[Metastatic Renal Cell Carcinoma in Paranasal Sinus for which Periodic Drug Withdrawal Schedule of Axitinib was Effective : A Case Report].

A 73-year-old male patient underwent a right nephrectomy for renal cell carcinoma in 2008, and interferon-alpha was initiated as adjuvant treatment. Computed tomography (CT) scans showed lymphadenopathy above the left diaphragm, and treatment with interferon-2 was subsequently initiated in 2009. Nasal bleeding manifested in February 2010, and CT scans showed a soft-tissue density mass mainly located in the ethmoid sinus. A biopsy of the lesion was performed, and metastatic renal cell carcinoma was diagnosed. Treatment with sorafenib was consequently initiated and the paranasal metastasis showed a temporary partial response (PR). However, the metastatic lesion increased in size and caused repeated nasal bleeding that required blood transfusion. Although treatment with everolims was initiated, adverse events, such as rush, hypertensionnemia, and anemia due to nasal bleeding, developed. Treatment with axitinib was subsequently initiated. However, because adverse events, such as severe diarrhea, renal dysfunction and proteinuria manifested, the dose of axitinib was gradually decreased, and a periodic drug withdrawal schedule (11 days on, 3 days off) was finally initiated, which controlled these adverse events. The metastatic lesions showed a PR for 31months following axitinib administration.

[Vesicoappendiceal Fistula: A Case Report].

A 65-year-old man had been aware of pieces of food occasionally in the urine since February 2008. In November 2010, he came to an outpatient clinic with high fever and cloudy urine and was diagnosed with urinary tract infection. Because he had fecaluria, interconnection between urinary bladder and digestive tract was suspected. Although excretory urography showed no remarkable findings, an outflow of contrast media into the appendix was demonstrated in the cystography. By cystoscopy, the fistula hole was confirmed on the posterior wall of the bladder and inflow of feces from the hole was noticed. Operation was performed under the diagnosis of vesicoappendiceal fistula. The appendix was adhesive to the ileum, the right side of the bladder and the upper side of the rectum, and an en bloc resection was performed. Because the fecalith existed near the fistula, appendicitis appeared to induce inflammatory change and abscess formation around the appendix, and the abscess might have perforate into the bladder.