Successful treatment of metastatic adenocarcinoma of the urachus: report of 2 cases with more than 10-year survival.

Metastatic urachal cancer is often considered lethal. We report 2 cases of metastatic urachal carcinoma successfully treated with surgical excision followed by combinations of surgery, radiation, and chemotherapy against local recurrence and/or distant metastases, with a recurrence-free survival period of more than 10 years. These cases provide support for multimodal treatments of metastatic urachal cancer.

[Giant testicular tumor associated with scrotal gangrene: a case report].

A case of giant testicular tumor associated with scrotal gangrene is reported. A 33-year-old man had a swollen scrotum (15 cm) accompanied with necrosis and a foulodor. The tumor had invaded the scrotum, perineum and the left spermatic cord. Serum alpha-fetoprotein level was 15,487 ng/ml. The chest radiograph revealed multiple metastases. Bilateral high orchiectomies and local resection with a wide margin were performed. The tumor weighed 2.5 kg and the histopathological diagnosis was teratocarcinoma. He was treated with 3 courses of chemotherapy with cisplatin, etoposide and peplomycin. A second-look surgery revealed no viable cancer cells in the residual masses. The patient has been free of recurrence 4 months postoperatively.

[Surgery for bone metastasis of testicular tumor: a case report].

A 31-year-old man was admitted to our hospital with the chief complaint of painful right scrotal swelling. Based on the diagnosis of right testicular tumor with multiple lung metastasis and L2 vertebral body metastasis, right high orchiectomy and three courses of chemotherapy (peplomycin, etoposide, CDDP) were performed. Histological diagnosis was teratocarcinoma. With the complete remission for lung metastasis and no change for bone metastasis, L2 spondylectomy and additional four courses of the same chemotherapy were performed. The patient has been free of the disease for 11 months after the spondylectomy.

[Malignant fibrous histiocytoma of spermatic cord: a case report].

A 52-year-old man presented with a painful, gradually enlarging mass in the left inguinal region. An ultrasound examination demonstrated a lobulated, heterogenous tumor 6.0 x 4.0 x 3.0 cm in diameter, which separated from the left testis and epididymis. Radical inguinal orchiectomy with wide en bloc local resection was performed. Histologic diagnosis was a malignant fibrous histiocytoma (MFH) with a giant cell variant. The patient underwent postoperative regional irradiation and has been alive without metastasis and local recurrence 3 months after the operation. Among the 19 patients with MFH of spermatic cord reported in Japan, only two cases were of giant cell type of MFH including the present case.

[A case of secondary leukemia in anaplastic seminoma patient treated with long-term chemotherapy].

A 46-year-old man had received a long-term induction plus salvage chemotherapy for anaplastic seminoma with stage IV disease. Chemotherapy regimens and cycles included the following; four cycles of bleomycin plus vinblastine plus cisplatin (BVP); eight cycles of cyclophosphamide, vincristine, and cisplatin (COP); three cycles of etoposide plus cisplatin (EP); thirteen cycles of etoposide with ifosfamide and cisplatin (VIP). The total cumulative dose of etoposide was 4250 mg/m2. Severe and persistent pancytopenia developed 32 months after starting etoposide-based salvage chemotherapy. Bone marrow examination showed hypercellular marrow containing 68% myeloblasts but peroxidase reaction was negative. CD-13 was 30.1% which meant that leukemia was myelogenous. Therefore, he was diagnosed as acute myelogenous leukemia. French-American-British classification was MO. Chromosome analysis revealed a t (8; 21)(q22;q22) cytogenetic abnormality. This case may be compatible with the clinical and cytogenetic characters of epipodophyllotoxin-related leukemia. We conclude that high doses of etoposide seem to be leukemogenic. To our knowledge, this is the first reported case in the literature relevant to epipodophyllotoxin-related secondary leukemia in testicular tomor in Japan.

[A case of nonseminomatous germ cell tumor: usefulness of alphafetoprotein subfraction].

Alfa-fetoprotein (AFP) is an indispensable examination in the management of non-seminomatous germ cell tumor. However, many liver diseases also frequently show the elevation of AFP. Therefore, it is essential to discriminate between yolk sac-derived component and liver-derived one. A 32-year-old male who had suffered from chronic hepatitis, visited our clinic in December, 1991. He complained of left scrotal atrophy and dull pain. Surgical specimen was histologically diagnosed as embryonal carcinoma with syncytiotrophoblastic giant cell. The levels of tumor markers, such as AFP, beta-human chorionic gonadotropin (beta-HCG), were estimated. Both of them were elevated, and radiographical studies demonstrated metastatic lesions of bilateral lung field and retroperitoneal lymph nodes (RPLN). After three courses of cisplatin based chemotherapy, lung and RPLN metastases diminished and serum beta-HCG had normalized. However, the serum AFP persisted to show an abnormally high concentration. The subfraction profile with lens culinaris hemagglutinin (LCA) was estimated. The one after the first course was compared with the one after third course. The latter one showed complete diminution of peak 2. This implied the diminishment of yolk sac element.