[RETROSPECTIVE ANALYSIS OF POSITIVE SURGICAL MARGIN AT RADICAL PROSTATECTOMY].

We retrospectively reviewed 182 patients who underwent radical prostatectomy in our hospital between April, 2009 to December, 2012, and who had not received any prior hormonal therapy. We also excluded the patients who couldn't followed up more than 6 months after surgery and pN1 patients. Positive surgical margins were observed in 65 cases. We determined what were the significant factors associated with the margin status. The another aim of present study is to evaluate the risk factor which might have significance for biochemical recurrence. BMI ≥ 25.0, prostate volume < 40 cm3, and biopsy positive core ≥ 25% were significant predictors of positive surgical margin. PSA nadir ≥ 0.02 ng/ml and pT3 were the significant factors which associated with biochemical recurrence of those patients with positive margin status.

One-month relative dose intensity of not less than 50% predicts favourable progression-free survival in sorafenib therapy for advanced renal cell carcinoma in Japanese patients.

BACKGROUND: Sorafenib is a multikinase inhibitor used as a second-line treatment for metastatic renal cell carcinoma (mRCC). However, it is very difficult to estimate sorafenib dosage because it is difficult to maintain stable administration and dosage intervals due to several side-effects. We examined the correlation between relative dose intensity (RDI) and clinical outcome of sorafenib therapy in a multi-institutional study. METHODS: A study population of 70 first-line therapy-refractory patients with pathologically confirmed RCC was eligible for this investigation. Clinical outcomes were evaluated according to clinicopathological features and RDI for 1 month (1M-RDI). RESULTS: There was significant difference in progression-free survival (PFS) time but not overall survival (OS) time when the 1M-RDI cut-off value was ≥ 50%. In 15 patients (21.4%) with 1M-RDI of <50%, median PFS time was 4.1 months (95% I collagen (95% CI): 2.0-6.2), whereas it was 10.5 months (95% CI: 7.6-13.4) in the patients with 1M-RDI of ⩾50% (P=0.022). Multivariate analysis showed 1M-RDI status to be significantly associated with PFS (HR: 3.838, 95% CI: 1.658-8.883, P=0.002) but not OS (P=0.328). CONCLUSION: Although this study was retrospective, a 1M-RDI cut-off value of ≥ 50% for sorafenib may be the first factor to predict PFS but not OS in cytokine pretreated mRCC patients. The data indicate that a dose of 400mg/day of sorafenib administered successively for the first one month was necessary to prolong disease stabilisation and could be tolerated by Japanese patients.

[An unusual case of cystic nephroma protruding into the renal pelvis].

Cystic nephroma is a relatively rare and benign renal lesion of uncertain etiology. Approximately 200 cases have been described, but only a few cases of cystic nephroma with prominent renal pelvis involvement have been reported. Here, we report an unusual case of cystic nephroma that protruded into the renal pelvis. A 45-year-old woman hospitalized because of a right renal mass detected on clinical examination. The diagnosis of a malignant or benign lesion was not clear. A right nephroureterectomy was performed. The characteristics of the resected specimen were consistent with those of cystic nephroma. Macroscopic examination revealed that the giant lesion originated from the upper renal pelvis and extended into the renal pelvis. The patient is currently free from disease at eight months after the surgery. In general, this tumor arises from the renal parenchyma. To our knowledge, this is the fifth case report on cystic nephroma with prominent renal pelvis involvement.

[A case of liposarcoma of spermatic cord with a hydrocele].

A 59-year-old man was referred to our hospital with the chief complaint of painless left scrotal swelling. He was diagnosed with left hydrocele testis and underwent puncture of hydrocele. Radical hydrocelectomy was performed because of its frequent recurrence in a short period. A hard mass was found across the spermatic cord during the operation. The mass was removed, and histopathological examination revealed a well-differentiated liposarcoma. This was the 107th case of liposarcoma of the spermatic cord and the 3rd case with a hydrocele.

[A case of retroperitoneal myxofibrosarcoma].

A 63-year-old man presented to our hospital suffering from dull pain in his right flank and general malaise.Abdominal computed tomography (CT) revealed a 21X14 cm retroperitoneal tumor adjacent to the right kidney. He underwent extirpation of the tumor,which weighed 2,900 g. Histopathological diagnosis was high-grade myxofibrosarcoma. Six months after initial surgery,CT revealed isolated metastasis in the upper lobe of the left lung,which was surgically treated. Eleven months after the original tumor excision, CT revealed lymph node metastasis dorsal to the inferior vena cava,which was also removed. Because he refused to receive adjuvant chemotherapy,he was observed for 2 months until CT revealed multiple liver metastases and para-aortic lymph node metastasis. He underwent 1 cycle of combined chemotherapy with doxorubicin and carboplatin,but metastatic lesions grew larger rapidly and his general state became too poor to continue chemotherapy. He is under best supportive care 17 months after the initial surgery.

[Case report: collecting (Bellini) duct carcinoma during the follow-up for bladder cancer].

A 78-year-old man had undergone transurethral resection of bladder tumor (TUR-Bt) 6 times since he was diagnosed as having bladder cancer. Past histology was urothelial carcinoma, pTa, G1-G2. During the follow-up, recurrent bladder cancer was found. Enhanced computed tomography and drip infusion pyelography revealed pelvic cancer with tumor embolus in the inferior vena cava. Therefore, TUR-Bt and total ureteronephrectomy with removal of the thrombus from the vena cava was performed. The histopathological diagnosis was urothelial carcinoma of the bladder and Bellini duct carcinoma of the kidney, but in immunohistostaining surgical specimen of both bladder and kidney showed some similarities. This disease is rare. Several reports indicate an association between Bellini and urothelial carcinoma. We describe the case of the Bellini duct carcinoma of the kidney during the follow-up for bladder cancer with possibility of the association between Bellini and urothelial carcinoma.

[Experitoneal bladder perforation due to in-dwelling urethral catheter successfully treated by urethral drainage: a case report].

Perforation of the bladder related to long-term indwelling urethral catheter is a rare and serious complication. A 85-year-old man with an indwelling urethral catheter presented severe hematuria, abdominal pain with rebound tenderness and muscular tension over the suprapubic area after the exchange of the urethral catheter. Computed tomography and cystogram revealed experitoneal bladder perforation due to indwelling catheter. Three weeks after the indwelling urethral catheter had been placed, the perforation was closed. In most cases, laparotomy and suprapubic cystostomy are performed. We describe the case of experitoneal bladder perforation successfully treated by urethral drainage.

[Case report: a case of localized amyloidosis of the ureter].

A 78-year-old man visited our hospital with a chief complaint ofmacrohematuria in January 2006. Ultrasonography and computed tomography showed left hydronephroureter due to the enhanced tumor which was 10 mm in diameter in the lower ureter. Urine cytology was Class II. Retrograde pyelography could not be performed because of severe pain and hematuria. We considered the possibility of the malignant neoplasm and performed left total ureteronephrectomy in March 2007. The mucosa of the ureter was thickened and sclerosed. Microscopic appearance of the surgical specimen shows non-structural fibrosis and stained red with Congo-red stain. So amyloidosis of the ureter was suspected. After the systemic examination, the diagnosis was localized amyloidosis of the ureter. After 8 months, recurrence has not been pointed out.

[Successful treatment of hemorrhagic cystitis after radiation therapy with intravesical instillation of aluminium hydroxide gel and magnesium hydroxide: report of a case].

A 77-year-old man was admitted to our hospital due to macrohematuria and bladder tamponade. Bladder hemorrhage caused by radiation therapy had not improved after bladder lavage, intravesical drip infusion, medication of hemostatics, and transurethral coagulation. Bladder hemorrhage had completely disappeared 7 days after the intravesical instillation of 50-100 ml aluminium hydroxide gel and magnesium hydroxide for an hour per day. This method is easy and can be performed without complications. This method might be useful as first-line therapy in the case of severe bladder hemorrhage.

Chondroid syringoma of the scrotum.

A 70-year-old Japanese man complained of a nodular, non-tender scrotal mass, which had been gradually increasing in size over the last 10 years. Excisional biopsy of the scrotal specimen revealed chondroid syringoma, a very rare benign tumor, more likely to occur in the head and neck region. This is the eighth such case reported, and is an important type of scrotal tumor.

[Case of retroperitoneal paraganglioma].

Paragangliomas are rare neuroendocrine tumors that arise from hyperplastic paraganglionic cells and occur in or near the ganglia of the autonomic nervous system. Paragangliomas are classed as either functional or nonfunctional based on production of catecholamines. We report a case of retroperitoneal nonfunctional paraganglioma, which was successfully resected. A 26-year-old man presented with complaints of a mass palpable in his left lateral region. Blood and urine studies, including catecholamines, were within normal limits. Computed tomography and magnetic resonance imaging showed a solid cystic mass in the left retroperitoneal space without any distant metastasis. On exploration, there was an encapsulated, vascular mass 10 cm in diameter. There was no pedicle and no connection of the tumor to the abdominal or retroperitoneal organs. Complete excision of the tumor was performed smoothly. The postoperative period was uneventful. Histological findings were of paraganglioma, and there was no surgical margin. The patient did not receive any further treatment. Nine months after surgery, there were no signs of tumor recurrence.

[Case of self mutilation of urethra in a Munchausen's syndrome patient].

A 33-year-old man presented with urethral bleeding and syncope. Urethroscopy revealed erosive lesion with bleeding at bulbar urethra. Magnetic resonance imaging, biopsy, and blood examination were performed, but the cause of urethral bleeding was not identified. By accident, chopsticks with blood ware detected in his ward. It was revealed that urethral bleeding was caused by self-mutilation with chopsticks. He consulted a psychiatrist, and was diagnosed with 'munchausen's syndrome'.

[Sarcomatoid carcinoma of the urinary bladder: report of a case].

A 77-year-old man was admitted to our hospital for a scheduled examination after transurethral resection of transitional cell carcinoma of urinary bladder. Tumor reccurence was found in the bladder by cystoscopic examination. Total cystectomy and unilateral cutaneous ureterostomy were performed. Histologically the tumor was composed of epithelial and sarcomatous elements. Therefore, we diagnosed this tumor as sarcomatoid carcinoma. The patient died of lung metastasis three months after operation. Autopsy findings showed lung metastasis and local reccurence which were composed of carcinomatous and sarcomatous elements. About 64 cases of sarcomatoid carcinoma of the urinary bladder have been reported in the Japanese literature and are reviewed briefly here.

[Recrudescence of prostate cancer with low serum level of PSA and high serum level of CEA and CA19-9: a case report].

We report a case of primary adenocarcinoma of the prostate producing carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9). A 64-year-old man referred to our hospital with dysbasia. Two years ago, he was diagnosed with prostate cancer at another hospital and received radiotherapy and endocrine therapy. Serum CEA and CA 19-9 levels were increased to 3,990 ng/ml and 11,700 U/ml at the time of our hospitalization. However, his serum PSA level remained low. After hospitalization, the disease rapidly progressed and he died a month later. In the histology of autopsy specimen, the prostate showed no sign of malignancy, but bone showed metastasis of prostate cancer. Immunohistochemical staining for CEA and PSA demonstrated the existence of each protein in bone metastasis.

[Analysis of transrectal needle biopsy of the prostate: usefulness of systematic 12 core biopsy].

A total of 978 of transrectal prostate biopsies performed between January 1998 and December 2005 at Ikeda Municipal Hospital were reviewed to determine the usefulness of the systematic 12 core biopsy including the apex and transition zone (TZ). Prostate cancer was detected in 531 of the 978 cases (54.3%). The systematic 6 core biopsy was performed between 1998 and 2000. In this group the cancer detection rate was 40.8% (87 out of 213 cases). In the systematic 12 core biopsy group since 2001 the cancer detection rate was 58.0% (444 out of 765 cases). The cancer detection ratio in the systematic 12 core biopsy group was significantly higher than that in the 6 core group (p<0.0001). In the subgroup whose prostate-specific antigen (PSA) value was in the gray zone (4. 1-10.0 ng/ml), the cancer detection rate was 22.9% (25 of 109 cases) in the systematic 6 core biopsy group and 45.7% (186 of 407 cases) in the systematic 12 core biopsy group. Of the 444 cases diagnosed as having prostate cancer by the systematic 12 core biopsy, 64 cases (14.4%) had positive cores only in additional cores from the apex and TZ. Our study revealed that the systematic 12 core prostate biopsy including the apex and TZ was useful for improving the cancer detection ratio of the prostate.

[A case of giant renal artery aneurysm].

A 72-year-old woman consulted our hospital for a cystic mass in the right kidney. Ultrasonography and drip infusion pyelography revealed a right renal cystic mass 10 cm in diameter and right hydronephrosis. Computed tomography (CT) and magnetic resonance imaging revealed a giant mass with partial calcification in the right renal hilus. The mass was diagnosed the fusiform aneurysm 10 cm in diameter occurring in the main stem of right renal artery by selective abdominal angiography and 3-dimensional CT. We performed total nephrectomy and the histological finding was atherosclerosis. A total of 485 cases of renal artery aneurysm have been reported in Japan. These cases and 15 cases of renal artery aneurysm more than 5.0 cm in diameter are herein reviewed.

[Invasive bladder cancer recurrenced 5 years after complete response status by chemotherapy and radiotherapy: a case report].

A 72-year-old man had undergone trasucethral resection of bladder tumor (TUR-Bt) three times from 1990 to 1991 and he had been lost to follow with no recurrence from 1996, came to our hospital complaining of asymptomatic macrohematuria in May 1999. A bladder tumor existed around the right ureteral orifice with right hydronephrosis. MRI and TUR-Bt revealed that the cancer was transitional cell carcinoma (TCC) > small cell carcinoma, G3, pT3b. Because the patient insisted on bladder preservation, intra arterial chemotherapy with cisplatinum (CDDP) and epirubicin (EPI-adr) followed by radiotherapy with CDDP was performed. The treatment resulted in a clinical complete response (CR), and the bladder was preserved. In January 2004, an invasive bladder cancer recurred at the left lateral wall. This time, neoadjuvant intra-arterial chemotherapy with CDDP and EPI-adr, followed by radical cystectomy was performed. Histologically, the recurrent bladder cancer was TCC, G3, pT3b.

[A case of renal angiomyolipoma with marked cystic degeneration and pseudoaneurysm].

A 59-year-old woman consulted our hospital for a left renal mass which she had been aware of for 4 years. The tumor was in the lower portion of the left kidney. It was a cystic tumor whose wall was enhanced on computed tomography and magnetic resonance imaging. The lesion 3.0 cm in diameter, which was enhanced equally to the aorta, was found in a part of the wall. It was thought to be a pseudoaneurysm by renal angiography. We suspected a cystic renal cell carcinoma because of the plural feeding arteries and tumor staining, and performed left total nephrectomy. Pathological diagnosis was angiomyolipoma with few fat components. To our knowledge only 3 previous cases of renal angiomyolipoma with marked cystic degeneration have been reported in Japan. In all 3 cases, it was difficult in preoperative diagnosis to distinguish angiomyolipoma with cystic degeneration from cystic renal cell carcinoma complicated cyst. Moreover, this is the first reported case of renal angiomyolipoma with marked cystic degeneration and pseudoaneurysm.