Crossed ectopia of left vas deferens, leaving ipsilateral seminal vesicle in normal position.

A 19-year-old man with crossed ectopia of the vas deferens was investigated with special reference to right hydronephrosis and renal dysfunction. There was no vesicoureteral reflux. The left kidney was hypoplastic or dysplastic and the left ureter emptied into the left seminal vesicle. The right malrotated hydronephrotic kidney was in the lumbar position. The right lower ureter communicated with either the right seminal vesicle or the ampullary portion of the left vas deferens and drained into the bladder at the normal site. The end of the right vas deferens was dilated. The left vas deferens crossed the midline and opened into the right seminal vesicle, leaving the ipsilateral seminal vesicle in the normal position. A search of the literature failed to reveal any similar anomalies.

Left preureteral vena cava (retrocaval or circumcaval ureter) associated with partial situs inversus.

We present a rare case of left preureteral vena cava associated with partial situs inversus. A 68-year-old woman was referred to our clinic for further study of left hydronephrosis on computerized tomography. The abdominal viscera were in mirror image and the heart was levocardia. The middle portion of the left ureter was dorsal to the left inferior vena cava. The left ureter was reanastomosed ventral to the inferior vena cava. To our knowledge, coexistence of preureteral vena cava and partial situs inversus has not been reported previously in the literature.

[Adrenal ganglioneuroma].

We report a case of adrenal ganglioneuroma. A 29-year-old man was referred to our clinic for further investigation of right abdominal mass incidentally discovered by ultrasonography. Endocrinological study was unremarkable. Abdominal computed tomography revealed well-defined, 6-cm-long oval mass with mottled calcification. Adrenal scintigraphy showed enlarged adrenal gland with low accumulation. T1-image of magnetic resonance depicted hypointensity tumor in comparison with liver. Extirpation of this tumor disclosed yellowish white, homogeneous mass, 101 g in weight and 7 by 7 by 3.5 cm in diameter. Pathological diagnosis was ganglioneuroma. All reported cases of adrenal ganglioneuroma exceeded 5 cm in diameter. This indicates malignancy in computed tomography. Therefore, we should be careful in diagnosing ganglioneuroma.

Histological analysis of high-grade superficial bladder tumour.

Segmental cystectomy or total cystectomy was performed in 26 patients with newly diagnosed stage T1, grade 3 transitional cell carcinoma of the bladder. Their histological specimens were assessed with regard to types of tumour cell spread, small vessel involvement and coexistent carcinoma in situ. Patients were followed for 12 to 141 months. Broad front type and tentacular type spread were seen in 57.7% and 38.5%, respectively. Small vessel involvement was seen in 38.5% of patients. Coexistent carcinoma in situ was found in as many as 65.4%. Urethral recurrence was found in 4 patients out of 26. These data suggest that the high incidence of coexistent carcinoma in situ may be the most important cause of the unsatisfactory prognosis for stage T1, grade 3 bladder cancer.

[Tumor factors concerned with primary culture of transitional cell carcinomas].

We investigated retrospectively tumor factors such as tumor organ, method of tumor collection, tumor morphology and grade, concerned with primary cultures of transitional cell carcinomas of bladder, renal pelvis and ureter. Moreover, we investigated whether chemotherapy before tumor collection influence on the success rate of primary culture. After mechanical disaggregation of specimens from 42 bladder cancers and 11 renal pelvic or ureter cancers, monolayer cultures were carried out. When epithelial growth or colony-formation was observed, we determined that primary culture was succeeded. In total 30 primary cultures out of 53 (56.6%) were successful and tumor organ or method of tumor collection did not influence primary cultures. The success rates in the groups of papillary tumors and non-papillary tumors were significantly different (72.4% and 37.4%, respectively). Culture was more successful with grade 1 tumors. Although intravesical chemotherapy before tumor collection did not influence the success rate of primary culture, one-shot intra-arterial infusion chemotherapy made it worse (p less than 0.05) and it was concerned with histopathological effects according to the classification of Shimosato and Oboshi.

[Adrenal hemangioma: a case report].

We report a rare case of adrenal hemangioma incidentally discovered by computed tomography (CT) in a 75-year-old female, the hormonal examination showed within the normal range, and ultrasound-sonography, CT scan and angiography disclosed the mass to be a non-functioning adrenal tumor. The tumor was removed operatively and the pathological finding was adrenal hemangioma. Twenty reported cases found in the Japanese literature are reviewed.

[Bilateral testicular tumors of germ cell origin: a case report--a review of 136 cases in Japanese literature].

A case of bilateral testicular germ cell tumors in a 23-year-old male is reported. He was admitted to the Department of Urology, Yamagata Prefecture Kahoku Hospital with the chief complaint of painless swelling in the left intrascrotal contents. Left high inguinal orchiectomy was carried out. At the same time, right hydrocele operation and right testicular biopsy were performed. Subsequent histological examination revealed anaplastic seminoma in the left testis and typical seminoma in the right. On July 21, 1988, he was referred to our clinic and right high inguinal orchiectomy was carried out. Postoperative chemotherapy was performed with CDDP, VP-16 and peplomycin, and postoperative course was uneventful with no distant metastasis or local recurrence. A total of 136 cases of bilateral testicular germ cell tumors in the Japanese literature are reviewed.

[Studies on prognosis of prostate cancer with bone metastasis by using pretreatment bone scintigraphy].

The pretreatment bone scans on 40 patients with prostate cancer with bone involvement were reviewed and the prognostic impact of the initial extent of bone metastasis was evaluated. On the bases of the number or extent of bone metastasis, the patients were divided into 2 groups and survival for each group was compared. We also assessed the correlations between the extent on bone metastasis and other pretreatment characteristics: age, symptoms, serum acid phosphatase, serum alkaline phosphatase, and the histological differentiation of primary tumor. At the same time, the prognostic impacts of these pretreatment characteristics were evaluated. The extent of bone metastasis on the scan correlated with survival, but other characteristics did not have a predictive value except for histological grade. Though the histological differentiation of primary tumor was related to survival, the survival rates differed by the initial extent of disease among the same histological grade patients. Thus the extent of bone metastasis was shown to predict survival in metastatic prostate cancer.

[Undescended testis cancer: report of two cases--review of the literature of 179 cases in Japan].

Recently, we experienced two cases of testicular tumor in patients with cryptorchidism. Case 1: A 35-year-old man was admitted because of right inguinal mass. He had a tumor of right undescended testis and underwent right orchiectomy. Case 2: A 45-year-old man, who was pointed out to have bilateral cryptorchidism was admitted because of right groin mass. He underwent right orchiectomy and left orchiopexy. Histological examination of two cases were seminoma. Testicular tumor in undescended testis was made with 179 reported cases from the Japanese literature.

[Results of surgical treatment and postoperative adjuvant chemotherapy of renal pelvic and ureteral cancer].

During the 10-year-and-9-month period from July 1977 to March 1988, 34 cases of renal pelvic and ureteral cancer were surgically treated with total nephroureterectomy combined with partial cystectomy. In cases where the histopathological examination of the surgically excised specimen disclosed a high stage, high grade cancer with vascular tumor invasion, postoperative adjuvant chemotherapy was carried out using cisplatin, cytosine arabinoside and tegafur. Of the 34 cases, 22 are still alive, 7 (20.6%) died of cancer and 5 died of other causes. Histopathologically, all of the 7 patients who died of cancer were found to have grade 3 and stage pT2 or pT3 cancers with intravascular tumor invasion. Cisplatin was used in 13 of the 18 high grade, high stage cases with intravascular tumor invasion. The mortality due to cancer in these 13 cases was 30.8%, while 3 and 5-year survival rates were 69.2% and 51.9%, respectively. In the remaining 5 cases in which cisplatin was not used for postoperative chemotherapy, the mortality due to cancer was 60.0% and the 3 and 5-year survival rates were 53.3% and 26.7%, respectively. Thus, the patients who received postoperative chemotherapy tended to show a better survival rate than those who did not, although the difference in the survival curves between the two groups was not statistically significant. The results from the present study suggest the usefulness of postoperative adjuvant chemotherapy in high stage, high grade renal pelvic and ureteral cancer with intravascular tumor invasion.

Preoperative intra-arterial infusion chemotherapy for patients with bladder cancer.

The effectiveness of the preoperative intra-arterial infusion chemotherapy was studied in 27 patients with muscular invasive bladder cancer. Severe histological destruction of tumor structures was found in 7 cases in the removed bladder at surgery. For these cases, 3-year and 5-year survival rates were 100%. On the other hand, for cases whose destruction of tumor structures was of mild degree or less, 3-year survival rates were 51.9-57.1%. No serious side effect was observed. This preoperative therapy was thought to offer advantages for some patients with muscular invasive bladder cancer.

[Chemoendocrine therapy of newly diagnosed advanced prostatic cancer].

From November 1981 to November 1987, 35 patients with newly diagnosed advanced prostatic cancer (6 Stage C cases and 29 Stage D2 cases) were treated by chemoendocrine therapy consisting of orchiectomy, diethylstilbestrol-diphosphate and cisplatin. Objective responses were assessed at 3 months after the start of treatment. Of the 35 patients, 8 had PR (partial response) and 27 was objective stable by NPCP criteria. Objective progression was not seen. In analysis of long-term results, the 3-year and 5-year survival rate for total cases were 75.8% and 60.7%, respectively. For Stage C cases, the 3-year and 5-year survival rates were 100% and 100%; for Stage D2 cases, they were 72.2% and 54.2%, respectively. Relapse was seen in 7 (24.1%) of the 29 Stage D2 cases. All of these 7 patients had poorly differentiated adenocarcinoma and most of them had more than 10 bone metastases. As for side-effects, gastroenteric symptoms (nausea and vomiting), anemia and slight liver dysfunction were seen. These results suggest that the chemoendocrine therapy is an effective treatment in newly diagnosed cases of advanced prostatic cancer.

Preoperative one-shot intra-arterial infusion chemotherapy for bladder cancer.

We have performed preoperative one-shot intra-arterial chemotherapy since 1976. However, in some cases, the results have not been satisfactory. Experimental studies were conducted to choose the drugs most suitable for this procedure. Drugs that were considered to be effective against bladder cancer, i.e., thio-TEPA, adriamycin (ADM), and cis-platinum (CDDP), were separately administered to groups of dogs via the common iliac artery or cephalic vein, and the concentrations of these drugs in the serum, bladder (mucosa and muscular layer), ileum, kidneys, and liver were measured 1 h later. The results revealed significantly high concentrations of intra-arterially injected ADM and CDDP in the bladder mucosa, suggesting that these drugs may be suitable for intra-arterial injection. It also appeared that thio-TEPA is unsuitable for this procedure. In clinical studies of 29 cases, preoperative one-shot intra-arterial injections were performed prior to total cystectomy or segmental resection of the bladder, and the effectiveness of the treatment was evaluated in terms of the histological effect, survival, and the relationship with the characteristics of the tumor. The results showed that the prognosis for cases showing therapeutic histological effectiveness (grade-IIb according to the classification of Shimosato et al.) was extremely good. Many patients in the grade-IIb group had stage-pT2 tumor or a tumor in the lateral wall. However, there seemed to be no significant differences between the drugs with respect to their histological effects.

[Cancer of the bladder in a patient with spinal cord injury].

A case of cancer of urinary bladder in a 39-year-old incomplete C7 paraplegic male is reported. He was injured in 1962, and was admitted to our department in August, 1982 because of macrohematuria. Intravenous pyelography showed dilation of right ureter and pelvis. Cystography revealed filling defect on the right wall of bladder, but vesicoureteral reflux was not seen. Endoscopically, we found the tumor on the right wall, which seemed to invade to the trigone and right ureteral orifice. CT scan and pelvic angiography showed that the tumor extended extramurally of the bladder and metastasized to lymph-nodes. In November, 1982, bilateral ureterocutaneostomy, and 30 days later, total cystectomy were performed. The removed bladder demonstrated transitional cell carcinoma with undifferentiated tumor cells. The patient died of recurrence of the tumor in the small pelvic cavity, 60 days later. Ten cases of bladder cancer in patients with spinal cord injury were collected from Japanese literature including ours, and the importance of periodic cytology, cystoscopy and random biopsy for early diagnosis of bladder cancer on paraplegics were discussed.

[A study of post-operative chemotherapy for renal pelvic and ureteral tumors].

A study was made of the relationship between post-operative chemotherapy and metastasis and recurrence of bladder tumor in 9 patients with renal pelvic and ureteral tumors. Within 6 months on average, post-operative metastasis was found in 33.3% (3 out of 9 cases). Differentiating according to the type of chemotherapy, the rate of occurrence of metastasis was 50% (2 out of 4) in the case of treatment with either a combination of FT-207, chromomycin A3 and cytosine arabinoside, or with FT-207 alone, while it was 100% (2 out of 2) in stage pT2 and pT3 patients. For combined administration of CDDP, FT-207 and cytosine arabinoside, or for that of CDDP and neocarzinostatin, on the other hand, the rate of occurrence of metastasis was only 20% (1 out of 5) in stage pT2 and pT3 patients, while CDDP administration was found to be effective for preventing post-operative metastasis. However, while recurrence of bladder tumor was found in a total of 3 out of 9 cases (33.3%), recurrence occurred in 40% (2 out of 5) of the cases treated with CDDP. The administration of CDDP was therefore not found to be effective for preventing recurrence of bladder tumor.