A case of sarcoidosis-like reaction associated with immune checkpoint inhibitors in metastatic renal cell carcinoma.

INTRODUCTION: Immune checkpoint inhibitors are one of the standard treatments for metastatic renal cell carcinoma. Among immune-related adverse events, the sarcoidosis-like reaction is frequently difficult to differentiate from cancer progression. CASE PRESENTATION: A 58-year-old man with renal cell carcinoma with multiple lung metastases was treated with ipilimumab and nivolumab after nephrectomy. Computed tomography after three courses of treatment revealed hilar/mediastinal lymphadenopathies, pleural nodules, and pulmonary interstitial lesions, whereas lung metastases were markedly regressed. Considering positive findings of Gallium scintigraphy and serological tests together, we clinically judged the new lesions as a sarcoidosis-like reaction and continued the treatment until cessation by liver dysfunction. After discontinuation of the immunotherapy, the sarcoidosis-like reaction was regressed without cancer relapse. CONCLUSION: We report here the first case of a clinically diagnosed sarcoidosis-like reaction in metastatic renal cell carcinoma following treatment with immune checkpoint inhibitors.

Significance of PSA Screening in Niigata, Japan: Survey of Actual Status of New Cases of Prostate Cancer.

PURPOSE: This study aims to investigate the utility of prostate-specific antigen (PSA) screening by conducting an all-case survey of newly diagnosed prostate cancer patients at Niigata Prefecture, Japan. PATIENTS AND METHODS: Depending on whether patients were subjected to screening, information was prospectively collected on all prostate cancer patients newly diagnosed between October 1, 2019, and September 30, 2020, at all institutions in Niigata Prefecture where urologists performing prostate biopsy routinely work and differences in clinical parameters were investigated. RESULTS: PSA was measured in 478 out of 1332 patients (35.8%) as part of a community health screening. The rate of metastatic carcinoma (M1) in all patients was 14.9%. When patients were divided into three categories of population-based screening (community health screening and workplace health screening), opportunistic screening (PSA measurements at complete medical check-ups or on patient request), and testing triggered by clinical symptoms or findings, the proportion of metastatic cancer was 4.5%, 3.7%, and 30.6%, respectively, demonstrating that the number of distant metastases was significantly lesser in all patients who underwent screening. CONCLUSION: The one-year all-case survey of newly diagnosed prostate cancer patients demonstrated that PSA screening significantly contributed to the early diagnosis of current prostate cancer in Japan.

Ureteropelvic junction disruption associated with Chance fracture dislocation: A case of seat belt injury.

We experienced a rare case of ureteropelvic junction disruption (UPJD) as a seat belt injury. A 19-year-old female was transferred after a car accident while wearing a seat belt. Computed tomography showed multiple fractures including Chance fracture dislocation of the first lumbar spine and right renal laceration with partial infarction. Emergency posterior spinal fusion was performed. The next day, computed tomography revealed right perirenal contrast extravasation, and right UPJD was confirmed with retrograde urography and ureteroscopy. Ureteropelvic reanastomosis was performed. Computed tomography of excretory phase or repeat evaluation is recommended to prevent delayed diagnosis of UPJD including seat belt injury.

Pancreatic metastasis from locally recurrent neuroendocrine differentiated prostate cancer after radical prostatectomy.

Pancreatic metastasis from prostate cancer (PC) is quite rare. Herein, we report the case of a 67-year-old man with pancreatic metastasis from a neuroendocrine differentiated PC (NEDPC), a local recurrence after radical prostatectomy and androgen deprivation therapy for 6 years. Chemoradiotherapy was initiated for the locally recurrent NEDPC, and it had almost disappeared after the therapy. However, rapidly enlarged pancreatic metastasis from the NEDPC was detected 6 months after therapy. There is no standard treatment available for pancreatic metastasis from NEDPC owing to its rarity; hence, further knowledge and clinical experience regarding it are crucial.

Duodenal and rectal obstructions due to urothelial cancer infiltration from recurrent renal pelvic cancer in the bladder wall: An autopsy case.

Duodenal and rectal obstructions due to urological malignancies are relatively uncommon. We report an autopsy case of an 83-year-old man with a history of renal pelvic cancer who presented these obstructions. Autopsy revealed that urothelial cancer infiltrated the bladder wall, duodenal wall, rectal wall, and prostate and widely spread in the retroperitoneal lymphatic vessel. We concluded that renal pelvic cancer recurred in the bladder wall and then infiltrated into each organ because of lymphatic dissemination. The gastrointestinal obstructions due to urinary tract cancer were lethal. Further knowledge and clinical experience regarding these types of obstructions are crucial.

Trousseau's syndrome manifesting as multiple cerebral infarctions caused by bladder cancer.

Cerebral infarction in patients with cancer is often called Trousseau's syndrome, which is a cancer-associated hypercoagulative state that causes thrombosis; however, the syndrome is rarely caused by bladder cancer. We report a case of Trousseau's syndrome manifesting as multiple cerebral infarctions caused by advanced bladder cancer in a 46-year-old male patient. The patient died due to the infarctions in the hospital. The prognosis of patients with Trousseau's syndrome caused by advanced cancer is poor. According to changing urological clinical settings, considering the risk of Trousseau's syndrome has become crucial for urologists treating patients with advanced cancer.

Common iliac artery thrombosis as a possible complication of the pluck technique in nephroureterectomy.

Common iliac artery (CIA) thrombosis is a rare surgical complication which may cause serious leg damage and may occasionally be fatal. We experienced two cases of CIA thrombosis in nephroureterectomy with the pluck technique for upper tract urothelial carcinoma. Patients were treated using emergent femoro-femoral bypass, and one patient was treated with fasciotomy of the lower extremity for compartment syndrome. CIA thrombosis is considered a possible complication of nephroureterectomy, particularly with the pluck technique in open surgery. Arterial thrombosis in intrapelvic surgery including nephroureterectomy should be carefully considered for patients at risk.

Late-onset rectal bleeding with hemorrhagic shock after transrectal prostate needle biopsy.

Late-onset rectal bleeding after transrectal prostate needle biopsy is potentially life-threatening. We report the case of a 75-year-old male who presented with severe rectal bleeding 3 days after transrectal prostate needle biopsy. Because the bleeding could not be arrested by conservative treatment, emergent colorectal endoscopic clipping (twice) and elective angiography were performed. Packed red blood cell transfusion (14 units in total) was required to treat the developed hemorrhagic shock. Colorectal endoscopy and arterial embolization are effective treatments for severe rectal bleeding after transrectal prostate needle biopsy and should be performed without hesitation.

Dedifferentiated spermatic cord liposarcoma with macroscopic ossification.

INTRODUCTION: Liposarcoma is a malignant neoplasm of the adipose tissue, and dedifferentiated liposarcoma is a relatively rare subtype. Liposarcomas are typically located in the lower extremities or retroperitoneum, but dedifferentiated liposarcoma of the spermatic cord is rare and no case of it with macroscopic ossification has been reported in the literature. CASE PRESENTATION: A male presented to our hospital with a painful, palpable, and hard left suprapubic mass, formed over 3 months. The mass was diagnosed as a spermatic cord tumor and was resected using high orchiectomy. Due to the histological diagnosis of dedifferentiated spermatic cord liposarcoma with ossification and positive margins, a second extended resection and adjuvant radiotherapy were performed. CONCLUSION: To differentiate spermatic cord liposarcoma preoperatively is difficult. There is no gold standard treatment for it, although surgical complete resection with clear microscopic margins would be the most effective treatment.

Hypercalcemia associated with lymph node metastasis following radical cystectomy for bladder cancer.

INTRODUCTION: A part of hypercalcemia is a paraneoplastic syndrome. Its association with lymph node metastasis of bladder cancer has been infrequently reported in the literature. CASE PRESENTATION: A 75-year-old male presented with gross hematuria and was diagnosed with bladder cancer without metastasis. Following neoadjuvant chemotherapy, radical cystectomy was performed. The surgical margin was negative. The bladder cancer was classified as pT3bN0 and mainly constituted squamous differentiated urothelial carcinoma and sarcomatoid variant. His perioperative serum calcium levels were normal. At 6 months of surgery, computed tomography revealed lymph node enlargement, and additional 2 weeks later, he developed epileptic seizures with a serum corrected calcium level of 18.7 mg/dL. He was diagnosed with hypercalcemia caused by the lymph node metastasis of bladder cancer. Despite receiving several supportive therapies for 22 days, he died. CONCLUSION: Hypercalcemia associated with bladder cancer is highly resistant to existing therapy, particularly when caused by cancer metastasis.

Continuous remission of renal cell carcinoma with tumour thrombus after severe adverse events following short-term treatment with sunitinib.

A 64-year-old Japanese man with renal cell carcinoma (RCC) and tumour thrombus in the inferior vena cava was treated with sunitinib. Two weeks after treatment, he was hospitalised for disturbance of consciousness. Laboratory tests revealed high-grade hypoglycaemia, hyponatraemia, liver dysfunction and thrombocytopaenia with disseminated intravascular coagulation. Sunitinib was discontinued and the patient recovered after a protracted platelet transfusion. At 5 months after treatment, CT revealed that the tumour thrombus had disappeared and other lesions had regressed. MRI at 15 months revealed further regression and suggested the possibility of histological remission according to the signal intensity of fibrosis. A partial response persisted at 20 months after treatment, despite residual accumulation in the renal tumour evident on positron emission tomography. In summary, we present a case of locally advanced RCC accompanied by severe adverse events that showed a significant and durable response to treatment with sunitinib for just 2 weeks.

Obstruction of the ileal ureter by mesenteric vessels occurring 5 years after total ureteral substitution for bilateral ureteral stenosis due to systemic lupus erythematosus.

We previously reported a case of bilateral ureteral stenosis accompanied by systemic lupus erythematosus, which was successfully managed by total ureteral reconstruction using a segment of the ileum. Herein, we describe an unusual complication in the same patient, which we experienced 5 years after the ileal-ureteral substitution. Left-sided back pain repeated together with transient obstruction of the ileal ureter interposed between the right and left renal pelvis. Consequently, exploratory laparotomy revealed that left colic vessels oppressed and caused obstruction, and the obstructed ileal ureter was released by reconstitution of these vessels instead of re-anastomosis of the ileal ureter. Left hydronephrosis and related back pain disappeared postoperatively. The number of patients with an indication of ileal-ureteral substitution is increasing for various disorders, and thus, the present report gives additional suggestions for the follow up of patients with ileal ureter.

[Intermittent oral hormonal chemotherapy using estramustine phosphate and etoposide for the treatment of hormone-refractory prostate cancer].

Seventeen patients were given lower dose and intermittent oral administration of estramustine phosphate (6 mg/kg/day) and etoposide (30 mg/m2/day) for 7 days. Then administration was discontinued for 7 days. This administration cycle was repeated. Therapy was continued until evidence of disease progression or unacceptable toxicity occurred. Fifteen of the 17 patients were finally evaluated for PSA response. Overall, the pretreatment PSA levels were lowered at least 50% from baseline in 7 (47%) of the 15 patients. The median survival was 65 weeks. Five of the 17 patients complained of anorexia or nausea during the treatment, but none of them showed over grade 2 anorexia, none requiring transfusion or hospitalization. None of the patients showed edema, deep venous thrombosis, thrombocytopenia, anemia or myocardial infarction. Because of its rare and mild adverse effects, this intermittent administration of oral estramustine and oral etoposide may be a useful and secure regimen for hormone refractory prostate cancer.