[A case of renal cell carcinoma arising in bilateral original kidneys after failure of transplant graft function].

We report a case of renal cell carcinoma arising in bilateral original kidneys after failure of transplant graft function. A 47-year-old man had received a living related renal transplantation on December 10, 1985. He had resumed hemodialysis (HD) therapy because of graft failure on January 8, 1996. Periodic computed tomography (CT), after resumption of HD, revealed multiple cystic change in bilateral original kidneys and a mass in the right kidney. He was referred to our hospital on August 4, 1998 for management of the increased right renal lesion. Abdominal angiography demonstrated a hypervascular and solid mass not only in the right kidney but also in the left kidney. He underwent transperitoneal bilateral nephrectomy. Histopathological examination revealed renal cell carcinoma, bilaterally, with alveolar type and granular cell subtype. He was free of evidence of recurrence and metastasis for 30 months after nephrectomy.

[A compound tumor in the adrenal medulla--pheochromocytoma combined with ganglioneuroma: a case report].

We report a case of a compound adrenal medullary tumor. A 63-year-old woman was referred to our hospital for examination of a right adrenal tumor, incidentally found by abdominal computed tomography (CT). CT and magnetic resonance imaging (MRI) revealed a round heterogeneous tumor, 5 cm in diameter, on the upper pole of the right kidney. A view of the total body scan demonstrated the uptake into the tumor after the injection of 123I-metaiodobenzyl-guanidine. Serum and urinary adrenaline levels were slightly elevated, and urinary excretion of vanillylmandelic acid was markedly elevated. Her blood pressure was normal. From these findings, the tumor was suspected to be a pheochromocytoma of the right adrenal gland and was resected reteroperitoneally. Pathological diagnosis was a compound adrenal medullary tumor, which was composed of pheochromocytoma and ganglioneuroma. This combination of the adrenal medullary tumor is extremely rare, and to date this case may be the sixth case in the Japanese medical literature.

[Clinical experience of ileal neobladder for bladder cancer].

Between June 1993 and July 1996, an ileal neobladder was created in 20 patients after total cystectomy for bladder cancer. The mean post operative follow-up period was 32 months, with a range of 9 to 47 months. Ureteroileostomy was performed using the Le Duc-Camey procedure. There were 3 (15%) early postoperative complications, which were all of transient urine leakage from the neobladder. Late complications were encountered in 6 patients (30%), which were of stenosis of ureteroileal anastomosis in 2 (10%), stone in the neobladder in 2 (10%), neobladder-cutaneous fistula in 1 (5%) and neobladder-ureteral reflux in 1 (5%). Reoperation was necessary in 4 patients (20%); 2 for stenosis of ureteroileal anastomosis and 2 for removal of a stone in the neobladder. No urethral recurrence has been noted. Local recurrence occurred in 2 patients, who died of tumor progression 16 and 27 months postoperatively. All 20 patients were continent during the day time (100%), while 2 (10%) had nocturnal incontinence.

[A case of renal cell carcinoma found after skin metastasis].

A case of renal cell carcinoma, found after skin metastasis is presented. A 76-year-old woman came to our hospital complaining of two painless subcutaneous tumors in her left chest. Histopathological diagnosis was clear cell carcinoma. She underwent left nephrectomy and histopathological findings revealed renal cell carcinoma, alveolar type, clear cell subtype, grade 1. Lung metastasis was proved soon after the operation. We removed skin metastasis several times after the nephrectomy.

[Clinical studies of inverted papilloma of the bladder].

Clinical studies were conducted on 9 cases of inverted papilloma of the urinary bladder which were transurethrally resected between August, 1987 and July, 1995 at our hospital, in males between 29 and 81 years of age (mean:58.3). Six of the 9 inverted papillomas were localized at the bladder neck and 3 in the trigone. Cystoscopic examinations revealed that inverted papillomas were divided into two types, one with a thick and short stalk with a smooth surface and the other with a thin and long stalk with/without a partial papillary surface. The majority of the former was located in the trigone and all of the latter cases in the bladder neck, suggesting that the two types occurred at different sites. Pathological examination by Hematoxylin-Eosin staining demonstrated that 5 of the 9 cases were of the trabecular type and 4 were of the grandlar type. Immunohistochemically, none of the tumors were stained with the antiprostatic-specific-antigen antibody revealed. Follow-up periods after the operation were from 12 to 48 months(mean:26.6 months) and no recurrence was observed.

[Clinical studies of 15 cases of renal angiomyolipoma].

Fifteen cases of renal angiomyolipoma seen between May, 1988 and October, 1994 in our hospital are presented. Surgical treatment was performed in 6 cases, 1 of which was falsely diagnosed as liposarcoma by frozen specimen during the operation. Nine cases were only followed-up by ultrasonography and/or computed tomography. In 2 cases, in which enucleation was performed after a follow-up period of more than one year, tumors were inclined to grow rapidly. In 5 cases, which were not operated and followed-up for more than one year, tumors were inclined to grow very slowly.

[Giant schwannoma in the pelvic cavity presenting as renal failure: a case report].

A case of giant schwannoma in the pelvic cavity detected with renal failure is reported. A 50-year-old man was referred to another clinic with chief complaints of general fatigue and edema of the face and dorsa of the feet. On March the 4th 1994, he was hospitalized in the clinic because of renal failure. Bilateral hydronephrosis and a giant pelvic tumor were found by computed tomography (CT) and ultrasonography. Because bilateral percutaneous nephrostomies failed to recover his renal function, he was referred to our clinic for the purpose of hemodialysis and the further examination of the tumor on March 16, 1994. The pelvic angiography showed that the tumor was fed by the vessel from the left internal iliac artery. After the chemo-embolization from the feeding artery, tumor resection was performed on May 9, 1994. The tumor was 16x13x10 cm in size, and 1,110 g in weight. The histological findings of the tumor revealed the mixed type schwannoma of Antoni A and B. Six months after the operation, he has had no tumor recurrence. This is a rare case of pelvic schwannoma which was detected with renal failure. We reviewed and discussed 56 cases of schwannoma in the pelvic cavity, including our case, in the Japanese literature.

[Intrascrotal fibrous pseudotumor accompanied by pelvic kidney with ectopic ureteral opening: a case report].

A case of intrascrotal fibrous pseudotumor accompanied by pelvic kidney with ectopic ureteral opening is reported. The patient was a 65-year-old man with the complaint of swelling of the right scrotal contents. Ultrasonography showed a heterogeneous mass with acoustic shadow from the right epididymis to right spermatic cord. Intravenous pyelography revealed a non-visualizing right kidney. Endoscopic examination was performed because of the right non-functioning kidney and right epididymectomy was performed. Endoscopic findings showed that the ureteral opening existed at 6 degrees of the bladder neck. Retrograde pyelography demonstrated the right kidney in the pelvic cavity. The tumor was stony hard and 30 x 50 mm in size. Pathological diagnosis of the tumor was a fibrous pseudotumor. We reviewed and discussed 22 cases of fibrous pseudotumor, including our case, in the Japanese literature.

[Recurrence of transitional cell carcinoma in bilateral upper urinary tracts and ileal conduit with invasion in the abdominal wall around nephrostomy after total cystectomy: a case report].

A case of recurrence of transitional cell carcinoma in bilateral upper urinary tracts and ileal conduit with invasion in the abdominal wall around nephrostomy after total cystectomy is presented. A 33-year-old man with right nephrostomy, after total cystectomy, construction of ileal conduit, bilateral partial ureterectomy and left nephrectomy for transitional cell carcinoma at another hospital was referred to our hospital because of further recurrence in the right renal pelvis and ileal conduit. He had had left nephrostomy before the left nephrectomy was performed. Right nephrectomy and total extirpation of ileal conduit were performed and hemodialysis was started from the day after the operation. However, several weeks later, transitional cell carcinoma was detected pathologically in the left abdominal wall around the left nephrostomy which had been inserted. The renal pelvis was inferred to have leaked urine around the nephrostomy and invasion arose in this region. After radiation therapy he was discharged but he died from recurrence of carcinoma 9 months after the operation. After total cystectomy, examinations by percutaneous puncture of the renal pelvis are very effective for evidence of recurrence in the upper urinary tract. However, we emphasize that the percutaneous technique carries the risk of tumor invasion through the percutaneous urinary tract.

[Clinical studies of chemotherapy for patients with a solitary kidney after nephroureterectomy for advanced upper urothelial transitional cell carcinoma].

Between June, 1987 and December, 1993, ten patients with solitary kidney after total nephroureterectomy for advanced upper urothelial transitional cell carcinoma were treated with chemotherapy (M-VAC or modified M-VAC). This series comprised 6 males and 4 females between 27 and 81 years of age (mean age: 58.5 years). The site of primary lesions was the renal pelvis in one case, ureter in 5 and renal pelvis and ureter in 4. Histologically, these extripated tumors were all identified as transitional cell carcinoma, the stage being pT3 and pT4 in 9 and grade being G3 in 8 of the 10 patients. Among the 13 cases including the 3 cases of recurrence after first line chemotherapy, 7 had lesions suitable for the evaluation. Two of the 7 cases achieved complete response and four achieved partial response, resulting in an 86% response rate. Of the 10 patients, 4 died of metastasis of carcinoma and the others are still alive. The average period after operation among 10 patients was 25 months. Side effects related to this chemotherapy were as follows: general fatigue, nausea or vomiting and alopecia 100%, leucocytepenia (< or = 1,000/mm3) 23%, anemia (RBC < or = 250 x 10(4)/mm3) 62%, thrombocytopenia (< or = 5 x 10(4)/mm3) 46%. However, nephrotoxicity in spite of solitary kidney was not noticed in any patients. From our experience, we suggest that M-VAC or modified M-VAC chemotherapy are safe against patients with a solitary kidney after nephroureterectomy for advanced transitional cell carcinoma of the upper urinary tract.

[A case report of condyloma acuminatum in female urethra].

A case of condyloma acuminatum in female urethra is reported. A 53-year-old woman was referred to our clinic because of urethral bleeding. A tumor was noted around the external urethral meatus and the size of the tumor was 20 mm in diameter. Excision was performed on the tumor including the external urethral meatus. Pathological examination revealed condyloma acuminatum. Condyloma acuminatum in female urethra is very rare. We reviewed and discussed 6 cases of condyloma acuminatum in female urethra, including our case, in the Japanese literature.

[Cysts in the cavum tunica vaginalis testis: a case report].

A case of cysts in the cavum tunica vaginalis testis was reported. A 58-year-old man visited our clinic with the chief complaint of urethral bleeding. Urethro-cystogram revealed stricture of bulbous urethra. We palpated several pea-sized painless masses in the left scrotum. On ultrasonogram of the left scrotal contents several cystic lesions were detected at the cranial side of the left testis. At operation, cysts were found in the cavum tunica vaginalis testis, and were resected along with the tunica vaginalis. Fluid of the cysts was serous without sperm. Histopathologically mesothelial cyst was suspected. The incidence of cysts in the cavum tunica vaginalis testis is rare and only 17 cases have been reported in Japan. We reviewed 9 cases of cysts arising from lamina parietalis of tunica vaginalis.

[A case of bilateral epididymal leiomyomas].

A case of bilateral epididymal leiomyomas is reported. A 62-year-old man was referred to our hospital under the suspicion of left testicular tumor. A small hen-egg sized painless mass was palpated in the left scrotum and a little-finger-tip-sized mass in the right scrotum. At the operation, bilateral epididymal tumors were revealed, left high orchiectomy and right epididymectomy were performed. Gross evaluation revealed elastic hard tumors at the tail of bilateral epididymis. The left tumor was 40mm in diameter and the right was 10mm. On the cut surface, the tumors were yellowish and solid. Histopathologically they were diagnosed as epididymal leiomyoma. We reviewed 75 cases of epididymal leiomyoma reported in the Japanese literature. Bilateral cases accounted for 21% of the 75 cases.