[A case of idiopathic adrenal hemorrhage].

A 67-year-old woman underwent abdominal ultrasonography as part of a general health examination and was incidentally found to have a mass 5 cm in diameter in the left adrenal gland. She had no experience of abdominal trauma. Computerized tomography (CT) revealed a 5.5 x 5.0 cm mass in the left adrenal gland, which was heterogeneously enhanced by the contrast medium. Hormanal data for adrenal function were all within the normal range. For the suspected non-functioning adrenal tumor, the patient underwent adrenalectomy. Histopathological examination demonstrated only hematoma without tumor cells.

[Clinical study of surgical site infection following portless endoscopic urological surgery (PLES)].

We investigated the clinical risk factors and bacteriological examination for surgical site infection (SSI) in 144 portless endoscopic surgeries consisting of 66 clean and 78 clean-contaminated surgeries in urological diseases from April 2000 to December 2001. There were no cases of SSI in the clean surgeries. SSI occurred in 5 cases (3.5%) of clean-contaminated surgeries including total cystectomy and ileal conduit in 4 cases and total prostatectomy in 1 case. Multivariate statistical studies revealed that usage of ileum during operation and preoperative hypo-albuminemia were significant risk factors for SSI. Gram-negative rods and anaerobic bacteria were isolated from the operative wound in the total cystectomy and ileal conduit, suggesting that SSI in the operation with usage of the ileum was partially derived from contamination with endogenous bacteria, while, normal flora of the skin in the wound did not cause any post-operative SSI.

[A case of primary leiomyosarcoma of the spermatic cord].

A 46-year-old man was presented with a firm mass of the spermatic cord. He underwent left radical orchiectomy with clinical diagnosis of spermatic cord tumor. The pathological examination revealed leiomyosarcoma (3.6 x 2.7 x 1.0 cm, pT1bN0M0; 5th TNM, Stage IA; 5th AJCC). He is free of disease 3 year postoperatively.

Superior vena cava syndrome caused by supraclavicular lymph node metastasis of renal cell carcinoma.

A 65-year-old woman presented with gross hematuria in February 1997. Left renal tumor was revealed and radical nephrectomy was performed. Pathological examination revealed papillary renal cell carcinoma, pT3aN1M1 (ipsilateral adrenal gland). Interferon-alpha was administered for 1 year. Two years after the nephrectomy, metastasis to the left supraclavicular lymph node appeared. Seven years after the nephrectomy, the metastatic tumor invaded the brachiocephalic vein and extended to the superior vena cava (SVC), compatible with SVC syndrome. Although interferon-alpha and external-beam radiotherapy was performed, she died in February 2005. Autopsy revealed a left supraclavicular lymph node metastasis invading the thyroid gland, mediastinum, and brachiocephalic vein. The tumor thrombus descended via the SVC into the right atrium. The right lung artery was obstructed by tumor thrombus. There were no visceral metastases and no local recurrence.

Successful treatment of chemo-refractory pulmonary metastases of renal pelvic cancer by second-line chemotherapy including gemcitabine followed by salvage surgery.

A 51-year-old woman developed multiple pulmonary metastases after receiving nephroureterectomy and two cycles of adjuvant chemotherapy for the treatment of renal pelvic transitional cell carcinoma. All metastases disappeared after four cycles of methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy followed by radiotherapy; however, 8 months later two pulmonary metastases recurred. The patient was entered into a phase I study of combination chemotherapy with gemcitabine, etoposide and cisplatin, designed for chemorefractory urothelial cancer. The lung masses showed significant reduction after two cycles of this chemotherapy; following salvage surgery, the patient has been well with no evidence of recurrence for more than 3 years.

Late relapse of stage I testicular seminoma metastatic to just a para-ureteropelvic region.

A follow-up ultrasonography study 43 months after an operation for left stage I testicular seminoma in a 39-year-old man revealed left hydronephrosis. Serum beta-human chorionic gonadotropin (beta-hCG) levels were slightly increased. Computed tomography scans of the abdomen showed a bulky tumor around the ureteropelvic region without para-aortic lymph node enlargement, but did not show a clear distinction between a recurrence of the testicular tumor and an invasive ureteral tumor. After the patient underwent two cycles of chemotherapy with cisplatin and etoposide, the tumor mass decreased by approximately 60% and beta-hCG levels returned to normal. We then performed a resection of the residual tumor involving the upper ureter and left kidney and a retroperitoneal lymph node dissection under a clinical diagnosis of recurrence of the testicular tumor. Histologically, no viable cancer cells remained. The patient has been well with no evidence of recurrence for more than two years.