[A case of collecting duct carcinoma originating from renal cyst].

In December 2003, a 32-year-old man underwent puncture for right renal cyst at a clinic. Since puncture fluid was dark red color in spite of negative cytology, he was being followed, but after a while he did not show up for further examination. In November 2007, he revisited the clinic due to low-grade fever. Computed tomographic findings showed an enlarged cystic mass with a solid component invading the liver and lymph node swelling. He underwent right radical nephrectomy combined with partial liver resection and lymphadenectomy. Histological findings showed collecting duct carcinoma associated with clear cell carcinoma directly invading the liver with lymph node metastasis (pT4N2M0). Although he underwent 4 cycles of gemcitabine-cisplatin therapy and alfa interferon injection 3 times a week thereafter as adjuvant setting, multiple liver metastasis occurred 15 months after surgery. He died of cancer 31 months after surgery in spite of molecular targeted therapy including sorafenib and sunitinib.

Docetaxel in combination with estramustine and prednisolone for castration-resistant prostate cancer.

BACKGROUND: The aim of this study was to investigate the efficacy and toxicity of docetaxel-based chemotherapy, and to investigate pretreatment factors that can predict overall survival (OS) in patients with castration-resistant prostate cancer (CRPC). METHODS: From June 2005 to July 2010, 70 patients with CRPC underwent docetaxel-based chemotherapy at Wakayama Medical University and related hospitals. Docetaxel was given at a dose of 70 mg/m(2) once every 3 weeks or 35 mg/m(2) twice every 3 weeks. Oral estramustine 560 mg was given concurrently for five consecutive days during weeks 1 and 2 of each cycle, and prednisolone 10 mg was given every day. Dexamethasone 8 mg was premedicated intravenously before docetaxel administration. RESULT: The patients received a median of four cycles of treatment (range 1-31). In the serum prostate-specific antigen response, 13 (18.6%) patients achieved a complete response and 29 (41.4%) achieved a partial response. Median OS and time to progression were 14 months and 6 months, respectively. Median follow-up period was 9.5 months. Two independent pretreatment risk factors that predicted OS were visceral metastasis including lymph node metastasis and anemia. Grade 3/4 neutropenia and anemia occurred in 25.7 and 8.6% of the patients, respectively. Four treatment-related deaths were seen during the observation period. CONCLUSION: The combination of docetaxel, estramustine and prednisolone was effective in Japanese patients with CRPC; however, this combination therapy should be carefully indicated to elderly and/or poor performance status patients due to its toxicity. Visceral metastasis and anemia were identified as independent risk factors which could predict OS.

The prognostic significance of human equilibrative nucleoside transporter 1 expression in patients with metastatic bladder cancer treated with gemcitabine-cisplatin-based combination chemotherapy.

OBJECTIVE: To evaluate the expression of the human equilibrative nucleoside transporter 1 (hENT1) and excision repair cross complementing 1 (ERCC1) as possible prognostic factors for patients with metastatic bladder cancer treated with gemcitabine-cisplatin-based combination chemotherapy. PATIENTS AND METHODS: The present study retrospectively evaluated the expression of hENT1 and ERCC1 by immunostaining in chemo-naive primary bladder tumour specimens from 40 patients with metastatic bladder cancer who received treatment with gemcitabine-cisplatin-based combination chemotherapy at Wakayama Medical University Hospital and affiliated hospitals from May 2002 to July 2009. Immunohistochemistry on formalin-fixed, paraffin-embedded tissues was performed with specific hENT1 and ERCC1 antibodies scored by two pathologists who were blinded to clinical outcomes. The clinical and histopathological variables were analyzed to evaluate predictive values for survival. RESULTS: The median survival time in patients with high and low hENT1 expression was 17.3 and 11.6 months, respectively (log-rank test, P = 0.003). This contrasted with the median survival in patients with high and low ERCC1 expressions, which did not differ significantly (high ERCC1, 13.6 months; low ERCC1, 17.1 months; P = 0.178). In univariate Cox regression analyses for pretreatment clinicopathological variables, performance status (P = 0.02) and hENT1 expression (P = 0.004), but not ERCC1 expression (P = 0.182), were associated with overall survival. Multivariate analysis using a Cox proportional hazards model showed that hENT1 expression was an independent prognostic factor (P = 0.008). CONCLUSION: The data obtained in the present study show that high expression of hENT1 in tumour cells is associated with prolonged survival in patients with metastatic bladder cancer treated with gemcitabine-cisplatin-based combination chemotherapy.

Insulin resistance increases the risk of urinary stone formation in a rat model of metabolic syndrome.

OBJECTIVE: To investigate the association between metabolic syndrome and urinary stone disease, and whether insulin resistance associated with adiposity affects the risk of urinary stone formation, using a rat model of metabolic syndrome. MATERIALS AND METHODS: Four-week-old male Otsuka Long-Evans Tokushima 'Fatty' (OLETF, a model of human type 2 diabetes and metabolic syndrome) rats, and Long-Evans Tokushima (LETO, a non-diabetic control) rats (10 each) were given a standardized diet and free access to water. Body weight and serum and urinary biochemistry were determined every 4 weeks. Ten-week-old male OLETF and LETO rats were divided into three groups of nine each and treated with vehicle or oral administration of 3 or 10 mg/kg/day pioglitazone, an agent that improves insulin resistance. After 4 weeks, body weight and serum and urinary biochemistry were determined. RESULTS: The OLETF rats had significantly lower urinary pH and citrate excretion, and higher urinary uric acid and calcium excretion, than the LETO rats, with increases in body weight, serum triglyceride, glucose and insulin. The administration of pioglitazone to the OLETF rats for 4 weeks significantly increased urinary pH dose-dependently. There was no change in the urinary excretion of citrate, uric acid, calcium, oxalate or magnesium. CONCLUSION: These results indicate that metabolic syndrome causes the changes in urinary constituents, leading to increased risk of both uric acid and calcium stone formation. Improvement in insulin resistance, a central cause of metabolic syndrome, might prevent uric acid stone formation by raising urinary pH.

PSA at postoperative three months can predict biochemical recurrence in patients with pathological T3 prostate cancer following radical prostatectomy.

OBJECTIVES: To identify the prognostic factors and determine which pT3 prostate cancer patients can be safely followed up after surgery without any adjuvant treatment. METHODS: A retrospective review was carried out on 106 patients with pT3 prostate cancer. All preoperative and postoperative parameters, including the postoperative serum prostate-specific antigen (PSA) level at 3 months after surgery, were assessed by univariate and multivariate analyses. RESULTS: Mean follow-up period was 18 months. The overall biochemical recurrence-free rate was 53.7% and 34.1% at 12 and 36 months, respectively. On univariate analysis, all preoperative clinical factors were significantly correlated with biochemical progression. On multivariate analysis, pathological Gleason score, pathological stage and postoperative PSA were significant predictors. Among those with undetectable PSA after surgery, 38 patients (88.4% of 43) did not have disease progression during the follow-up period. On the other hand, of the 27 patients with detectable PSA that was not defined as progressive (range 0.01-0.20), 22 (81.5%) had biochemical disease progression. The progression free probability was significantly different between these two groups (P-value < 0.0001). CONCLUSIONS: pT3 prostate cancer patients showing low pathological Gleason score, without seminal vesicle invasion, and undetectable postoperative PSA values have low probability of PSA progression. Careful follow up including periodic PSA assessment and clinical observation represents an adequate strategy in the management of these patients.

[Primary adrenal leiomyosarcoma: a case report].

A 78-year-old female complained high fever and vomiting. The ultrasonographic examination revealed a giant tumor above the left kidney. She was referred to our hospital for further examinations and treatments. Radiographic examination showed a solid mass of 10 cm in diameter, smooth surface, and sharply-delimited, above the left kidney corresponding to the left adrenal gland. Other organs showed no evidence of disease. Hormonal examination was normal. She was diagnosed as left non-functioning adrenal tumor, and underwent surgery. The resected specimen was 11 x 10 x 7 cm, 460 g with a part of normal adrenal tissue on the surface. Histopathological examination revealed it as leiomyosarcoma. She has no evidence of disease twenty months after the operation. Primary adrenal leiomyosarcoma is extremely rare. To the best of our knowledge, there were only 22 reported cases including ours in the English and Japanese literature.

[A case of neonatal testicular torsion].

An infant normally delivered at the 38th week of gestation was referred to our department one day after birth for a firm and painless right hemiscrotal mass with bluish coloration. Since contralateral scrotum showed swelling, we performed emergency surgery on that day. The right spermatic cord was constricted due to extravaginal torsion, and degree and direction of torsion was unclear since the spermatic cord was already organized. Right testis showed irreversible necrotic change, requiring orchiectomy. We confirmed that left testis was intact and performed orchidopexy. Since high incidence of contralateral asymptomatic torsion has been reported in patients with prenatal testicular torsion, emergency surgery should be considered when contralateral scrotum shows abnormal findings.

[Testicular tumor following orchiopexy: a case report].

A 36-year-old male with history of left orchiopexy at age 11 received medical examination at the emergency department of our hospital with a left painful inguinal tumor as the chief complaint. A surgeon examined and suspected a femoral hernia. However, he noticed the patient having a tumor in the left scrotum as well, and referred the patient to our department. Alpha-fetoprotein was within the normal range, but beta-human chorionic gonadotropin and lactate dehydrogenase were slightly elevated. We diagnosed the case as a left testicular tumor and performed left high orchiectomy. On histopathological examination, the tumor was a seminoma and the left inguinal tumor was a lymph node metastasis (3 x 4 x 5 cm). After operation, the tumor markers became normal and radiographic examination showed no evidence of metastasis to the retroperitoneal lymph nodes and to other organs. Subsequently, the patient was given 2 courses of systemic chemotherapy (bleomycin, etoposide, cisplatin) as an adjuvant therapy. At present, eleven months after operation, he showed no evidence of recurrence. To the best of our knowledge, there are 47 reported cases of this disease including ours in Japan.