[Urinary re-diversion using afferent limb as an ileal conduit for urethral recurrence after ileal neobladder reconstruction by Studer method : a case report].

A 68-year-old man who had previously undergone radical cystectomy and ileal neobladder reconstruction by the Studer method for invasive bladder cancer one year ago was urgently admitted to our hospital with gross hematuria and severe anemia. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an expanded ileal neobladder with a huge coagulum and tumor. Cystoscopy showed a non-papillary tumor occurring from the urethral anastomotic region toward the ileal neobladder and suggested the possibility of partial invasion to the ileal neobladder wall. The pathologic diagnosis of transurethral resection was invasive urothelial carcinoma, high grade, G3. We performed resection of ileal neobladder and urinary re-diversion using an afferent limb as ileal conduit. Unfortunately, in this case, a radical cure was not provided, but we considered that urinary re-diversion using an afferent limb as ileal conduit can be a useful option for urethral recurrence after ileal neobladder reconstruction.

[Incomplete Reiter syndrome caused by BCG instillation : a case report].

A 91-year-old man was treated for upper urinary carcinoma in situ via intravesical bacillus Calmette Guérin (BCG) therapy using a double-J catheter. After the fourth infusion, he experienced fever of >38°C, multiple arthralgia, and back pain. One week after cessation of intravesical BCG immunotherapy and initiation of antibiotic treatment, he continued to complain of symptoms. Reiter's syndrome was diagnosed, and subsequently, an antitubercular agent, a nonsteroidal antiinflammatory drug and a corticosteroid were administered. His symptoms improved 17 days after onset. Reiter syndrome is an uncommon complication after intravesical BCG immunotherapy. Nevertheless, side effects may be severe and must be closely monitored.

[Endocervicosis/endosalpingiosis of the bladder: a case report].

Endocervicosis/ endosalpingiosis of the bladder is a very rare benign condition, with a total of 34 documented cases found in the literature. Herein, we report a 35-year-old woman with suspected bladder cancer following a cystoscopic examination, which revealed a mass on the right posterior bladder wall. Transurethral resection of the lesion was performed, and both pathological and immunohistochemical findings confirmed a diagnosis of endocervicosis/ endosalpingiosis. Recurrence was seen 6 months later in a follow-up cystoscopic examination and a partial cystectomy was performed. Since endocervicosis/ endosalpingiosis tends to recur, a partial cystectomy is the best therapeutic option for patients with persistent symptoms or recurrence.

[Epithelioid angiomyolipoma : a case report].

A 63-year-old woman with a right renal tumor diagnosed by ultrasound, consulted our hospital in October 2008. The findings of her physical examination were unremarkable. The results of urinalysis and other routine blood tests were normal. The urinary cytology was negative for malignant cells. Dynamic computed tomography showed a right renal mass (diameter, 7.5 cm), which was enhanced in the early phase and washed out in the late phase. We initially thought that the patient had renal cell carcinoma. Therefore, laparoscopic right nephrectomy was performed in October 2008. The tumor section was found to be encapsulated, and focal hemorrhage and necrosis were observed. Histological examination of the tumor by hematoxylin-eosin staining revealed that it contained polygonal cells, eosinophilic cytoplasm and large nuclei. Immunohistochemical staining of anticytokeratin antibodies AE1/AE3 and CAM5.2 (markers for renal cell carcinoma) was negative. However, immunohistochemical staining of HMB-45, a marker for melanoma, was positive. The patient was finally diagnosed with epithelioid angiomyolipoma. She did not show any evidence of tumor recurrence for 25 months after the surgery.

[Dieulafoy lesion of the ileal conduit: a case report].

Late side effects of ileal conduit are uncommon. Here we report a case of ileal conduit hemorrhage in a 78-year-old woman 8 years after radical cystectomy and ileal conduit diversion. The patient presented with gross hematuria and abdominal dynamic computed tomography showed extravasation of contrasts in ileal conduit and the patient was diagnosed with ileal conduit hemorrhage. Clipping hemostasis was performed under gastrointestinal endoscope and revealed that Dieulafoy's ulcer was the cause of ileal conduit hemorrhage. This is the first case of Dieulafoy's ulcer occurred in ileal conduit. Hemorrhage from ileal conduit is an important late side effect.

[A case of urethrovaginal fistula caused by a foreign body in the vagina].

A 25-year-old woman had a urethrovaginal fistula caused by a foreign body in her vagina. The patient had sought an appointment with a gynecologist for removal of the foreign body in her vagina. However, one day before the scheduled appointment, she developed acute urinary retention and visited the emergency room of our hospital. A urinary catheter inserted into the urethra was found to come out through the vagina. The foreign body, a bottle cap made of polypropylene and measuring 48 x 28 mm in size, was removed. A cystourethroscopic examination confirmed the presence of the urethrovaginal fistula. Repeat cystourethroscopy performed after one month of conservative management showed a persistent urethrovaginal fistula, which had, in fact, increased in size as compared with that at the initial examination. Surgery was undertaken for repair of the fistula ; fistula closure was successfully accomplished by suture in three layers : urethral wall, subcutaneous tissue, and the vaginal wall. This is the second report of a urethrovaginal fistula caused by a foreign body in the vagina.

[Prognostic significance of vascular invasion in patients with urothelial carcinoma treated with radical cystectomy].

A retrospective clinicopathological study of 82 patients with invasive urothelial carcinoma treated with radical cystectomy was performed. There were 62 men and 20 women, median age at operation was 68-years-old and the 5-year overall cancer-specific survival rate was 82.5%. Univariate analyses demonstrated that female patients had poor prognosis, and that lymphovascular invasion was a predictor of recurrence. Multivariate Cox regression analyses including age, grade, and vascular invasion, showed that vascular invasion was an independent predictor of recurrence (HR4.46, P=0.008).

[Leiomyosarcoma of the renal vein: a case report].

A 52-year-old male presented with left intermittent abdominal pain, and was subsequently diagnosed with a tumor in the hilum of the left kidney based on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Under suspicion of left renal cancer, we performed a retroperitoneoscopic left nephrectomy. Histopathological features of the resected specimen were compatible with leiomyosarcoma originating from the left renal vein. Immunohistologically, the tumor cells were spindle-shaped, arranged in bundles, and stained positive for a-smooth muscle actin and desmin. The patient was free from recurrence 2 years after surgery. The prognosis of leiomyosarcoma arising from the renal vein has been considered poor. Herein, we provide details of our case and also review 16 cases of leiomyosarcoma of the renal vein in Japan. We conclude that radical tumor resection is necessary for long-term survial.

Acute graft-versus-host-disease in kidney transplantation: case report and review of literature.

Graft-versus-host-disease (GVHD) is a complication of solid organ transplantation, most commonly of the small bowel or liver. Herein, we have presented a case of GVHD in a 27-year-old man who underwent an human leukocyte antigen (HLA) minor mismatch renal transplantation from his father. After the procedure, the patient presented with a fever, skin rash, and watery diarrhea. An allograft kidney biopsy demonstrated no sign of rejection; however, anti-A antibody was detected in plasma and progressive anemia was attributed to hemolytic anemia owing to a passenger lymphocyte syndrome. From those findings, we suspected that the clinical symptoms were caused by acute GVHD. An endoscopic biopsy of the colon revealed apoptotic cells consistent with the disease. We found reports of only 5 other GVHD cases after kidney transplantation. Several risk factors are associated with GVHD, such as transfer of graft lymphocytes, donor HLA homozygosity, and a relationship between recipient immunogenicity and immunosuppression. In this case, detection led to early diagnosis of donor-derived GVHD due to passenger lymphocyte syndrome. It is important keep GVHD in mind and to understand its risk factors as the mortality rate is high.

[Case of giant renal arteriovenous fistula in a long-term hemodialysis patient].

We report a case of giant left renal arteriovenous fistula (AVF). A 36-year-old man was diagnosed with chronic glomerulonephritis (CGN) by biopsy on the left kidney 11 years ago. He had been receiving hemodialysis for end-stage kidney disease from CGN since 10 years ago. A left renal cystic lesion was found and he was referred to our department for examination and treatment. He was diagnosed as having left AVF using imaging techniques (computed tomography, magnetic resonance imaging and Color Doppler ultra sonography). He underwent embolization of left renal artery using microcoils. After the surgery, there were no major complications, and there were no signs reccurence. AVF in a long-term dialysis patient is rare. We report this case and summarize the cases reported in Japan.

[Clinical studies of renal pelvic and ureteral cancers--comparison with or without asymptomatic macrohematuria at initial complaint].

We analyzed 95 patients with renal pelvic and ureteral cancers with total nephroureterectomy at our Department fromJanuary, 1997 to April, 2007. The patients were composed of 60 males and 35 females, between 41- and 90-years-old with a median age of 69-years-old. Histologically, there were 94 transitional cell carcinomas (TCC) and 1 TCC with squamous cell carcinoma. Fifty five cases (57.9%) were less than pT2, and 41 cases (42.1%) were more than pT3. Findings of lymphatic and venous invasion were present in 35 cases and 24 cases respectively. The overall survival rate at 5 years was 76.6%. In this series, pathological stage, infiltration pattern, lymphatic and/or venous invasion and the regional lymph nodes indicated a significantly poor prognosis. On the other hand, multivariate analysis using Cox proportional hazards regression revealed the presence of pathological stage as the most significant predictor of survival. Furthermore, we investigated histopathological prognostic factors of the patients separating asymptomatic macrohematuria group (AM group) and non-asymptomatic macrohematuria group (non-AM group). According to this analysis, non-AM group had worse pathological stage, grade and lymphatic invasion than AM group.

[Case of pancreatic leak after laparoscopic splenectomy for ABO-incompatible kidney transplantation recipient].

A 21-year-old man with bilateral hypoplastic kidneys underwent laparoscopic splenectomy and ABO-incompatible living renal transplantation. After the splenectomy, pancreatic leak occurred and it caused intra-abdominal bleeding on the 10th and 16th postoperative day, so emergency operations were performed. Then the graft function had become stable and he was discharged on the 75th postoperative day. Although intra-abdominal bleeding due to pancreatic leak often causes a fatal condition, he was successfully treated by suppression of pancreatic external secretion using octreotide and appropriate drainage.

[Successful preoperative interferon-alpha therapy of advanced renal cell carcinoma with tumor thrombus extending into the inferior vena cava: a case report].

We report a case of renal cell carcinoma in which interferon-a therapy was effective in reducing the tumor thrombus extending into the inferior vena cava. A 66-year-old man was referred to our hospital with a complaint of macroscopic hematuria, cough and general fatigue. We made a diagnosis of a left renal cell carcinoma with tumor thrombus by imaging examination. Because his performance status was 3, a radical operation was considered risky. Twenty-two months after the start of interferon-a therapy, the tumor thrombus was markedly reduced in size, and the clinical response was evaluated as partial response by the response criteria for urological cancer treatrment. Because of improvement of the performance status and downsizing of tumor thrombus, we performed radical nephrectomy. Pathological examinations revealed that viable renal cell carcinomas were found in the primary lesion and the tumor thrombus. In some cases, interferon-alpha therapy is useful and safe in the treatment of the tumor thrombus. Furthermore, radical nephrectomy and complete resection of the tumor thrombus prolongs postoperative survival.