[Effect of prophylactic intravesical instillation of pirarubicin to prevent recurrent bladder tumors following nephroureterectomy for upper urinary tract cancer].

We retrospectively evaluated 23 patients who had been administered pirarubicin by intravesical instillation once weekly for 5 weeks, after undergoing surgery for upper urinary tract cancer between May 2003 and October 2008. We compared their clinical records with those of 19 patients with upper urinary tract cancer subjected to nephroureterectomy between 1998 and 2008, and who did not receive intravesical instillation of pirarubicin. This prophylactic therapy was well tolerated and contributed to reduce the rate of bladder recurrence. The non-recurrence rate at 2 years was 87.0% in the instillation group and 68.4% in the non-instillation group (P＝0.0025). The overall analysis of the study population did not reveal any statistically significant risk factors of bladder recurrence.

[Metastatic micropapillary variant of the urinary bladder: progression from low grade non-muscle invasive bladder carcinoma].

We report a case of metastatic micropapillary variant of the bladder that progressed from low grade non-muscle invasive bladder carcinoma. Lung, para-aortic and pelvic lymph nodes metastatic lesions were found in a 62-year-old woman, who had been followed due to non-muscle invasive bladder carcinoma. The bladder wall was found to be thick by computerized tomography (CT). She had had transurethral resection of bladder tumor (TURBT) at 60 and 61 years old, followed by intravesical therarubicin and bacille Calmette-Guérin therapy, respectively. Both TURBT specimens showed low grade, non-muscle invasive urothelial carcinoma. The thickened bladder wall was resected transurethrally and the pathological examination revealed that the recurrent tumor was entirely composed of micropapillary variant component. There must have been tiny lesions of a micro papillary variant component after the second TURBT. Several reports suggest that intravesical BCG therapy was ineffective for micropapillary variant. So the UC component was substituted for micropapillary component.

[Pancreatic metastasis from renal cell carcinoma 25 years after radical nephrectomy].

We report a case of pancreatic metastasis from renal cell carcinoma detected 25 years after radical nephrectomy. A 74-year-old man, who had undergone radical nephrectomy for renal cell carcinoma at age 49, was found by computed tomography to have a strongly enhanced mass on the pancreatic head. The patient underwent pancreaticoduodenectomy and the pathological diagnosis was metastatic renal cell carcinoma. This was evidently a slow growing tumor because the metastatic pancreas tumor was well demarcated and the metastasis was found 25 years after the primary operation. Aggressive surgical treatment of isolated metastatic lesions offers a chance of long-term survival. Patients with a history of RCC should undergo a long-term follow-up to detect and evaluate metastasis to pancreas as well as other organs.

[A case of giant retroperitoneal paraganglioma].

Paraganglioma is a rare neuroendocrine tumor which arises from extra adrenal paraganglionic cells of the autonomic nervous system. We report a case of a giant retroperitoneal paraganglioma. A 43-year-old man referred to our hospital for further examination of a retroperitoneal mass. The patient had neither familial nor past medical history. The blood and urine test, laboratory examinations including cathecolamines, were unremarkable. Abdominal computed tomography showed an enhancing solid mass 13 cm in diameter on the left kidney. The invasion to the left kidney was suspected. Angiography showed the left renal, splenic, middle suprarenal and left inferior diaphragmatic artery feeding the tumor. The splenic and left inferior diaphragmatic artery were embolized before surgical treatment. The tumor, left kidney, adrenal gland and spleen were surgically resected. Histological examination revealed extra-adrenal paraganglioma, and there was no invasion of the tumor to the left kidney, adrenal gland and spleen. The patient has now survived more than 10 months following the surgery without tumor recurrence.

[ureterocele prolapse through the urethra: a case report].

We report a case of prolapse of a simple ureterocele presenting as perineural tumor. A 60-year-old woman presented with perineum pain and bleeding. A physical examination revealed a hard mass, 30 mm in diameter protruding from the external meatus. The computerized tomography, magnetic resonance imaging and cystography showed an uncharacterized tumor. Endoscopic examination was performed. However, just before resection the mass collapsed spontaneously and turned out to be a prolapse of ureterocele. No transurethral incision was performed. Eleven months postoperatively, the patient has not developed vesicoureteral reflux or urinary tract infection. Physicians should consider prolapse of a simple ureterocele in the differential diagnosis of the female meatal tumor.

[Verrucous carcinoma of penis: a case report].

We report a case of verrucous carcinoma of the penis. A 62-year-old man, who presented with penile swelling and pain, was referred to our hospital. Although, penile tumor biopsy revealed no evidence of malignancy, the patient presented with penile swelling and discharge. The penis was surgically resected and urinary diversion was performed. The pathological examination of the resected glans revealed verrucous carcinoma of penis. Furthermore, in situ hybridization revealed human papilloma virus (HPV) infection. This clearly showed that the verrucous carcinoma of the penis resulted from the HPV infection. The patient has survived for 14 months after surgery without local recurrence or metastasis.

[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.

[Eosinophilic cystitis caused by Seijo-bohhu-tou: a case report].

A 19-year-old woman was admitted to our hospital with a complaint of residual feeling, frequency and pain on urination. Laboratory analysis revealed an elevated eosinophilia count in peripheral blood and white blood cell count in urine. Lymphocyte stimulation test of Chinese herb named "Seijoh-bohhuh-toh" showed a positive reaction. Bladder symptoms were improved after ceasing this Chinese herb. From these points, we considered that the Chinese herb might have caused eosinophilic cystitis. We report this rare case with a review of the literature.

[Infantile testicular tumor (yolk sac tumor): a case report].

A 5-month-old-male was brought to our hospital in April 2004 with left scrotal swelling. His serum alpha-fetoprotein AFP and human chorionic gonadotropin-beta levels were 6,862.9 and < 0.1 ng/ml, respectively. Computed tomography (CT) revealed no metastasis. Left high ligation of testis was performed. Pathological examination demonstrated Yolk sac tumor. He is alive without evidence of recurrence for 53 months postoperatively.

Cardiac metastasis of renal pelvic cancer.

A 66-year-old man was referred to our hospital with chest discomfort and shortness of breath. Seven months previously he had undergone a laparoscopic left nephroureterectomy for a left renal pelvic tumor and was given two cycles of adjuvant chemotherapy (methotrexate, epirubicin and cisplatin). Echocardiogram showed an 8-mm sized mass extending from the right atrium into the right ventricle. On computed tomography, multiple lung tumors, as well as the right atrial and ventricular mass, were seen. The patient died of acute heart failure caused by right ventricular outflow obstruction. On autopsy, a right atrial and ventricular metastasis of the initial transitional cell carcinoma was found. The patient's cause of death was acute heart failure as a result of cardiac metastasis of his initial renal pelvic carcinoma.

Vascular cell adhesion molecule 1 predicts cancer-free survival in clear cell renal carcinoma patients.

PURPOSE: Vascular cell adhesion molecule 1 (VCAM1) is a cell surface glycoprotein implicated in various pathophysiologic conditions. We measured VCAM1 expression levels in tumor tissues and evaluated its significance and prognostic use in renal cell carcinoma (RCC). EXPERIMENTAL DESIGN: We used real-time quantitative PCR to examine the VCAM1 expression levels of a total of 485 sporadic renal tumors, including 429 clear cell, 21 papillary, 17 chromophobe, 11 oncocytomas, and 7 collecting duct carcinomas. We retrospectively examined the relationship of this expression to various clinicopathologic variables and the von Hippel-Lindau alteration status. We evaluated its significance with respect to patient survival rates using the Cox regression model combined with the split-sample method. RESULTS: Compared with normal kidney samples (n = 43), VCAM1 was significantly up-regulated in clear cell RCC and papillary RCC, whereas it was down-regulated in chromophobe RCC and oncocytoma. In clear cell RCC, VCAM1 expression levels were apparently high in patients asymptomatic at presentation and in patients with small tumor size, low-stage, low-grade, microvascular invasion-negative, and von Hippel-Lindau alteration-positive tumors. Univariate analyses showed that VCAM1 high expression is strongly associated with better outcomes in clear cell and papillary RCCs. Further, Cox multivariate analysis models combined with the split-sample method revealed that this association is significant only in cancer-free survival for patients with clear cell RCC after curative surgical resection. CONCLUSIONS: VCAM1 expression levels were found to be histologically subtype specific in renal tumors. Determination of the VCAM1 expression level as a biomarker can provide useful prognostic information for patients with clear cell RCC.

[Clinical results of infertility treatment to male patients with spinal cord injury].

It is difficult for male patients with spinal cord injury (SCI) to have children because of an ejaculation and dysfunction of spermatogenesis. However, owing to progress of assisted reproduction technology in recent years, it has become possible to have children even if the male has SCI, and the rate of success is improving gradually. During the 8 years from 1994 to 2002, infertility treatment was performed on 16 male patients with SCI consulting our hospital for acquistion of a child. We extracted their sperm by electroejaculation (EE) or testicular excision sperm extraction (TESE), and the sperm was artificially inseminated by the techniques such as artificial insemination with husband's semen (AIH), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). Consequently, it was successful in 14 pregnancies on 10 couples, and resulted in 11 healthy live births on 7 couples. Four cases resulted in abortion. Two spouses are pregnant at present. There were no remarkable differences between the success group and the failure group in the quality of sperm such as concentration and motility. The mean age of the spouses who became pregnant was slightly lower than that of those who did not. Assisted reproduction techniques as EE and ICSI were useful techniques for patients with SCI wishing to have children.