[Primary signet ring cell carcinoma of the urinary bladder: a case report].

Gross hematuria and urinary frequency caused a 71-year-old man to visit our hospital. A non-papillary tumor was identified on the posterior wall of the urinary bladder and the pathological diagnosis was signet ring cell carcinoma. Upper gastrointestinal endoscopy, computed tomographic scanning, barium enema revealed no involvement of other organs. Radical cystectomy and creation of an ileal conduit were performed. The histopathological stage was pT4N1M0. Apart from subacute ileus, the postoperative course was uneventful. Signet ring cell carcinoma of the bladder is a rare entity and we have identified 41 cases in the Japanese literature. This tumor usually has a poor prognosis. Our patient is currently free from disease at 5 months after the surgery.

[A case of metachronous adenocarcinoma of the urinary bladder and the right upper urinary tract].

Bilateral hydronephrosis identified by a local physician brought a 65-year-old man to our hospital. Emergency percutaneous nephrostomy was bilaterally established for obstructive renal failure. After recovering renal function, the patient underwent radical cystectomy under the diagnosis of invasive bladder cancer and the construction of an ileal conduit. The pathology reported well differentiated adenocarcinoma (pT2, pL1, pV1). Five years after the surgery, gross hematuria developed. A computed tomographic scan revealed right hydronephrosis with a solid mass in the upper calyx. The urinary cytology was negative. The patient underwent right nephrectomy in May, 1999. The pathology then revealed well differentiated adenocarcinoma in the renal pelvis and ureter (pT3, pL0, pV0 and pT1, pL0, pV0, respectively). He is alive with mild chronic renal insufficiency with evidence of tumor at ten months after surgery. To our knowledge, this is the first case of metachronous adenocarcinoma of the urinary bladder and the upper urinary tract reported in the Japanese literature.

[Hypogonadotropic hypogonadism treated with HCG monotherapy: report of 3 cases].

We report 3 cases of hypogonadotropic hypogonadism and the effects of human chorionic gonadotropin (HCG) monotherapy on plasma testosterone levels, which were related to clinical results. The patients were males 29, 21 and 14 years old. Each received 5,000 units of HCG subcutaneously or intramuscularly twice or three times a week for 16 to 40 months. Genital effects, including an increase in testicular volume were seen in all patients after 2 or 3 months. The increase in plasma testosterone level after HCG therapy was significantly correlated with the genital effects similarly to other treatments. Moreover, spermatozoa appeared in one case.

[Primary malignant melanoma of the female urethra: a case report].

The 20th case of primary malignant melanoma of the female urethra in the Japanese literature is reported. An 86-year-old woman presented with urethral bleeding. A hemorrhagic cheery-sized mass was identified at the urethral meatus, which extended into the vaginal mucosa, and was diagnosed as malignant melanoma after biopsy. Surgical treatment was abandoned because she had dementia and bilateral inguinal lymphadenopathy. She had no symptoms during the following 4 months.

[Primary carcinoma of the female urethra: report of five cases].

Between 1988 and 1996, we treated five patients with primary carcinoma of the female urethra between 65 and 79 years of age. Presenting symptoms included a urethral mass in 2 patients, hematuria in 1, dysuria in 1 and urethral bleeding in 1. Histopathology revealed squamous cell carcinoma in 4 cases and transitional cell carcinoma in 1. Clinical stage according to Grabstald's classification comprised Stage A in two cases, Stages B, C and D in one each. The modes of treatment were surgical resection alone in two, radiation therapy alone in two, and surgery with adjuvant chemotherapy in one case. Three patients without disease and two with disease are olive from 5 to 87 months after diagnosis.