[Case of testicular cancer with malignant transformation in the residual retroperitoneal mature teratoma 8 years after the initial chemotherapy].

We here report a case of the gradual maturation of teratoma during 8 years after the initial chemotherapy. A 21-year-old man was diagnosed as having a left testicular tumor with retroperitoneal lymph node metastasis around the left renal artery in 1988 and high inguinal orchiectomy was carried out. Histological examination revealed a mixed germ cell tumor composed of immature teratoma, embryonal carcinoma, and seminoma. He received four courses of PVB chemotherapy for his bulky lymph node metastasis. After normalization of the alpha-fetoprotein level, retroperitoneal lymph node dissection (RPLND) was performed. However, the nodes could not be dissected completely because of severe adhesions to the aorta. Histological examination revealed massive necrosis and immature teratoma. One cause of combination chemotherapy with cisplatin and etoposide was given following the surgery. In 1991, enlargement of the residual lymph nodes around the left renal artery was detected by CT scanning. Since both PVB chemotherapy and the combination of cisplatin with etoposide did not achieve remission, RPLND was performed again. Histological examination revealed a mature teratoma which was far more differentiated than that resected in 1988. In 1996, several enlarged para-aortic lymph nodes were found without the elevation of tumor makers, and en-bloc RPLND was performed. Microscopically, mature teratoma was observed in almost all specimens and, unexpectedly, adenocarcinoma was also observed in enteric elements of the mature teratoma. We concluded that we could not evaluate the malignant biological characteristics of teratoma from its maturation level and residual retroperitoneal teratomas should be as completely resected as possible.

IgA nephropathy associated with portal hypertension in liver cirrhosis due to non-alcoholic and non-A, non-B, non-C hepatitis.

A 69-year-old female was admitted to our hospital because of leg edema, proteinuria (2.1 g/day), and gross hematuria. She had non-alcoholic liver cirrhosis of unknown etiology. Esophageal varices also were found. Examination of the renal biopsy specimen revealed mesangial proliferative glomerulonephritis with IgA deposits. Propranolol was administered orally to reduce portal hypertension, resulting in a progressive decrease in urinary microalbumin excretion. This case suggests that portal hypertension is involved in the pathogenesis of IgA nephropathy in liver cirrhosis.

Coincidental renal cell carcinoma and renal angiomyolipomas in tuberous sclerosis.

We report a case of bilateral renal multiple angiomyolipomas associated with renal cell carcinoma on one side in a patient with tuberous sclerosis. The difficulties in diagnosis and management of such a condition are discussed.

[Atresia hymenalis with acute urinary retention: a case report].

We report a case of atresia hymenalis in a 14-year-old girl presenting with a clinical symptom of acute urinary retention. On physical examination she was found to have a lower abdominal mass and an imperforate bulging hymen. She underwent hymenal incision, and subsequently the symptom disappeared. It is very uncommon for atresia hymenalis to manifest itself with acute urinary retention as the first clinical sign, but we should consider this disease if a pubertal girl seeks medical opinion for acute urinary retention.

[Long-term results of M-VAC for the treatment of advanced urothelial cancer].

Total of 37 patients with measurable lesions originating in advanced urothelial cancers received M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) combination chemotherapy and have been followed for a minimum of 12 months. The study included initial diagnoses of 24 bladder cancers and 13 upper urinary tract cancers in patients whose mean age was 62 years. The patients received a mean of three cycles of M-VAC. Clinical complete remission was observed in five of the 37 patients (13.5%) and partial remission was achieved in 10 patients (27.0%) after mean treatment of 2.4 and 2.1 cycles, respectively, for an over-all objective response rate of 40.5%. The mean duration of response was 11.6 +/- 7.1 months and 4.4 +/- 3.5 months for complete and partial remissions, respectively. A mean of 5.2 +/- 1.7 cycles of M-VAC was given for complete remissions and 3.5 +/- 1.4 cycles in partial remissions. An over-all survival rates after one and two years were 28.125% and 5.859%, respectively. Two of the five patients who had once marked complete remissions died after a mean survival time of 14.5 +/- 4.5 months and three survived with a mean duration of 20.3 +/- 5.4 months. Meanwhile, all of the patients who had achieved partial remissions died after a mean survival of 9.1 +/- 5.4 months except for one patient who survived more than 12 months. These results indicate that M-VAC combination chemotherapy for advanced urothelial cancer is extremely efficacious in initial responses.(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study on prophylactic intravesical instillation of bacillus Calmette-Guerin (BCG) and adriamycin for superficial bladder cancers].

In this study we evaluated 77 patients with superficial bladder cancer who were treated with either intravesical bacillus Calmette-Guerin (BCG) (44 patients) or doxorubicin hydrochloride (Adriamycin, ADR) (33 patients) for prophylaxis of tumor recurrence after transurethral resection. The estimated actuarial probability of non-recurrence rate at three years for the BCG group was 73.0%, and the actuarial non-recurrence rate for the ADR group was 27.3%; a statistically significant difference (p = 0.0013). A comparison between the two groups was also made according to the patient's background, including whether the tumor was initial or recurrent, solitary or multiple, and the tumor grade. In all areas of the study, except for grade-1 tumors, the BCG group was significantly superior to the ADR group. The efficacy of BCG therapy as a result of different BCG treatment protocol was evaluated for six weekly instillations 1) without further maintenance instillation, 2) followed by 12 months of maintenance, and 3) followed by more than 18 months of maintenance. Long-term maintenance BCG instillation group (more than 18 months) showed the most favorable results, however, the differences were not statistically significant. These results indicate that intravesical BCG instillation was significantly superior to ADR in the prevention of bladder cancer recurrence and that six weekly intravesical BCG instillations may provide adequate prophylactic effects against recurrence of superficial bladder cancers.

Tuberculous epididymo-orchitis.

In the clinical course of epididymitis in a forty-four-year-old male patient, enlargement of ipsilateral testis developed which was difficult to distinguish clinically from testicular tumor. High inguinal orchiectomy was performed. Microscopic sections revealed many granulomas with caseous necrosis and giant cells. Tuberculous bacilli also were demonstrated in the histologic examination.

Transcatheter embolization for the rupture of congenital arteriovenous malformation of the kidney in pregnancy.

We report a case of gross hematuria owing to rupture of an arteriovenous malformation at 22 weeks of gestation. Transcatheter embolization was performed successfully. A healthy newborn was delivered by cesarean section 4 months after the embolization.