A CASE OF AN AROMATASE-PRODUCING SERTOLI CELL TUMOR PRESENTING WITH GYNECOMASTIA.

A 64-year-old man had complained of a left scrotal mass and gynecomastia since June 2012. A left testicular tumor was suspected and the patient was referred to our department in December 2013. He presented with bilateral gynecomastia and a painless left scrotal mass that was firm, smooth surfaced, and the size of large hen's egg. Levels of markers of testicular germ cell tumors were all within normal range. Endocrinological examination revealed a marked elevation in serum estradiol (E2) level. The patient underwent high inguinal orchiectomy in December 2013.The pathological diagnosis was a Sertoli cell tumor of the left testis. Immunohistochemistry revealed the expression of aromatase synthesis; we speculated that this E2 production by the tumor caused the gynecomastia.Serum E2 level normalized after the orchiectomy. Owing to the diagnosis of malignancy, retroperitoneal lymph node dissection was performed in January 2014. No lymph node metastasis was found in the specimen. The gynecomastia improved gradually, and the patient has been free of disease since the surgery.

Comparison of efficacy and safety of 1- and 3-month luteinizing hormone-releasing hormone agonist depots as initial therapies for prostate cancer.

BACKGROUND: We compared the efficacy and safety of 1- and 3-month depots of the luteinizing hormone-releasing hormone (LH-RH) agonist goserelin acetate in prostate cancer patients. METHODS: Patients were randomly assigned to the Direct Group that received the goserelin 3-month depot or the Switch Group that began with the 1-month depot for the first 3 months and then switched to the 3-month depot. All patients were co-administered the antiandrogen agent bicalutamide. Serum testosterone and prostate-specific antigen (PSA) levels and adverse events were recorded at weeks 4, 8, 12, and 24. RESULTS: Baseline testosterone levels in the Direct and Switch Groups were 4.98 and 5.07 ng/mL, respectively (P = 0.798). At each week, the levels in both groups were ≤0.50 ng/mL (castration level) with no significant differences between them. All of the patients in the Switch Group and 98.1 % in the Direct Group had achieved castration levels at week 12, and 100 % had achieved such levels at week 24. Baseline PSA levels in the Direct and Switch Groups were 52.37 and 46.72 ng/mL, respectively (P = 0.793). Levels in both groups dropped continuously, to about 1.0 ng/mL at week 24, with no significant differences between the groups at any time. Three patients in the Direct Group experienced adverse events that were attributed to the co-administered bicalutamide. CONCLUSIONS: There was no difference in the efficacy or safety between the 1- and 3-month depots of goserelin when given as initial prostate cancer treatment in combination with bicalutamide. Patients must be monitored for adverse events associated with bicalutamide.

[Docetaxel-based chemotherapy for hormone-refractory prostate cancer in Japanese patients : experience in a single institute].

Between April 2007 and November 2010, we treated 21 cases of hormone-refractory prostate cancer with docetaxel-based chemotherapy. The administered dose of docetaxel was from 40 to 75 mg/m2, and the treatments were repeated every 3 to 4 weeks. The patients were from 61 to 88 years old (median 78). Fourteen patients were alive, and seven had died. According to the prostate specific antigen response, the complete response rate was 30%, partial response was 10%, no change was 25%, and progressive disease was 25%, respectively. Median time to progression was 7.0 months (from 1 to 43 months), and median overall survival time after chemotherapy was 11.5 months (from 3 to 44 months). One patient died of adverse events. However, in most cases, hematological toxicities were tolerable and manageable, although neutropenia of grade 3 to 4 was observed. On the other hand, non-hematological toxicities that led to discontinuation of the therapy were observed in a few cases. Docetaxel-based chemotherapy was feasible and effective even for patients over 80 years old. In responding cases, it is important to maintain the chemotherapy as long as possible, by modifying the treatment procedures, while paying attention to the adverse events.

[Case of primitive neuroectodermal tumor of the kidney].

A 28-year-old woman presented with right flank pain. A large, firm, fixed mass was palpable in the right side of the abdomen. Computed tomography revealed a solid mass of the right kidney with extension into the renal vein and inferior vena cava. The patient underwent right radical nephrectomy with en bloc resection of the inferior vena cava containing tumor thrombus and right adrenalectomy. Histologically the tumor consisted of small tumor cells with rosette formation. Immunohistochemical staining was positive for CD99 and NSE. Analysis with polymerase chain reaction (PCR) demonstrated the EWS/FLI1 fusion products resulting from a chromosomal translocation. These findings were consistent with primary renal primitive neuroectodermal tumor (PNET). Two months after surgery, multiple lung, liver and lymph node metastases were found. The patient received 2 cycles of chemotherapy with cisplatin, ifosfamide, etoposide, resulting in a partial remission. She subsequently received 1 cycle chemotherapy with paclitaxel and carboplatin, resulting in no response. The metastatic lung and liver diseases progressed and she died 5 months after diagnosis.

Mucosa-associated lymphoma of the bladder with relapse in the stomach after successful local treatment.

A 64-year-old woman was referred to our hospital for management of an ovarian tumor. Abdominal computed tomography and magnetic resonance imaging revealed a dermatoid cyst of the ovary and a bladder tumor. Transurethral resection of the bladder tumor was performed. Histopathological examination of the tumor revealed non-Hodgkin's lymphoma of the mucosa-associated lymphoid tissue MALT type. The patient received radiotherapy for the bladder and had a complete response. Nineteen months later, gastrointestinal endosopy revealed the presence of a mass lesion in the stomach. Histopathological examination of biopsy specimens from this tumor indicated the same tumor as that in the bladder as they showed identical IgH gene rearrangement. Because of the detection of evidence of Helicobacter pylori (HP) infection in the gastric mucosal biopsy specimens, the patient was administered HP eradication therapy, but, the tumor persisted. After radiotherapy, the stomach tumor disappeared. Since then she remains without evidence of local recurrence or relapse.

[Small cell carcinoma of the prostate: a case report].

An 80-year-old man visited our hospital because of dysuria and pollakisuria. He had undergone anti-androgen therapy for prostate cancer for 8 months at another hospital. His serum prostate specific antigen (PSA) level was 14.4 ng/ml. We performed a prostate biopsy and identified poorly differentiated adenocarcinoma with Gleason score 4 + 5. After 4 months, his serum PSA level increased to 24.8 ng/ml, and we started maximum androgen blockade therapy using additional luteinizing hormone-releasing hormone (LH-RH) analogue. Subsequently, although his serum PSA level declined favorably, his condition worsened rapidly and he died at 16 months after the diagnosis. The autopsy pathology of his prostate revealed small cell carcinoma. We reviewed the initial biopsy specimens and found both small cell carcinoma and adenocarcinoma histologic types of prostate cancer.

Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis.

Sclerosing pancreatitis is associated with raised concentrations of IgG4. We treated 22 patients with sclerosing pancreatitis, and identified and followed-up three with concomitant hydronephrosis caused by ureteral mass, later diagnosed as retroperitoneal fibrosis. We histologically examined the ureteral and pancreatic lesions of these patients and noted abundant infiltration of IgG4-bearing plasma cells in both tissues. Treatment with corticosteroids lowered serum concentrations of IgG4. IgG4 might also have a pathological role in a systemic fibrosing process that includes pancreatic and retroperitoneal lesions.