[Adenocarcinoma arising in diverticulum of female urethra--a case report and review of the literature].

We report a case of adenocarcinoma within a female urethral diverticulum. The patient was a 54-year-old woman, with a three-month history of dysuria. On physical examination a soft, round mass was palpable in the anterior vaginal wall. Excretory urography demonstrated elevation of the bladder floor. Panendoscopy demonstrated a diverticulum at the 7 o'clock position in proximal urethra. A papillary mass confined to the diverticulum was identified and biopsied. The histopathologic findings showed adenocarcinoma. The patient underwent total cystectomy, pelvic lymphadenectomy, and creation of an ileal conduit. She was well 1 year and 5 months later.

[Prostatic carcinoma in a young adult: a case report].

We report a case of carcinoma of the prostate in a 30-year-old man. Serum acid phosphatase was normal. A transrectal biopsy of the prostate demonstrated an undifferentiated carcinoma. Total prostatocystectomy was performed and subsequent pathologic report stated that the mass was an undifferentiated carcinoma of the prostate gland. Metastases to the intrapelvic lymph node were present. Although immunohistochemical prostatic acid phosphatase (PAP) activity was not demonstrated, prostatic specific antigen (PSA) staining revealed a positive reaction within the tumor cells, confirming prostatic carcinoma. The patient's course has been uneventful without any recurrence by the intermittent adjuvant chemotherapy 8 months postoperatively. Review of the literature in Japan disclosed 16 cases (including our case) of carcinoma of the prostate in patients under 40 years of age.

[Periarteritis nodosa of the epididymis].

A thirty-one-year-old man with a scrotal swelling on the left side was found to have periarteritis nodosa of the epididymis (epididymal arteries). No systemic symptoms were present. Review of the literature revealed only two similar cases.

[Advanced prostate cancer with normal serum prostate-specific antigen values].

Although prostate-specific antigen (PSA) is a valuable marker of prostate cancer, some untreated patients with advanced prostate cancer have normal PSA values. Over a period of 5 years, we reviewed pretreatment serum PSA levels in 131 patients with advanced prostate cancer (stages C and D). Ten patients (7.6%) had normal PSA values. The histological type of prostate cancer associated with normal PSA values was variable and the prognosis was not so poor. Immunostaining for PSA was performed on the resected prostate tissue of the 10 patients. PSA staining was positive in 5 cases, negative in 3 cases, and equivocal in the remaining 2 cases. In conclusion, PSA is not always useful, especially for following patients with normal PSA values.

[True hermaphrodite with ipsilateral vas deferens and intrascrotal ovary].

A 15-year-old, legally male patient came to our department with chief complaint of gynecomastia. Serum testosterone was at a low level of 1.6 ng/ml, and prolactin a high level of 23 ng/ml. Blood type was a mixed type of both type A and type B, and a chromosomal analysis with peripheral blood lymphocytes demonstrated a mosaic of 46, XX/46, XY. During the follow-up, he complained a painful swelling in his right scrotum, and received an emergent surgery. A large amount of blood was noted in the right scrotum. Unicorn uterus, Fallopian tube and finbriae were observed, and a thumb-sized gonad with hemorrhage and fissure was also seen in the upper part of the scrotum. The right gonad was an ovary and no testicular tissue was confirmed in the right scrotum, whereas the right vas deferens was noted. The left testis was accompanied by an induration on its upper pole which was histologically found to be ovarian tissue. The patient was diagnosed as a true hermaphroditism with 46, XX/46, XY chimera that had an ovary with inguinal uterus hernia and an unusual vas deferens in the right scrotum and an ovotestis in the left. It was considered that an adequate amount of testosterone secreted from the left testis during the early embryonal period might have affected the descent of the right ovary into the scrotum and on the development of the right vas deferens.

Uterus didelphys with unilateral imperforate vagina and ipsilateral renal agenesis.

Uterus didelphys with unilateral imperforate vagina is rare. Interestingly, in all reported cases in which the urinary tract was investigated renal agenesis was found on the side of the obstructed hemivagina. We report 2 cases of this unusual and interesting condition, and review the embryogenesis of müllerian duct abnormalities associated with renal agenesis, as well as the clinical findings, diagnosis and management. We stress the importance of prompt and accurate diagnosis, and treatment as a means to avoid unnecessary surgical procedures.