A complete response to Pembrolizumab for metastatic collecting duct carcinoma of the kidney.

Collecting duct carcinoma, also known as Bellini duct cancer, is a rare subtype of renal cell carcinoma with a poor prognosis in the metastatic setting. There are limited data to suggest the efficacy of targeted therapy or immune checkpoint inhibitors for collecting duct carcinoma, except for small series and case reports. Herein, we present the case of a patient with collecting duct carcinoma who exhibited a complete response to pembrolizumab and long-term remission approximately 5 years after drug withdrawal.

Impact of Fish Intake Frequency on Cardiovascular Disease-Specific Survival in Hemodialysis Patients.

Introduction: Cardiovascular disease (CVD) is the leading cause of death in hemodialysis patients (HPs). As a food source, fish contains both CVD-preventive and CVD-promoting fatty acids; however, there is no consensus on fish consumption as a preventive measure for CVD in HPs. This single-center longitudinal cohort study aims to assess the impact of fish intake frequency (FIF) per week on CVD in Japanese HPs. Methods: Upon the initiation of the study, 148 HPs were evaluated to determine the FIF, and blood samples were analyzed. These patients were then monitored for 6 years.The relationships between each FIF and blood sampling data, CVD-specific survival (CSS), and new CVD-free survival (nCFS) were statistically calculated using Kaplan-Meier survival curves. Results: During the observation period, 65 deaths were reported, 16 of which were attributed to CVD. Further, 53 patients developed new CVD onset, and no association was found between the FIF and blood sampling data. Based on the Kaplan-Meier survival curves, there was a significant difference in the CSS probability rates at 72 months between patients with an FIF of ≥4 (0.719, 95% confidence interval (CI): 0.530-0.842) and those with an FIF of ≤3 (0.930, 95% CI: 0.851-0.968) (p < 0.01). However, the nCFS probability at 72 months did not significantly differ between patients with an FIF of ≥4 and those with an FIF of ≤3. Multivariate Cox proportional hazards regression showed that an FIF of ≥4 (hazard ratio: 3.64, 95% CI: 1.22-10.9, p = 0.02) was an independent predictor of CSS, but not of nCFS. Conclusions: It was suggested that a higher FIF in HPs might be one of the risks for developing CVD with increased mortality.

A case of intrascrotal extratesticular schwannoma.

Schwannomas are benign tumors arising from Schwann cells, which compose the myelin sheath covering peripheral nerves. Although schwannomas can develop in various locations throughout the human body, the scrotum is a rare site for development of a schwannoma. Furthermore, to the best of our knowledge, no study to date has focused on the detailed imaging findings of intrascrotal schwannoma.

Mamushi bites in a kidney transplant recipient.

Introduction: Mamushi bites are the most common venomous snakebites in Japan. The clinical course of a common mamushi bite is known, and its alarming complication and cause of death are acute renal failure due to the venom. However, reports of mamushi bites in kidney transplant recipients are lacking, and the clinical course is unknown. Case presentation: A 66-year-old man who was bitten by a mamushi 3 years after kidney transplantation. Similar to the course of a typical mamushi bite, his severity gradually worsened to its peak 3 days after the bite, after which he turned lightly. A sufficient amount of infusion and continued immunosuppressive drugs were used to avoid acute renal failure. Conclusion: Even if the mamushi bite occurs in a kidney transplant recipient, the course and management may be the same as usual by continuing the immunosuppressive drugs and a sufficient amount of infusion.

Degarelix as a neoadjuvant hormonal therapy for acute urinary tract toxicity associated with external beam radiotherapy for intermediate- and high-risk prostate cancer: a propensity score matched analysis.

BACKGROUND: In prostate cancer treatment, lower urinary tract symptoms significantly improve with luteinizing hormone-releasing hormone antagonists use compared with agonists. However, it is unclear whether luteinizing hormone-releasing hormone antagonists can decrease acute urinary tract toxicity during external beam radiotherapy. This study aimed to assess whether luteinizing hormone-releasing hormone antagonists used as neoadjuvant therapy reduced acute urinary tract toxicity during external beam radiotherapy compared with luteinizing hormone-releasing hormone agonists. METHODS: The study included 78 patients who underwent intensity-modulated radiation therapy for intermediate- and high-risk prostate cancer between April 2013 and January 2020. Irradiation was initiated after 3-6 months of neoadjuvant therapy. Androgen deprivation therapy was given to the intermediate-risk group for 6 months and the high-risk group for 2-3 years. The European Organization for Research and Treatment of Cancer/Radiation Therapy Oncology Group toxicity grading scale was used to evaluate the urinary tract system toxicity. Relevant clinical factors were used in matching patients based on propensity scores to enable comparison between the groups. RESULTS: Each group had 27 matched patients. There was no reduction in urinary tract toxicity with the use of luteinizing hormone-releasing hormon antagonists (P = 0.624). For patients with an International Prostate Symptom Score of ≥11 at the start of treatment, 18 patients in each group were matched. Significantly lower scores were observed in the luteinizing hormone-releasing hormon antagonist group (P = 0.041). CONCLUSIONS: Luteinizing hormone-releasing hormon antagonists may reduce acute urinary tract toxicity during prostate cancer external beam radiotherapy compared with luteinizing hormone-releasing hormon agonists, in particular in patients with moderate to severe symptoms at the start of treatment.

Severe immune thrombocytopenia induced by nivolumab in a patient with metastatic renal cell carcinoma.

In the Checkmate-025 trial, nivolumab treatment prolonged overall survival among patients with previously treated advanced renal cell carcinoma (RCC) compared with treatment with everolimus. Although effective, nivolumab is associated with immune-related adverse events (irAEs). However, the occurrence of hematological irAEs is rare. Some studies have reported on nivolumab-induced thrombocytopenia. Nivolumab associated thrombocytopenia in almost all patients improved with administration of various drugs. However, there have been only a few cases that have reported death owing to cancer aggravation. In this paper, we have described a case of nivolumab-induced thrombocytopenia after third-line treatment for metastatic RCC.

Laparoendoscopic single-site nephrectomy for hemodialysis patients with dialysis-related renal tumors.

PURPOSE: The purpose of this study is to assess the efficacy of laparoendoscopic single-site (LESS) nephrectomy in hemodialysis patients, we compared outcomes between LESS nephrectomy and conventional laparoendoscopic nephrectomy in hemodialysis patients with dialysis-related renal tumors. MATERIAL AND METHODS: A total of 16 hemodialysis patients who underwent LESS nephrectomy (LESS-N; n = 8) or conventional laparoendoscopic nephrectomy (C-N; n = 8) between November 2003 and July 2012 were retrospectively evaluated. Outcomes were compared between the two groups. RESULTS: Patient and tumor characteristics were similar between the LESS-N and C-N groups. The mean operative duration was longer in the LESS-N than in the C-N group (231.0 ± 26.7 min versus 188.6 ± 36.4 min; p = .025). The mean estimated blood loss was lower in the LESS-N compared with the C-N group (26.4 ± 14.4 ml versus 65.6 ± 45.2 ml; p = .047). Postoperative complications were observed in three cases, comprising one case of retroperitoneal hematoma in the LESS-N group and one case each of peritoneal hematoma and retroperitoneal abscess in the C-N group. Surgical scarring was minimal in the LESS-N group. CONCLUSIONS: Although there is a little extension of the operating time, LESS nephrectomy in hemodialysis patients is a feasible procedure compared with the conventional method.

Patient-reported postoperative pain, body image, and cosmetic satisfaction after transumbilical laparoendoscopic single-site adrenalectomy.

INTRODUCTION: Laparoendoscopic single-site surgery is a recently innovated urologic surgical procedure. Transumbilical laparoendoscopic single-site adrenalectomy (LESS-A) is technically safe and feasible in patients with benign adrenal tumors. To improve patient counseling and informed consent, we evaluated patient-reported postoperative pain, body image, and cosmetic satisfaction after transumbilical LESS-A. METHODS: We reviewed 24 patients who underwent transumbilical LESS-A and assessed their operative and esthetic outcomes and incisional pain. Incisional pain was evaluated using a 10-point visual analog scale, and the body image and cosmetic satisfaction were measured using a questionnaire that included a body image scale (range, 5-20 points) and a cosmetic scale (range, 3-24 points). RESULTS: Pure LESS-A was performed on 10 patients using a multichannel port; an additional 5-mm trocar was used in two obese patients. Supplementary to the single-incision approach, one or two 3-mm ports were used in 12 patients. The mean operative time was 203 min; the mean blood loss was 41 mL. The mean pain visual analog scale scores on postoperative days 1, 3, and 7 were 3.5, 2.2 (P = 0.012), and 1.5 points (P = 0.018), respectively. The mean body image scale and cosmetic scale scores indicating wound satisfaction 1 month after the surgery were 20 and 22 points, respectively. Although one patient had liver injury during surgery, the postoperative course during the 3-month follow-up was uneventful. CONCLUSION: Transumbilical LESS-A confers less postoperative pain and better cosmetic satisfaction than conventional laparoscopic adrenalectomy. Therefore, this procedure could potentially become a standard treatment option for benign adrenal tumors.