Inferior mesenteric artery aneurysm: case report and literature review.

An inferior mesenteric artery (IMA) aneurysm is the rarest among visceral artery aneurysms. A 69-year-old man was referred to our hospital with an asymptomatic IMA aneurysm associated with occlusion of the superior mesenteric artery (SMA) and celiac artery (CA). After revascularization of the SMA with an 8-mm expanded polytetrafluoroethylene (ePTFE) graft, the aneurysm was resected, and the IMA was reconstructed. The "jet disorder" phenomenon has been thought to cause an IMA aneurysm in the case of CA and SMA obstruction. We consider it better to revascularize not only an IMA but also an SMA or CA for preventing that phenomenon.

[A long-term survival case of advanced sigmoid colon cancer with massive metastases to the para-aortic lymph nodes].

We report a long-term survival case of advanced sigmoid colon cancer with massive metastases to the para-aortic lymph nodes. The patient was a 63-year-old male. He underwent sigmoidectomy with D3 + para-aortic lymphadenectomy for advanced sigmoid colon cancer. Histological examination showed a moderately differentiated adenocarcinoma, ss, ly2, v2, n4 (total 30/64, para-aortic lymph nodes 18/39). From 6 months to 4 years after the operation, tegafur/uracil (UFT) was performed as chemotherapy. After 8-year disease-free interval, CT showed solitary mediastinal lymph node metastases. He underwent thoracoscopic mediastinal lymphadenectomy. Histological examination revealed metastases from colon cancer.

[Local recurrence of spermatic cord liposarcoma: a case report].

A 46-year-old man had undergone radical high orchiectomy because of a tumor of the right spermatic cord. Pathological diagnosis was atypical lipomatous tumor. Six years later, he had asymptomatic swelling in his right groin. Local recurrence was suspected, and surgical resection of the tumor with a sufficient surgical margin was performed. Pathological diagnosis was well-differentiated liposarcoma, sclerosing type. Ten cases of recurrent spermatic cord liposarcoma, including the present case, have been reported in Japan. Because of the possibility of local recurrence, spermatic cord liposarcoma needs strict and long-term follow up.

Testicular epidermoid cyst in Klinefelter's syndrome.

A 38-year-old Japanese man was referred to our outpatient clinic for treatment of infertility. Semen analysis showed azoospermia. Chromosome analysis revealed a 47XXY karyotype, and non-mosaic Klinefelter's syndrome (KFS) was diagnosed. Upon physical examination, the patient's right testicular volume was 30 mL and the left testicular volume was 3 mL. Laboratory tests showed normal levels of lactate dehydrogenase, alpha-fetoprotein, and human chorionic gonadotropin beta-subunit. The plasma luteinizing hormone and follicle-stimulating hormone levels were increased to 15.7 mIU/mL and 45.9 mIU/mL, respectively. The plasma testosterone was decreased to 0.25 ng/mL. Magnetic resonance imaging showed a right testicular mass of low-signal intensity on the T1-weighted image and of high-signal intensity on the T2-weighted image. Therefore, the final diagnosis was KFS with a right testicular tumor. Thus, a right high orchiectomy was performed. Histological examination revealed an epidermoid cyst of the right testis. Epidermoid cysts in cases of KFS are rare. To our knowledge, only seven cases, including ours, have been reported in the literature.

[A case of carcinosarcoma of the urinary bladder].

We report a case of carcinosarcoma of the urinary bladder. A 50-year-old man visited our hospital with asymptomatic macroscopic hematuria as a chief complaint. Excretory urography revealed a filling defect in the right wall of the bladder, and subsequent cystoscopy revealed a non-papillary tumor above the right orifice. The patient underwent total cystectomy and had a neobladder constructed with the ileum (Hautmann's method). Microscopic examination showed a tumor composed of a mixture of transitional cell carcinoma and rhabdomyosarcoma. Immunohistochemical examination showed that the area of epithelium component was positive for cytokeratin and the non-epithelium area was positive for vimentin, there being no relationship between the two. The patient began complaining of coccyalgia 10 days after the operation. He died about 1 month after the operation because of the recurrence in the pelvic cavities.