[A CASE OF PROSTATE CANCER WITH SECONDARY HYPOGONADISM].

A 70 year-old man underwent contrast CT, which revealed his swollen left inguinal and pelvic lymph nodes. The lymph nodes reduced in size without any treatments in a follow-up examination. In 2013, the lymph nodes enlarged again, and FDG-PET/CT showed high value at the prostate and multiple lymph nodes. The levels of serum PSA was high (PSA=682 ng/ml), therefore he underwent a prostate biopsy in his previous hospital and was diagnosed prostate cancer with metastasis of lymph nodes (cT2cN1M1a). Androgen deprivation therapy (ADT) was administered; however, the levels of serum PSA didn't reduce and lymph nodes enlarged further. He was referred to our hospital for further evaluation and treatment. The levels of serum total testosterone before ADT administration at his previous hospital was less than 0.05 ng/ml, which meaned that he had been hypogonadism. Brain MRI revealed a pituitary tumor, and he was diagnosed secondary hypogonadism due to the pituitary tumor. This was thought a rare case of a prostate cancer with secondary hypogonadism which had become castration resistant at the time of diagnosis.

[Renal Epithelioid Angiomyolipoma with Spontaneous Rupture: A Case Report].

A 66-year-old woman was referred to our hospital for a right renal mass found in the examination for sudden right flank pain. Abdominal computed tomography (CT) revealed a right renal tumor, 8.0 cm in diameter, with massive hemorrhage due to spontaneous tumor rupture. After transcatheter arterial embolization, right radical nephrectomy was successfully performed. The histopathological diagnosis of the renal tumor was epithelioid angiomyolipoma (eAML). Postoperative chest CT showed two lung tumors. Therefore, the lung tumors were resected and diagnosed as a primary lung adenocarcinoma and a sclerosing angioma. Although renal eAML is thought to have malignant potential, there has been no local reccurence nor distant metastases of renal eAML 11 months after the surgery.

[CLINICAL SURVEILLANCE OF PROSTATE CANCER--COMPARISON WITH CLINICAL MASS STUDY IN JAPAN].

OBJECTIVES: We report on the treatment trends and outcomes for prostate cancer in our clinic retrospectively, and compared our data with the domestic clinical mass study for prostate cancer. We then validated the legitimacy of our selected therapy for prostate cancer. PATIENTS AND METHODS: Eight hundred and eighteen patients at our clinic had histologically confirmed adenocarcinomas of the prostate between January, 2000 and January, 2013. RESULTS: The age distribution was from 47 to 100 years-old, with a median age of 72 years-old at diagnosis. Clinical TNM staging indicated that 301 cases (36.8%) were stage I, 303 cases (37.0%) were stage II, 101 cases (12.3%) were stage III and 113 cases (13.8%) were stage IV. Three hundred and fifty two cases (43.0%) received some form of androgen deprivation therapy (ADT). Retropubic prostatectomy (RPX) or radiation therapy (RT), including external beam radiation therapy and brachytherapy, was performed in 242 (29.6%) and 136 (16.6%) cases, respectively. The median overall survival was 56.3 months and the respective cause specific 5 year and 10 year survival rates of the 818 cases were 92.0% and 77.8%. Respectively, they were 100% and 100% for T1, 98.7% and 97.4% for T2, 90.7% and 38.5% for T3, and 60.8% and 38.9% for T4. JUA (Japanese Urological Association) Cancer Registration Statistics includes 11,385 eligible cases of prostate cancer, and had the same distribution and the same therapy trends as our data base. NUORG (Nara Uro-oncological Research Group), the data base of 2,303 prostate cancer patients, and our clinical study had the same distribution of D'Amico risk groups. Finally we validated JCAP (Japan Study Group of Prostate Cancer) recommended J-CAPRA scores in our prostate cancer patients who received primary androgen deprivation therapies. Progression free survival and cause specific survival were related to J-CAPRA scores. DISCUSSION/CONCLUSION: The Japanese prostate cancer patients have higher prostate-specific antigen at diagnosis, higher Gleason score and higher clinical stage than the US patients. The higher rate of primary androgen deprivation therapy is characteristic for the Japanese patients.

[Unilateral synchronous occurrence of renal pelvic urothelial carcinoma and renal cell carcinoma : report of two cases].

Two cases of unilateral synchronous occurrence of renal pelvic urothelial carcinoma and renal cell carcinoma are presented. Case 1 : A 70-year-old woman presented with macroscopic hematuria. Retroperitoneoscopic nephroureterectomy was performed under the diagnosis of renal pelvic carcinoma. Pathological diagnosis was not only renal pelvic urothelial carcinoma but also renal cell carcinoma 1.5×0.5 mm in diameter. Case 2 : A 79-year-old man with hormonal therapy for prostate cancer complained of macroscopic hematuria. Right nephroureterectomy was performed under the diagnosis of right renal pelvic carcinoma and right renal cell carcinoma. Pathological findings were the same as preoperative diagnosis. To our knowledge, 21 cases of unilateral synchronous occurrence of renal pelvic urothelial carcinoma and renal cell carcinoma have been reported in the Japanese literature including our cases and the clinical features are reviewed.

[Prostate cancer with disseminated carcinomatosis of bone marrow initially presenting with disseminated intravascular coagulation syndrome: a case report].

A 56-year-old man was admitted to our hospital complaining of dyspnea, general fatigue and lumbago. Several examinations revealed severe pancytopenia with disseminated intravascular coagulation (DIC), multiple lymph node metastases, and extremely high serum prostate specific antigen (PSA) level. Hormonal therapy under a diagnosis of advanced prostate cancer was started. Bone marrow biopsy, performed for the assessment of pancytopenia, revealed that there were no hematopoietic cells but only diffuse infiltration of prostate cancer cells. His bone scintigraphy showed a super scan image. Therefore, our diagnosis was prostate cancer with disseminated carcinomatosis of bone marrow. Although the response to hormonal therapy had been initially good, the time to PSA nadir was 9 weeks and he died 34 weeks after the start of the treatment. To our knowledge, 20 cases of prostate cancer with disseminated carcinomatosis of bone marrow have been reported in the Japanese literature including this case and the clinical features are reviewed.

[Giant non-functioning adrenocortical carcinoma effectively treated with preoperative transarterial embolization: a case report].

An 80-year-old women consulted a physician because of weight loss and slight fever. Since a large retroperitoneal tumor was found, the patient was referred to our hospital. Based on abdominal computed tomography, magnetic resonance imaging and blood tests, preoperative diagnosis was non-functioning left adrenal tumor, 13 cm in diameter. Preoperative abdominal angiography revealed that the tumor was supplied blood by the left adrenal artery, left renal artery through left renal upper segment, splenic artery, pancreas tail artery, and middle colic artery. We performed transcatheter arterial embolization (TAE) of some of these tumor-supplying vessels. Three days after the TAE, adrenalectomy was performed without blood transfusion. Histopathological examination of the tumor was adrenocortical carcinoma of low grade malignancy.

[Testicular cancer with inguinal lymph node metastasis in a patient with prior orchiopexy for undescended testis: a case report].

A 36-year-old man referred to our hospital with the chief complaint of painful left inguinal mass and fever. He had undergone left orchiopexy for undescended testis at 10 years of age. With the suspicion of an incarceration of inguinal hernia, an operation was performed. However, there was no hernia sac, and only swelling inguinal lymph nodes were found. Pathological diagnosis of the nodes was metastatic embryonal carcinoma, with suspicion of testicular origin. As scrotal ultrasonography revealed a hypoehcoic mass within the left atrophic testis, left high orchiectomy was performed. Pathological diagnosis of the left testicular mass was seminoma. A definite diagnosis was left testicular cancer, mixed type of seminoma and embryonal carcinoma, with inguinal nodes metastasis, pT1N2M0. He received 3 courses of bleomycin, etoposide, and cisplatin (BEP) chemotherapy, and there has been no sign of metastasis nor recurrence 18 months after the operation. To our knowledge, this is the 11th case in Japan of testicular cancer with inguinal node metastasis in a patient with prior orchiopexy for undescended testis.

[Metachronous bilateral testicular tumors in a case of male infertility].

A 42-year-old man referred to our hospital with the chief complaint of a solid mass of right scrotal contents. As ultrasonography revealed a right testicular tumor, right high orchiectomy was performed and the pathlogical diagnosis was testicular seminoma. At the age of 35-year-old, he was admitted to another hospital for male infertility due to azoospermia. Because left testicular tumor was found, left high orchiectomy was performed, with right testicular biopsy and testicular sperm extraction of the right testis at the same time. Pathological diagnosis revealed left testicular seminoma and no malignancy of the right testicular biopsy specimen. After the second operation, he has been receiving androgen replacement therapy, with no evidence of tumor recurrence.

[Giant solitary fibrous tumor of a kidney: a case report].

Renal solitary fibrous tumor (SFT) has been reported infrequently. We report a case in a 39-year-old woman with a 9-month history of sense of abdominal fullness. Computed tomography revealed well-encapsulated heterogeneous tumors involving the lower pole of the left kidney with left renal vein extension. The tumors measured approximately 20 cm in diameter and displaced adjacent organs. We performed preoperative transcatheter arterial embolization of the left renal artery. Left nephrectomy with complete tumor resection was achieved without major complications. The tumors were well-circumscribed and composed of spindle cells in a collagenous stroma. Immunohistochemistry showed reactivity for CD34 and bcl-2. Immunohistochemical stains for c-kit and CD10 were negative. A diagnosis of SFT was made based on light microscopy and immunohistochemistry. The patient is alive with no evidence of disease 6 months after the operation. This case is the largest renal SFT in the Japanese literature.

Determination and characterization of hydroxylated polychlorinated biphenyls (OH-PCBs) in serum and adipose tissue of Japanese women diagnosed with breast cancer.

In the present study, we analyze and characterize the levels of PCBs and OH-PCBs in serum and breast adipose tissue, and measure TH (total 3,5,5'-triiodothyronine (tT3) and total l-thyroxine (tT4)) levels in serum of Japanese women diagnosed with breast cancer (n = 51) to know how PCBs affect thyroid hormone homeostasis. Concentrations of Sigma(90)OH-PCBs in serum and adipose tissues were 630 pg g(-1) serum wet wt. and 140 pg/ g(-1) lipid wt., respectively, and the levels of OH-PCBs in adipose tissues were 4-5 times lower than in serum. The tT3 and tT4 concentrations in serum (n = 20) were 1.3 ng g(-1) serum wet wt. and 62 ng g(-1) serum wet wt., respectively. Among all the OH-PCBs, 4'-OH-CB101/120, 4-OH-CB107/4'-OH-CB108, 3'-OH-CB138, 4-OH-CB146, 3-OH-CB153, 4'-OH-CB172, and 4-OH-CB187 were the dominant isomers in serum. No significant correlation between the concentrations of the TH and OH-PCBs in serum was observed (p > 0.05). The results indicated that the relationship between the OH-PCB levels and the thyroid hormone markers was rare. From analysis of two kinds of human biological samples, it was estimated that OH-PCBs have little effect on thyroid hormone homeostasis.

Androgen decline in patients with nonobstructive azoospemia after microdissection testicular sperm extraction.

OBJECTIVES: Microdissection testicular sperm extraction (TESE) is the ideal procedure for obtaining a high sperm retrieval rate. However, few studies of the postoperative endocrinologic course have been reported. We evaluated the endocrinologic course for 1 year after microdissection TESE and compared the results with the testicular histologic findings. METHODS: A total of 69 patients with nonobstructive azoospermia who had undergone microdissection TESE were included. The overall sperm retrieval rate was 50.7%. The endocrinologic data were evaluated before and 3, 6, and 12 months after surgery. RESULTS: The mean serum total testosterone level in patients with hypospermatogenesis decreased postoperatively and had recovered by 12 months (102%). The mean serum total testosterone level in patients with Klinefelter syndrome also decreased postoperatively but had recovered to only 50% of the baseline value at 12 months after microdissection TESE. At 12 months, the mean serum total testosterone level in patients with maturation arrest was 93.1% of the preoperative level and that in patients with Sertoli cell-only syndrome was 80.6% of the preoperative level. The preoperative serum luteinizing hormone and follicle-stimulating hormone in patients with Klinefelter syndrome was high and remained high after microdissection TESE. The mean serum luteinizing hormone and follicle-stimulating hormone levels in patients with hypospermatogenesis did not change, and those in patients with maturation arrest increased continuously after microdissection TESE. Finally, those in patients with Sertoli cell-only syndrome increased up to 6 months after surgery and decreased after that. CONCLUSIONS: The results of our study indicate that long-term endocrinologic follow-up is necessary after microdissection TESE, particularly for patients with Klinefelter syndrome to detect hypogonadism.

In vitro evaluation of atmospheric particulate matter and sedimentation particles using yeast bioassay system.

Little information on the evaluation of airborne particulate matter (APM) and sedimentation particles from subway stations is available. The thermal metamorphism of train wheels generating toxic particles in subway stations is a possibility. In this study, the toxicity and physiological effects of particles from subway stations were evaluated using a yeast bioassay system. Estrogenic and antiestrogenic activities of APM in APM extracts from subway stations were determined. No estrogenic activity was found in the APM fractions and their S9-activated APM samples. Sedimentation dust samples also showed no estrogen activity. In contrast, extracts from sedimentation dust samples showed antiestrogen activity. Marked yeast toxicity was observed in the samples extracted from sedimentation dust. Potent yeast toxicity was also found in the S9-activated extracts from sedimentation dust. The results suggest that sedimentation dust from a semiclosed area of a subway system has antiestrogen activity, although both the origin and generation system of this activity are uncertain. These pollutants in sedimentation dust may change to a more toxic form in vivo by S9 activation.

A case of primary hyperparathyroidism in childhood found by a chance hematuria.

A 10-yr-old boy visited Minoh City Hospital complaining of gross hematuria. Laboratory investigations revealed hypercalcemia, hypophosphatemia, and elevated serum levels of parathyroid hormone. A stone was found in the right ureter with drip infusion pyelography. A parathyroid adenoma was successfully diagnosed with computed tomography, ultrasonography, and methoxy-2-isobutyl isonitrile (MIBI) scintigraphy. Multiple endocrine neoplasia was ruled out by normal results of endocrine laboratory examinations. Extracorporeal shock wave lithotripsy was performed to treat the urolithiasis, and the parathyroid adenoma was surgically removed. Primary hyperparathyroidism is rare in childhood; however, this case suggests that gross hematuria is an important sign of hyperparathyroidism.

[Complications of tension-free vaginal tape procedure: a comparison of the vaginal and abdominal approaches].

OBJECTIVES: The objectives of this clinical study is to demonstrate our experience of the abdominal approach (from the abdominal wall to the vagina) for the tension-free vaginal tape (TVT) operation and to identify factors responsible for complications relating to the puncture. MATERIALS AND METHODS: One hundred and fifty-one cases of patients with stress incontinence who underwent the tension-free vaginal tape operation were analyzed. Among them, 75 cases underwent the TVT procedure with the vaginal approach (from the vagina to the abdominal wall) and the remaining 76 cases underwent the TVT procedure with the abdominal approach (from the abdominal wall to the vagina). The TVT procedure with abdominal approach was performed in almost the same manner as described in the guiding booklet provided by Gynecare. Student's t-test was used to detect the differences in ages and operating times between the abdominal and vaginal approach cases. Chi-square test was used to analyze the difference between complication rates of the two procedures. Multivariate logistic regression analysis was used to determine the relationship between complications related to the puncture and such factors as age, concomitant operation for genital organ prolapses, approach routes and past history of intra-pelvic surgery. RESULTS: Differences between the abdominal and vaginal approach cases as regards age of patients and operating time were not significant. Chi-square test showed that the difference between the complication rates of the two procedures was not significant. Complications relating to the puncture consisting of bladder perforation and intra-pelvic hematoma occurred in nine cases in the vaginal approach group. Since an abdominal guide passed very close to the urinary bladder in one case in the abdominal approach group, we counted this as a bladder perforation case. Seven cases out of these ten cases with complications had a past history of intra-pelvic operation. Multivariate logistic regression analysis showed that the risk factors associated with these complications were the vaginal approach procedure [odds ratio (OR) 11.4, 95%confidence interval (CI) 1.4-96.4] and past history of intra-pelvic surgery [OR8.2, 95%CI 1.9-35.5]. CONCLUSION: The difference between the complication rates of the two procedures was not sig- nificant. The vaginal approach puncture and the past history of intra-pelvic surgeries were the risk factors for the complications relating to the puncture.

Running suture for vesicourethral anastomosis in minilaparotomy radical retropubic prostatectomy.

INTRODUCTION: We used a running suture method for vesicourethral anastomosis in patients undergoing minilaparotomy radical retropubic prostatectomy. TECHNICAL CONSIDERATIONS: The vesicourethral anastomosis using a single knot at the 6:30-o'clock position is created with two steps of semicircular running suture. A total of 21 consecutive patients underwent this running suture method using the Endostitch in the hands of a single surgeon (T.M.) between March and November 2004. The running suture procedure was completed in 15 minutes on average. After surgery, no urinary leakage at the anastomotic site was found. Satisfactory continence was achieved in the short term in 100% (0 to 1 pad per day) of cases. However, dilation at the anastomosis using a metal dilator was required in 2 patients immediately after surgery. CONCLUSIONS: The running suture method is considered a feasible alternative in minilaparotomy radical retropubic prostatectomy.

Outcome of gonadotropin therapy for male hypogonadotropic hypogonadism at university affiliated male infertility centers: a 30-year retrospective study.

PURPOSE: Hypogonadotropic hypogonadism (HH) is an uncommon cause of male infertility. Even specialized centers see small numbers of patients and have little experience in restoring fertility in these patients. To explore the phenotypic heterogeneity and treatment outcome of HH, we summarized our 30-year experience. MATERIALS AND METHODS: Medical charts of 36 male patients (age range 11 to 42 years) with HH (81% primary, 19% secondary) treated at university affiliated male infertility centers were reviewed. Pubic hair stage, genital stage, testicular volume (TV), sexual function and sperm production were determined before and after human chorionic gonadotropin/human menopausal gonadotropin (hCG/hMG) treatment. Differences were analyzed statistically. RESULTS: The population was stratified according to initial TV into a small testis subset (TV less than 4 ml in 23) and a large testis subset (TV 4 ml or greater in 13). Comparison of these 2 subsets revealed significant differences in the incidence of cryptorchidism (39% vs 8%) and Kallmann's syndrome (22% vs 0%), pubic hair stage (1.3 +/- 0.5 vs 3.5 +/- 1.4), genital stage (1.2 +/- 0.4 vs 3.9 +/- 0.9) and TV (1.6 +/- 0.9 vs 7.5 +/- 3.5 ml). Long-term administration of hCG/hMG for 12 to 240 months (average 56 +/- 11) resulted in sperm production in only 36% of the small testis subjects but in 71% of the large testis subjects. CONCLUSIONS: Initial TV values provide insight into phenotypic variables such as time of onset and severity in patients with primary or secondary HH, and may predict sperm output in response to hCG/hMG therapy.

A rapid and sensitive analysis of diphenylarsinic acid in water by gas chromatography/mass spectrometry.

A rapid and sensitive analytical method using pentafluorothiophenol (PFTP) derivatization was applied to detect diphenylarsinic acid (DPAA) in water. In this study, the optimum derivatization conditions, such as acid concentration, reaction time and reaction temperature, were investigated to develop a suitable procedure for DPAA determination. After extracting the derivatives into benzene, the determination was carried out by gas chromatography/mass spectrometry (GC/MS) with selected ion monitoring (SIM). The detection limit of the method was 9.4 microg/l, and the overall recoveries obtained from real environmental samples were 88.9 - 104.7% and coefficient variations were 5.1 - 13.9%.

[Safety and efficacy of a new vessel-sealing device for laparoscopic varicocelectomy].

PURPOSE: To evaluate the safety and efficacy of a new vessel-sealing device (LigaSure) for laparoscopic varicocelectomy. MATERIALS AND METHODS: To evaluate the safty, after elective varicocelectomy, the internal spermatic veins (n = 8) were sealed ex vivo with a 5-mm laparoscopic Maryland-style LigaSure (LigaSure Lap), and bursting pressures were measured. To evaluate the efficacy, a retrospective review of our clinical experience with LigaSure (n = 13) and clip (n = 13) in laparoscopic bilatelal varicocelectomy from June 2000 to October 2002 was performed and certain parameters were abstracted, including operative time, estimated blood loss and perioperative complications. RESULT: In the ex vivo study the mean varicocele vessele diameter was 2.5 +/- 0.8 mm (mean +/- SD) and bursting pressure was 449 +/- 95.2 mmHg. Six were burst in normal vessel walls at the average bursting pressure of 442 mmHg and two in the occlusions at the average bursting pressure of 508 mmHg. The difference was not statistically significant. Reliable vessel sealing was achieved in all the patients. The mean operative time showed significant decrease in the LigaSure group compared with the clip group, 70 +/- 20 minutes versus 117 +/- 27 minutes (p < 0.05). Estimated blood loss was minimal and no perioperative complications occurred in both groups. CONCLUSIONS: Our study suggests that a vessel-sealing device appears to be a safe and feasible alternative to the clip in laparoscopic varicocelectomy. It offers the advantage of reducing operative time.

Impact of age, follicle stimulating hormone and Johnsen's score on successful sperm retrieval by microdissection testicular sperm extraction.

Background: The spermatozoa retrieval rate achieved by microdissection testicular sperm extraction (TESE) for patients with non-obstructive azoospermia is still approximately 50%, despite technical advances. Predicting a successful outcome is important to avoid unnecessary surgery. A study was conducted to determine a method for calculating the predicted probability of successful microdissection TESE. Methods: Testicular spermatozoa were retrieved in 41 of 100 patients by microdissection TESE. Ten clinical factors were examined in the search for an optimal logistic model for predicting a good outcome. Once the best delimiting value was established, sensitivity and specificity were calculated. Results: Patient age, serum follicle stimulating hormone (FSH) concentration and Johnsen's score (JS) were shown to be influential factors by multivariate logistic analysis. The mathematical model for predicting the probability of a successful outcome was as follows: P = (1 + exp[0.144 × patient age - 0.059 × serum FSH concentration - 1.310 × JS])-1. When a predictive probability of 49.7% was selected as the best cut-off value, sensitivity and specificity were 78.0% and 76.3%, respectively. Conclusion: This present model is very useful for predicting successful microdissection TESE. In addition, we suggest that a younger patient age would increase the probability of success with this procedure. (Reprod Med Biol 2005; 4: 53-57).

Prediction of successful outcome of microdissection testicular sperm extraction in men with idiopathic nonobstructive azoospermia.

PURPOSE: Microsurgical techniques in testicular sperm extraction can improve sperm retrieval in patients with nonobstructive azoospermia (NOA). However, spermatozoa retrieval rates have still been reported to be around 50% for patients with NOA. Thus, a reliable prediction method for successful outcome is needed to avoid unnecessary surgery. In this retrospective study we determined the diagnostic and predictive values of noninvasive parameters used in the treatment of patients with NOA. MATERIALS AND METHODS: We analyzed 9 preoperative factors including patient age, testicular volume and endocrinological data of 100 patients with NOA using multivariate logistic modeling. Testicular spermatozoa were retrieved successfully in 41 of the 100 patients (41%). RESULTS: We found that the concentrations of follicle-stimulating hormone (FSH), total testosterone (TT) and inhibin B were considered the most influential preoperative factors. We developed a formula to calculate the probability of successful outcome, P = [1 + exp(5.201 - 0.048 x FSH - 0.449 x TT - 0.021 x inhibin B)](-1). Association of predicted probabilities and observed responses was 0.77. A predicted probability of more than 15.7% was found to be the best cutoff. Sensitivity was 71.0% and specificity was 71.4% as determined by receiver operating characteristic analysis. CONCLUSIONS: We concluded that our formula should be useful for doctors considering microdissection testicular sperm extraction for patients with NOA because our equation uses noninvasive parameters without a preoperative testicular biopsy, which is a relatively invasive examination.