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There have been few reports of multimodal treatment such as chemotherapy and surgical resection for testicular tumors over 40 years old. In this case, a 64-year-old man with nonseminoma, pT2N2M1aS1, stage IIIb, IGCCC good prognosis completed induction chemotherapy, followed by retroperitoneal lymph node dissection and resection of lung metastases. Chemotherapy (4 courses of etoposide and cisplatin therapy) was completed without serious adverse events other than grade 4 neutropenia. Resection of the residual tumor confirmed no viable tumor cells. There was no evidence of recurrence or elevation of tumor markers in the following 6 months. Similar cases could increase with the increase of testicular tumors in the elderly.

A 54-year-old female underwent open left adrenalectomy for a left adrenal tumor in 2013. The pathology showed metastatic poorly differentiated adenocarcinoma. Despite a close examination, the primary tumor could not be identified. During the follow-up, a computed tomographic scan showed a hyper vascular tumor in the left breast in2015. A left mastectomy was performed for diagnosis and treatment. The pathology showed invasive ductal carcinoma of the breast. Comparing the histopathology and immunohistochemistry of the breast tumor with the adrenal tumor, the adrenal tumor was finally confirmed as metastatic invasive ductal carcinoma. Adrenal gland metastasis from invasive ductal carcinoma is said to be extremely rare. To our knowledge, there have been no reports of cases in which metastatic invasive ductal carcinoma of the adrenal gland was found before the primary site. We report this case with some literature review.

A 22-year-old woman who was referred to our hospital presented with a complaint of urinary incontinence since childhood. Abdominal contrast-enhanced computed tomography revealed complete duplication of the left ureter. In addition, the upper half of the left kidney showed poor contrast, accompanied by signs of hydronephrosis. Magnetic resonance urography failed to show an opening between the upper half of the left kidney and the ectopic ureter. Cystoscopy revealed two normally positioned ureteral orifices. After intravenous injection of indigo carmine, however, the dye became evident in the vagina. Thus, she was diagnosed to have urinary incontinence due to complete duplication of the left ureter and an ectopic ureteral opening into the vagina. Transcatheter arterial embolization of the upper half of the kidney, the origin of the ectopic ureter, immediately relieved the patient of urinary incontinence. At the 6-month follow-up, the patient had experienced no recurrence or complications.

A 67-year-old man with non-muscle invasive bladder cancer (NMIBC) underwent transurethral resection (TUR) in January 2008. The pathological diagnosis was urothelial carcinoma (UC), grade 2, pT1. A second TUR was performed 2 months later, and no evidence of malignancy was found. After surgery, he was followed up via cystoscopy and urine cytology for 9 years, with no recurrence of the bladder tumor. In November 2017, he visited our orthopedic department complaining of pain in his left leg. Magnetic resonance imaging revealed an enlarged para-aortic lymph node (a suspected metastasis). Computed tomography (CT) revealed several enlarged lymph nodes but no recurrence in the bladder. A CT-guided biopsy was performed, and histopathological examination revealed a metastasis of the urothelial carcinoma. After definitive diagnosis, he received four cycles of gemcitabine-cisplatin chemotherapy. NMIBC with no local progression rarely causes distant metastases, but the possibility is always there.

The patient is a 72-year-old man who was referred to our hospital with an elevated prostate specific antigen (PSA) level. He was diagnosed with prostate cancer (cT2aN0M0) at the age of 62 years. He had undergone radical proton beam radiotherapy. The PSA level decreased to a nadir of 0.217 ng/ml after 5 years, gradually increasing thereafter to 1.595 ng/ml during the next 5 years. Although magnetic resonance imaging of the prostate showed an abnormal signal area in the prostate, repeated biopsies of the prostate revealed no malignant findings. Contrast-enhanced abdominal computed tomography (CT), bone scintigraphy and fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/CT did not detect any abnormalities in the prostate or metastatic lesions. ¹⁸F-prostate specific membrane antigen (PSMA)-PET/CT showed no accumulation in the prostate, but some accumulation in a left obturator lymph node. Open pelvic lymph node dissection was performed, and pathological examination confirmed lymph node metastasis from the prostate cancer. The PSA level decreased from 2.482 ng/ml preoperatively to 0.391 ng/ml at 3 months postoperatively. PSMA-PET/CT might be useful for early localization of recurrent lesions in biochemical recurrence after radical treatment for prostate cancer.

A 25-year-old woman, with chief complaints of palpitation and vomiting, was suspected of having acute myocarditis and was taken to our critical care center. She was diagnosed with Takotsubo syndrome based on the results of echocardiography, coronary angiography, and myocardial biopsy. The 24-hour urine test showed high levels of normetanephrine and noradrenaline. The abdominal computed tomographic scan showed a presacral tumor (26 mm) just below the aortic bifurcation, and ¹³¹I-meta-iodobenzylguanidine scintigraphy showed abnormal accumulation in the tumor. Finally, she was diagnosed with Takotsubo syndrome associated with presacral paraganglioma. The hemodynamics became stable with conservative treatment. Then she underwent elective laparoscopic surgery. The histopathological analysis revealed paraganglioma. The immunohistochemistry for succinate dehydrogenase was negative in the tumor cells. There has been no recurrence as of 15 months after surgery.

A 12-year-old girl was found to have decending colon diverticulum perforation and retroperitoneal abscess on computed tomography (CT) carried out to determine the cause of fever and stomachache. CT-guided drainage tube placement was performed. She was suspected of having MEN2B from her specific facial appearance, Marfan-like body shape and lingual mucosa neuroma. Cervical ultrasonography and serum tumor marker revealed medullary thyroid carcinoma and metastasis to cervical lymph node. Genetic examination revealed a mutation of RET gene codon 918. Therefore, she was diagnosed as having MEN2B. Laboratory data showed elevated urinary catecholamines. Metaiodobenzylguanidine (MIBG) adrenal scintigraphy showed bilateral adrenal uptake and a definitive diagnosis of bilateral adrenal pheochromocytomas was made. Discharge from the drainage tube persisted and it was difficult to continue conservative treatment. Therefore, laparoscopic bilateral adrenalectomy and transverse colon colostomy were performed. Subsequently, total thyroidectomy and cervical lymph node dissection were performed. At five years of follow up, bilateral lung metastases were observed, but the serum calcitonin level was normal and the patient is under observation.

A 66-year-old man was referred to our hospital because of positive fecal occult blood test. Gastric and rectal cancers were diagnosed by upper and lower endoscopic biopsy, respectively. Enhanced computed tomography (CT) indicated a pulmonary tumor and a left adrenal mass with a diameter of 15 mm presenting heterogenous enhancement. The pulmonary tumor was diagnosed as adenocarcinoma by bronchoscopic biopsy. F18 fluoro-2-deoxy D-glucose (FDG) PET/CT showed abnormal FDG accumulation (maximum standardized uptake value=26. 1) in the left adrenal mass consistent with a metastatic adrenal tumor. Although radical surgical therapy was performed for the synchronous triple cancers of gastric, colon, and lung cancer, the patient refused adrenalectomy for the left adrenal tumor. One year after surgery, CT revealed an increase in the adrenal tumor diameter to 18 mm without development of new metastases. Laparoscopic adrenalectomy was performed for the left adrenal tumor which was strongly suspected of being a metastatic tumor. Pathological diagnosis was adrenal cortical adenoma. There has been no recurrence for 5 years after surgery for simultaneous triple cancer.

We report a case of perivascular epithelioid cell tumor (PEComa) of the uterus associated with tuberous sclerosis complex discovered as a result of intraabdominal bleeding. A 54-year-old woman visited the department of obstetrics and gynecology with chief complaints of genital bleeding and abdominal pain lasting three weeks. Abdominal computed tomography (CT) revealed intraabdominal bleeding from the uterine corpus. She had a history of bilateral renal angiomyolipoma, which was treated with partial bilateral nephrectomy at age 25. Moreover, pulmonary lymphangioleiomyomatosis was diagnosed at age 43. Both conditions were detected by the CT scan during this hospitalization. Immediately after the CT scans, the patient entered a state of hemorrhagic shock, and we performed an emergency simple total hysterectomy. Histopathological examination on the resected specimen yielded a diagnosis of uterine perivascular epithelial cell tumor (PEComa). After making a definitive diagnosis of tuberous sclerosis complex (TSC), systemic evaluation was performed. As a result, multiple skin and intracranial lesions characteristic of TSC were identified and we stated administration of everolimus.

A 53-year-old man visited a doctor due to left inguinal enlargement. He was diagnosed with left inguinal hernia with omentum as the content by a computed tomography (CT)scan. He underwent open inguinal hernia repair ; however, an inguinal tumor was diagnosed intraoperatively and was resected as much as possible. Although the tumor resection was macroscopically incomplete, he was followed up without any treatment because the tumor was histologically diagnosed as lipoma. Sixteen months after surgery, a 15 cm inguinal mass and a 7 cm left intrascrotal mass were detected by follow-up CT, and he was referred to our hospital. He underwent open surgery for wide excision of the tumor with a diagnosis of spermatic cord liposarcoma and left hydrocele of testis. The spermatic cord tumor was histologically diagnosed as well differentiated liposarcoma. He has been alive without recurrence for more than 10 months after surgery. It is sometimes difficult to distinguish a spermatic cord liposarcoma from inguinal hernia by imaging examinations.

A 62-year-old man had been treated for urethral stricture developed after his right kidney was harvested for donation to his sister 34 years ago. Transurethral biopsy was performed because of positive urinary cytology and squamous cell carcinoma was detected from the site of urethral stricture. The patient with the desire to preserve the penis was referred to our department. Magneticresonanc e imaging showed no evidence of invasion to subepithelial tissue. Re-biopsy from the site of urethral stricture revealed squamous cell carcinoma in situ. Under the diagnosis of urethral carcinoma cTisN0M0, urethrectomy of anterior urethra with perineal urethrostomy was performed. Histopathological diagnosis was squamous cell carcinoma of the urethra pTis and surgical margins were negative. The patient reported complete urinary continence, normal erections and ejaculation from his urethrostomy. He showed no evidence of recurrence at 28 months after surgery.

Renal angiomyolipoma (AML) and aneurysm are common in tuberous sclerosis complex (TSC) and represent the main causes of morbidity in adults with TSC. Herein, we report a 22-year-old woman with TSC-associated AMLs and renal aneurysms. She was referred to our hospital for the treatment of multiple renal aneurysms larger than 5 mm in diameter. The previous hospital considered that transcatheter arterial embolization (TAE) of bilateral renal aneurysms would cause deterioration of renal function. To estimate the impact of TAE on renal function, we superimposed contrast enhanced computed tomography (CT) over single-photon emission CT (SPECT)-CT. This fusion image, referred to as functional kidney mapping image, revealed the location of renal arteries and aneurysms, and normal renal parenchyma simultaneously. Functional kidney mapping image was useful to distinguish the AML region from the normal renal parenchyma, and revealed that the planned embolization site was a non-functioning parenchyma. Therefore, TAE for her multiple renal aneurysms was successfully performed without deterioration of her renal function.

Microscopic subinguinal varicocelectomy has a recurrence of less than 1%, and varicocele recurrence is supposed to be an uncommon post-surgery adverse event. At present, no guidelines exist for the management of recurrent varicoceles after surgery. In this report, we present two cases of post-surgery recurrent varicocele of the testis. Case_1 : A 23-year-old male patient who had undergone microscopic subinguinal varicocelectomy for a grade 3 varicocele was referred to our hospital because of recurrent varicocele. Retrograde venography revealed the persistence of dilated spermatic veins. The former surgeon preserved the dilated vas deferens vein, and this was considered a possible cause of persistence of dilated spermatic veins. The vein considered as vas deferens vein was actually an internal spermatic vein. Case_2 : A 28-year-old male patient complained of recurrence of varicocele two months after the original operation for a grade 3 varicocele. Internal spermatic vessels were slightly visualized on retrograde venography. The possible cause of persistence in this case was insufficient ligation of the internal spermatic vessels. We performed embolization in both cases of recurrent varicocele. Both cases were successfully treated, and there has been no recurrence. Our findings suggest that percutaneous transcatheter embolization of the testicular vein may be effective in the management of postsurgical recurrent varicocele of the testis.

A 61-year-oldman presentedwith a chief complaint of abdominal pain. Enhancedcomputed tomography andmagnetic resonance imaging showeda left adrenal mass with a diameter of 7 cm with heterogeneous enchancement. He was referredto our hospital for further treatment. No endocrinological abnormality was detected. The tumor showed abnormal uptake on fludeoxyglucose positron emission tomography scan. Preoperative diagnosis was left adrenocortical carcinoma (cT2N0M0). Tumor excision was performedandpathological findings on the resectedspecimen revealedleiomyosarcoma of the left adrenal grand. The patient has been followed up for 16 months with no additional treatment. No evidence of local recurrence or metastasis was seen.

We report a case of recurrent renal cancer in the autografted kidney, treated with percutaneous cryoablation. A 59-year-old man who had bilateral renal tumors underwent radical left nephrectomy, ex vivo right partial nephrectomy and auto-transplantation at the right ileal fossa in our hospital 11 years ago. Histopathological examination showed clear cell renal cell carcinoma in bilateral kidneys (pT1bN0M0). He had been followed at another hospital without tumor recurrence for 11 years. In 2014, an enhanced CT scan revealed a renal tumor with a diameter of two centimeters in the autografted kidney, which was thought to be a recurrence of the initial renal cancer. He was referred to our hospital for further evaluation and treatment. He underwent percutaneous renal tumor biopsy, which confirmed renal cancer recurrence, followed by percutaneous cryoablation. Three months after cryoablation, an enhanced CT showed that the enhancement lesion in the autografted kidney had disappeared, and these findings were confirmed pathologically by absence of malignancy by a subsequent needle biopsy. The level of serum creatinine (sCr) was 1.16 md/dl immediately before cryoablation and 1.46 mg/dl at three months after cryoablation. Nine months after cryoablation, the patient had no reccurence and renal function was stable (sCr 1.43 mg/dl).

A 63-year-old male with a past history of left nephrectomy due to clear cell renal cell carcinoma at the age of 57 was admitted for further evaluation. Enhanced abdominal computed tomography revealed that there were several hypervascular tumors in the pancreas and a single hypervascular tumor in the gallbladder. Laparoscopic cholecystectomy was performed to obtainpathological diagnosis. Microscopically, the tumor in the gallbladder was filled with clear cells and was diagnosed as metastatic gallbladder cancer from the previous clear cell renal cell carcinoma. Metastatic renal cell carcinoma to the gallbladder is extremely rare, with reported frequencies of less than0. 6% in687 autopsies. We hereinreport a case inwhich cholecystectomy enabled a successful diagnosis and review the reported 22 cases in Japanese patients.

We report here a rare case of urethral fistula and scrotal abscess associated with colovesical fistula due to sigmoid colon cancer. An 84-year-old male was referred to our hospital complaining of macrohematuria, fecaluria, pneumaturia and micturitional pain. Computed tomography (CT) showed colovesical fistula. Other examinations, including colonoscopy and cystoscopy, did not reveal a clear cause for the colovesical fistula. Only an elevated serum level of the tumor marker CA19-9 suggested the possibility of sigmoid colon cancer. Eleven days after hospitalization, bilateral scrotal contents had swollen rapidly to the size of a goose egg. CT suggested urethral fistula with scrotal abscess formation. Drainage of scrotal abscess and colostomy were performed. Intraoperatively, the fistula of the bulbar urethra was revealed. Because increased serum CA19-9 suggested a diagnosis of sigmoid colon cancer, cystectomy and sigmoid colectomy with right nephrectomy were performed. Pathological examination revealed adenocarcinoma of sigmoid colon with bladder invasion. His condition was improved with rehabilitation 6 months after operation.

We present a case study of a 46-year-old man with extra gonadal germ cell tumor with multiple lung metastases and very high levels (324, 100 mIU/ml) of the tumor marker human chorionic gonadotropin (hCG). He underwent chemotherapy with VP-16, ifosfamide and cisplatinum regimen, but on day 2, he noticed strong dyspnea. A chest X-ray showed bilateral infiltration of the lungs, and he was diagnosed with acute respiratory distress syndrome (ARDS) from choriocarcinoma syndrome. After ARDS improved, he underwent modified bleomycin, VP-16 and cisplatinum for induction therapy again. After salvage chemotherapies, levels of the tumor marker hCG decreased to normal levels, and retroperitoneal lymph node dissection and left lung wedge resection were performed to confirm pathological complete remission. No obvious recurrence, as shown by tumor markers and imaging studies, has been observed for 17 months after the treatments.

A 42-year-old female patient had been receiving medication for hypertension. Her symptoms worsened in 2007. A computed tomography image revealed a 2.5 cm round mass in the right adrenal gland. According to a careful examination, the patient was diagnosed with primary aldosteronism and subclinical Cushing's syndrome. There were no remarkable physical features related to Cushing's syndrome. The patient chose a medical therapy instead of surgery. In 2012, regardless of strict diet therapy, however, the patient gained 10 kg weight in a year. The diagnosis was the same as that determined in 2007, except for exceeding value of cortisol over the criterion for Cushing's syndrome. A laparoscopic right adrenalectomy was performed to attenuate Cushing's syndrome. The histopathological examination revealed an adrenocortical adenoma. The patient lost 4.5 kg of weight 2 months after the surgery.

We report a case of deep vein thrombosis and acute pulmonary thromboembolism that occurred during chemotherapy for urethral carcinoma. A 68-year-old woman suffered from dysuria for a period of 2 years. When the symptoms worsened, a urethral catheter was placed and she was referred to our hospital for further examinations. Imaging analysis revealed a urethral tumor with multiple metastases. Pathological diagnosis on a specimen obtained from transurethral resection of the urethral mucosa was urothelial carcinoma and combined chemotherapy with gemcitabine and cisplatin was administered. On day 6 of the second course, the patient collapsed and was found to be in cardiorespiratory arrest. Cardiopulmonary resuscitation was successful and she received percutaneous cardiopulmonary support. Computed tomography at that time revealed a pulmonary embolism and deep vein thrombosis in the right popliteal vein. After her condition improved, an inferior vena cava filter was inserted to avoid further thromboembolism. The patient decided to continue the chemotherapy despite this episode. After the fourth course of combined chemotherapy, the urethral tumor and metastatic tumors were downsized, and she could urinate as she did before.

Most stage I testicular germ cell tumors are curable by orchiectomy alone. However, some tumors recur and require subsequent treatment. The point for the management of stage I testicular germ cell tumors is how to reduce the recurrence rate by appropriate adjuvant treatment with less adverse events. The strategy for stage I seminoma and stage I nonseminoma is different. The adjuvant treatment options include radiotherapy and 1-2 courses of carboplatin for seminoma and retroperitoneal lymph node dissection (RPLND) and 1-2 courses of bleomycin, etoposide and cisplatin chemotherapy for nonseminoma. This review discusses recent literature on adjuvant treatment and updates the consensus for the management of stage I testicular germ cell tumor.

A 78-year-old woman had undergone radical cystectomy and construction of ileal conduit because of bladder cancer in 1988. Eighteen years after the operation, she was referred to our hospital with the chief complaint of abdominal pain and oliguria. She had a mass just superolateral to the stoma with tenderness and reddish skin. Abdominal X-ray and computed tomographic scanning showed free air and peristomal intestinal dilation in the subcutaneous area. With a diagnosis of incarcerated parastomal hernia and intestinal perforation, emergency operation was performed. The orifice of the hernia was located in the superolateral aspect of the stoma. The ascending colon was locally necrotic and perforated. Usually, the orifice of parastomal hernia is so wide that incarceration rarely occurs. Parastomal hernia treated with emergency operation is rare, with only 9 cases, including our case, reported in the Japanese literature. Three cases had ileal conduit, and the content of the hernia was the ascending colon only in our case.

A 58-year-old man, who had undergone sigmoidectomy for sigmoid colon adenocarcinoma 3 years earlier, was referred to our clinic because of left ureteral tumor incidentally found by computed tomography (CT). Under the diagnosis of left ureteral carcinoma, retroperitoneoscopic left nephroureterectomy was performed. Pathological examination revealed adenocarcinoma of the left renal pelvis and ureter. Subtype of the adenocarcinoma was 'enteric type'. Five months later, urine cytology was positive and multiple non-papillary tumors were found on cystoscopy. By the transurethral resection of the tumors, bladder tumors appeared to be adenocarcinoma. Carefully considering the pathological findings and clinical course, we concluded that the tumor was not metastatic but primary adenocarcinoma followed by intravesical recurrence.

A 63-year-old Japanese man with a 1-month history of dyschezia and dysuria was referred to our hospital. Transrectal ultrasonography and magnetic resonance imaging demonstrated a mass involving the prostate, measuring about 6.5 cm. The serum prostate specific antigen was 20.3 ng/ml. By the transperineal needle biopsy, it was suspected to be fibrosarcoma. Total pelvic exenteration was performed. Histopathological examination of the tumor revealed carcinosarcoma of the prostate. One month after the operation local recurrence was manifested by perineal pain. The recurrent tumor grew rapidly with severe pain. The patient's condition deteriorated, and finally he died of the disease nine months after the operation. Carcinosarcoma of the prostate is a rare neoplasm and very aggressive. There is no established protocol for its treatment and its prognosis is usually poor. This is the 49th case reported in the literature.

We report a case of peritoneal mesothelioma presenting with bilateral hydronephrosis, which was difficult to be diagnosed. A 43-year-old woman was admitted to our hospital with acute renal failure. Ultrasonography revealed bilateral hydronephrosis. Retrograde pyelography revealed the stenosis of bilateral lower ureter. Pelvic magnetic resonance imaging demonstrated only a small mass lesion around the bilateral ureter. Other examinations showed no findings of malignancy. Under the diagnosis of retroperitoneal fibrosis, steroid therapy was performed. After 3 months, computed tomography (CT) revealed multiple abdominal masses. Percutaneous needle biopsy of tumor was performed. Pathological diagnosis was peritoneal mesothelioma. Chemotherapy based on the pleural mesothelioma was done but not effective, she died 9 months after the first medical examination.

We studied 18 cases of vesicointestinal fistula surgically treated between January 2001 and July 2005. The underlying'cause was an inflammatory disease in 12 cases, a carcinoma in 5 and injury (post-radiation therapy) in 1 case. The fistula was visualized by cystography in 2 cases and enterography in 4. Surgical procedures were cystectomy with enterectomy in 2 cases, partial cystectomy with enterectomy in 3, bladder wall overlay-suture with enterectomy in 6 and enterectomy alone in 4. In 3 cases, colostomy without enterectomy was performed for palliative surgery. In all cases the postoperative course was good and surgical treatment was effective. Surgical procedures varied in each case depending on the etiology and the patient's condition.

Case 1 : A 76-year-old man with a chief complaint of dysuria had an elevated prostate specific antigen (PSA) level of 24.9. He underwent a transperineal needle biopsy of the prostate, and the histopathological diagnosis was prostatic small cell carcinoma. The cancer was clinically diagnosed as T3bN1M1 with multiple lung metastases. He started receiving hormonal therapy. After three months of hormonal therapy, the multiple lung metastases disappeared. Thereafter, the serum PSA level and the tumor volume increased and he died 12 months from the start of therapy. Case 2: A 79-year-old man was referred to our hospital with a chief complaint of dysuria. The serum level of PSA was elevated to 10.4. Transperineal prostate biopsy revealed prostatic small cell carcinoma. The cancer was clinically diagnosed as T3bN1M1, and hormonal therapy was started. Subsequently, although his serum PSA level declined, his condition worsened rapidly and he died five months after the start of therapy.

A 68-year-old man visited our department with a complaint of persistent hemorrhage from ileal conduit. He had undergone total cystourethrectomy and ileal conduit construction for invasive bladder cancer in April 2000. He had been suffering from persistent stomal bleeding, although he received ligation of varices as well as occasional transfusions. Revision of the ileal conduit was performed in September 2002. Stomal bleeding has not recurred for 19 months.

We report three cases of endometrioid adenocarcinoma of the prostate. Case 1: A 71-year-old male was admitted with a complaint of micturition pain. Serum prostatic specific antigen (PSA) was 12 ng/ml. Radical prostatectomy following needle biopsy was performed in May 1998. Histopathological diagnosis was prostatic endometrioid adenocarcinoma (pT2bpN0M0). Case 2: A 71-year-old male was admitted with a complaint of macrohematuria. PSA was 18 ng/ml. Cystoprostatectomy and ileal conduit construction following needle biopsy were performed in July 2002. The tumor that was diagnosed as endometrioid adenocarcinoma, invaded the bladder neck (pT4pN0M0). Case 3: An 86-year-old male was referred to our department for elevated PSA (16.8 ng/ml). Prostatic needle biopsy was performed and histopathological diagnosis was endometrioid adenocarcinoma with a part of well differentiated adenocarcinoma (T2bN0M0). PSA dropped to an undetectable range after total androgen blockade therapy.

A 76-year-old male was admitted with a complaint of dysuria. Serum prostatic specific antigen was 28 ng/ml. Transperineal prostatic biopsy was performed and histopathological diagnosis was signet ring cell carcinoma with a part of poorly differentiated adenocarcinoma. Imaging studies showed that the tumor was localized in a large part of the prostate, and no abnormality was found in the stomach, the intestine, or the colon. Cystoprostatectomy and ileal conduit construction were performed in November 2002. Immunohistochemistry revealed that the specimen included the signet ring cells, which were stained for prostate specific antigen antibody, but not with periodic acid schiff. He is alive with no evidence of disease in 13 months after the operation.

A 88-year-old woman presented with bladder tamponade caused by gross hematuria. She had received 2 courses of bacillus-Calmette-Guerin (BCG) intravesical instillation therapy 4 months previously because of the bladder tumor with carcinoma in situ (CIS). Imaging studies and cystoscopy showed a bladder tumor invading into perivesical fat. She underwent total cystectomy and bilateral ureterocutaneostomy on May 27, 2002. Histopathologically, the tumor consisted of squamous cell carcinoma and transitional cell carcinoma.

A 34-year-old man was referred to our hospital for small lung nodules. An imaging study including a computed tomographic scan and magnetic resonance imaging showed bilateral lung tumors and huge mass arising from the lower pole of the right kidney as well. The patient underwent right radical nephrectomy in May 2002. Pathological examination revealed that the tumor was pheochromocytoma, which developed from extra-adrenal tissue. In 6 cycles of CVD systemic chemotherapy (Cyclophosphamide 750 mg/m2, Vincristine 1.4 mg/m2, Dacarbazine 600 mg/m2), the lung tumors were decreasing in size, and were removed by a surgical procedure in January 2003. Pathological examination revealed that the lung tumors were pheochromocytomas metastasized from the primary tumor. He is alive without evidence of disease 5 months after the lung operation.

A 59-year-old male with a complaint of gross hematuria was found to have a pedunculated and non-papillary tumor on the prostatic urethra. The tumor was resected transurethrally. The pathological finding was inverted papilloma. Although the majority of the cases of inverted papilloma have been found in the bladder, we reported the 32nd case located on the prostatic urethra in Japan.

A 68-year-old male was admitted to our hospital with the complaint of left painless mass of extratesticular scrotal content. Laboratory examinations were unremarkable. The tumor was resected by operation. The removed specimen was solid, 15 x 15 x 20 mm in size. Histopathological findings revealed leiomyoma. Other cases from the Japanese publications, together with our case, are reviewed.

A 59-year-old man had undergone total cystourethrectomy for bladder cancer (TCC G2 > G3 pT1) in July, 1991. Eight years later, he visited our department complaining of bleeding from external urethral meatus. Imaging study including computed tomographic (CT) scan and magnetic resonance imaging (MRI) showed a tumor arising from the urethral remnant and left inguinal lymph node involvement. Partial penectomy and left inguinal lymphadenectomy were performed. Histopathological examination revealed that both tumors were transitional cell carcinomas suggesting recurrence of bladder cancer. Two courses of M-VAC chemotherapy were given as adjuvant therapy.

A 65-year-old male was admitted with the chief complaint of voiding difficulty on 28 October, 2001. He was in the state of urinary retention. Urological investigation including cystosocopy, urethrocystography, and urodynamic study revealed an areflex-type bladder, according to the new International Continence Society (ICS) classification with no prostatic urethral obstruction. He was diagnosed with neurogenic bladder although the cause of detrusor areflex was unknown. Because all medication was ineffective, transurethral resection of prostate was performed on 11 January, 2002, but urinary retention could not be relieved. After operation, he complained of muscle weakness of upper extremities and poor control of bowels. He was diagnosed with Lambert-Eaton myasthenic syndrome associated with small cell lung carcinoma. His myasthenic symptoms, including autonomic symptoms were relieved after chemotherapy and radiation for small cell lung carcinoma.

A 62-year-old man underwent right adrenalectomy for pheochromocytoma in May 1987. He was referred to our department for a right renal tumor suggested by ultrasound sonography in December 2000. Computated tomography and MRI showed a 10 cm mass arising from the upper pole of the right kidney. 131I-MIBG scintigram showed strong radio isotope accumulation consistent with the tumor. Right nephrectomy and subsegmental hepatectomy were performed. Histological findings led to the diagnosis of malignant pheochromocytoma. In February 2001, he complained of paraplasia due to Th2 bone metastasis. Radiation and CVD (cyclophosphamide, vincristine, dacarbazine) chemotherapy resulted in tumor regression and marked improvement of clinical symptoms.

In case 1, a 24-year-old man was admitted with left lumbago. Abdominal computed tomographic (CT) scan showed the huge mass (8 x 10 x 13 cm in diameter) in the left retroperitoneal space, which lack enhancement and had a irregular margin. Percutaneous needle biopsy guided by ultrasonography was performed. In case 2, a 74-year-old woman was admitted with right lower abdominal pain. Laboratory data showed the renal failure. Imaging study revealed bilateral hydronephroses and bilateral masses at both common iliac vessels. A retroperitoneoscopic biopsy was performed. We diagnosed both cases as retroperitoneal fibrosis and administered prednisolone for 10 months. The masses decreased in size and the symptoms disappeared in both cases.

Extremely rarely renal cell carcinoma metastasizes to the contralateral perirenal fat. A 57-year-old male was admitted with macroscopic hematuria and lower left abdominal pain in December 1994. He was diagnosed with left renal cancer, and underwent left radical nephrectomy (RCC pT2, grade 1) in January 1995. Followup imaging studies showed a tumor arising from the right perirenal fat in 5 years. Tumor excision was performed in May 2000. Pathological findings revealed renal cell carcinoma growing in the fat, which had the same, pathology as the left renal cancer.

Extremely rarely renal cell carcinoma metastasizes to the contralateral renal pelvis or ureter. A 42-year-old man had undergone left radical nephrectomy for renal cell carcinoma (pT1b, grade 2) in March, 2000. Fifteen months later, he complained of macroscopic hematuria. Computed tomographic scanning and retrograde pyelography showed a right renal pelvic tumor. Enucleation of pelvic tumor was performed and a parenchyma mass incidentally identified in the right kidney was also resected. Histopathological examination of each tumor revealed renal cell carcinoma identical to the primary tumors in the left kidney suggesting metastasis to renal pelvis and de novo tumor or metastasis in the right kidney.

A 72-year-old female with a complaint of hemorrhagic leucorrhea was referred to our department. She had a black tumor on her urethral meatus suspected as a malignant melanoma. Urethrectomy, vulvectomy, partial vaginectomy, bilateral inguinal lymphadenectomy, and cystostomy were performed. Pathological diagnosis was malignant melanoma of the urethra. Local recurrence and lymph node metastasis were found 9 months later, and she has been given DAV-feron combined therapy.