[A case of complete disappearance of paraneoplestic syndrome after curative resection of bone metastasis in renal cell carcinoma].

A case of renal cell carcinoma presenting with paraneoplastic syndrome is reported. A 69-year-old man with uncontrolled diabetes was incidentally found to have a left thoracic tumor and a right renal tumor. He had intermittent fever of 39℃ or more and laboratory data showed diabetes and high C-reactive protein level. A radical nephrectomy was performed, but the neoplastic syndrome did not improve. After a second surgery consisting of complete resection of solitary bone metastasis the symptoms resolved immediately. At 6 months postoperatively, he had no reoccurence. Generally prognosis of patients with bone metastasis from renal cell carcinoma has been said to be poor, but surgical control of bone metastasis may be a key factor for the prognosis of patient with metastatic RCC in the era of targeted therapy.

[Case of abdominal wall malignant peripheral nerve sheath tumor which is difficult to distinguish from a urachal disease].

Malignant peripheral nerve sheath tumors (MPNST) are highly malignant soft tissue sarcomas. It is very rare for MPNST to arise in the abdominal wall. We report a case of abdominal wall MPNST that was difficult to distinguish from a urachal disease. A 72-year-old woman found a mass of the umbilicus in October 2011. She visited a digestive surgery department in November because it gradually enlarged. Diagnostic imaging suggested a urachal tumor. She was then referred to our clinic. Contrast enhanced CT showed that the 5-cm cystic tumor extended from the umbilicus to abdominal wall. The tumor showed low uptake value in PET-CT. We diagnosed her with a urachal cyst, but could not deny urachal carcinoma. Therefore, we performed surgical resection in January 2012. The pathological diagnosis was MPNST. She has not experienced recurrence for 9 months. MPNST mostly occur in the retroperitoneum close to the spine, extremities, head, and neck. It is very rare for them to occur in the abdominal wall. This is the sixth case including overseas reports. In addition, this is the first case in which it was difficult to distinguish from a urachal disease.

[Retrospective analysis of predicting biochemical recurrence after initial radical prostatectomy].

We evaluated clinical outcomes of radical prostatectomy in 244 patients who had undergone radical prostatectomy as initial treatment from January 2000 to December 2011, and were followed up for more than 6 months. Biochemical recurrence after prostatectomy was defined as prostate-specific antigen (PSA) level of at least 0. 2 ng/ml. We evaluated potential risk factors for significant associations with biochemical recurrence. Median follow-up period after prostatectomy was 49 months (range, 6-144). Of the total, 192, 31, and 20 patients were at pathological stage pT2, pT3a, and pT3b, respectively. In 83 patients with the positive surgical margin, apexes were mostly in the positive area. Of the 68 patients with PSA recurrence, PSA non-relapse rate was 66.6% for 5 years. Multivariate analysis was performed for seminal vesicle invasion, PSA nadir, surgical margins, and Gleason score. Thirty-two patients with PSA recurrence underwent salvage radiotherapy, and the biochemical recurrence rate at 5 years was 73.8%. The group in which the PSA level before salvage radiotherapy was ＜0.5 ng/ml had a low rate of biochemical recurrence. We must consider the recurrence of poorly differentiated or non-confined cancer after radical prostatectomy. These results suggest that early use of salvage radiotherapy is effective for patients with biochemical recurrence after radical prostatectomy.

[Two cases of pellagra associated with chemotherapy of docetaxel, estramustine, dexamethasone].

An 81-year-old male with hormone refractory prostate cancer, received chemotherapy of Docetaxel, Estramustine and dexamethasone as an outpatient. After 4 courses of chemotherapy, he was admitted to our hospital in December 2007 because of general fatigue, appetite loss and erythema of the back of hands and face. He was diagnosed with pellagra. Nicotinic acid was administered and the symptoms disappeared. An 80-year-old male with hormone refractory prostate cancer, received chemotherapy of Docetaxel, Estramustine and dexamethasone without admission. After 8 courses of the chemotherapy, appetite loss appeared. In January 2008, medical examinations revealed nails peeling off, facial erythema and erosion of the back of his hands. He was diagnosed with pellagra. Nicotinic acid was administered and the symptoms disappeared. Pellagra, a nicotinic acid deficiency disease, is rarely observed clinically nowadays. However, it may occur in the patients, undergoing chemotherapy without admission.

[A clinical study for intravesical recurrence after surgical therapy of urotherial carcinoma of the upper urinary tract].

To identify the risk factors for developing subsequent bladder carcinoma in patients undergoing surgical management of urothelial carcinoma (UC) of the upper urinary tract, we retrospectively studied 119 (median age 69, 81 males and 38 females) patients who underwent surgical resection at Yokohama Municipal Citizen's Hospital, Yokosuka Kyousai Hospital and Chigasaki Municipal Hospital from August 1980 to September 2006. After a median follow up of 37.7 months, 42 cases (35.3%) developed recurrent bladder cancer and the intravesical recurrence-free survival rate at 5 years (Kaplan-Meier method) was 57.7%. Bladder cancer was significantly more common in patients who had smaller primary tumors (less than 3 cm: p0.0444) by univariate analysis. This factor was also identified as independent predictor for the intravesical recurrence by multivariated analysis (p0.0495, Hazard ratio 2.099). In 42 intravesical recurrence cases, invasive recurrence was seen in 9 cases (21.4%). Invasive recurrence appeared to occur in the patients who were older and had longer interval by intravesical recurrence.

[Low-dose docetaxel, estramustine and dexamethasone combination chemotherapy for hormone-refractory prostate cancer].

The objective of this study was to evaluate the efficacy and safety of low-dose docetaxel, estramustine and dexamethasone combination chemotherapy in patients with hormone-refractory prostate cancer (HRPC). Sixty-nine patients with HRPC were enrolled. Docetaxel was given at a dose of 25 mg/m(2) on days 1 and 8 every 3 weeks, oral estramustine 280 mg twice daily on days 1 to 3 and 8 to 10, and oral dexamethasone 1 mg daily throughout the course. Cycles were repeated every 21 days. Treatment was continued until disease progression or excessive toxicity. Patients were evaluated for response and toxicity. Patients received a median of eleven cycles (range : 1-25). Prostatic-specific antigen (PSA) was decreased greater than 50% in 53 (77%) out of 69 patients and median duration of PSA response was 10.2 months. Median time to progression and overall survival 10.2 and 24 months, respectively. Grade 1-2 fatigue was the most common toxicity observed in 10 (15%) patients. Grade 3-4 toxicities were observed in five (7%) patients (2 thrombosis, 2 bilirubin elevation, and 1 aspartate transaminase/alanine transaminase elevation). Low-dose docetaxel, estramustine and dexamethasone combination chemotherapy is an effective and well tolerated treatment for Japanese HRPC patients.

[A clinical study concerning survival of operative cases for the transitional cell carcinoma of the upper urinary tract].

To identify prognostic factors influencing survival in transitional cell carcinoma (TCC) of the upper urinary tract, we retrospectively studied 189 (median age 70, 130 males and 59 females) patients who underwent surgical resection at our 3 hospitals from August 1980 to September 2006. After a median follow up of 47.8 months, 45 cases (23.8%) died of cancer and the 5-year and 10-year disease-specific survival rate (Kaplan-Meier method) was 70.5 and 67.1%. Because lymphatic and vascular involvements, pattern of infiltration and location of tumor had loss of data, only the univariate analysis was done. They were observed to be significantly different by the univariate analysis. The significant prognostic factors for survival using Cox-proportional hazard models were tumor stage, tumor grade, lymph node metastasis, and surgical margin status. Adjuvant chemotherapy was not the prognostic factor in our multivariate analysis.

Acute scrotum caused by Henoch-Schönlein purpura.

A boy aged 3 years and 11 months with arthralgia and purpuric skin rash was diagnosed with Henoch-Schönlein purpura (HSP) following an acute occurrence of his scrotal pain and swelling 17 days after the appearance of arthralgia. Immediate scrotal exploration was performed to confirm vasculitis of the left epididymis compatible with a scrotal manifestation of HSP. Postoperative course was uneventful. Twenty-five cases of HSP with acute scrotum reported in Japan, including this case, are calculated and discussed.

[Investigation of 14 renal cell carcinoma cases with tumor thrombus in the inferior vena cava].

Renal cell carcinoma tends to progress into the renal vein and inferior vena cava. We investigated 14 cases of renal cell carcinoma with tumor thrombus in the inferior vena cava. Surgery was performed in nine cases and mean survival was 53 months. Two cases are alive 8 years after the operation without recurrence or metastasis. The mean survival of 5 cases without operation was 7 months. Surgical management should be considered as a benefit for RCC patients with tumor thrombus in the inferior vena cava.