[Late Relapse of Testicular Cancer at the Pelvis with Elevated AFP Levels : A Case Report].

We report a patient with seminoma which recurred as late relapse at the pelvis with elevated alphafetoprotein (AFP) levels. A 40-year-old man presented with a left testicular tumor and subsequently underwent high orchiectomy in 2006. Pathological findings showed that the tumor was a seminoma with invasion into the tunica albuginea (pT2N0M0). Seven years after surgery, computed tomography showed a 12×8.7 mm, well-circumscribed, pelvic cystic tumor, and AFP and human chorionic gonadotropin levels were elevated. He was clinically diagnosed with recurrent testicular cancer. Despite the fact that the patient had four courses of bleomycin, etoposide, and cisplatin (BEP), the tumor enlarged and AFP levels were still elevated. Therefore, we performed open excision of the pelvic tumor. Judging from the pathological report, we made the final diagnosis of mature cystic teratoma. The patient was free of recurrence or metastasis within 48 months of follow-up.

Prognostic impact of perioperative lymphocyte-monocyte ratio in patients with bladder cancer undergoing radical cystectomy.

Various systemic inflammatory response biomarkers are associated with oncological outcome. We evaluated the superiority of prognostic predictive accuracy between neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR), and the prognostic significance of their perioperative change in patients with bladder cancer undergoing radical cystectomy (RC). We retrospectively analyzed 302 patients who had undergone RC in four institutions. Comparison of predictive accuracy between NLR and LMR was performed using receiver operating characteristic curve analysis. Overall survival (OS) and cancer-specific survival (CSS) were assessed with the Kaplan-Meier method and Cox regression analysis. Preoperative and postoperative LMR showed higher predictive accuracy for OS than NLR did (p = 0.034). Applying a cutoff of 3.41, change in perioperative LMR stratified patients into three groups (low, intermediate, and high risk), showing a significant difference in OS and CSS (p < 0.001, each), and pathological outcomes. Multivariable analyses for OS and CSS showed that poor changes in LMR (high risk) were an independent prognostic factor (hazard ratio 5.70, 95 % confidence interval 3.49-9.32, p < 0.001; hazard ratio 4.53, 95 % confidence interval 2.63-7.82, p < 0.001; respectively). Perioperative LMR is significantly associated with survival in patients with bladder cancer after RC, and it is possibly superior to NLR as a prognostic factor.

A novel risk stratification model, involving preoperative lymphocyte-monocyte ratio and standard pathological factors, for overall survival in patients with bladder cancer undergoing radical cystectomy.

OBJECTIVE: To evaluate the ability of preoperative lymphocyte-monocyte ratio to predict prognosis and determine post-operative risk stratification in patients with bladder cancer undergoing radical cystectomy. METHODS: A retrospective review of the 210 patients who had undergone radical cystectomy for bladder cancer from 2006 to 2013 identified 181 patients with sufficient data to evaluate the prognostic significance of the lymphocyte-monocyte ratio. Overall survival was assessed by the Kaplan-Meier method. The association of clinicopathological findings with overall survival was evaluated by a multivariate Cox proportional model, and a novel risk stratification model to predict prognosis was established. RESULTS: Median follow-up after radical cystectomy was 6.0 years. The 5-year overall survival rate was significantly lower for patients with low than high lymphocyte-monocyte ratio (27.6 vs 80.7%, P < 0.001). Multivariable analyses showed that pT ≥2, pN ≥1, positive margins and low lymphocyte-monocyte ratio were independent predictors of overall survival. A post-operative risk stratification model using these factors showed significant differences among the three subgroups (low, intermediate and high risk) with a concordance index of 0.84. The 5-year overall survival rates in patients at low, intermediate and high risk were 85.4, 45.5 and 0%, respectively (P < 0.001). CONCLUSIONS: Preoperative lymphocyte-monocyte ratio, pathological tumor and lymph node stage and positive margins are significantly associated with overall survival in patients who have undergone radical cystectomy for bladder cancer.

Evaluation of prognostic factors after radical prostatectomy in pT3b prostate cancer patients in Japanese population.

OBJECTIVE: The purpose of the current study was to evaluate prognostic factors after radical prostatectomy for prostate cancer patients with seminal vesicle invasion (pT3b) in the Japanese population. METHODS: Between January 2005 and December 2011, 814 patients underwent radical prostatectomy without neoadjuvant hormonal therapy at our institutions. Among these patients, 31 were (3.8%) presented with pT3b. Kaplan-Meier method was used to determine biochemical recurrence-free, disease-specific and overall survival of patients in this group. Proportional hazards models were used to determine predictors of biochemical recurrence-free survival. RESULTS: The median follow-up period was 60 months (range, 9-108 months). During follow-up, 23 patients (74.2%) experienced biochemical recurrence, and the overall 3-year probability of freedom from biochemical recurrence was 29%. However, only one patient died of the disease, and the 5-year overall survival was 92%. In multivariate analysis, age at the time of surgery was the only significant variable for predicting biochemical recurrence after radical prostatectomy (P = 0.0356, hazard ratio = 0.92, 95% confidence interval = 0.851-0.994). CONCLUSIONS: Patients with seminal vesicle invasion of pathological specimens after radical prostatectomy have high biochemical recurrence, but the survival was favorable especially in light of current multimodal treatment regimens. However, patients with younger age at the time of surgery, in particular, should receive multimodal treatments to improve their outcome.

Pathological outcomes of Japanese men eligible for active surveillance after radical prostatectomy.

BACKGROUND: The aim of this study was to analyze the pathological features of prostatectomy specimens from patients with low-risk prostate cancer eligible for active surveillance (AS) and evaluate preoperative data suitable for predicting upstaged (≥pT3) or upgraded disease (Gleason score of ≥7), defined as 'reclassification'. METHODS: A retrospective analysis of 521 consecutive radical prostatectomy procedures (January 2005 through to December 2011) performed at our institution without neoadjuvant hormonal therapy was performed. Eighty-four patients fulfilled the following criteria-clinical T1 or T2 disease, prostate-specific antigen (PSA) level of ≤10 ng/ml, one or two positive biopsies, and Gleason score of <7. Clinicopathological features at diagnosis were compared between patients with and without reclassification after radical prostatectomy. RESULTS: Forty of 84 patients (47.6 %) had a Gleason score of ≥7, and 8 (9.5 %) had upstaged disease (≥pT3). Seven patients with upstaged disease also showed upgraded reclassification. Two patients with reclassification showed biochemical recurrence at 59 and 89 months after surgery, respectively. Preoperative parameters evaluated included age, PSA level, PSA density (PSAD), clinical T stage, and number and percentage of positive prostate cores. Among 82 patients with complete data, univariate analysis showed that PSAD (ng/ml(2)) was a significant parameter to discriminate patients with reclassified disease and those without reclassified disease (p < 0.001). Multivariate analysis revealed that PSAD was the only independent variable to predict disease with reclassification (p = 0.006). CONCLUSIONS: Preoperative PSAD may be a good indicator for selecting patients eligible for AS in the Japanese population.

A renal epithelioid angiomyolipoma/perivascular epithelioid cell tumor with TFE3 gene break visualized by FISH.

We present a case of renal epithelioid angiomyolipoma (eAML)/perivascular epithelioid cell tumor (PEComa) with a TFE3 gene break visible by fluorescence in situ hybridization (FISH). Histologically, the tumor was composed of mainly epithelioid cells forming solid arrangements with small foci of spindle cells. In a small portion of the tumor, neoplastic cells displayed nuclear pleomorphism, such as polygonal and enlarged vesicular nuclei with prominent nucleoli. Marked vascularity was noticeable in the background, and perivascular hyaline sclerosis was also seen. Immunohistochemically, neoplastic cells were diffusely positive for α-smooth muscle actin and melanosome in the cytoplasm. Nuclei of many neoplastic cells were positive for TFE3. FISH analysis of the TFE3 gene break using the Poseidon TFE3 (Xp11) Break probe revealed positive results. Reverse transcriptase-polymerase chain reactions (RT-PCR) for ASPL/TFE3, PRCC/TFE3, CLTC/TFE3, PSF/TFE3, and NonO/TFE3 gene fusions all revealed negative results. This is the first reported case of renal eAML/PEComa with a TFE3 gene break, and it has unique histological findings as compared to previously reported TFE3 gene fusion-positive PEComas. Pathologists should recognize that PEComa with TFE3 gene fusion can arise even in the kidney.

[Laparoscopic renal surgery in the elderly].

It is clear that laparoscopic renal surgery has significant advantages over open renal surgery. However, current data on whether these benefits carry over to the elderly are less robust. The objective of this study was to compare the perioperative parameters of laparoscopic nephrectomy and nephroureterectomy in patients aged 70 and over versus those under 70 years of age. The new scoring system, the "E-PASS" (estimation of physiologic ability and surgical stress) was also studied. This scoring system predicts the postsurgical risk by quantifying the patient's reserve and surgical stress. E-PASS comprises the perioperative risk score (PRS), the surgical stess score (SSS), and the comprehensive risk score (CRS) that is determined using the other two scores. Between January 2006 and December 2009, a total of 55 patients who underwent laparoscopic renal surgery met the study inclusion criteria. The perioperative parameters were comparable in the younger patients and the older patients, including SSS, the postoperative complication rate, the operation time and the hospital stay. Laparoscopic renal surgery is feasible and well tolerated in elderly patients, with a low perioperative morbidity and surgical stress. Further examination on the E-PASS scoring system for application to urologic surgery was considered to be necessary. Age alone should not exclude elderly patients from definitive treatment at the outset.

[An analysis of upper urinary tract recurrence following radical cystectomy for bladder cancer].

Transitional cell carcinoma of the urothelium is often multifocal, and subsequent tumors may occur anywhere in the urinary tract afer treating the initial carcinoma. The risk of an upper urinary tract recurrence following a radical cystectomy has been reported to be approximately 2 to 8%, but there are few reports with regard to the pattern and predictive factors of upper tract recurrence. We report here the incidence and pattern of upper tract recurrence following a radical cystectomy. Of the 166 patients 5 (3%) had upper tract recurrence. The prognosis of upper urinary tract recurrence is significantly better than other site of recurrence.