Co-expression of ERCC1 and Snail is a prognostic but not predictive factor of cisplatin-based neoadjuvant chemotherapy for bladder cancer.

Neoadjuvant chemotherapy (NC) for bladder cancer has been reported to significantly improve the 5-year survival rate. The aim of the present study was to examine the roles of ERCC1 and Snail in determining the response to chemotherapy in bladder cancer treated with NC and radical cystectomy (RC). The expression of the Snail and ERCC1 proteins was determined by immunohistochemical staining of specimens obtained from 58 patients with bladder tumors treated with NC and RC. The correlation between clinical response and the expression of Snail and ERCC1 was investigated. Snail and ERCC1 were co-expressed in 24 (41.4%) of the 58 patients. A marked correlation was found between the expression of Snail and ERCC1 (P=0.001). The co-expression of Snail and ERCC1 was not able to predict pathological complete response (P=0.202). Results of the univariate analysis revealed that the co-expression of Snail and ERCC1 predicted shorter disease-free survival (DFS) and overall survival (OS) than the negative expression of Snail and/or ERCC1. Moreover, the co-expression of ERCC1 and Snail was the only predictive factor for both DFS (P=0.029) and OS (P=0.040). The expression of Snail was correlated with that of ERCC1 and the co-expression of Snail and ERCC1 was the only significant predictive factor of shorter DFS and OS in patients with bladder cancer treated with NC and RC.

[Bilateral upper tract urothelial carcinoma eight years after total cystectomy and Indiana pouch urinary diversion for bladder cancer : a case report].

A 46-year-old man underwent total cystectomy and Indiana pouch urinary diversion for bladder cancer in 2001. Pathological examination revealed an urothelial carcinoma of the bladder (pT2N0M0). He was referred to our hospital for bilateral hydronephrosis in June 2009. Cytological examination of the urine was negative. Percutaneous nephrostomy was performed, and we suspected bilateral ureteral tumors from pyelo-ureterography. Percutaneous ureteroscopy revealed a papillary tumor in the right ureter. Since there appeared to be a papillary tumor in the left ureter, we decided to perform ureterectomy for bilateral ureteral tumors, and to keep the bilateral nephrostomy tube for urinary diversion. Pathological examination revealed urothelial carcinoma in bilateral ureters. There has been no sign of recurrence at 17 months after the operation.

Clinical outcome and prognostic factors of sorafenib in Japanese patients with advanced renal cell carcinoma in general clinical practice.

OBJECTIVE: Effects of sorafenib in general clinical practice, especially those with patients of Asian ethnicity, have been rarely investigated. We assessed efficacy, safety and prognostic factors for progression-free survival in Japanese patients receiving sorafenib for advanced renal cell carcinoma. METHODS: We performed a retrospective analysis of 159 Japanese patients with renal cell carcinoma. Progression-free survival was estimated by the Kaplan-Meier method. Objective response (per Response Evaluation Criteria in Solid Tumors) and safety were assessed. Cox proportional hazards model was used to identify independent prognostic factors for progression-free survival. RESULTS: The median progression-free survival was 9.0 months (95% confidence interval, 7.5-10.6 months). In 142 patients with measurable lesions, the objective response rate was 21.8%, and disease control was achieved in 85 (59.9%) patients. Adverse events of any grade occurred in 152 patients (95.6%). Most common adverse events causing discontinuation or interruption of sorafenib were hand-foot skin reaction (22%), rash (10.7%) and liver dysfunction (10.7%). Dose reduction or therapy interruption due to adverse events was required in 128 patients (80.5%). Univariate and multivariate analysis revealed that favorable prognosis according to Memorial Sloan-Kettering Cancer Center prognostic factors and relative dose intensity during the first month of treatment of ≥50% were significant factors for predicting superior progression-free survival with sorafenib treatment. CONCLUSIONS: Sorafenib was effective in Japanese patients with advanced renal cell carcinoma in general clinical practice and was tolerated although most patients required dose reduction or interruption of therapy. Future studies should establish new strategies for treatment without sacrificing both efficacy and patient quality of life.

[Vesicovaginal fistula caused by abdominal hysterectomy and sacrocolpopexy with polypropylene mesh (GYNEMESH): a case report].

A 45-year-old woman underwent abdominal simple hysterectomy and sacrocolpopexy with polypropylene mesh (GYNEMESH) for uterine prolapse at the department of Gynecology in October 2006. One month after the operation, she visited our department with a complaint of urinary incontinence. Cystography and magnetic resonance imaging revealed a vesicovaginal fistula. A foley catheter was indwelt for the purpose of conservative treatment, but failed. Considering possible infection and inflammation remaining, we decided to perform abdominal repair of the vesicovaginal fistula about three months after the operation. Transabdominal repair of the vesicovaginal fistula was performed in February 2007. During the operation, a fistula 3 mm in diameter was confirmed just adjacent to the distal edge of the polypropylene mesh which had been fixed between the bladder and the anterior wall of vagina. Eleven days after the operation, cystography revealed no evidence of the vesicovaginal fistula. There has been no sign of recurrence at three years after the operation.

[Pheochromocytoma with retroperitoneal hemorrhage after abdominal trauma].

A 35-year-old man was delivered to the emergency room complaining of right flank pain because of blunt abdominal trauma sustained while playing baseball. Enhanced computed tomography (CT) revealed a right adrenal mass and fluid collection around the mass. We diagnosed the mass as pheochromocytoma by endocrinological examination and radioisotopical imaging test. After absorption of the hematoma three months after the injury, laparoscopic right adrenalectomy was performed. He had an uncomplicated postoperative course without supplementation of catecholamine. Pathological findings were compatible with pheochromocytoma. Eight months after the operation, he had no evidence of recurrence.

[Plasmacytoid urothelial carcinoma of the bladder: a case report].

We experienced a case of plasmacytoid urothelial carcinoma of the bladder. A 79-year-old man was referred with urinary frequency. Computed Tomography, Magnetic Resonance Imaging and ultra-sonography of the abdomen showed a diffuse and invasive mass occupying most of the bladder. Cystoscopy showed mostly non papillary tumor in the bladder, which was resected. Pathological examination of the specimen showed a diffuse monotonous cellular infiltration that invaded the lamina propria and the muscularis propria. He received radical cystectomy, and two cycles of systemic chemotherapy were performed with methotrexate, etoposide, vinblastine, and cisplatin, due to a lymphnode metastasis (pT3a, pN1, M0). He was disease free for 11 months. The tumor cells were medium-sized, round with eosinophilic cytoplasm and eccentric nuclei, producing a plasmacytoid appearance. Immunohistochemical studies were positive for epithelial markers and negative for lymphoid markers. So, we could diagnose as plasmacytoid urothelial carcinoma. This is a rare tumor. This case is the 30th case in the English literature.

[A case of retroperitoneal solitary fibrous tumor associated with hypoglycemia].

Solitary fibrous tumor is an uncommon mesenchymal lesion, seldom associated with hypoglycemia and rarely presents as a retroperitoneal tumor. We present a case in a 56-year-old male patient whose initial symptom was unconsciousness due to hypoglycemia (blood glucose 16 mg/dl). Computed tomography indicated a mass (about 20 x 15 x 15 cm) in the retroperitoneum. Only surgical treatment was performed and the patient has been without hypoglycemia and recurrence for 12 months after surgery. This case had "patternless pattern" characterized by a haphazard, storiform arrangement of short spindle or ovoid cells, and "hemangiopericytoma-like appearance" with prominent vascularity by thin-walled vessels, as expressed CD34 immunohistochemically. Pathohistological examination revealed increased cellularity in the tumor tissues as well as tissues with atypical nuclei of the tumor cells with some cell division. Western immunoblotting and immunohistochemistry showed that tumor produced big IGF-II, leading to hypoglycemia. Due to these findings, it was diagnosed as malignant solitary fibrous tumor associated with non-islet cell tumor hypoglycemia (NICTH). This case is the second malignant solitary fibrous tumor in the retroperitoneum with hypoglycemia in the English literature.

[Female urethral adenocarcinoma with urinary retention: a case report].

A 57-year-old woman presented with urinary retention. Computed tomography revealed a pelvic mass. Vaginal examination revealed an elastic-hard mass beneath the anterior vaginal wall. Intravenous pyelography demonstrated the filling defect of bladder. Magnetic resonance imaging revealed the mass that had invaded bladder neck at dorsal side of urethra. Pathological examination of transvaginal needle biopsy suggested well-differentiated adenocarcinoma. Total cystectomy and ileal conduct formation was performed. Pathological diagnosis was urethral adenocarcinoma. She had local recurrence at perineum at seven months after the operation, and tumor resection was performed. Five months after the operation, she had no evidence of recurrence.

Alternative nonsteroidal antiandrogen therapy for advanced prostate cancer that relapsed after initial maximum androgen blockade.

PURPOSE: Large meta-analyses have documented that maximum androgen blockade with nonsteroidal antiandrogens for advanced prostate cancer confers survival benefits, although it remains controversial. Also, we and others have reported the effectiveness of second line hormonal therapy for prostate cancer that relapses after initial hormone therapy. However, there is little clinical evidence of the effectiveness of the latter treatment strategy. Therefore, in this multicenter trial in Japan we analyzed clinical outcomes following alternative changing from 1 nonsteroidal antiandrogen to another, ie bicalutamide to flutamide and flutamide to bicalutamide, for advanced prostate cancer that relapsed after initial maximum androgen blockade. MATERIALS AND METHODS: The study included 232 patients with advanced prostate cancer who were initially treated with maximum androgen blockade, including surgical or medical castration combined with nonsteroidal antiandrogens. If a patient relapsed while on first line therapy, we discontinued antiandrogen and evaluated the patient for antiandrogen withdrawal syndrome. We then administered an alternative antiandrogen and evaluated its effect. RESULTS: The incidence of antiandrogen withdrawal syndrome after initial maximum androgen blockade was 15.5% for bicalutamide and 12.8% for flutamide. A prostate specific antigen decrease after antiandrogen withdrawal was a prognostic factor. Nonsteroidal antiandrogens as alternative therapy in patients with relapse after the initial maximum androgen blockade were effective (prostate specific antigen decrease greater than 50%) as second line maximum androgen blockade. Of 232 patients 142 (61.2%) showed a prostate specific antigen decrease in response to an alternative antiandrogen. These responders had significantly better survival than nonresponders, suggesting that responsiveness to second line therapy predicts increased survival. CONCLUSIONS: Following maximum androgen blockade with an alternative nonsteroidal antiandrogen is effective for advanced prostate cancer that has relapsed after initial maximum androgen blockade. Even a partial response to second line maximum androgen blockade was associated with improved survival. Our data support the notion that responders to second line regimens are androgen independent but still hormonally sensitive.

Hyperbaric oxygen therapy for radiation-induced hemorrhagic cystitis.

Hyperbaric oxygen (HBO) therapy has recently emerged as a potential primary option for the management of hemorrhagic cystitis. We review our experience treating hemorrhagic cystitis with HBO. Between January 2001 and May 2007, eight patients with radiation-induced hemorrhagic cystitis underwent HBO therapy. There were five men and three women with a mean age of 64.3 years (47-73). Radiation was given for local disease, and the mean dosage delivered was 56.6 Gy (42-70). The mean duration between the onset of hematuria and the beginning of HBO therapy was 8.9 months (3-34). Mean follow-up period was 15.5 months (2-31). Hematuria resolved completely in six of the eight patients, one of whom suffered recurrence of hematuria and was treated with HBO until the hematuria resolved again. The response rate was 75%, compatible with the previous reports, and no side-effects of HBO were noted. HBO treatment should be attempted for radiation-induced hemorrhagic cystitis.

[Carcinosarcoma of the prostate: a case report].

A 63-year-old Japanese man with a 1-month history of dyschezia and dysuria was referred to our hospital. Transrectal ultrasonography and magnetic resonance imaging demonstrated a mass involving the prostate, measuring about 6.5 cm. The serum prostate specific antigen was 20.3 ng/ml. By the transperineal needle biopsy, it was suspected to be fibrosarcoma. Total pelvic exenteration was performed. Histopathological examination of the tumor revealed carcinosarcoma of the prostate. One month after the operation local recurrence was manifested by perineal pain. The recurrent tumor grew rapidly with severe pain. The patient's condition deteriorated, and finally he died of the disease nine months after the operation. Carcinosarcoma of the prostate is a rare neoplasm and very aggressive. There is no established protocol for its treatment and its prognosis is usually poor. This is the 49th case reported in the literature.

[Primary adenocarcinoma of renal pelvis and ureter suspected as metastatic tumor: a case report].

A 58-year-old man, who had undergone sigmoidectomy for sigmoid colon adenocarcinoma 3 years earlier, was referred to our clinic because of left ureteral tumor incidentally found by computed tomography (CT). Under the diagnosis of left ureteral carcinoma, retroperitoneoscopic left nephroureterectomy was performed. Pathological examination revealed adenocarcinoma of the left renal pelvis and ureter. Subtype of the adenocarcinoma was 'enteric type'. Five months later, urine cytology was positive and multiple non-papillary tumors were found on cystoscopy. By the transurethral resection of the tumors, bladder tumors appeared to be adenocarcinoma. Carefully considering the pathological findings and clinical course, we concluded that the tumor was not metastatic but primary adenocarcinoma followed by intravesical recurrence.

[Parastomal hernia with incarcerated necrosis at ascending colon 18 years after the construction of ileal conduit: a case report].

A 78-year-old woman had undergone radical cystectomy and construction of ileal conduit because of bladder cancer in 1988. Eighteen years after the operation, she was referred to our hospital with the chief complaint of abdominal pain and oliguria. She had a mass just superolateral to the stoma with tenderness and reddish skin. Abdominal X-ray and computed tomographic scanning showed free air and peristomal intestinal dilation in the subcutaneous area. With a diagnosis of incarcerated parastomal hernia and intestinal perforation, emergency operation was performed. The orifice of the hernia was located in the superolateral aspect of the stoma. The ascending colon was locally necrotic and perforated. Usually, the orifice of parastomal hernia is so wide that incarceration rarely occurs. Parastomal hernia treated with emergency operation is rare, with only 9 cases, including our case, reported in the Japanese literature. Three cases had ileal conduit, and the content of the hernia was the ascending colon only in our case.

[Prostate small cell carcinoma: report of two cases that differed in treatment responsiveness].

Case 1 : A 76-year-old man with a chief complaint of dysuria had an elevated prostate specific antigen (PSA) level of 24.9. He underwent a transperineal needle biopsy of the prostate, and the histopathological diagnosis was prostatic small cell carcinoma. The cancer was clinically diagnosed as T3bN1M1 with multiple lung metastases. He started receiving hormonal therapy. After three months of hormonal therapy, the multiple lung metastases disappeared. Thereafter, the serum PSA level and the tumor volume increased and he died 12 months from the start of therapy. Case 2: A 79-year-old man was referred to our hospital with a chief complaint of dysuria. The serum level of PSA was elevated to 10.4. Transperineal prostate biopsy revealed prostatic small cell carcinoma. The cancer was clinically diagnosed as T3bN1M1, and hormonal therapy was started. Subsequently, although his serum PSA level declined, his condition worsened rapidly and he died five months after the start of therapy.

[Clinical study of 18 vesicointestinal fistulas].

We studied 18 cases of vesicointestinal fistula surgically treated between January 2001 and July 2005. The underlying'cause was an inflammatory disease in 12 cases, a carcinoma in 5 and injury (post-radiation therapy) in 1 case. The fistula was visualized by cystography in 2 cases and enterography in 4. Surgical procedures were cystectomy with enterectomy in 2 cases, partial cystectomy with enterectomy in 3, bladder wall overlay-suture with enterectomy in 6 and enterectomy alone in 4. In 3 cases, colostomy without enterectomy was performed for palliative surgery. In all cases the postoperative course was good and surgical treatment was effective. Surgical procedures varied in each case depending on the etiology and the patient's condition.

[Peritoneal mesothelioma presented with bilateral hydronephrosis: a case report].

We report a case of peritoneal mesothelioma presenting with bilateral hydronephrosis, which was difficult to be diagnosed. A 43-year-old woman was admitted to our hospital with acute renal failure. Ultrasonography revealed bilateral hydronephrosis. Retrograde pyelography revealed the stenosis of bilateral lower ureter. Pelvic magnetic resonance imaging demonstrated only a small mass lesion around the bilateral ureter. Other examinations showed no findings of malignancy. Under the diagnosis of retroperitoneal fibrosis, steroid therapy was performed. After 3 months, computed tomography (CT) revealed multiple abdominal masses. Percutaneous needle biopsy of tumor was performed. Pathological diagnosis was peritoneal mesothelioma. Chemotherapy based on the pleural mesothelioma was done but not effective, she died 9 months after the first medical examination.

[A case of recurrent ileal conduit hemorrhage].

A 68-year-old man visited our department with a complaint of persistent hemorrhage from ileal conduit. He had undergone total cystourethrectomy and ileal conduit construction for invasive bladder cancer in April 2000. He had been suffering from persistent stomal bleeding, although he received ligation of varices as well as occasional transfusions. Revision of the ileal conduit was performed in September 2002. Stomal bleeding has not recurred for 19 months.

[Signet ring-cell carcinoma of the prostate: a case report].

A 76-year-old male was admitted with a complaint of dysuria. Serum prostatic specific antigen was 28 ng/ml. Transperineal prostatic biopsy was performed and histopathological diagnosis was signet ring cell carcinoma with a part of poorly differentiated adenocarcinoma. Imaging studies showed that the tumor was localized in a large part of the prostate, and no abnormality was found in the stomach, the intestine, or the colon. Cystoprostatectomy and ileal conduit construction were performed in November 2002. Immunohistochemistry revealed that the specimen included the signet ring cells, which were stained for prostate specific antigen antibody, but not with periodic acid schiff. He is alive with no evidence of disease in 13 months after the operation.

[A case of extra-adrenal pheochromocytoma presenting with lung metastasis].

A 34-year-old man was referred to our hospital for small lung nodules. An imaging study including a computed tomographic scan and magnetic resonance imaging showed bilateral lung tumors and huge mass arising from the lower pole of the right kidney as well. The patient underwent right radical nephrectomy in May 2002. Pathological examination revealed that the tumor was pheochromocytoma, which developed from extra-adrenal tissue. In 6 cycles of CVD systemic chemotherapy (Cyclophosphamide 750 mg/m2, Vincristine 1.4 mg/m2, Dacarbazine 600 mg/m2), the lung tumors were decreasing in size, and were removed by a surgical procedure in January 2003. Pathological examination revealed that the lung tumors were pheochromocytomas metastasized from the primary tumor. He is alive without evidence of disease 5 months after the lung operation.

[Squamous cell carcinoma of the urinary bladder after intravesical bacillus Calmette-Guerin therapy for carcinoma in situ: a case report].

A 88-year-old woman presented with bladder tamponade caused by gross hematuria. She had received 2 courses of bacillus-Calmette-Guerin (BCG) intravesical instillation therapy 4 months previously because of the bladder tumor with carcinoma in situ (CIS). Imaging studies and cystoscopy showed a bladder tumor invading into perivesical fat. She underwent total cystectomy and bilateral ureterocutaneostomy on May 27, 2002. Histopathologically, the tumor consisted of squamous cell carcinoma and transitional cell carcinoma.