[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.

[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.

[Case report: a case with small cell carcinoma of the bladder transformed from urothelial carcinoma].

A 69 year-old woman visited our hospital with a chief complaint of macrohematuria in April 2004. She was diagnosed with bladder tumor. She underwent transurethral resection ofbladdar tumor three times and right partial ureterectomy for ureteral tumor following primary bladder carcinoma. All pathological findings demonstrated that the tumor was urothelial carcinoma (UC), G1-G2, pT1 including right ureteral tumor. In spite of intravesical instillation of BCG, recurrent invasive bladder tumor was found in June 2006. In July 2006, we performed total cystectomy and construction of ileal conduit. Surgical specimen revealed small cell carcinoma and immunohistochemical staining with NSE and synaptophysin was positive. On day 67 after operation, the patient died of multiple metastases to liver and bone.

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.

Brain metastasis from small-cell neuroendocrine carcinoma of the urinary bladder: a case report.

Eight months after radical surgery for small-cell neuroendocrine carcinoma (SCNC) of the urinary bladder, a 69-year-old man was admitted with a brain tumor in the left frontal lobe. The tumor, about 5 cm in diameter, was intensely but heterogeneously enhanced on computed tomography and magnetic resonance imaging. The tumor was subtotally removed, leaving only the portion adjacent to the anterior horn of the left lateral ventricle. Microscopically, the tumor was composed of diffuse sheets of small tumor cells with round to spindle-shaped nuclei, indistinct nucleoli, scant or absent cytoplasm, and indistinct cell margins. Immunohistochemically, the tumor cells were positive for synaptophysin, neuron-specific enolase, chromogranin A, and keratin. Ultrastructurally, the tumor cells showed classic neurosecretory granules and microvilli in the cytoplasm. The tumor was diagnosed as a brain metastasis from SCNC of the urinary bladder. After surgery, whole-brain radiation therapy of 40 Gy was performed, which succeeded in controlling the residual tumor. However, 4 months after surgery, the patient died of meningeal carcinomatosis. To our knowledge, this is the first report focusing on brain metastasis from SCNC of the urinary bladder. The clinicopathological features and pathological diagnosis of this tumor are discussed.