A case of mammary-type myofibroblastoma of the inguinal region.

INTRODUCTION: Myofibroblastoma is usually occurred in the breast and extra-mammary disease is rare. PRESENTATION OF CASE: A 38-year-old man was admitted to our hospital for further examination of the left inguinal tumour, present and enlarging for 16 months. The tumor was 50 mm in diameter, well-circumscribed, firm, and painless. Ultrasonogaphy, computed tomography(CT) and magnetic resonance imaging (MRI) could not provide the definitive diagnosis. Surgical exploration confirmed a 50 mm tumour with a clear surface with a thin capsule. Complete excision was achieved. Histopathology confirmed the tumor had oval and spindle shaped fibroblastic cells with rich collagen deposition. It stained positive for ER, CD34, desmin and CD10 but negative for -smooth muscle actin and S-100. A mammary-type myofibroblastoma was diagnosed based on these results. DISCUSSION: An extra-mammary myofibroblastoma is very rare and first reported in 2001. Since then, over 160 cases have been reported. On immunohistochemistry, these lesions are characteristically positive for CD34 and desmin, with variable staining for α-smooth muscle actin. Once the diagnosis is made, regardless of size or location, this tumour behaves in a benign fashion after surgical excision reported so far. CONCLUSION: This case is rare, but the correct diagnosis and treatment is important for good prognosis.

[A Crossover Comparison Study on Lower Urinary Tract Symptoms with Overactive Bladder Secondary to Benign Prostatic Hyperplasia: Naftopidil versus Tamsulosin with Solifenacin].

We compared the efficacy of naftopidil monotherapy with combination therapy using tamsulosin hydrochloride and solifenacin succinate in the treatment of lower urinary tract symptoms (LUTS) with overactive bladder (OAB) secondary to benign prostatic hyperplasia (BPH). Thirty one patients were enrolled in a randomized crossover study. Fourteen patients were initially prescribed naftopidil 75 mg (N) for 8 weeks, followed by tamsulosin 0.2 mg and solifenacin 5 mg (TS) for 8 weeks (group N) ; another 17 were initially prescribed TS, followed by N (group TS). The efficacy variables were the changes in international prostate symptom score (I-PSS), quality of life (QOL) score, overative bladder symptom score (OABSS), and post-void residual (PVR) urine volume. After the study, a questionnaire survey was carried out about the choice of treatment. After treatment with each agent, total I-PSS, storage symptom score, QOL score and OABSS except for the daytime frequency were significantly improved from baseline. PVR was significantly increased after TS treatment. There were no significant differences between the two treatments except for PVR. As a result of the questionnaire survey, 13 patients chose N and 17 chose TS. In conclusion, N monotherapy can be expected to have an equal effect in the treatment of LUTS with OAB secondary to BPH in comparison with TS combination therapy.

Advanced prostate cancer with extremely low prostate-specific antigen value at diagnosis: an example of high dose hook effect.

A 67-year-old man presented with a lower abdominal mass. Radiographic examination revealed a huge mass filling the entire pelvis. Although prostate-specific antigen (PSA) was 1.4 ng/ml, percutaneous needle biopsy revealed adenocarcinoma compatible with prostate cancer, which stained positive for PSA. Hormone therapy was initiated and 1 month later his PSA was as high as 2713 ng/ml, although the mass had decreased in size. High dose hook effect was suspected and hormone therapy was continued. PSA is presently under control and below 0.1 ng/ml. When prostate cancer with very high PSA is suspected and the PSA value is unexpectedly low hook effect should be considered and PSA should be re-analyzed.

A case of lupus cystitis diagnosed from urinary symptoms as the sole initial complaint.

Cystitis related with systemic lupus erythematosis (SLE) is termed as lupus cystitis. It is a subtype of SLE in which gastrointestinal and bladder symptoms are prominent and it usually manifests with other symptoms of SLE. We present a case in a 37-year-old woman whose sole complaint was the severe urinary symptoms. A biopsy of the bladder showed inflammation in the submucosa and the finding of vasculitis. An autoimmune disease was suspected from the blood serum sample. A further laboratory study was performed and she was diagnosed with SLE and lupus cystitis. Prompt therapy with corticosteroids resulted in the improvement of the severe bladder symptoms.

[Testicular cancer with inferior vena caval embolus causing pulmonary embolism following chemotherapy: a case report].

A 21-year-old male presented with right scrotal discomfort. Right high orchiectomy revealed non-seminoma and he was diagnosed with stage I non-seminoma. Since acute myeloid leukemia (AML) was diagnosed incidentally, no adjuvant therapy was given and he received chemotherapy for AML. One year later, he complained of lumbago and general malaise. Complete remission of AML had been achieved and bone marrow puncture revealed no signs of recurrence. Computed tomography showed retroperitoneal lymph node swelling, inferior vena caval embolus distal to the hepatic vein, and multiple lung nodules. Metastasis of testicular neoplasm was suspected and chemotherapy with Bleomycin, Etoposide, and Cisplatin was started. On the fourth day of chemotherapy, the patient complained of sudden dyspnea and acutely went into shock. Pulmonary embolism was diagnosed and an inferior vena cava filter was placed. Chemotherapy was continued for four courses and the tumor showed complete remission. He has been free of disease for 24 months. In rare cases of testicular cancer with inferior vena caval embolus, the physician should be aware of the possibility of causing pulmonary embolism after chemotherapy.

[A case of primary signet ring cell carcinoma of the urinary bladder presenting as nocturnal incontinence].

This is a report of our experience of a case of primary signet ring cell carcinoma of the urinary bladder. The patient was a 56-year-old man who was referred to our hospital presenting with incontinence and lumbago. A drip infusion pyelography study indicated bilateral hydronephrosis and a contracted bladder. Signet ring cell carcinoma was observed in the bladder submucosa after the second transurethral biopsy set. No other cancer lesions could be identified even after careful examination. Therefore, it was diagnosed as a primary signet ring cell carcinoma of the bladder. Total cystectomy with bilateral uretero-cutaneostomy reconstruction was performed. The pathological stage was T4bN0M0 and the surgical margin was positive at the site of the pubic bone. Adjuvant therapy was not given. There was no evidence of disease 20 months after the operation. In Japan, this is the third case of primary signet ring cell carcinoma of the bladder presenting as incontinence.

[Renal pelvic cancer representing G-CSF production and hypercalcemia simultaneously: a case report].

A 73-year-old man was admitted to the hospital complaining of gross hematuria and left flank pain. Abdominal ultrasonography and computed tomography revealed a left renal tumor with extracapsular extension. Laboratory data showed marked leukocytosis of 121,000/mm3 and hypercalcemia of 12.3 mg/dl without any findings of inflammatory disease or bone metastasis. Enzyme immunoassay of the serum demonstrated a high level of granulocyte colony-stimulating factor (250 pg/ml) and parathyroid hormone-related protein (1,069 pmol/l). Pathological diagnosis of needle biopsy specimen of the primary tumor was transitional cell carcinoma which was suspected to have originated from renal pelvis. Immunohistochemical examination with anti-granulocyte colony-stimulating factor monoclonal antibody demonstrated granulocyte colony-stimulating factor production in cancer cells. The patient underwent a course of systemic chemotherapy, but died two months after diagnosis. To our knowledge, this is the first report of renal pelvic cancer representing granulocyte colony-stimulating factor production and hypercalcemia simultaneously.

[Sarcomatoid carcinoma of the renal pelvis: a case report].

A 65-year-old man visited our hospital with the complaint of left hypochondrial pain. Since he had left giant hydronephrosis due to ureteral stone, we performed left nephrectomy. Unexpectedly, macroscopic examination of the resected kidney revealed multiple yellowish nodules located in the renal pelvis and calyces. Histopathologically the nodules consisted of two pattern of malignancy, transitional cell carcinoma and spindle sarcomatous tumor. Immunohistochemical examination showed that spindle cells were stained positive for cytokeratin, and the final diagnosis was sarcomatoid carcinoma of left renal pelvis. Postoperatively, the patient underwent two courses of adjuvant chemotherapy, but metastases to retroperitoneal lymph nodes were noted two months after operation. He died of the disease eight months postoperatively.