[Primary squamous cell carcinoma of the prostate forming a rectourethral fistula: a case report].

Eleven cases of squamous cell carcinoma of the prostate have been previously reported in the Japanese medical literature. Patients with this type of carcinoma have dismal prognoses. Herein, we report a case in a 61-year-old man who was admitted to our hospital and whose chief complaints were dysuria and high fever. Pyuria, bacteriuria, and the results of a digital rectal examination suggested acute prostatitis. Despite the administration of antibiotics, the dysuria did not improve. A transrectal needle biopsy was performed, and histology of the tissue showed squamous cell carcinoma. After chemotherapy using methotrexate, pirarubicin, and cisplatin, total pelvic excentration was performed. At 12 months after the operation, the patient is alive with no evidence of the disease.

The critical role of blood from HLA-homozygous donors in fatal transfusion-associated graft-versus-host disease in immunocompetent patients.

Fatal transfusion-associated graft-versus-host disease developed in a 69-year-old woman with colon cancer who underwent elective hemicolectomy. During the perioperative period, she was transfused with 4 units of nonirradiated fresh whole blood less than 6 hours after the blood was donated by family members. She was immunocompetent and was not treated with any immunosuppressive agents such as corticosteroids, chemotherapy, or irradiation therapy. The implicated donor was thought to be her daughter, who was homozygous for an HLA haplotype that was shared with the recipient: A24, Bw52, CBL, DR2. This is the most common haplotype in the Japanese population. This case and others in the Japanese literature indicate that the transfusion of fresh, nonirradiated blood that contains immunocompetent lymphocytes and peripheral hematopoietic precursor cells from HLA-homozygous donors can be lethal to the recipient.

[Spinal subdural abscess--report of a case and a review of the literature of 43 cases].

Spinal subdural abscess is rare, compared with spinal epidural abscess. The first case was reported by Sittig in 1927. Only 43 cases have been reported throughout the literature. We experienced an atypical fulminant case of spinal subdural abscess, following the operation for intracranial aneurysms. The patient was a 48-year-old male, admitted to our hospital on April 9, 1987 with complaining of sudden headache and vomiting. A lumbar puncture proved subarachnoid hemorrhage (S.A.H.), CT scan revealed saccular aneurysms in left middle cerebral artery and left internal carotid-ophthalmic artery. Radical surgical treatment for those aneurysms was undergone successfully. Neither cerebral ventricular nor cisternal drainage was established. His postoperative course was uneventful until the 9th postoperative day. He suddenly complained of pain in his legs and back, followed by paraplegia, respiratory, and cardiac arrests with clinical course of several hours. Antibiotics had been used for eight days after surgery, and there was no clinical evidence of inflammation sign. For his abrupt aggravation, a spinal infarction was suspected. However, the autopsy demonstrated that the dorsal side of the entire spinal cord was covered with masses of pus, and central necrosis and hemorrhage of the spinal cord mainly occupied the central gray matter; so-called Pencilsharped softening. In this case, the cause of spinal subdural abscess was unclear. But the lumbar puncture performed on the day of admission, was most responsible. Also, the reasons why the clinical course of our case was rapid and fulminant were discussed with preference of spinal abscess to primary spinal circular disorder. 44 cases in the literature, including the presented report, was reviewed. Those symptomatology, predisposing factors, pathogenesis, the extent of spinal subdural abscess, clinical diagnosis, treatment, and prognosis were discussed. Among previous cases, this case was one of the most extensive subdural abscess and fulminant clinical course.

[A case of adenocarcinoma of the bladder infiltrating to sigmoid colon].

A 65-year-old man was admitted to our clinic with the chief complaint of gross hematuria and burning on urination. Cystoscopy revealed a papillary broad base tumor on right lateral and posterior wall. Barium enema showed a tumor of sigmoid colon. The other gastrointestinal and genitourinary tracts were examined but no tumor lesion could be found. Total cystectomy and partial resection of sigmoid colon were done, and the urinary tract was reconstructed using a Kock continent ileal reservoir. Histological findings revealed adenocarcinoma of its infiltration to the sigmoid colon.

[A case of leiomyosarcoma of the prostate].

A 50-year-old man with the symptom of anal pain was treated by pelvic exenteration, ileal conduit diversion and artificial anus. The pathologic diagnosis was leiomyosarcoma of the prostate. At 5 months post-operatively, the patient had no evidence of metastasis or recurrence.

[An autopsy case of triple cancer associated with superior vena cava syndrome].

In recent years, because of advances in diagnostic techniques and therapy for malignant tumors, it is not rare to encounter cases of primary multiple malignant neoplasms. However, triple cancer is still rare. We report a case of triple cancer--gastric cancer, sigmoid colon cancer and malignant fibrous histiocytoma. To our regret, we could not make a diagnosis while the patient was alive. Careful examination of a cancer patient is important because malignant tumors may develop at any time.

Carcinogenicity of boiling water extract of bracken, Pteridium aquilinum.

Carcinogenicity of an aqueous extract of bracken was studied in inbred strain ACI rats. In Experiment 1, Group 1 rats received a diet containing unprocessed dry bracken powder for 3 months, Group 2 received the boiling water extract of dry bracken as drinking water for 16 months, Group 3 received the cold water extract of dry bracken as drinking water for 16 months, and Group 4 received a diet containing the concentrated boiling water extract of dry bracken during the whole experimental period. Rats in Experiment 2 also received a diet containing the boiling water extract of dry bracken. A control group was fed a normal diet. Majority of the animals in Group 1 developed multiple ileal tumors, such as adenomas and adenocarcinomas. In Group 2, 6 of 11 rats which survived beyond 7 months developed tumors in either the ileum or urinary bladder, or in both. Rats in Group 3 had no tumor. In Group 4 and in Experiment 2, all the animals except 1 rat in Experiment 2 had urinary bladder tumor. Furthermore, almost all the rats in these groups had simultaneously ileal tumors. Based on these results, it may be assumed that the carcinogen in bracken is extractable in boiling water and is most probably also water-soluble.

Extraneural metastasis of pineal tumor.

The case of an eight-year old male with a pineal tumor is reported, in which metastases occurred to extraneural organs. The pineal tumor consisted of portions of benign teratoma, malignant ependymoma and embryonal carcinoma. Only the embryonal carcinoma metastasized. The intracanial and spinal subarachnoid space alos was invaded by disseminated embryonal carcinoma. There have been seven other similar cases reported. All patients were males from five to 34 years of age.