RESUMO
Case 1: The patient was a 68-year-old man. Abdominal computed tomography performed during hospitalization for the close observation of a pituitary gland tumor, showed a right renal mass. Percutaneus needle biopsy revealed IgG4-related disease of the kidney. Pituitary gland tumor biopsy also indicated that the lesion was associated with IgG4-related disease. The pancreas did not show abnormalities. The patient was treated with prednisolone, and both renal and pituitary lesions markedly decreased in size. Case 2: the patient was an 80-year-old man. Right hydronephrosis was observed, and computed tomography showed a right pelvic tumor. Right renal pelvic tumor was diagnosed, and the patient underwent right nephroureterectomy. Pathological examination showed that this tumor was also associated with IgG4-related sclerotic disease. IgG4-related disease tends to occur in multiple organs. This condition should be considered when treating patients with multiple sclerotic diseases. However, in some patients, the disease may be localized to a single site. Further studies are required to elucidate the characteristics of IgG4-related disease.
Assuntos
Imunoglobulina G/análise , Nefropatias , Idoso , Idoso de 80 Anos ou mais , Humanos , Nefropatias/patologia , Masculino , EscleroseRESUMO
Primary amyloidosis of the seminal vesicle is a rare disease entity. We report here a case of localized seminal vesicle amyloidosis with hematospermia. A 66-year-old man visited our hospital with a chief complaint of hematospermia. T2 weighted magnetic resonance imaging (MRI) showed a hypointensity mass in the left seminal vesicle. Needle biopsy revealed amyloidosis of the seminal vesicle. Without any specific treatment, the mass lesion disappeared on MRI, and hematospermia was improved.
Assuntos
Amiloidose/patologia , Glândulas Seminais/patologia , Idoso , Amiloidose/complicações , Hemospermia/etiologia , Humanos , MasculinoRESUMO
Purpura nephritis and autosomal dominant polycystic kidney disease are relatively rare kidney disorders. We present a case complicated by these two diseases. A 68 year-old man with polycystic kidney disease was referred to our hospital with a high fever lasting 3 days and pyuria. Pyelonephritis was suspected based on computed tomography findings of bilateral swelling of the kidney. Inflammation subsided gradually after the initiation of antimicrobial therapy. However, approximately 3 weeks later, the patient developed a fever and skin purpura on the extremities, stomach colic pain, gross hematuria, and increased proteinuria was evident. Therefore, we diagnosed Henoch-Schönlein purpura complicated with nephritis based on biopsies of the skin and the kidney. Immunosuppressant therapy was administered; every symptom was relieved and proteinuria decreased for approximately 20 months.
RESUMO
AIM: To evaluate the clinical results of external-beam radiotherapy (EBRT) for muscle-invasive bladder cancer (MIBC) in elderly or medically-fragile patients. PATIENTS AND METHODS: Twenty-five consecutive patients with MIBC (cT2-4N0-1M0) receiving EBRT were retrospectively analyzed. Their median age was 82 years. Radiotherapy median dose was 60 Gy administered in 30 fractions. RESULTS: Median follow-up period was 14.7 months. Median overall survival (OS) and progression-free survival (PFS) were 14.7 months and 7.8 months, respectively. The OS, cause-specific survival (CSS), and PFS rates at 1-year were 56.0%, 68.5%, and 40.0%, respectively. The local progression-free rates (LPFR) at 6 months and 1 year were 89.3% and 59.5%, respectively. Performance status 3 was a significantly unfavorable factor for OS, CSS, and progression-free survival; clinical N stage was a significantly unfavorable factor for progression-free survival; and lower irradiation dose (≤50.4 Gy) was a significantly unfavorable factor for LPFR. CONCLUSION: EBRT for elderly or medically-fragile patients is feasible, and achieves acceptable local progression-free status.
Assuntos
Idoso Fragilizado , Músculo Liso/efeitos da radiação , Neoplasias da Bexiga Urinária/radioterapia , Bexiga Urinária/efeitos da radiação , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Estudos de Viabilidade , Feminino , Avaliação Geriátrica , Humanos , Estimativa de Kaplan-Meier , Masculino , Músculo Liso/patologia , Invasividade Neoplásica , Estadiamento de Neoplasias , Radioterapia/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologiaRESUMO
Here, we report a case of matrix stone in a 32-year-old man with diabetes, gout, and chronic renal failure. The patient complained of pain in the left flank. He had undergone an operation for bilateral vesicoureteral reflex at the age of 17 and matrix stone discharge was repeated. Computed tomography revealed a soft tissue mass in the right hydroureter. Percutaneous ureteral lithotripsy was performed successfully. Analysis of the stone components revealed the stone to be composed entirely of protein. Radiological imaging of matrix stones may be difficult to separate from urothelial cancers.
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Proteínas/análise , Cálculos Ureterais/química , Cálculos Ureterais/terapia , Adulto , Complicações do Diabetes/complicações , Diagnóstico Diferencial , Gota/complicações , Humanos , Falência Renal Crônica/complicações , Masculino , Cálculos Ureterais/etiologia , Neoplasias Urológicas/diagnósticoRESUMO
A 41-year-old Japanese woman was admitted to our hospital for right abdominal mass. Various examinations revealed a retroperitoneal lymphangioma. Tumor resection was performed and pathological diagnosis was a mucinous cystadenocarcinoma. It seems that screening with the tumor markers will be helpful for the diagnosis, because it is very difficult to diagnose a retroperitoneal mucinous cystadenocarcinoma before the operation.
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Cistadenocarcinoma Mucinoso/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adulto , Cistadenocarcinoma Mucinoso/patologia , Diagnóstico Diferencial , Feminino , Humanos , Linfangioma/diagnóstico , Neoplasias Retroperitoneais/patologiaRESUMO
PURPOSE: The study aims to assess the usefulness of PET with C-acetate and F-FDG to differentiate renal cell carcinoma (RCC) from complicated renal cysts. METHODS: Thirty-one patients were enrolled, 14 patients with complicated renal cysts (12 with Bosniak III and 2 with Bosniak IV) and 17 patients with 19 solid renal tumors. The patients underwent both C-acetate PET and FDG PET. Nephrectomy or partial nephrectomy was performed after the PET scans. RESULTS: In 29 patients, 32 renal lesions were diagnosed as RCC. Twenty-three of the 32 RCCs (72%) had positive C-acetate PET findings, whereas only 7 FDG PET studies were positive (22%). Considering the relationship between tumor size measured by macroscopic appearance of resected tumors and PET results, 22 of 25 (88%) tumors more than 1.5 cm showed positive C-acetate PET findings. In 12 patients with Bosniak III renal cysts, 10 renal lesions were diagnosed as RCC. In this subgroup, 5 of the 10 RCCs (50%) had positive C-acetate PET findings, whereas 2 RCCs (20%) had positive FDG PET findings. None of the cases with benign findings had positive C-acetate PET or FDG PET scans. CONCLUSIONS: C-acetate PET demonstrates a pronounced increase in tracer uptake in RCC, especially in renal tumors more than 1.5 cm, and displays a higher sensitivity than FDG PET. These preliminary data show that C-acetate may be a useful PET tracer to exclude RCC in complex renal cysts.
Assuntos
Acetatos , Carbono , Fluordesoxiglucose F18 , Neoplasias Renais/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Neoplasias Renais/patologia , Pessoa de Meia-Idade , Carga TumoralRESUMO
We report a rare case of ectopic ureter accompanied by a giant ureteral stone and pyonephrosis. A 19-year-old Japanese woman consulted our hospital due to low-grade fever and pain in the left flank. The patient had seeping urinary incontinence since childhood. Ultrasonography demonstrated left dysplastic lumbar kidney with hydronephrosis and plain kidney-ureter-bladder film showed a left giant ureteral stone. The left kidney showed no excretion of contrast medium on drip infusion pyelography. After further examination, a diagnosis of left simple ectopic ureter emptying into the vagina was made. Percutaneous nephrostomy penetrating the major psoas muscle was carried out for intractable pyonephrosis, followed by left nephroureterectomy and lithectomy. These procedures resulted in improvement in the patient's symptoms.
Assuntos
Pionefrose/diagnóstico , Ureter/anormalidades , Ureterolitíase/diagnóstico , Adulto , Feminino , Humanos , Pionefrose/complicações , Pionefrose/cirurgia , Ureter/cirurgia , Ureterolitíase/complicações , Ureterolitíase/cirurgiaRESUMO
The case is reported of incarcerated intestinal hernia in a hernia sac of reversed ileal conduit wall protruding through the stoma. An 82-year-old woman presented with suspected parastomal intestinal hernia. The patient had undergone total cystectomy with ileal conduit construction 3 years previously, followed by stomal reconstruction surgery for stomal stenosis 2 years later. She had been taking various kinds of purgatives for severe constipation. Initially, this case was diagnosed as parastomal hernia, but emergency surgery demonstrated that incarcerated intestinal hernia in a hernia sac of reversed ileal conduit wall was protruding through the stoma. This case was apparently caused by high abdominal pressure and thinning of the ileal conduit wall.