospital for a right renal mass. A computed tomography revealed a 9 cm right renal tumor and bilateral adrenal masses (3.5 cm on the right side and 4.5 cm on the left). A right radical nephrectomy and bilateral adrenalectomy demonstrated renal cell carcinoma with metastasis to bilateral adrenal glands. The pathological findings of the right renal tumor showed clear cell carcinoma, G3 > G2 and both adrenal tumors showed the same pathology as the right renal tumor. The patient is alive with lung metastasis after 15 months postoperatively treated with interferon-alpha.
