[Tuberculous epididymitis caused by intravesical BCG therapy: a case report].

We describe a case of tuberculous epididymitis that occurred 35 months after completion of a course of intravesical Bacillus Calmette-Guerin (BCG). A 67-year-old man had received trasuretheral resection for bladder cancer in February 1997. Two weeks after the operation, a course of 8 weekly intravesical instillations of BCG (Tokyo 172 strain) was carried out between March and April, 1997. Under the diagnosis of benign prostatic hypertrophy, transuretheral resection of the prostate was performed in March 1998. Multiple tuberculous nodules were histopathologically detected in resected prostatic tissues. The patient complained of a small nodule in the right epididymal tail in August 2001. The nodule developed during 6 weeks, with spontaneous perforation of the scrotal skin and discharge of pus. The pus contained acid-fast bacilli, which were shown to be tubercle bacilli by polymerase chain reaction (PCR) with pan-mycobacterium primer. MPB64-T2, T6 and pncA-7, 11C were positive, while PT-1, 2 and pncA-7, 10 were negative by PCR. These results revealed that Mycobacterium bovis (BCG Organism) was the cause of the epididymitis. Drug therapy for 3 months with rifampicin, isoniazid and ethambutol was initiated in September 2001, and right orchiectomy was performed in October. Histopathological examination showed tuberculous epididymitis. In this case, persistent BCG organisms may have reached the epididymis from the prostate, and may have been activated by immunosuppression associated with aging. In addition, PCR with species-specific primers was useful in differentiating Mycobacterium bovis from Mycobacterium tuberculosis.

[Signet ring cell carcinoma of the prostate successfully treated with endocrine therapy: a case report].

A 67-year-old man complained of dysuria. The prostate was enlarged and stony hard. The serum level of prostate specific antigen was abnormally high (46.2 ng/ml). Prostatic biopsy showed signet ring cells which were stained positive for prostate specific antigen and poorly differentiated adenocarcinoma. Computed tomographic scan revealed the enlargement of the para-aortic lymph nodes. Endocrine therapy with luteinizing hormone-releasing hormone agonist was started. After two months, the serum level of prostate specific antigen decreased to the normal range. The pathological findings and the good response to endocrine therapy in our case suggest that signet ring cell carcinoma of the prostate is only a morphologic variant of ordinary prostatic adenocarcinoma.

[Small cell carcinoma of the prostate successfully treated with combined chemotherapy and radiotherapy: a case report].

A 49-year-old man complained of dysuria and pollakisuria. The prostate was enlarged, and the serum level of prostate specific antigen was within the normal range. Under the diagnosis of benign prostatic hypertrophy, transurethral resection of the prostate was performed. Unexpectedly, histopathological examination of the resected tissues revealed pure small cell carcinoma. The serum level of progastrin-releasing peptide (ProGRP) was slightly elevated. The cancer was clinically diagnosed as stage C. Pelvic radiotherapy combined with chemotherapy using cisplatin (CDDP) and etoposide (VP-16) was started according to the treatment for limited small cell cancer of the lung. After one month, the serum level of ProGRP decreased to the normal range. After four months, the prostate was reduced in size without any findings of metastases on computed tomography, and prostate biopsy revealed no viable cancer cells.