[Long-term oral low-dose cyclophosphamide-induced hemorragic cystitis which was successfully treated by ureterostomy: a case report].

An 80-year-old man presented to our hospital with macroscopic hematuria. Before coming to our hospital, he was treated for multiple myeloma with cyclophosphamide. We detected diffuse dilation of capillary on urinary bladder mucosa on cystoscopy, and diagnosed the patient with cyclophosphamide-induced hemorrhagic cystitis. Macroscopic hematuria once resolved by indwelling urethral catheter, but recurred and bladder tamponade developed. We performed transurethral electric coagulation. Macroscopic hematuria temporarily disappeared, but again relapsed. Then we performed intravesical instillation of aluminum hydroxide gel, but without a clear effect and the patient developed hemorrhagic shock. Eventually, we performed bilateral ureterostomy because the disease was unresponsive to less invasive therapies. Vesical bleeding disappeared and the patient was discharged 32 days after surgery. The treatment for multiple myeloma has been continued without cyclophosphamide since surgery.

[A case of primary malignant retroperitoneal mesothelioma needed to differentiate adrenal tumor].

Malignant mesothelioma is a neoplasm which tends to develop along serosal surfaces, such as the pleura and peritoneum. We report a rare case of malignant retroperitoneal mesothelioma in a 27-year-old woman. The patient was admitted with a chief compliant of intermittent high fever once a month, and left retroperitoneal tumor was detected by dynamic abdominal computed tomography. Since an adrenal tumor was suspected, laparoscopic tumor extirpation was performed. Immunohistochemically tumor cells were positive for calretinin and thrombomodulin, but negative for carcinoembryonic antigen (CEA) and Ber-Ep4. Based on these findings, primary malignant retroperitoneal mesothelioma was diagnosed.

[A case of renal pelvic tumor due to phenacetin abuse].

A 65-year-old female had been taking analgesics containing phenacetin, because of severe headaches since 1958. The total dose of phenacetin that she had taken was calculated to be 8.0 kg. She visited the department of urology in our hospital in August, 1999 complaining of gross hematuria. A solid mass was detected in her left renal pelvis on the abdominal computed tomographic (CT) scan. Under the diagnosis of a left renal pelvic tumor, nephrouretectomy was performed in September, 1999. Histopathological diagnosis was grade 2 transitional cell carcinoma. Interstitial nephritis was also observed. Our case is the twenty-second report of an urinary tract tumor associated with phenacetin abuse in Japan.