ABSTRACT
A 27-year-old man visited our hospital with painless swelling of the left scrotum. Hematologic studies showed the following levels of lactate dehydrogenase, 3,171 IU/l ; alpha-fetoprotein, 2.2 ng/ml ; and ß- human chorionic gonadotropin, 0.4 ng/ml, and abdominal computed tomography revealed a mass of 10×8 ×4 cm in the left testis, and that of 3.5×3.0×5.0 cm in the left renal hilar lymph node, without any other metastasis. Left high inguinal orchiectomy was performed, and histopathological examination revealed mixed form with seminoma and teratoma. He was diagnosed to have a left germ cell tumor with left renal hilar lymph node metastases, pT1, N3, M0, stage II C, indicating poor prognosis with IGCCC. The patient received four cycles of chemotherapy, COMPE regimen (CDDP, VCR, MTX, PEP, VP-16 [etoposide]). After lactate dehydrogenase, alpha-fetoprotein, and ß -human chorionic gonadotropin all normalized, retroperitoneal lymph node dissection was performed. Histopathological examination revealed only a mature teratoma. Two and half years later, hematologic studies showed blast transformation. Bone marrow biopsy revealed acute myeloblastic lymphoma (M2). The patient received one cycle of AraC and daunorubicin, one cycle of high dose AraC, and three cycles of AraC and mitoxantrone. After chemotherapy, he has maintained a disease-free status for 11 years. In this case, etoposide, a topoisomerase II inhibitor, was the presumed cause of therapy-related acute myeloid leukemia. After administering chemotherapeutic agents especially etoposide, it is important to check blood count periodically for a long time.
Subject(s)
Antineoplastic Agents, Phytogenic/adverse effects , Etoposide/adverse effects , Leukemia, Myeloid, Acute/chemically induced , Neoplasms, Germ Cell and Embryonal/drug therapy , Testicular Neoplasms/drug therapy , Adult , Antineoplastic Agents, Phytogenic/administration & dosage , Etoposide/administration & dosage , Humans , Leukemia, Myeloid, Acute/pathology , Lymphatic Metastasis , MaleABSTRACT
A 49-year-old man presented with elevated serum creatinine. He had histories of pancreatic pseudocyst caused by alcoholic pancreatitis and right nephrectomy due to renal cell carcinoma. Computed tomographic scan demonstrated that a subcapsular renal cyst appeared adjacent to the pancreatic pseudocyst and compressed the parenchyma of the left kidney. Since the renal subcapsular cyst was suspected to directly communicate with the pancreatic pseudocyst, endoscopic ultrasound-guided transgastric drainage of pancreatic pseudocyst was performed. After the intervention, the renal subcapsular cyst disappeared without formation of a pancreatic fistula and renal dysfunction was promptly improved. He remains free of relapse for more than 1 year.
Subject(s)
Drainage/methods , Endosonography/methods , Kidney Diseases, Cystic/etiology , Pancreatic Pseudocyst/surgery , Humans , Male , Middle Aged , Pancreatic Pseudocyst/complicationsABSTRACT
A 66-year-old man presented with multiple bilateral renal nodular lesions demonstrated by enhanced computed tomographic scan. He had a history of autoimmune pancreatitis and renal cell carcinoma, which had been treated with partial nephrectomy. We performed renal biopsy under ultrasound guidance. Pathological examination revealed plasma cell infiltration to the renal interstitium. Serum IgG4 level was high and we diagnosed as IgG4-related tubulointerstitial nephritis. After one month of oral steroid therapy the multiple nodular lesions disappeared.
