Late recurrence of late-onset large cell calcifying Sertoli tumor successfully managed by early surgical intervention.

Large cell calcifying Sertoli tumor is an uncommon testicular neoplasm. We present a case of a 36-year-old man with a late-onset large cell calcifying Sertoli tumor that resulted in a solitary lung metastasis 5 years after radical orchiectomy. Pulmonary wedge resection was performed, and there was no recurrence at the 18-month follow-up after resection of the lung metastasis. Because of its malignant potential, late-onset large cell calcifying Sertoli tumor requires long-term follow-up.

Malignant melanoma of the male urethra with increased 5-S-cysteinyldopa: A case report.

INTRODUCTION: We herein present a case of malignant melanoma of the male urethra with an increased serum 5-S-cysteinyldopa concentration. CASE PRESENTATION: A 77-year-old man visited our hospital complaining dysuria and a dark brown mass protruding from the external urethral meatus. His serum 5-S-cysteinyldopa concentration was elevated beyond the upper limit of the reference range. Biopsy of the tumor was performed, and the histological diagnosis was malignant melanoma. He underwent total penectomy, and the serum 5-S-cysteinyldopa concentration was normalized. He remained alive without evidence of locoregional recurrence or distant metastases for 6 months after surgery. CONCLUSION: Malignant melanoma of the male urethra is uncommon. The prognosis is favorable if it is detected in its early stages. This case report suggests that measurement of the serum concentration of 5-S-cysteinyldopa, a melanin metabolite, is useful for early diagnosis of male urethral melanoma.

Favorable outcome of intraoperative radiotherapy to the primary site in patients with metastatic prostate cancer.

BACKGROUND: The aim of this study was to determine whether local radiotherapy to the prostate by intraoperative radiotherapy (IORT) increases the overall and cancer-specific survival rates of patients with metastatic prostate cancer. METHODS: Between 1993 and 2000, 102 patients with prostate cancer were treated with a combination of (a) IORT of the prostate (25 or 30 Gy per fraction); (b) external beam radiotherapy of the prostate (30 Gy in 10 fractions), starting approximately 1 week post-operatively; and (c) endocrine treatment. Of these, 16 patients had stage D1 disease (D1 IORT group), 32 had stage D2 disease without visceral metastasis (D2 IORT group), and 38 had stage D2 disease without visceral metastasis and did not receive local therapy (D2 control group). Overall and cancer-specific survival rates were compared. RESULTS: The 5- and 10-year cancer-specific survival rates were 75.9 and 52.7 %, respectively, in the (D1 + D2) IORT group and 45.8 and 33.5 %, respectively, in the D2 control group, with cancer-specific survival being significantly longer in the D2 IORT than in the D2 control group (P = 0.030). Univariate and multivariate reduced-rank regression analyses showed that extent of skeletal disease Grade 4 and non-regional lymph node metastasis were significantly prognostic of poorer cancer-specific survival (P < 0.001 each). CONCLUSIONS: Local radiotherapy to the prostate by IORT in patients with metastatic prostate cancer may contribute to better survival, especially in patients without extent of skeletal disease Grade 4 or non-regional lymph node metastasis.

[Three Successful TUR Treatments of Urinary Bladder Recurrence of Colorectal Carcinoma].

We analyzed whether TUR was feasible in 4 cases of urinary bladder recurrence of sigmoid colon cancer that invaded into the bladder. Case No. 1 involved a 66-year-old male who presented with sigmoid colon cancer that had invaded the urinary bladder; he underwent sigmoidectomy with partial bladder resection. Six months after the operation, a small, protruded lesion in his urinary bladder was detected and TUR was performed. He has been cancer free for 10 years. Case No. 2 involved a 53- year-old female who underwent sigmoidectomy and hepatectomy for her sigmoid colon cancer and liver metastasis. She developed bladder and liver metastases, which were resected. Four months later, she underwent TUR because she developed a small recurrent tumor in the bladder. Since then, she has had no intrapelvic recurrence for 6 years. Case No. 3 was a 44- year-old male who underwent bladder-preserving resection for a sigmoid colon cancer that had invaded his bladder. He developed a relatively large bladder tumor 1 year 6 months later. TUR was performed and he was administered CRT. He has had no recurrences for 2 years 5 months. Case No. 4 was a 68-year-old male who underwent bladder-preserving surgery for a sigmoid colon cancer that had invaded his bladder. Because he developed a recurrence in the bladder, he underwent TUR 3 months later. He developed a recurrence in the bladder again 1 year 7 months later, and he underwent TUR again. Multiple organ metastases became evident and was prescribed chemotherapy for 2 years. From these cases, we conclude that TUR may be a feasible option for small, protruded recurrences in the bladder, but we should not hesitate to perform total cystectomy if the first TUR is unsuccessful.

The processus vaginalis transection method is superior to the simple prophylactic procedure for prevention of inguinal hernia after radical prostatectomy.

BACKGROUND: We compared retrospectively the efficacy of two methods for prevention of post-radical prostatectomy inguinal hernia: blunt dissection of the peritoneum at the internal inguinal ring, and isolation of the spermatic cord from the peritoneum (simple prophylactic procedure) and transection of the processus vaginalis. METHODS: Of the 367 patients who underwent open radical retropubic prostatectomy for clinically localized prostate cancer between February 2005 and March 2012 at Saitama Cancer Center Hospital, 344 patients whose follow-up period was more than 2 years were enrolled in this study. Of these patients, 178 patients received the simple prophylactic procedure and 57 underwent processus vaginalis transection. We evaluated the risk factors for inguinal hernia (age; anastomotic stricture post radical prostatectomy; prophylactic procedures for inguinal hernia; previous history of abdominal surgery; previous inguinal hernia surgery; body mass index) using univariate and multivariate analysis. The effects of the two prophylactic procedures on incidence of inguinal hernia were analyzed using Kaplan-Meier plots. RESULTS: The incidence of inguinal hernia was 24.8 % in those not undergoing the prophylactic procedure; 18.5 % in those undergoing the simple prophylactic procedure; and 0.00 % in those undergoing the processus vaginalis transection procedure (p < 0.001). In univariate and multivariate analysis, undergoing the processus vaginalis transection procedure and high body mass index were significant predictors for hernia-free survival after radical prostatectomy. CONCLUSION: Our data suggest that the processus vaginalis transection procedure is superior to the simple prophylactic procedure for the prevention of inguinal hernia after radical prostatectomy.

Development of a novel interferon-α2b gene construct with a repetitive hypoxia-inducible factor binding site and its suppressive effects on human renal cell carcinoma cell lines in vitro.

BACKGROUND: Despite the advent of targeted therapies, interferon-alpha (IFN-α) remains a therapeutic option for advanced renal cell carcinoma (RCC), especially in Japan, with a treatment response rate of 15-20 %. To improve the efficacy of IFN-α-based therapies, we evaluated a novel treatment strategy for RCC using an IFN-α2b gene construct with a repetitive hypoxia-inducible factor binding site. METHODS: We constructed an expression plasmid designated 5HREp-IFN-α2b containing the coding region of the IFN-α2b gene. Five copies of the hypoxia-response element (HRE) sequences were inserted upstream of the IFN-α2b gene, and the construct was transfected into human RCC cell lines ACHN, 786-O and KU19-20. The concentrations of IFN-α2b in the conditioned media were measured by enzyme-linked immunosorbent assay. Cell viabilities were determined by MTS assays. RESULTS: Construct-induced IFN-α secretion was confirmed in all three cell lines. IFN-α production was significantly enhanced by the hypoxia-mimicking agent deferoxamine mesylate in cell lines expressing the wild-type von Hippel-Lindau (VHL) gene (KU19-20 and ACHN) compared with cells expressing the mutant VHL gene (786-O). The construct exerted significant suppressive effects on the viabilities of all RCC cell lines. CONCLUSION: This is the first study to report on the construction of a cytokine gene with a repetitive hypoxia-inducible factor binding site and its application in the suppression of human cancer cells. Gene therapy using this IFN-α2b gene construct with HREs may represent a novel treatment modality for advanced RCC.

[Case of septic shock caused by extended spectrum ß-lactamase producing Escherichia coli after transrectal prostate biopsy, successfully treated by endotoxin adsorption therapy].

A 62-year-old man, with a family history of prostate cancer, referred to our hospital because of elevated prostate-specific antigen (PSA) (6.02 ng/ml). After prophylactic administration of antibiotics (cefotiam), transrectal needle biopsy of the prostate was performed. He was admitted to the hospital due to high fever the next evening. His blood pressure was below the shock level, and his renal function deteriorated progressively. Suspecting septic shock, the patient was treated with Meropenem, γ-globulin, and dopamine, which were not effective. Then, endotoxin adsorption therapy was employed and the condition of the patient recovered soon after the initiation of the therapy. Extended spectrum ß -lactamase-producing Escherichia coli was found in his urine. Pathological diagnosis of the biopsy specimen was atypical glands.

Treatment outcome of patients with extragonadal nonseminomatous germ cell tumors: the Saitama Cancer Center experience.

BACKGROUND: Survival of patients with extragonadal nonseminomatous germ cell tumors remains inferior to that of patients with advanced testicular cancer, although treatment is often the same for both conditions. In addition, the prognosis for nonseminomatous tumors has been shown to be worse than for seminoma. METHODS: Thirteen patients with extragonadal nonseminomatous germ cell tumors were treated between 1998 and 2011; the primary tumors were located in the mediastinum in six and in the retroperitoneum in seven. At initial diagnosis seven patients had distant metastases. According to the IGCCC, eleven patients had poor prognosis and two were intermediate. All 13 patients received cisplatin or carboplatin-based chemotherapy as initial treatment. The patients were further treated by use of a multi-modal strategy which included high-dose chemotherapy, aggressive surgery, and early introduction of salvage regimens. RESULTS: Complete response was obtained for eight patients. Among these complete responders, one patient remained relapse-free after post-chemotherapy surgical excision of viable cancer tissue. In the course of the chemotherapy, four patients died from cancer progression and one patient died as a result of post-chemotherapeutic sepsis. The other eight patients were alive at the end of the observation period. At the last observation all surviving patients were without evidence of disease. Five-year overall survival for all 13 patients was 62 %, and 5-year cancer-specific survival was 68 %. CONCLUSION: Our results indicate that even patients with far-advanced extragonadal nonseminomatous germ cell tumors can be cured by intensive chemotherapy plus surgery.

[Outcome of simple prophylactic procedure of inguinal hernia after radical prostatectomy].

Blunt dissection of the peritoneum at the internal inguinal ring and isolation of the spermatic cord from the peritoneum have been demonstrated to be effective for the prevention of post radical prostatectomy (RRP) inguinal hernia. We tested the efficacy of this simple procedure and analyzed the factors affecting the incidence of inguinal hernia. Of the 298 patients who underwent open RRP for clinically localized prostate cancer between February 2005 and March 2011 at Saitama Cancer Center hospital, 186 patients received the simple prophylactic procedure of inguinal hernia. We evaluated the risk factors of inguinal hernia (age, time of operation, intraoperative bleeding, prophylactic procedure of inguinal hernia, previous history of abdominal surgery, previous history of inguinal hernia surgery, nerve sparing, lymph node dissection, body-mass-index (BMI), hypertension, diabetes, and smoking) by univariate and multivariate analysis. Effects of the simple prophylactic procedure on incidence of inguinal hernia were analyzed using Kaplan-Meier plots. The incidence of inguinal hernia was 29.6% in those without the prophylactic procedure, and 11.4% in those with the prophylactic procedure. In univariate and multivariate analysis, only low BMI was a significant risk factor for inguinal hernia after RRP. Accordingly, the incidence of inguinal hernia was not affected by the prophylactic procedure in Kaplan-Meier analysis. Though the simple prophylactic procedure might be useful for prevention of post-radical prostatectomy inguinal hernia, its efficacy was demonstrated to be limited.

[Result of treatment for advanced germ cell tumor in the last decade].

PURPOSE: We retrospectively analyzed our therapeutic results of advanced male germ cell tumors in terms of efficacy and feasibility of our treatment strategy. PATIENTS AND METHODS: Fifty-one new cases were treated in Saitama Cancer Center between April 1997 and August 2007. Patients age ranged from 16 to 58 (median 33). Primary site of the tumor was testis in 41 (80%) patients, retroperitoneum in 6 (12%), and mediastinum in 4 (8%). Histology of the primary germ cell tumor was pure seminoma in 14 (27%), and non-seminoma in 30 (59%). Twenty (39%), 14 (27%) and 17 (33%) were classified as good-, intermediate-, and poor-risk, retrospectively, based on The International Germ Cell Consensus Classification (IGCCC) criteria. The initial treatment for good-risk patients was BEP x 3. Intermediate- or poor-risk patients were treated by VIP from 1997 to 2000, VIPVB from 2001 to 2004, and BEP from 2005 to 2007. Second line salvage treatments were high-dose VIP or ICE from 1997 to 2000. TIP x 4 has been employed since. Marker-negative cases with residual tumors underwent surgical resection of the mass lesion. RESULTS: Five-year survival rate was 100%, 74%, and 76% in patients with good-, intermediate- and poor-risk characteristics, respectively. After two courses of initial chemotherapy, tumor marker decline was satisfactory in 37 patients (73%) and unsatisfactory in 14 (27%). Of these 14 patients, 12 (86%) had unsatisfactory hCG decline, 4 (29%) had unsatisfactory AFP decline, and 2 (14%) had unsatisfactory decline in both markers. Five-year overall survival was 94% in cases with satisfactory maker decline and 71% in those with unsatisfactory marker decline (p = 0.03). CONCLUSIONS: In this IGCCCG era, 5 year survival rates of the advanced germ cell tumors have improved by the earlier administration of second line chemotherapies based on both the prognostic factor-based staging system and the tumor marker decline in initial chemotherapy. Development of effective treatment for cases with unfavorable tumor maker decline is the most challenging issue to be addressed.

Favorable response to combination treatment of cimetidine, cyclooxygenase-2 inhibitor and renin-angiotensin system inhibitor in metastatic renal cell carcinoma: Report of three cases.

We report three cases of metastatic renal cell carcinoma (RCC) in which combination treatment of cimetidine, cyclooxygenase-2 inhibitor and renin-angiotensin system inhibitor (angiotensin converting enzyme inhibitor or angiotensin II type 1 receptor antagonist) (CCA therapy) was effective. Case 1: A 47-year-old man who had a 12-cm right renal tumor with multiple pulmonary and hepatic metastases refused cytokine therapy for economic reasons and received CCA therapy. All of the metastases showed partial remission, which continued for 12 months. Case 2: A 62-year-old man with multiple pulmonary and mediastinal lymph node metastases from clear cell RCC refractory to interferon-alpha and interleukin-2 started CCA therapy. Partial remission has been maintained for 16 months. Case 3: A 64-year-old man with pulmonary metastases from clear cell RCC discontinued interferon-alpha treatment due to its side effects after six months and received CCA therapy. Pulmonary metastases showed partial remission for 31 months. The CCA therapy could be an alternative treatment for metastatic RCC patients unfit for cytokine therapy.

[Myelolipoma of the adrenal gland presenting as upper abdominal symptoms: a case report].

A case of adrenal myelolipoma is presented. A 39-year-old woman was admitted to our hospital for further examination of a right adrenal mass, which was found by examination for nausea, vomiting and upper abdominal pain. Imaging analyses by computed tomography and magnetic resonance imaging revealed a round fatty mass. Endocrine study of the adrenal gland showed normal results. Right adrenalectomy was performed. The tumor weighed 240 g and the histological diagnosis was adrenal myelolipoma. Postoperative course was uneventful and upper abdominal symptoms disappeared after surgery.