Supposed pituitary-production of human chorionic Gonadotropin induced by androgen deprivation therapy.

INTRODUCTION: The main cause of slightly elevated human chorionic gonadotropin (HCG) after successful treatment of male germ cell tumors is considered to be pituitary-derived HCG. It is well known that pituitary-derived HCG is frequently detected in postmenopausal women. We evaluated the status of serum HCG in men with elevated gonadotropins, which were induced by androgen deprivation therapy, using commercially available assays. MATERIALS AND METHODS: We enrolled 44 patients with prostate cancer, who underwent luteinizing-hormone releasing hormone agonist treatment. We measured serum follicle-stimulating hormone (FSH), serum luteinizing hormone (LH), serum total HCG, serum free HCG-ß subunit, and urine total HCG 3 times per patient, on the day of treatment initiation, the next day, and 3 months after. RESULTS: On the day after treatment initiation, serum and urine HCG was detected in 61% and 73% of patients, respectively. Markedly strong correlations were observed between serum/urine HCG and FSH/LH. In particular, receiver operating characteristic curve analysis indicated excellent area under the curve (0.977, 95% confidence interval 0.951-1.003)) for serum HCG-detectable LH. At the cutoff value of 21.07 mIU/mL for serum HCG-detectable LH, the sensitivity and specificity were 96.7% and 95.3%, respectively. Serum HCG-ß was not detectable at any times in any patients. CONCLUSIONS: Suggested pituitary-derived HCG can be frequently detected in patients with elevated gonadotropins, and there is a firm association between HCG detection and gonadotropin levels.

[A Case of Rectum-Infiltrating Prostate Cancer Mimicking Prostate-Infiltrating Rectal Cancer].

A 71-year-old man was admitted to the department of general surgery at our hospital due to constipation. A large bowel endoscopic examination revealed a stenosis of the rectum near the anus. The pathological diagnosis of the biopsy was poorly differentiated adenocarcinoma. After a computed tomography/magnetic resonance imaging examination, rectal cancer infiltrating the prostate was the diagnosis. External beam radiation therapy and chemotherapy were performed. After those neoadjuvant therapies, an abdominoperineal resection of the rectum (Miles) and a retropubic radical prostatectomy were performed. The final pathological diagnosis was prostate cancer infiltrating the rectum. Prostate cancer infiltrating the rectum is rare because of the Denonvillier's fascia barrier. However, it is difficult to distinguish prostate cancer infiltrating the rectum from rectal cancer infiltrating the prostate. Thus, when we see rectal cancer infiltrating the prostate, prostate cancer infiltrating the rectum should be suspected, serum prostate specific antigen (PSA) level should be determined, and PSA immunostaining should be performed.

[A Case of Hemodialysis-Associated Pelvic Amyloidoma Mimicking Renal Cancer-Associated Etiology].

Patients with renal insufficiency receiving long-term hemodialysis often develop so-called hemodialysis amyloidosis characterized by systemic ß 2-microglobulin amyloid lesions, while patients with renal cell carcinoma may develop amyloid A(AA) amyloidosis. Herein, we present a 67-year-old man on thirty-yearlong hemodialysis who was diagnosed to have left renal cell carcinoma coincident with a large spaceoccupying lesion adjacent to the psoas muscle in the pelvic cavity. An ultrasound-guided percutaneous needle biopsy was performed at the time of laparoscopic radical nephrectomy. The pathological work-up on the needle biopsy specimen revealed that the lesion was not an AA amyloidoma but a ß2-microglobulin amyloidoma, which is a rare manifestation of hemodialysis amyloidosis.

[Spontaneous Infection of an Atrophic Ureter with an Ectopic Ureteral Opening after Living-Donor Renal Transplantation in a Patient with Kabuki Syndrome].

A 24-year-old woman with a high fever presented at our hospital. She had been diagnosed with Kabuki syndrome at the age of 4 years because she had the typical facial features of the condition ; she had undergone living donor renal transplantation 12 years prior. She was prescribed a course of antibiotics to treat pyelonephritis of the transplanted kidney and the high fever disappeared, but the fever developed again 3 days after the discharge. Abdominal computed tomography revealed a tubular structure of recent onset running from the left dorsal side to the lower part of the bladder. This structure was filled with pus, which we drained. We also performed laparoscopic ureterectomy of the left ureter to achieve a complete cure. No complication was observed after the surgery and the graft renal function did not deteriorate further.

[Primitive neuroectodermal tumor of kidney : a case report].

A 16-year-old man was referred to our hospital for asymptomatic gross hematuria. The findings of abdominal ultrasonography were normal. A month later, gross hematuria disappeared, and he was not followed after that. A month later, the patient was taken to our hospital in an ambulance for severe back pain and recurring gross hematuria. Computed tomography (CT) revealed a large right renal tumor with tumor thrombus penetrating inside the inferior vena cava. The patient underwent radical nephrectomy and embolectomy. The pathological diagnosis of the tumor was diagnosed as primitive neuroectodermal tumor (PNET) of kidney by immunostaining and gene analysis. We started adjuvant chemotherapy soon after the operation. However, at 10 months after, multiple pulmonary metastases were detected. The patient was treated with salvage chemotherapy, surgery and irradiation therapy as combined modality therapy. Nevertheless, he died 18 months after the diagnosis.

Novel germline variant of TMEM127 gene in a patient with familial pheochromocytoma.

SUMMARY: Pheochromocytomas (PCCs) and paragangliomas (PGLs) are rare tumours with a heterogeneous genetic background. Up to 40% of apparently sporadic PCC/PGL cases carry 1 of the 12 gene germline mutations conferring genetic susceptibility to PCC/PGL. Although the precise mechanisms are unclear, TMEM127 is one of the rare responsible genes for PCC/PGL. Here we report the case of a patient with familial PCC having a novel TMEM127 variant (c.119C > T, p.S40F). In silico prediction analysis to evaluate the functional significance of this variant suggested that it is a disease-causing variant. A PCC on the left side was considered to be the dominant lesion, and unilateral adrenalectomy was performed. The histopathologic findings were consistent with benign PCC. A loss of heterogeneity of the TMEM127 variant was detected in the surgically removed tumour. LEARNING POINTS: c.119C > T (p.S40F) is a novel TMEM127 variant that can cause pheochromocytoma.The tumour showed loss of heterozygosity of this TMEM127 variant.The clinical phenotype of this mutation is putative bilateral pheochromocytoma in the 4th decade.Unilateral adrenalectomy may be performed as the initial surgery in such cases.

Supposed pituitary-production of human chorionic Gonadotropin induced by androgen deprivation therapy

ABSTRACT Introduction: The main cause of slightly elevated human chorionic gonadotropin (HCG) after successful treatment of male germ cell tumors is considered to be pituitary-derived HCG. It is well known that pituitary-derived HCG is frequently detected in postmenopausal women. We evaluated the status of serum HCG in men with elevated gonadotropins, which were induced by androgen deprivation therapy, using commercially available assays. Materials and Methods: We enrolled 44 patients with prostate cancer, who underwent luteinizing-hormone releasing hormone agonist treatment. We measured serum follicle-stimulating hormone (FSH), serum luteinizing hormone (LH), serum total HCG, serum free HCG-β subunit, and urine total HCG 3 times per patient, on the day of treatment initiation, the next day, and 3 months after. Results: On the day after treatment initiation, serum and urine HCG was detected in 61% and 73% of patients, respectively. Markedly strong correlations were observed between serum/urine HCG and FSH/LH. In particular, receiver operating characteristic curve analysis indicated excellent area under the curve (0.977, 95% confidence interval 0.951-1.003)) for serum HCG-detectable LH. At the cutoff value of 21.07 mIU/mL for serum HCG-detectable LH, the sensitivity and specificity were 96.7% and 95.3%, respectively. Serum HCG-β was not detectable at any times in any patients. Conclusions: Suggested pituitary-derived HCG can be frequently detected in patients with elevated gonadotropins, and there is a firm association between HCG detection and gonadotropin levels.