Appendiceal carcinoma invading the urinary bladder.

A case is reported of a 78-year-old woman with appendiceal carcinoma invading the bladder causing irritative symptoms. Although several imaging studies suggested that the secondary bladder tumor was of cecal or appendiceal origin, such as abscess or mucocele, histologic findings on transurethral and transvaginal biopsy were inconclusive. However, following laparotomy, pathologic examination of the frozen sections revealed a mucinous cystadenocarcinoma originating in the appendix and a right hemicolectomy and en bloc partial cystectomy were performed. One year after the operation, the patient was well with no evidence of recurrent cancer.

Endocrinologically active retroperitoneal ganglioneuroma with positive iodine-131-metaiodobenzylguanidine scintigraphy.

BACKGROUND: A case of retroperitoneal ganglioneuroma incidentally found by ultrasonography in a 56-year old woman is presented. METHODS/RESULTS: Computed tomography revealed a solid round tumor 6 cm in diameter on the upper pole of the right kidney. Iodine-131-metaiodobenzylguanidine weakly accumulated in the tumor 24 and 48 h after the injection. Her serum catecholamines were within normal limits apart from slightly elevated norepinephrine at one of the two examinations. During the operation her serum epinephrine and dopamine levels were elevated to about 50 and 800 times higher than pre-operative values, respectively. CONCLUSION: This case is a rare ganglioneuroma in an adult patient that is endocrinologically active.

A case of perirenal hemangioma mimicking renal cell carcinoma.

PURPOSE: We present a rare case of perirenal hemangioma that was detected incidentally. METHODS/RESULTS: Radiographic examinations revealed a 3.5 cm mass at the left renal hilum adjacent to the left renal parenchyma, which was difficult to differentially diagnose from renal cell carcinoma. Tumor resection was performed successfully. CONCLUSIONS: There was no recurrence observed 14 months after surgery.

Possible misinterpretation on computed tomography of left inferior vena cava as retroperitoneal lymph node metastasis: a report of two cases.

PURPOSE: We report on two cases of retroperitoneal lymph node metastasis of testicular cancer with left inferior vena cava. METHODS/RESULTS: A 25-year-old man with a left testicular cancer with pulmonary and retroperitoneal lymph node metastases received three courses of VIP (etoposide, ifosfamide and cisplatinum) chemotherapy. Subsequent abdominal computed tomography (CT) revealed round lesions enhanced with contrast agent on both sides of the aorta inside the degenerated lymphadenopathy. These lesions were regarded as a duplicated inferior vena cava (IVC) and this was confirmed at retroperitoneal lymph node dissection. The second case is of a 21-year-old man with a left testicular cancer with pulmonary, liver and widespread lymph node metastases. Subsequent to a course of VIP chemotherapy, super high-dose chemotherapy was administered. Abdominal CT revealed a round mass enhanced with contrast agent on the left side of the aorta adjacent to the degenerated lymphadenopathy, which was regarded as the transposed left IVC and this was confirmed at lymph node dissection. CONCLUSIONS: In both cases, initial CT failed to detect the lesions as the left IVC and there was a possibility for the misinterpretation of such venous anomalies with residual lymphadenopathy.

[High dose chemotherapy with peripheral blood stem cell transplantation (PBSCT) For advanced testicular cancer].

Five patients with metastatic testicular cancer of advanced extent according to the Indiana University criteria were enrolled into this study. All tumors were non-pretreated non-seminomas. Initially all patients were treated with standard dose etoposide, ifosfamide and cisplatin (VIP) regimen. The response of two cycles of VIP was evaluated by tumor markers and diagnostic imagings. Two of the five patients showed a good response to VIP and subsequently achieved a pathological complete response (pCR) following surgical resection of residual masses after 3 or 5 courses of VIP. However, they suffered from severe myelosuppression and underwent peripheral blood stem cell transplantation (PBSCT) following the final course of VIP. The remaining three patients unlikely to be cured by VIP underwent chemotherapy consisting of high dose ICE:ifosfamide (6-10 g/m2 over 4days) carboplatin (1,500 mg/m2 over 4 days), etoposide (1,600-2,400 mg/m2 over 4 days) combined with PBSCT. This regimen resulted in one partial response (PR) with marker-negative and two PR with marker-positive. Residual masses were removed in all three patients and viable tumor cells were found in two. Of the five patients enrolled, four patients (80%) remain disease-free with minimal follow-up of 20 months, and the remaining one died of cancer 10 months after PBSCT. No serious side effects or complications were encountered. This study shows that standard dose induction therapy of VIP followed by early salvage chemotherapy of high dose ICE with PBSCT is well tolerated and effective in the treatment of advanced poor-risk testicular cancer.

[Squamous cell carcinoma of ureter in a patient with functional solitary kidney treated by partial ureterectomy: a case report].

We report a case of squamous cell carcinoma of ureter. A 60-year-old female was referred to our hospital for the right hydronephrosis and the left atrophic kidney. She had been suffering from severe renal dysfunction and had hemodialysis a month earlier. Retrograde and antegrade right pyelography revealed complete obstruction of the right lower ureter about 2 cm in length. Transcutaneous retrograde left pyelography revealed vesicoureteral junction stenosis. After improvement of the renal function by transcutaneous right nephrostomy, the patient underwent right partial ureterectomy. Pathological examination revealed squamous cell carcinoma, grade 2, pT3 in the right ureter. Neither local recurrence nor distant metastasis has occurred for 19 months and the patient retains moderate renal function. We reviewed sixty-four cases of ureteral squamous cell carcinoma in the Japanese literature and discussed the renal parenchymal sparing surgery for the disease.

A case of renal cell carcinoma associated with synchronous contralateral renal pelvic cancer and bladder tumor.

We report a case of renal cell carcinoma associated with synchronous contralateral renal pelvic cancer and bladder tumor. The patient underwent total nephroureterectomy for the left renal pelvic cancer with transurethral resection of the bladder tumor. After 2 courses of combination chemotherapy, we performed surgical enucleation of the right renal cell carcinoma. Although transurethral resection of the recurrent bladder tumors was undergone 17 months after the last operation, the patient retains normal renal function.

Urachal adenocarcinoma accompanied by a large spherical calcified mass.

We report a case of urachal adenocarcinoma, accompanied by a large spherical calcified mass adherent to the bladder dome of a 63-year-old man. The patient underwent partial cystectomy including en bloc resection of the urachus, and remains free from the disease after a 32-month follow-up period.

[Magnetic resonance imaging for the evaluation of prostate cancer metastatic to bone].

The response of bone metastatic lesions to endocrine therapy was assessed by repeated magnetic resonance imaging (MRI) and an isotope bone scan after an average period of 7.0 months (2-10 months) in 12 patients with prostate cancer. MRI used both T1-weighted spin echo technique and short TI IR (STIR) sequence. Of 7 patients with hormone-dependent cancer, the bone metastatic lesions resolved or became vague in all patients on STIR image, while in only 4 and 3 on T1-weighted image and bone scan, respectively. Of 5 patients with hormone-refractory cancer, the lesions progressed on both MRI and bone scan in all patients except one who had initially had diffusely metastatic lesions of systemic bone. The results indicate that STIR image of MRI is helpful for the therapeutic evaluation of bone lesions.

[Pelvic kidney associated with staghorn calculus and renal pelvic cancer: a case report].

A 63-year-old man was admitted to our hospital with complaints of right lower abdominal pain and stone excretions. The patient was diagnosed as having a pelvic kidney associated with staghorn calculus and extended pyelolithotomy was to be performed. However, during the operation, a papillary tumor was found in the renal pelvis occupied with staghorn calculus. As the pathological examination of its frozen section was low grade transitional cell carcinoma, nephro-ureterectomy was performed. Pelvic kidney associated with staghorn calculus or renal pelvic tumor with stones is not rare, but pelvic kidney associated with staghorn calculus and renal pelvic cancer is extremely rare.

[Benign hemorrhagic renal cyst mimicking cystic renal cell carcinoma].

We experienced four cases of benign hemorrhagic renal cyst which were indistinguishable from cystic renal cell carcinoma on ultrasonography, computer tomographic scanning, magnetic resonance imaging and angiography. Nephrectomy was performed in one case and enucleation of the mass in the other three. Pathological diagnoses were hemorrhagic septate cyst in two cases, cyst with inflammation containing old blood clots in one, and organized hemorrhagic cyst with calcification in one. Conservative surgeries should be considered when the definite diagnosis for renal hemorrhagic cysts is not made.

[Acute respiratory failure resulting from diffuse microscopic pulmonary tumor emboli by bladder cancer: a case diagnosed at autopsy].

A 71-year-old man who had undergone a total cystectomy and a transureterocutaneostomy more than a year earlier was admitted to our hospital on February, 1992 because of the chief complaints of anorexia and systemic bone pain due to multiple bone metastases of bladder cancer. At two weeks after the admission, he had a sudden attack of dyspnea. His chest reontgenogram revealed no significant abnormalities. He had repeated attacks and died of respiratory failure two days after the first attack. An autopsy disclosed diffuse microscopic pulmonary tumor emboli in the pulmonary arteries and arterioles of bilateral lungs, but there was no parenchymal metastasis. The metastatic lesions in the sinusoids of the liver were also occupied by numerous tumor emboli, suggesting that the tumor emboli in the lungs had derived from those in the sinusoids. Microembolization of the whole lung area must be considered as a cause of clinically unexplained dyspnea.