Computed tomography for the management of exit-site and tunnel infections in peritoneal dialysis patients
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PURPOSE: To evaluate the effectiveness of computed tomography (CT) for detection of exit-site and tunnel infections with a Tenckhoff catheter. MATERIALS AND METHODS: The study enrolled patients with exit-site or tunnel infections who underwent ultrasonography (US), CT scans, and subsequent catheter removal or partial catheter reimplantation from 2010 to 2014. Control cases on peritoneal dialysis who underwent abdominal CT scans for other reasons were randomly selected. Attenuation of the soft tissue around the Tenckhoff catheter was measured in Hounsfield units (HU). RESULTS: 9 infected cases and 15 control cases were identified. CT showed increased attenuation around the catheter in all cases, while ultrasonography detected a hypoechoic area only in one case with abscess formation. Maximal attenuation of the inflamed soft tissue was high (median, 36 HU) compared with normal fatty tissue (median, -75 HU). In all cases, one or two sites with increased fat density were observed focally along the catheter, and these areas did not always extend directly from the exit site. CONCLUSIONS: In this retrospective study comprising a small number of cases, increased attenuation of fatty tissue around the Tenckhoff catheter correlated with exit-site or tunnel infections. CT might be an auxiliary tool for diagnosis, although CT costs much more than US and is not always available in general practice. Further prospective studies are needed.
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Resection of bulky chromophobe renal cell carcinoma resolved severe idiopathic thrombocytopenic purpura: A case report.

Idiopathic thrombocytopenic purpura associated with renal cell carcinoma is relatively rare. We report the case of a 48-year-old woman with massive renal cell carcinoma, measuring approximately 20 × 14 × 14 cm, who presented with severe thrombocytopenia: platelet count, 2000 cells/µL. After confirming normal bone marrow, she received high-dose dexamethasone and intravenous gamma globulin, which raised the platelet count to normal levels. She then underwent left radical nephrectomy. The pathological examination showed chromophobe renal cell carcinoma. After the resection, the platelet count was maintained within the normal range without any treatment. The current case is the first report of chromophobe renal cell carcinoma causative of severe idiopathic thrombocytopenic purpura.

Two cases of prostate cancer with disseminated carcinomatosis of the bone marrow treated with novel hormonal agents.

Introduction: Disseminated carcinomatosis of the bone marrow in prostate cancer is rare and has a poor prognosis. Although strong evidence suggests that novel hormonal agents improve the prognosis of metastatic prostate cancer, their effectiveness in cases of disseminated carcinomatosis of the bone marrow remains unclear. Case presentation: We encountered two cases of prostate cancer with disseminated carcinomatosis of the bone marrow at the time of initial diagnosis. One patient was treated with enzalutamide, abiraterone, docetaxel, cabazitaxel, denosumab, and radium-223 and died 38 months after the initial diagnosis. The other patient was treated with apalutamide and denosumab, and had progression-free survival for 17 months after the initial diagnosis. Conclusion: These results suggest that novel hormonal agents may improve the prognosis of prostate cancer even in patients with disseminated carcinomatosis of the bone marrow.

Prostate-specific antigen doubling time predicts the efficacy of site-directed therapy for oligoprogressive castration-resistant prostate cancer.

Background: In recent years, site-directed therapies (SDTs) targeting progressive lesions in patients with oligometastatic prostate cancer have attracted attention. However, whether they effectively treat oligoprogressive castration-resistant prostate cancer (CRPC) remains unclear. Here, we investigated the efficacy of SDT in patients with oligoprogressive CRPC and identified prognostic factors. Methods: We reviewed 59 patients with oligoprogressive CRPC who underwent SDT targeting prostate or metastatic lesions between April 2014 and March 2022. We evaluated the associations between several pretreatment clinical variables and treatment procedures and a >50% prostate-specific antigen (PSA) response, progression-free survival (PFS), and time to next treatment (TTNT). Results: A PSA response of >50% was observed in 66% of patients. The median PFS and TTNT were 8.3 months and 9.9 months, respectively. Patients with PSA doubling time ≥6 months showed a higher >50% PSA response rate (87% vs. 45%; P < 0.001), longer PFS (median, 15.0 vs. 5.0 months; P < 0.001), and longer TTNT (median, 16.3 vs. 5.9 months; P < 0.001) than patients with PSA doubling time <6 months. In multivariate analyses, a PSA doubling time of ≥6 months independently predicted a >50% PSA response, favorable PFS, and TTNT (P = 0.037, 0.025, and 0.017, respectively). Conclusion: PSA doubling time of ≥6 months may be a key indicator of the favorable efficacy of SDT for oligoprogressive CRPC.

Safe administration of ipilimumab plus nivolumab to a dialysis patient with renal cell carcinoma.

INTRODUCTION: The combination of ipilimumab plus nivolumab has been used as first-line therapy for metastatic renal cell carcinoma. While it is well known that hemodialysis patients have a higher rate of renal cell carcinoma compared to the general population, no reports have described the safety of ipilimumab-nivolumab in metastatic renal cell carcinoma patients on hemodialysis. CASE PRESENTATION: A 73-year-old man with a 21-year history of dialysis was referred to our department in 2019 for bilateral renal tumors and multiple lung nodules. He had already been diagnosed with bilateral renal tumors in 2015, without undergoing surgery due to comorbidities. In May 2019, contrast-enhanced computed tomography revealed multiple lung metastases in addition to the existing renal tumors; consequently, he was treated with four doses of nivolumab-ipilimumab with no adverse events. CONCLUSION: The combination of ipilimumab plus nivolumab was safely used in a hemodialysis patient with metastatic renal cell carcinoma.

Carbon 11-choline positron emission tomography/computed tomography and palliative local therapy for castration-resistant prostate cancer.

PURPOSE: Carbon 11-choline positron emission tomography/computed tomography (11C-choline PET/CT) and subsequent local therapy for oligometastatic prostate cancer have been reported to be effective, but their effectiveness in castration-resistant prostate cancer (CRPC) remains unclear. Here, we evaluated the findings of 11C-choline PET/CT in CRPC patients and the efficacy of local treatments in correspondence of the pathologic choline uptake. METHODS: We collected 12 cases of CRPC patients who underwent 11C-choline PET/CT between 2014 and 2016. The outcomes assessed included age, the prostate-specific antigen (PSA) value, the findings of 11C-choline PET/CT, the subsequent treatments, the PSA response following the treatments, and the progression-free survival (PFS). RESULTS: Seven of 12 cases (median PSA, 3.29 ng/mL) had local prostate cancer and/or one or two metastatic lesions detected by the choline PET/CT. These localized lesions were treated with radiotherapy or lymphadenectomy. PSA decreased in all the seven cases and median PSA response was 86% (range, 23-100%). Median PFS was 8.5 months (range, 2.8-25.3 months). The other five cases (median PSA, 7.41 ng/mL) had multiple metastases and systemic therapies were continued in those cases. CONCLUSIONS: 11C-choline PET/CT and the correspondent local treatments may play an important role in the treatment sequence of CRPC in selected patients.

Adjuvant chemotherapy is possibly beneficial for locally advanced or node-positive bladder cancer.

BACKGROUND: This study aimed to evaluate the outcomes of cisplatin-based adjuvant chemotherapy (AC) after radical cystectomy (RC) in non-organ-confined bladder cancer. METHODS: Sixty-one patients who did not receive neoadjuvant chemotherapy (NAC) underwent RC for locally advanced (pT3-4) or node-positive (pN1-3) bladder cancer, or both, between 1990 and 2012. Of these patients, 39 (64%) received cisplatin-based AC after RC (AC group) and the remaining 22 patients (36%) did not (non-AC group). Cancer-specific survival (CSS) and recurrence-free survival (RFS) were compared between the groups. RESULTS: The AC group was significantly younger (P = .004), but no significant differences were noted between the groups for pT stage, pN stage, nuclear grade, renal function, and salvage chemotherapy rates after recurrence. During a follow-up of 29 months (median), 40 patients (67%) experienced recurrence/metastasis and 34 (56%) died of recurrent bladder cancer. The AC group showed better RFS than the non-AC group, but the difference was not statistically significant (median survival time [MST], 23.7 vs. 11.4 months, respectively; P = .154). CSS was significantly better for the AC group than for the non-AC group (MST, 57.4 vs. 17.9 months, respectively; P = .008). On multivariate analysis, AC was an independent predictive factor for both RFS (hazard ratio [HR], 0.325; P = .005) and CSS (HR, 0.186; P < .001), along with surgical margin status and lymphovascular invasion (LVI). In a subgroup analysis of 31 node-positive cases, the AC group had a significantly better CSS compared with the non-AC group (P = .029). Analysis of node-negative cases (n = 30) yielded no significant benefit for AC. CONCLUSION: Our observations suggest that postoperative cisplatin-based AC improves survival in locally advanced or node-positive bladder cancer, especially in node-positive cases.