[Primary renal malignant lymphoma in a hemodialysis patient : a case report].

A 71-year-old female on hemodialysis was referred to our hospital for a left renal mass which was incidentally found during a medical check-up. Abdominal computed tomography with intravenous contrast enhancement showed an iso-dense enhanced mass. Under the diagnosis of renal cell carcinoma, retroperitoneoscopic radical nephrectomy was performed. Histopathological examination revealed follicular lymphoma. This was the 20th case of primary renal lymphoma in Japan.

[Renal actinomycosis with pneumonia].

A 55-year-old man was hospitalized for pneumonia. His fever did not subside despite administration of antibiotics ; therefore, he was referred to our hospital. A chest radiograph and thoracic computed tomography showed multiple tubercles ; abdominal computed tomography (CT) showed left renal abscess. The patient's temperature fell after antibiotic administration, but inflammation reaction exacerbated. Abdominal CT showed inflammation spreading to the subcutaneous tissues. We considered renal resection, but the patient could not be administered general anesthesia because of low breathing function caused by pneumonia. We attempted open drainage and wedge resection of the left renal under local anesthesia ; but we were not able to identify the infectious bacteria. Four days later, the patient had blood poisoning and died because of deterioration of breathing function. Actinomyces was detected in the lungs and the kidneys by pathological examination.

[Primary small cell carcinoma of the bladder in which the bladder preservation was achieved by chemotherapy and transurethral resection].

A 78-year-old man was referred to our hospital for asymptomatic gross hematuria on April 16, 2007. Cystoscopy and abdominal computed tomography revealed a nonpapillary tumor at the upper area of the bladder. Abdominal and thoracic computed tomography showed no lymph nodes and no metastasis to other organs. Transurethral resection of bladder tumor (TURBT) was performed, and a pathological diagnosis of small cell carcinoma of the bladder at stage pT2N0M0 was made. Considering the patient's age and the location of the tumor, we administered chemotherapy using carboplatin and etoposide after resection of the tumor. After 2 courses of chemotherapy, a second-look TURBT was performed, and pathological examination showed no viable tumor cells. Cystoscopy performed after 3 months revealed recurrence of a nonpapillary tumor at a different area of the bladder. We performed TURBT and made a pathological diagnosis of small cell carcinoma of the bladder at stage pT1N0M0. The patient was free from disease in January 2011.

[Retention cyst of the prostate in a patient with urinary difficulty].

A 54-year-old man visited our clinic for dysuria. Transabdominal ultrasonography revealed a multilocular cyst at the neck of the bladder, and a cystoscopy revealed obstruction of the neck of the bladder. Dysuria improved after tamsulosin treatment was initiated, and abdominal magnetic resonance imaging (MRI) showed disappearance of the cyst. The patient had urinary difficulty again after 2 years. An MRI and cystoscopy revealed recurrence of the cyst. Tamsulosin administration was reinitiated, but his urinary difficulty did not improve. Transurethral resection of the cystic wall was performed. Histopathological examination indicated a retention cyst.

[Urethral disruption treated by echo guided endoscopic management: a case report].

We report a case of 63-years-old man with a chief complaint of urinary retention and urethral meatal bleeding due to straddle injury. Urological examination revealed proximal bulbous urethral disruption with 1 cm gap, and then cystostomy was placed. Afterwards, urethral disruption was treated by echo guided endoscopic urethroplasty. Transurethral resection of scar tissue was performed twice for postoperative urethral stricture. Postoperative voiding cystourethrography revealed no urethral stricture. The patient voids well without urinary incontinence and erectile dysfunction. Recently, endoscopic urethroplasty, which is easy, minimally invasive, and repeatable in comparison with open urethral reconstruction, has been frequently performed for urethral disruption as endoscopic instruments functionally develop. Echo guided image in the present case is so useful that proximal and distal end of urethral disruption can be shown in same plane, indicating that primary urethral tract can be reconstructed without injury of rectum and urethra.

[A case of multiple renal hemangioma].

A 53-year-old man presented with a right heterogeneous renal tumor detected by ultrasonography (US) on a routine health check. He had no complaint. Computed tomography (CT) revealed a 4 cm-diameter heterogeneous tumor located near a calcification of the right kidney, which was not so enhanced. Subsequent magnetic resonance imaging (MRI) and angiography could not rule out the malignancy of the tumor, so we performed total nephrectomy. Pathological diagnosis was multiple renal hemangioma. Multiple renal hemangioma is a rare disease, being the second reported case in the Japanese literature.

[Intraluminal ureteral hematoma complicating anticoagulant therapy].

Intraluminal ureteral hematoma is a rare disease and only a few cases have been previously described. We report a case of intraluminal ureteral hematoma induced by anticoagulant therapy. A 65-year old man having the oral anticoagulant therapy for prevention of secondary thrombolism following atrial fibrillation was referred to us for gross hematuria. Ultrasound sonography (US) revealed right renal mild wide pelvis. Computed tomography (CT) showed the right ureteral submucosal hematoma. This ureteral hematoma penetrated the ureteral mucosa and caused macrohematuria. The patient had been anticoagulated on Warfarin with Bucolome for 18 days, so the prothrombin times (PT) was found to be excessively prolonged beyond the normal therapeutic range. The oral anticoagulation was stopped and intravenous Vitamin K2 was given, so PT was normalized. Though estimate hemorrhage quantity reached 1,200 ml, we had no blood transfusion. The hematoma was completely diminished 4 months later, no reccurence has been occurred. Bucolome has especially pharmacokinetic positive interaction to Warfarin, so we must check PT-INR frequently.