[Comparison of ventral and dorsal lymph node metastases of obturator nerve in radical prostatectomy].

OBJECTIVE: In this study, we assessed the significance of complete dissection of the dorsal lymph node of the obturator nerve during radical prostatectomy. PATIENTS AND METHODS: Fifty-six patients undergoing open radical prostatectomy and pelvic lymph node dissection for treatment of prostate cancer were included in this study. Neoadjuvant hormonal therapy and radiation therapy were not performed in any of the patients. First, pelvic lymph node dissection was performed between the external iliac vein and obturator nerve and classified as "ventral lymph node of the obturator nerve". Then, the tissue located in the area between the obturator nerve and the surface of the obturator internus muscle was removed and classified as "dorsal lymph node of the obturator nerve". Both lymph nodes were meticulously examined by identical pathologist. Lymph node yields, lymph node positive rate, and the factors associated with lymph node metastasis were studied. RESULTS: Eight of the 56 patients had pelvic lymph node metastases (6 were high risk and 2 were intermediate risk according to the D'Amico's criteria). In the 8 node-positive patients, only 1 patient had positive lymph node in "ventral lymph node of the obturator nerve" exclusively. Four patients had positive lymph node exclusively in "dorsal lymph node of the obturator nerve" and 3 patients had in both "ventral and dorsal lymph nodes of the obturator nerve". The total lymph node yields from "ventral lymph node of the obturator nerve" and "dorsal lymph node of the obturator nerve" were 459 (8.2 per patient) and 117 (2.1 per patient), respectively. The total numbers of positive lymph nodes from "ventral lymph node of the obturator nerve" and "dorsal lymph node of the obturator nerve" were 6 and 12, respectively. Lymph node positive rate was significantly higher in "dorsal lymph node of the obturator nerve" (10%) than "ventral lymph node of the obturator nerve" (1.3%) (P < 0.0001). The level of prostate-specific antigen (> or = 20 ng ml), Gleason score sum at prostate biopsy (> or = 9), and lymph node yield (> or = 16) were associated with lymph node status on univariate analysis. In multivariate analysis, only lymph node yield was associated with lymph node status. CONCLUSIONS: Dorsal lymph nodes of the obturator nerve should be dissected completely during radical prostatectomy.

Granular cell tumor of the urethra.

A 38-year-old woman was referred for urethral tumor treatment. Needle biopsy of the tumor was performed. Histologically, the tumor was composed of large polygonal cells with eosinophilic and periodic acid-Schiff (PAS)-positive granular cytoplasm, indistinct cell margins and small round central nuclei. Immunohistochemical staining for S100 protein, vimentin, and neuron-specific enolase (NSE) was positive, indicating that it was a granular cell tumor. Excision of the tumor including the urethra and appendicovesicostomy using the Mitrofanoff principle were performed. There has been no tumor recurrence in the 8 months after the operation.

[Deep vein thrombosis caused by pelvic lymphocyst following radical prostatectomy: a case report].

A 66-year-old man was admitted with distal edema of his right leg. He had undergone radical prostatectomy and pelvic lymphadenectomy for prostatic cancer 23 days previously. Abdominal computed tomography (CT) showed a lymphocyst (4.5 x 3.0 cm) along the right pelvic wall compressing the right external iliac vein. CT with contrast medium showed thrombus formation (about 9 cm) in the distal portion of the right external iliac vein and femoral vein. An inferior vena cava filter was placed to prevent pulmonary embolism, and anticoagulation with warfarin was started. One week later, CT showed shrinkage of the lymphocyst and thrombus in the vein, as well as a large thrombus trapped in the filter. Follow-up CT taken 2 months later revealed marked reduction of the lymphocyst and absence of thrombus in both the vein and filter. A lymphocyst, also known as a lymphocele, is a complication of radical pelvic surgery. Most lymphocysts are asymptomatic and regress spontaneously, but may lead to deep vein thrombosis and pulmonary embolism, usually a few weeks after surgery. Careful observation is needed even after discharge from hospital.

[Metachronous bilateral testicular cancer: report of two cases].

We report two cases of metachronous bilateral testicular tumors. In the first case (48 years old), and the second case (39 years old) the contralateral tumor developed 106 months and 63 months after the initial therapy, respectively. In both cases, the primary and the contralateral tumors were stage I seminomas. The patients underwent high inguinal orchiectomy and adjuvant retroperitoneal irradiation for the primary tumor, and only high inguinal orchiectomy for the contralateral tumor. There was no recurrence following the second operation in either case. In the second case, preoperative cryopreservation of the semen was performed for future artificial insemination. Long-term follow-up of contralateral testis is necessary for patients with testicular cancer, even if good prognosis is expected. The quality of life of the patients with bilateral testicular tumors should be maintained by preserving fertility and replacing androgen.

[Epidermoid cyst of the penis: a case report].

A 62-year old man presented with a painless, slowly growing mass of the penis, which had been noted since childhood. A cystic mobile mass about 2.5 cm in diameter was found at the ventral aspect of the glans penis. Excision of the mass was performed to confirm the diagnosis. There was no communication with the urethra. The pathological diagnosis was epidermoid cyst of the penis. Epidermoid cysts of the penis are rare, and many of them arise on the penile raphe, which are thought to be one of the type of rapheal cyst. To our knowledge, this is the 7th case in the Japanese literature.

[A case of stone formation in the Mainz pouch using appendix as the efferent limb: a case report].

A large calculus (6.0 x 4.5 x 7.0 cm sized) in the continent urinary pouch was detected incidentally by computed tomography in a 7-year-old man with a gall bladder stone. He underwent a total cystectomy and Mainz pouch formation using appendix as the efferent limb for bladder cancer 7 years ago. Urine culture showed Proteus mirabilis and Escherichia coli, and urine pH was 8.5. The stone was removed successfully through a pouchotomy and composed mainly of struvite. The stone analysis was MAP; 88% and CaCO3; 12%. Convalescence was uneventful. This is the first case of in Mainz pouch using appendix as the efferent limb.