Effects of thienopyridine class antiplatelets on bleeding outcomes following robot-assisted radical prostatectomy.

This study aimed to assess the effects of thienopyridine-class antiplatelet agents (including ticlopidine, clopidogrel, and prasugrel) on bleeding complications in patients who underwent robot-assisted radical prostatectomy. This cohort study used a database for robot-assisted radical prostatectomy at 23 tertiary centers nationwide between 2011 and 2022. Patients who received thienopyridines (thienopyridine group) were compared with those who received aspirin monotherapy (aspirin group). The primary outcome was the incidence of bleeding complications. High-grade complications were defined as Clavien-Dindo grade III or higher. The risks of these outcomes were evaluated using inverse probability of treatment weighted regression models. The study results demonstrated that thienopyridine therapy was associated with a higher risk of overall bleeding complications (OR: 3.62, 95%CI 1.54-8.49). The increased risks of the thienopyridine group were detected for low-grade bleeding complications (OR: 3.20, 95%CI 1.23-8.30) but not for high-grade bleeding complications (OR: 5.23, 95%CI 0.78-34.9). The increased risk of bleeding complications was not observed when thienopyridine was discontinued (OR: 2.52, 95%CI 0.83-7.70); however, it became apparent when it was continued perioperatively (OR: 4.35, 95%CI 1.14-16.61). In conclusion, thienopyridine increased the incidence of bleeding complications, particularly low-grade bleeding complications, following robot-assisted radical prostatectomy. These bleeding effects emerged when thienopyridine was continued perioperatively.

Pancreatitis as immune-related adverse event during pembrolizumab therapy for multiple lung metastases from renal pelvic cancer.

Introduction: Pembrolizumab administration has become the standard of care for patients with urothelial carcinoma, though a variety of adverse events have been reported. Presented here is a rare case of pancreatitis that occurred as an immune-related adverse event. Case presentation: An 81-year-old man undergoing treatment with pembrolizumab for multiple lung metastases from renal pelvic cancer was presented with a fever and diagnosed with pancreatitis based on elevated pancreatic enzyme levels and imaging findings. There was no history of alcohol consumption or findings indicating gallstones, elevated liver enzymes, or abdominal complications. The patient was diagnosed with immune-related adverse event pancreatitis and treated with Lactate Ringer's solution (3000 mL/day) and steroids, during which his condition improved. Conclusion: Although pancreatitis is a rare complication, it should always be considered as a potential immune-related adverse event in patients treated with an immune checkpoint inhibitor such as pembrolizumab.

A case of Avelumab response to multiple bone and lymph node metastases of plasmacytoid variant bladder cancer.

A 74-year-old man was diagnosed with bladder cancer and referred to our department. For definitive diagnosis, transurethral resection of the bladder tumor(TURBT) was performed. The pathological result showed plasmacytoid variant of urothelial carcinoma. Subsequently, robot-assisted radical cystectomy, lymph node dissection and ileal conduit was performed, but multiple bone metastases and periaortic lymph node metastases newly appeared 30 days later. Gemcitabine and cisplatin (GC) was started, and after 4 courses, the patient became Partial Response (PR), and was switched to Avelumab as maintenance therapy. After about 1 year of maintenance therapy, the patient is still in PR.

A case of renal schwannoma.

The patient was referred to our department from neurosurgery for close examination of a renal mass that had been present in the lower pole of the kidney for approximately 2 year. Retrograde Pyelography and Ureteroscopy showed no obvious neoplastic lesion in the renal pelvis. Therefore, Percutaneous renal tumor biopsy was performed. The pathological result was Schwannoma. The patient was followed up for 1 year after the biopsy. No progression was observed for approximately 3 years after the renal mass was first discovered. Because renal schwannomas are extremely rare, we report this case with a literature review.

A case of bladder perivascular epithelioid cell tumors.

Perivascular epithelioid cell tumor (PEComa) was introduced in the WHO classification of bone and soft tissue tumors in 2002, and Bladder PEComa is very rare. A 60-year-old man underwent TURBT after CT and cystoscopy revealed a 2.5 cm tumor with a concave center on the posterior wall of the bladder. Pathological examination revealed a perivascular epithelioid cell tumor, which was diagnosed as primary bladder PEComa after systemic examination. We report a case of partial bladder resection for bladder PEComa, a type of mesenchymal tumor that does not originate from the bladder mucosa.

A case of infectious thoracic aortic aneurysm after intravesical Bacillus Calmette-Guérin instillation therapy for a superficial bladder cancer.

Intravesical Bacillus Calmette-Guérin instillation therapy after transurethral resection of bladder tumor is considered as the most effective treatment for prophylaxis against the recurrence of high-risk, non-muscle bladder cancer. However, intravesical Bacillus Calmette-Guérin instillation therapy has some characteristic complications. Here, we report a case of infectious thoracic aortic aneurysm related to prior intravesical Bacillus Calmette-Guérin instillation, which consequently allows the spread into the adjacent lung tissue and secretion in sputum of Mycobacterium bovis.

Solitary synchronous gastric metastasis of renal cell carcinoma.

INTRODUCTION: There have been some reports describing metastasis to the stomach from renal cell carcinomas. However, there are few reports describing solitary synchronous gastric metastasis of renal cell carcinomas. CASE PRESENTATION: The patient was a 70-year-old woman who underwent an upper gastrointestinal endoscopy to examine her progressive weight loss. There was a submucosal tumor in the stomach, which was biopsied. The gastric tumor was pathologically proven to be a metastatic clear cell renal cell carcinoma. Furthermore, contrast-enhanced computed tomography showed right renal cell carcinoma invading the renal vein (cT3aN0M0). The patient underwent right radical nephrectomy and endoscopic resection for the treatment of the primary renal cancer and the gastric metastatic lesion, respectively. The resected specimen of the stomach had a clear resection margin. CONCLUSION: Endoscopic resection for early stage gastric metastatic lesions of renal cell carcinomas is a reasonable approach because it is a minimally invasive surgical technique.

[Investigation of the Risk for Biochemical Recurrence after Radical Prostatectomy Using the Length of the Positive Surgical Margin Microscopically Measured from the Surgical Specimen].

Radical prostatectomy is one of the major treatment options for patients with localized prostate cancer, and biochemical recurrence (BCR) after surgery is regarded as one of the representative indicators of the oncological outcome. The positive surgical margin (PSM) of the surgical specimen is considered to be one of the risk factors for BCR and its length (LPSM) was reported to be positively correlated with the risk for BCR. We retrospectively investigated the relationship between BCR and LPSM in 115 patients who underwent radical retropubic prostatectomy or laparoscopic radical prostatectomy without neoadjuvant hormone therapy at Shimada Municipal Hospital between 2008 and 2016. We found that the patients with a LPSM of 3 mm or longer had a higher risk for BCR than those with a LPSM shorter than 3 mm (HR 10.98, 95% confidence interval : 3.09-39.06, p <0.001), and patients with pT3 disease with a LPSM of 3 mm or longer had a higher risk for early BCR. Therefore, the LPSM may be a useful parameter to predict BCR after radical prostatectomy.

[A Case Of cT3bN2M0 Pleomorphic Giant Cell Carcinoma of the Bladder without Recurrence after Neoadjuvant Chemotherapy and Radical Cystectomy for 4 Years].

Pleomorphic giant cell carcinoma of the bladder is a highly malignant subtype and its prognosis is very poor. Among 22 previously reported cases, 14 cases were diagnosed as muscle-invasive tumors and the 10 patients died within 1.5 years after the initial diagnosis. We herein report a long-surviving patient with cT3bN2M0 pleomorphic giant cell carcinoma of the bladder without recurrence. A 73-year-old man presented with macroscopic hematuria and cystoscopy revealed a papillary nodular tumor 45 millimeters in diameter at the right bladder wall. Bilateral external iliac lymph node metastases were found on computed tomography (CT) and magnetic resonance imaging (MRI). The histopathological diagnosis of the transurethral resection specimen was pleomorphic giant cell urothelial carcinoma, high-grade, G3, pT2 or higher. The pleomorphic giant cells were composed of large epithelioid cells with single or multiple bizarre nuclei. The patient underwent 2 cycles of neoadjuvant chemotherapy using gemcitabine and cisplatin. Follow-up CT and MRI revealed disappearance of iliac lymph node matastases. Laparoscopic radical cystectomy and lymphadenectomy were performed. The histopathological diagnosis was pleomorphic giant cell urothelial carcinoma, ypT3aN0M0, RM0. Giant cells were found in 70% of the tumor. No recurrence has been found for 4 years after surgery. If neoadjuvant chemotherapy is effective, long-term survival without recurrence may be possible after radical cystectomy even in cases of muscle-invasive or N2 pleomorphic giant cell carcinoma of the bladder.

[A Case of PT1 Plasmacytoid Variant Bladder Cancer Treated by Bladder Conserving Therapy].

Plasmacytoid variant bladder cancer is a highly malignant subtype associated with a high propensity for invasion, metastasis and poor prognosis. Among approximately 100 reported cases, most were diagnosed at an advanced stage and only 10 were diagnosed at a non-muscle-invasive stage. Due to the limited data on clinical features of non-muscle-invasive plasmacytoid variant bladder cancer, its treatment has not been established. We report a long-surviving patient with pT1 plasmacytoid variant bladder cancer in whom the bladder was conserved after detailed pathological examinations of the transurethral resection (TUR) specimen and intensive follow-up. A 65-year-old man presented with macroscopic hematuria. Cystoscopy revealed a nodular tumor 11 millimeters in diameter and no metastasis was observed on computed tomography. The histopathological diagnosis of the TUR specimen was pT1 plasmacytoid variant urothelial carcinoma of the bladder. Microvascular invasion was not found by immunohistochemical staining and histopathological examination of the specimen from the second TUR indicated no residual cancer. The patient strongly desired bladder conservation and additionally underwent intravesical instillation therapy with 40 mg of mitomycin C weekly for 6 consecutive weeks. Follow-up cystoscopy demonstrated 3 small papillary tumors 12 months after intravesical instillation therapy, but histopathologically, the recurrent tumors were pTa with pTis urothelial carcinomas without plasmacytoid components. To treat pTis disease, he subsequently underwent intravesical BCG instillation therapy. The plasmacytoid variant bladder cancer has not recurred for 26 months since the initial diagnosis. Non-muscle-invasive and localized plasmacytoid variant bladder cancer may be treated with bladder conserving therapy.

[The Combination Therapy of Gemcitabine Plus Paclitaxel Induced Complete Response in a Tongue Skin Brain Metastasis of Bladder Carcinoma: A Case Report].

Tongue, skin and brain metastases of bladder cancer are very rare and few cases have been reported. We report a case of tongue, skin and brain metastases of bladder cancer. A 61-year-old woman was referred to our hospital with gross hematuria. Transurethral resection of the bladder (TURBT), tongue biopsy and skin biopsy were performed. Pathological findings showed urothelial carcinoma, G2, micro papillary variant, pT2＞ and tongue and skin metastases from urothelial carcinoma of bladder. After three cycles of chemotherapy (gemcitabine plus paclitaxel), tongue and skin metastases disappeared. Cystoscopy revealed no tumor of bladder. Eleven months later, she was admitted to our hospital because of disturbance of consciousness. Magnetic resonance imaging (MRI) showed multiple brain metastases. Rechallenge of chemotherapy (gemcitabine plus paclitaxel) restored from disturbance of consciousness and MRI showed partial response of brain metastases. We performed six additional courses of chemotherapy. Skin, tongue and brain metastases from bladder cancer indicate poor risk. Chemotherapy (gemcitabine plus paclitaxel)could be effective against these matastases.

[IgG4-related tubulointerstitial nephritis presented with multiple renal nodular lesions].

A 66-year-old man presented with multiple bilateral renal nodular lesions demonstrated by enhanced computed tomographic scan. He had a history of autoimmune pancreatitis and renal cell carcinoma, which had been treated with partial nephrectomy. We performed renal biopsy under ultrasound guidance. Pathological examination revealed plasma cell infiltration to the renal interstitium. Serum IgG4 level was high and we diagnosed as IgG4-related tubulointerstitial nephritis. After one month of oral steroid therapy the multiple nodular lesions disappeared.

Activation of the JNK pathway by nanosecond pulsed electric fields.

Nanosecond pulsed electric fields (nsPEFs) are increasingly recognized as a novel and unique tool in various life science fields, including electroporation and cancer therapy, although their mode of action in cells remains largely unclear. Here, we show that nsPEFs induce strong and transient activation of a signaling pathway involving c-Jun N-terminal kinase (JNK). Application of nsPEFs to HeLa S3 cells rapidly induced phosphorylation of JNK1 and MKK4, which is located immediately upstream of JNK in this signaling pathway. nsPEF application also elicited increased phosphorylation of c-Jun protein and dramatically elevated c-jun and c-fos mRNA levels. nsPEF-inducible events downstream of JNK were markedly suppressed by the JNK inhibitor SP600125, which confirmed JNK-dependency of these events in this pathway. Our results provide novel mechanistic insights into the mode of nsPEF action in human cells.