[Post-Operative Immediate Single Instillation of Chemotherapy as Prevention of Recurrence after Transurethral Resection of Intermediate-High Risk Non-Muscle-Invasive Bladder Cancer].

We retrospectively evaluated the efficacy of immediate single instillation (SI) of pirarubicine hydrochloride (THP) in the chemoprevention of intermediate and high risk patients with non-muscle-invasive bladder cancer (NMIBC). The study population consisted of 256 intermediate and high risk patients with NMIBC who underwent Bacillus Calmette-Guerin (BCG) induction therapy or delayed intravesical chemotherapy between 1999 and 2014. We introduced SI of 30 mg THP in 30 ml normal saline for all cases in 2010, and thus earlier cases could be considered as historical controls. As BCG induction therapy, patients received 80 mg of BCG Tokyo strain 2 weeks after transurethral resection of bladder tumor (TURBT), and the instillations were repeated weekly for 8 weeks. On the other hand, as delayed intravesical chemotherapy, patients received 30 mg THP in 30 ml normal saline over a period of 6 months starting 2 weeks after TURBT. The instillation schedule was once a week for 1 month, every other week for 1 month and once a month for 4 months. The patients were followed with cystoscopy and urine cytology every 3 months for the first 2 years and every 6 months thereafter. The 3-, and 5-year non-recurrence rates were 80. 3 and 80.3%, respectively, in the single immediate instillation group and 69.7 and 64.5%, respectively, in the control group. Univariate analysis revealed a significant difference between the SI group and the control group (P=0. 025). Multivariate analysis showed that there was an independent and significant recurrence risk factor in selecting chemotherapy instead of BCG in additional intravesical instillation therapy and not to perform SI. Limitations of our study are its retrospective and nonrandomized nature with a limited number of patients.

[Post-Operative Single Immediate Intravesical Instillation Chemotherapy as Prophylaxis for Reccurence after Transurethral Resection of Low Risk Non-Muscle-Invasive Bladder Cancer].

We evaluated the efficacy of single-dose instillation of pirarubicine hydrochloride (THP) in the chemoprophylaxis of non-muscle-invasive bladder cancer(NMIBC). In a retrospective study, 135 evaluable patients were assigned to three groups after transurethral resection of bladder tumors (TURBT). In group 1, patients received no adjuvant therapy after TURBT. In group 2, patients received a single-dose of 30 mg THP in 30 ml normal saline immediately after TURBT. In group 3, patients received 30 mg THP in 30 ml normal saline 2 weeks after TURBT , and the instillations were repeated for 4 weeks, then every other week twice and successively monthly for 6 months. Patients were followed with cystoscopy and urine cytology every 3 months for the first 2 years and every 6 months thereafter. The 3- and 5-year non-recurrence rates were 66.9%, and 66.0%, respectively, in group 1, 85.6%, and 85.6%, respectively, in group 2, and 93.6%, and 77.9%, respectively, in group 3. There was a significant difference only between group 1 and group2 (P ＝0.048). With respect to the recurrence per month, there was a significant difference between the 3 groups (P＝0.014) for the first 2 years. However, there was no significant difference thereafter. Limitations of our study are its retrospective and nonrandomized nature with a limited number of patients.

[Malignant fibrous histiocytoma/undifferentiated pleomorphic sarcoma of the penis: a case report].

We report the case of a malignant fibrous histiocytoma/undifferentiated pleomorphic sarcoma (MFH/UPS) of the penis in a 78-years-old-man who had undergone previous radical prostatectomy, external beam radiation therapy for prostatic adenocarcinoma. The mass was a 9-cm firm lesion at the base of the penis predominantly composed of malignant spindle cells arranged in sweeping fascicles and storiform pattern. The tumor cells stained for vimentin, beta-smooth muscle actin, S-100, and were negative for keratin, desmin, Melan A, PSA. Despite total penectomy, he developed a local reccurence 4 months after surgery, and died from dissemination 6 months after surgery. This is the 8th case of penile MFH/UPS.

Biphasic and monophasic sarcomatoid carcinoma of the urinary bladder.

We report a rare case of sarcomatoid carcinoma of the urinary bladder which showed both of biphasic and monophasic phenotypes through its clinical course. A 64 year-old man presented with gross hematuria and interrupted voiding. Radiological examination demonstrated a pedunculated tumor in the bladder with no distant metastases. Pathological diagnosis of transurethral resection revealed biphasic sarcomatoid carcinoma, pT1, composed of squamous cell carcinoma component and spindle cell component. The disease repeated local recurrences and partial and total cystectomies were performed, respectively. The recurrent tumors were monophasic sarcomatoid carcinoma purely composed of spindle cell component. The patient died of local and metastatic disease 13 months after the diagnosis. We consider that sarcomatoid carcinoma should be resected radically at the initial surgical treatment because of aggressive potential of spindle cell component. To our knowledge, this is the first case in which biphasic sarcomatoid carcinoma of the bladder recurred as monophasic tumor. The pathological study and management of this neoplasm are discussed, and the literature is reviewed.

Collecting duct carcinoma producing granulocyte-colony-stimulating factor (G-CSF).

We present a 67-year-old male with a rare case of collecting duct carcinoma producing granulocyte colony-stimulating factor. He was referred to us with lumbago and fever. Laboratory testing showed leukocytosis and computed tomography revealed a left renal mass. After chemotherapy with gemcitabine and nedaplatin, computed tomography showed a partial response. A left nephroureterectomy was performed. The histopathological diagnosis was collecting duct carcinoma producing granulocyte-colony-stimulating factor. White blood cell levels were reduced to 9900/mm(3). No recurrence was detected after completion of adjuvant chemotherapy and the patient was discharged from the hospital. However, 3 months later, computed tomography revealed multiple lung metastasis. Nedaplatin- based chemotherapy was administered but computed tomography after chemotherapy identified a progressive disease. The patient died 9 months after the operation.

[A case of transitional cell carcinoma with squamous differentiation which developed squamous cell carcinoma in situ in the clinical course].

In August 2000, a 62-year-old woman presented to another municipal hospital with macroscopic Transurethral resection of bladder tumor (TUR-Bt) was performed. The pathological hematuria. diagnosis was transitional cell carcinoma (TCC), G2 > squamous cell carcinoma (SCC). TUR-Bt repeated in July 2003 indicated recurrence. The pathological diagnosis was TCC, G2. She was referred to our hospital in August 2003 because she desired bladder preservation. After cystoscopy and random biopsy, pathological diagnosis was TCC with squamous differentiation, G1-G2, pTis. She received 7 weekly intravesical bacillus Calmette-Guerin (BCG) instillations. In April 2004, TUR-Bt was repeated and multiple recurrences were found. The pathological diagnosis was TCC with squamous differentiation, G1-G2, pTa. She received 10 weekly intravesical Pirarubicin hydrochroride instillations. In August cystoscopy and random biopsy were performed for evaluation of the intavesical instillation treatment. Pathological diagnosis was atypical squamous cells. In November, cystoscopy revealed recurrence of a bladder tumor. After admission, a small papillary tumor and multiple flat lesion biopsies demonstrated SCC without obvious invasion. The patient underwent cystectomy. There were widespread areas of full thickness squamous atypia. Most of the bladder did not show appearance of typical TCC, but the final pathological diagnosis was TCC because the case developed from TCC and could not be diagnosed as pure SCC. The diagnosis of SCC in situ of bladder is difficult, and this may contribute to its rarity.

[A case report of splenic abscesses due to pyonephrosis].

We report a rare case of splenic abscesses that were derived from left pyonephrosis. A 58-year-old woman was referred to our hospital with complaints of fever and epigastralgia. Computed tomography revealed splenic abscesses and left pyonephrosis with staghorn calculi. After admission, her condition improved with conservative therapy. Eight months later, the splenic abscesses had disappeared. The patient was then readmitted and left nephrectomy was performed to prevent relapse of the splenic abscesses. We suspected that direct invasion of inflammation from the left pyonephrosis caused the splenic abscesses, as her left kidney had adhered to the spleen. Only one case of splenic abscesses derived from a urinary tract infection has been reported in Japan.