[Case of renal subcapsular hematoma caused by flexible transurethral lithotripsy].

A 39-year-old man with macroscopic hematuria was admitted to our hospital. A stone, 5 mm in diameter was detected in the right ureteropelvic junction after abdominal computed tomography and plain abdominal radiography. We performed flexible transurethral lithotripsy (f-TUL) and crushed the stone and extracted almost all stone fragments without any complications. However, almost immediately after the operation, the patient began to complain about pain in the right back. In the results of abdominal plain computed tomography right renal subcapsular hematoma was detected. Because active bleeding was not observed in the results of enhanced computed tomography, only conservative treatment was performed. The patient was discharged from the hospital on day 11 of hospitalization. One month after the operation, plain computed tomography was performed and diminished subcapsular hematoma was detected. Renal subcapsular hematoma is assumed to be a unique complication of extracorporeal shock wave lithotripsy. This is the first report of a case of renal subcapsular hematoma caused by f-TUL. The onset of renal subcapsular hematoma following f-TUL could have been caused either because the laser fiber thrust into the renal lithiasis unintentionally or because the internal pressure of the renal pelvis increased substantially during the operation.

[A case of metastatic tumor of the spermatic cord from gastric cancer].

A 52-year-old man underwent distal gastrectomy for gastric cancer in November, 2007. In November, 2009, he visited our department with chief complaint of swelling of right intrascrotum and an inguinal mass. The tumor was suspected to be a primary tumor of the spermatic cord or metastasis of the gastric cancer. An operation was performed and histopathological examination revealed adenocarcinoma in the spermatic cord. Microscopic appearance of the surgical specimen of the right spermatic code demonstrated a CK7＋/ CK20- expression pattern, which is the same as that of past gastric cancer. These results suggested that the spermatic cord tumor was a metastatic lesion from the gastric cancer. The patient died 12 months later. Metastatic tumor of the spermatic cord resulting from gastric cancer is rare. We should take metastatic tumor into consideration the possibility of tumor of the spermatic code or tumor in the scrotum particularly when the patient has had an operation for cancer of the digestive system.

[Amyloidosis of the urethra: a case report].

A 26-year-old man was introduced to our hospital with a complaint of macrohematuria. Endoscopic examination showed a small tumor in the anterior urethra. Microscopic examination of a biopsy specimen taken under lumbar anesthesia showed amyloid deposition in the urethral submucosa. On Congo red staining, amyloid was visualized as orange material, showing characteristic birefringence under polarized light. Amyloidosis of the urethra was diagnosed. Because the patient refused to undergo duodenal or rectal biopsy, the possibility of systemic amyloidosis could not be completely excluded. No recurrence has been noted since the endoscopic examination, and no further symptoms have been reported.