[Primary Pulmonary Cryptococcosis Mimicking Lung Metastases of Bladder Cancer : A Case Report].

A 70-year-old woman was diagnosed with bladder cancer (muscle invasive adenocarcinoma) via transurethral resection of bladder tumor in 2013. A month after the procedure, she underwent total cystectomy and ileal conduit diversion. Histopathological diagnosis was adenocarcinoma pTis pN0. In 2019, a computed tomography showed multiple nodules, each up to 1 cm in diameter, mainly in the right lower lobe. Metastatic lung cancer was suspected. She underwent thorascopic partial resection of the right lung, and was diagnosed with primary pulmonary cryptococcosis.

[A Case Report : FDG Uptake to Brown Adipose Tissue Activated by Elevated Serum Catecholamine in a Patient with Pheochromocytoma].

A 69-year-old woman was admitted to the previous hospital because of a right adrenal tumor detected by a medical checkup. Although the tumor was diagnosed as non-functional adrenal adenoma, abdominal computed tomography (CT) revealed a left renal mass which was suspected to be renal cell carcinoma. Chest CT seeking for metastatic lesions revealed lung cancer of the left lung. First, laparoscopic radical nephrectomy was performed. After the surgery, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT performed for staging of the lung cancer demonstrated FDG uptake to the left lung mass, the heart, the right adrenal mass and perirenal regions of the right kidney. The patient showed elevated serum catecholamine level and hypertensive emergency. She was admitted to our hospital with a suspicion of pheochromocytoma of the right adrenal gland and multiple paraganglioma. CT and magnetic resonance imaging showed that the heart and the perirenal regions had no tumors. We considered these lesions brown adipose tissue. Under the diagnosis of pheochromocytoma of the right adrenal gland, laparoscopic partial adrenalectomy was performed. The clinical course after the surgery was uneventful. FDG PET-CT revealed that FDG uptake to brown adipose tissue disappeared 6 months after the partial adrenalectomy.

[Primary Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma with Large Cell Transformation of the Prostate : A Case Report].

Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the prostate is rare. MALT lymphoma with large cell transformation like a diffuse large B-cell lymphoma (DLBCL) of the prostate is extremely rare. To the best of our knowledge, only one case has been previously reported. A 65-year-old man with difficulty on urination was referred to our department, in April 2014, because of abnormal findings of magnetic resonance imaging (MRI) and positron emission tomography-computed tomography imaging. Routine laboratory tests including prostate specific antigen and soluble interletkin-2 recepter were within normal limits, and the physical examination was unremarkable. In July 2007 and August 2009, he was submitted for a transrectal prostate biopsy, and then a histological examination for chronic prostatitis. In addition to the biopsy, transurethral resection of the prostate was performed. Histological examination revealed primary MALT lymphoma with large cell transformation of the prostate. Complete clinical investigation, including bone marrow biopsy, did not show any involvement of other sites by lymphoma, he received 3 cycles of chemotherapy consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) followed by radiation therapy with a total dose of 46 Gy. The patient has been in complete remission for 6 months after the chemoradiation therapy.

[Intrarenal Bacillus Calmette-Guerin perfusion therapy was effective for carcinoma in situ of the upper urinary tract after ileal conduit replacement : a case report].

A 63-year-old man who had undergone radical cystectomy and ileal conduit formation for invasive bladder cancer 3 years before presented with continuous positive urinary cytology in the ileal conduit. His diagnosis was carcinoma in situ (CIS) of the left upper urinary tract. He was treated with Bacillus Calmette-Guérin (BCG) perfusion therapy using a single-J ureteric stent. BCG (80 mg) in 100 ml saline was instilled in a one-hour period weekly for 6 weeks. Usage of another catheter was effective for continuing the therapy. Urinary cytology in the left upper urinary tract and the ileal conduit became negative after the therapy. There was no evidence of recurrence or metastasis of urothelial carcinoma 6 months after the therapy.

[The efficacy of ethinylestradiol for castration-resistant prostate cancer].

OBJECTIVE: We analyzed the efficacy of ethinylestradiol as estrogen therapy on Castration-resistant Prostate Cancer (CRPC). PATIENTS AND METHODS: The study was conducted on 14 patients who were diagnosed as having CRPC and who were being prescribed ethinylestradiol (1.5-2.0 mg/day) with aspirin (100 mg/day) and an LH-RH agonist in our hospital from August 2011. RESULTS: All patients had already been treated with a combined androgen blockade (CAB), 8 patients had been treated with docetaxel, 9 patients with tegafur-uracil, 4 patients with estramustine phosphate sodium. Age and prostate-specific antigen (PSA) at prescription of ethinylestradiol was 55-85 (median 75.5) and 0.784-508.7 ng/ml (median 4.842 ng/ml). Thirteen patients (92.9%) achieved a decline in PSA, 8 patients (57.1%) achieved a decline in PSA > 50%. Time to progression was 0-18 months (median 7 months), and there were no severe adverse events including venous thromboembolic diseases. CONCLUSION: Oral ethinylestradiol administration may have efficacy for CRPC without severe adverse events. Ethinylestradiol may be one of the selective drugs for CRPC patients who do not wish to undergo intravenous chemotherapy or become resistant to docetaxel.

[Incomplete Reiter syndrome caused by BCG instillation : a case report].

A 91-year-old man was treated for upper urinary carcinoma in situ via intravesical bacillus Calmette Guérin (BCG) therapy using a double-J catheter. After the fourth infusion, he experienced fever of >38°C, multiple arthralgia, and back pain. One week after cessation of intravesical BCG immunotherapy and initiation of antibiotic treatment, he continued to complain of symptoms. Reiter's syndrome was diagnosed, and subsequently, an antitubercular agent, a nonsteroidal antiinflammatory drug and a corticosteroid were administered. His symptoms improved 17 days after onset. Reiter syndrome is an uncommon complication after intravesical BCG immunotherapy. Nevertheless, side effects may be severe and must be closely monitored.

[A case of myxofibrosarcoma of the bladder].

A 43-year-old woman presented to our hospital with the chief complaints of gross hematuria and dysuria. Cystoscopy and magnetic resonance imaging showed a tumor on the dome of the bladder and large blood clots. Computed tomography demonstrated no findings of distant metastasis. Following transurethral resection of the tumor, the tumor was histologically diagnosed as myxofibrosarcoma with muscular invasion, and partial cystectomy was performed in September 2009. There has been no evidence of recurrence or metastasis for 24 months postoperatively. In addition, the Japanese literature on myxofibrosarcoma of the bladder was reviewed and discussed.

[Excellent growth following testosterone replacement therapy in identical twin with bilateral anorchia].

Bilateral anorchia is defined as the complete absence of testicular tissue with a normal male karyotype and phenotype. Although the precise etiology is not well understood, mechanical causes during or after testicular descent have been suggested, while genetic factors have also been reported. We treated a patient with bilateral anorchia who obtained excellent growth bytestosterone replacement therapyas compared with his normal identical twin. The patient was diagnosed with negative elevation of testosterone after hCG administration and surgical exploration confirmed the absence of a testicular structure. We began testosterone replacement therapyfrom 13 years old with the goal of matching the development of his brother. Four months after initiating therapy, the patient showed voice breaking and pubic hair growth. Thereafter, there were scant differences in height and secondarysexual characteristics as compared with his brother.

[Two cases of urolithiasis induced by topiramate].

Topiramate is an antiepileptic medicine that has been used adjunctively in the treatment of refractory seizures in Japan since 2007. Topiramate has been shown to inhibit specific carbonic anhydrase activity in the kidney and may induce a distal type of renal tubular acidosis. Case 1 : A 22-year-old male was referred to our hospital after complaining of left flank pain. He developed a seizure disorder and had been using topiramate for 4 months. Drip infusion pyelography showed a left ureteral stone. Case 2 : A 7-year-old boy presented with gross hematuria. He developed West syndrome and had been using topiramate for 6 months. A computed tomographic scan showed a right kidney stone.

[Bilateral giant renal angiomyolipoma following hemodialysis in a patient with tuberous sclerosis].

A 49-year-old woman with tuberous sclerosis visited our hospital complaining of left abdominal pain. She had been diagnosed with bilateral renal angiomyolipoma (AML) when she was 32 years old and had been on maintenance hemodialysis since the age of 44. Magnetic resonance imaging showed bilateral giant renal AML and hemorrhage in the AML of the left kidney. Transthoracolumbar left nephrectomy was performed in March 2008. The resected specimen weighed 3.2 kg. The histological diagnosis was consistent with AML. In addition, the Japanese literature on giant renal AML was reviewed and discussed.

[A case of ascending colon carcinoma metastasized to an inguinal hernia sac].

While inguinal hernia is one of the most common diseases, metastatic cancer of an inguinal hernia sac is rare. We report a case of ascending colon cancer metastasized to an inguinal hernia sac. A 60-year-old man, who was undergone a right hemicolectomy for an ascending colon cancer, was pointed out a palpable inguinal mass at one year and eight months after the operation. He was diagnosed as inguinal hernia, and herniorrhaphy was performed. In the operation, a tumor of the inguinal hernia sac, which invaded to spermatic cord, could be found and was removed with right testis. Bassini's method was performed after the resection of the inguinal tumor. Histological examination revealed that the tumor was metastasis of colon carcinoma. Examination of the entire body showed no other metastasis. As for the advanced colon cancer, we need to mention the possibility of metastatic saccular tumor.