Non-papillary serous cystadenoma of the epididymis associated with infected hydrocele of the testis: A case report.

A 50-year-old Japanese man with enlargement of the right scrotum was presented to our hospital. Preoperative examination confirmed a multilocular cyst with septa attached to the testis. Radical orchiectomy was performed. Pathological examination revealed closely-located two cysts; larger one was infected hydrocele testis, and smaller one was epithelial cyst, which were immunohistochemically positive widely for estrogen receptor (ER) and partly for progesterone receptor (PR). We concluded that the smaller cyst was serous cystadenoma of the epididymis.

Oncological outcomes of metastatic testicular cancers under centralized management through regional medical network.

OBJECTIVE: To investigate the dose intensity of induction chemotherapy and oncological outcomes of metastatic testicular cancer under centralized management through a regional medical network. MATERIALS AND METHODS: We retrospectively analyzed the outcomes of 86 metastatic testicular cancer patients who were given induction chemotherapy at Tsukuba University Hospital and four branch hospitals between January 2000 and November 2010. Principally, management of patients with poor-prognosis disease and patients having risk factors for bleomycin, etoposide and cisplatin were referred to Tsukuba University Hospital before chemotherapy. For high-risk groups, etoposide and cisplatin or etoposide, ifosfamide and cisplatin was used as an alternative to bleomycin, etoposide and cisplatin. RESULTS: Overall, 56 and 30 patients were treated at Tsukuba University Hospital and branch hospitals, respectively. Forty-seven, 18 and 21 patients were classified with good-, intermediate- and poor-prognosis disease, respectively, according to the International Germ Cell Cancer Collaborative Group criteria. Eighteen of the 21 patients (86%) with poor-prognosis disease were treated at Tsukuba University Hospital from the beginning of induction chemotherapy. Induction chemotherapy with a high relative dose intensity was possible in most patients. The average relative dose intensity of each drug was >0.96. Treatment procedures other than induction chemotherapy were efficiently centralized; 74% of post-chemotherapy surgery and all second-line or subsequent chemotherapies were performed at Tsukuba University Hospital. The 5-year overall survival rates of the good-, intermediate- and poor-prognosis groups were 97, 93 and 84%, respectively. CONCLUSIONS: Induction chemotherapy with high relative dose intensity, post-chemotherapy surgery and salvage chemotherapy was accomplished efficiently through centralization of management. Oncological outcomes were excellent, especially in patients with poor-prognosis disease, whose 5-year OS reached 84%.

A case of metastatic testicular cancer complicated by pulmonary hemorrhage due to choriocarcinoma syndrome.

A 40-year-old man was referred to our hospital for treatment of metastatic testicular cancer. Computerized tomography revealed multiple lung, liver, and retroperitoneal lymph node metastases. In addition, magnetic resonance imaging revealed multiple brain metastases. Induction chemotherapy with bleomycin, etoposide, and cisplatin was started the day after a high orchiectomy. The pathological diagnosis of the surgical specimen was yolk sac carcinoma. The serum human chorionic gonadotropin (hCG) was markedly increased to 630,000 mIU/ml, which suggested the presence of a choriocarcinoma element at metastatic sites. The patient subsequently suffered respiratory failure due to pulmonary hemorrhage. Intensive supportive care prevented a fatal outcome. Physicians who treat advanced testicular tumors should be aware of the potential complication of acute pulmonary hemorrhage, called choriocarcinoma syndrome, in cases with a high hCG level, which indicates a rapidly progressive and high-volume choriocarcinoma.

[Renal cell carcinoma with bilateral adrenal and small intestinal metastases: a case report].

A 69-year-old man who had a complaint of melena and hematemesis was referred to our hospital for further evaluation and treatment of renal masses, bilateral adrenal swelling and a tumor in the small intestine. The abdominal CT scan demonstrated two tumors sized 45 mm and 15 mm in diameter, located in the center and lower pole of the left kidney. Bilateral adrenal swelling and a small intestinal tumor with invagination were also observed. We diagnosed left renal cell carcinomas with bilateral adrenal metastases or hyperplasia, and a primary or metastatic small intestinal tumor. He received left radical nephrectomy, right adrenalectomy, and small intestinal resection. Pathological diagnosis was renal cell carcinoma, granular cell carcinoma, G2>G3>G1, INFalpha, v (+), pT1a, pM1, Stage IV. Bilateral adrenal swelling and small intestinal tumor were metastases from the renal cell carcinoma After operation, we administered interferon-alpha and steroid replacement. He died after 27-month follow-up period because of renal cell carcinoma. Renal cell carcinoma with simultaneous metastases to bilateral adrenal glands and the small intestine is extremely rare.

Feasibility of classical secondary hormonal therapies prior to docetaxel therapy in Japanese patients with castration-resistant prostate cancer: Multicenter retrospective study.

BACKGROUND: We retrospectively analyzed castration-resistant prostate cancer (CRPC) patients treated with secondary hormonal therapies (SHTs) prior to docetaxel therapy. METHODS: The cases of 73 CRPC patients who underwent docetaxel therapy in 2005-2011 at four hospitals in Ibaraki, Japan were analyzed. We determined the cause-specific survival (CSS) from the start of docetaxel therapy and the time point of CRPC diagnosis, and we compared the CSS achieved with/without prior classical SHTs, which were defined as low-dose steroid and estramustine phosphate. RESULTS: Of the 73 enrolled patients, 26 underwent docetaxel therapy (DOC group), and 47 underwent SHTs (SHTs-DOC group) as the initial treatment for CRPC. In the docetaxel therapy, the rate of prostate-specific antigen responses were higher in the DOC group compared with the SHTs-DOC group (76.9% vs. 44.7%, P = 0.0066). The median CSS from the docetaxel therapy initiation was not significant but longer in the DOC group than in the SHTs-DOC group (23.4 months vs. 16.6 months, P = 0.0969). However, the median CSS from the time of CRPC diagnosis did not significantly differ between the DOC and SHTs-DOC groups (23.4 months vs. 24.7 months, P = 0.9233). In a univariate analysis, pain and visceral metastasis appeared to be risk factors for the CSS in the SHTs-DOC group. The patients with pain and/or visceral metastasis had significantly poorer survival than those without these factors in the SHTs-DOC group (31.5 months vs. 16.8 months, P = 0.0053). CONCLUSION: The induction of SHTs prior to docetaxel therapy is an acceptable treatment option with some survival benefits for CRPC patients without pain and visceral metastases.

[Idiopathic testicular infarction: a case report].

We herein report a case of idiopathic testicular infarction. The patient was a 20-year-old man with the chief complaint of right testicular swelling and pain. Ultrasonography and color Doppler sonography demonstrated a hypoechoic lesion without any blood supply. Torsion of the right spermatic cord was most suspected, but we could not exclude the possibility of testicular cancer judging from the findings obtained by computed tomography and magnetic resonance imaging. Surgical exploration did not reveal any torsion of the spermatic cord. Subsequently, right high orchiectomy was performed because of the risk of a testicular cancer. Histopathological examination revealed a hemorrhage and congestion of the testis and epididymis.

[Bilateral testicular tumors recurring 31 years after the initial treatment: a case report and the literature review].

We herein report a case of bilateral testicular germ cell tumor recurring 31 years after right high inguinal orchiectomy. In 2003, a 62-year-old man presented with a mass in the left testis. Ultrasonography demonstrated three hypoechoic mass and microlithiasis of the left testis. Abdominal and breast computed tomography revealed no lymph adenopathy and any metastasis. The preoperative diagnosis was stage I testicular tumor and subsequently left high orchiectomy was performed. Histological examination revealed typical seminoma. At present, the patient is free from recurrence after the surgery. To our knowledge, 166 cases were reported in Japan. Approximately fifty percent of metachronal bilateral testicular tumors previously reported have been recurred after five years and more from the initial surgery. In the testicular cancer, long-term follow-up and self examination of the scrotum are of great importance. We review the metachronal bilateral testicular germ cell tumors previously reported in Japan.