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A 67-year-old man with castration-resistant prostate cancer associated with multiple bone metastases had been treated with zoledronic acid and docetaxel. Although there was no evidence of damage around the right lower jaw bone, the patient complained of pain in May 2011, which worsened during the next 2 weeks and was followed by difficulty with breathing. Computed tomographic (CT) findings of the cervical area showed swelling of the cervical tissue with air and tightening of the trachea, suggesting cellulitis caused by gas gangrene. He was intubated and treated with antibiotics. On the 12th hospital day, CT scan revealed a pharyngeal abscess and we performed a drainage operation. On the 20th hospital day, bone of the intraoral lower jaw was exposed, revealing that the infection was caused by osteonecrosis. Additional CT findings showed the abscess extending to the mediastinum and multiple liver metastases. Although antibiotic therapy was continued, the patient died of liver failure on the 61st day.

A 65-year-old man was referred to our hospital because of an elevated value of prostate specific antigen (PSA) (10.9 ng/ml). An eight-core prostate biopsy was negative. One year later, serum PSA increased to 55. 8 ng/ml and pelvic magnetic resonance imaging (MRI) showed a left external iliac lymph node enlargement. A ten-core prostate biopsy was negative. Six months later, the serum PSA increased to 88.1 ng/ml, but an seventeen-core prostate biopsy was negative again. A positron emission tomographycomputed tomography scan showed nothing other than increased uptake localized to the left enlarged external iliac lymph node. Pelvic lymphadenectomy was performed and histological examination, including immunohistlogical staining with PSA, confirmed lymph node metastasis from prostate cancer. Androgen deprivation therapy was started and 2 month later, serum PSA declined to below 1.0 ng/ml., errataのpdfは、泌尿器科紀要vol.58 no.11 p.659(2012年11月発行)

A 61-year-old man came to our hospital with a complaint of lower abdominal pain. Computed tomography (CT) and magnetic resonance imaging (MRI) around his abdominal area showed large multiple cysts in the pelvis suggesting a malignant tumor. He showed high levels of serum carbohydrate antigen 19- 9 (CA19-9) and carcinoembryonic antigen (CEA). The complete diagnostic studies, including upper gastrointestinal endoscopy and colonoscopy examinations, failed to demonstrate the presence of alimentary primary tumors. With the diagnosis of cystic tumor in the pelvis, the operation was performed. The cysts adhered firmly to the surrounding organs including bladder and peritonium, which could not be resected completely. A histopathological diagnosis was papillary adenocarcinoma positive for prostate specific antigen (PSA). Because the level of serum PSA was 9.39 ng/ml, prostate biopsy was performed and ductal adenocarcinoma of prostate was revealed. After the operation, the levels of serum CA19-9 and CEA decreased to a normal level. Androgen deprivation therapy (ADT) was started, and the level of PSA was normalized one month later. Ductal adenocarcinoma forming cysts is rare. We reviewed 15 cases reported in the Japanese literature.

The patient was a 67-year-old man who was started on peritoneal dialysis for treatment of diabetic nephropathy in March 2010. He received an ABO-compatible living-donor kidney transplant from his wife in October 2010. The immunosuppressive regimen consisted of tacrolimus, mycophenolate mofetil, steroid and basiliximab. Before the operation, a bump on his forehead/temple region that was increasing in size for years was noted. The bump had a scaly surface and the top of the bump was sloughed on postoperative day 14. Histological examination suggested malignancy. On postoperative day 21, a skin biopsy was performed by dermatologists and squamous cell carcinoma was confirmed. On postoperative day 36, wide excision and transposition flap procedures were performed by the plastic surgeon. At 15 months after transplantation, the kidney graft was functioning well with a serum creatinine level of 0.84 mg/dl and there was no sign of recurrence of the squamous cell carcinoma.

1)回腸新膀胱を20例に施行した.重篤な術後早期合併症はなく, 再手術を施行した症例もなかった. 2)晩期合併症として尿管回腸吻合部狭窄が2例あり, 1例は尿管回腸新吻合術を施行, 1例は内視鏡的に狭窄部を拡張した.回腸新膀胱内結石が2例に発生し, ESWL及び砕石術をそれぞれ施行した. 3)全例が自然排尿可能であり, 夜間尿失禁を認めたものが2例(全失禁)あった.回腸新膀胱過伸展による回腸新膀胱周囲炎が1例あり創部との間に尿瘻を形成した.残尿や回腸新膀胱容量等の定期的チェックと回腸新膀胱に対する十分な教育的指導が重要と思われた. 4)術後の局所再発を2例に認めたが, 尿道再発はなかった, Between June 1993 and July 1996, an ileal neobladder was created in 20 patients after total cystectomy for bladder cancer. The mean post operative follow-up period was 32 months, with a range of 9 to 47 months. Ureteroileostomy was performed using the Le Duc-Camey procedure. There were 3 (15%) early postoperative complications, which were all of transient urine leakage from the neobladder. Late complications were encountered in 6 patients (30%), which were of stenosis of ureteroileal anastomosis in 2 (10%), stone in the neobladder in 2 (10%), neobladder-cutaneous fistula in 1 (5%) and neobladder-ureteral reflux in 1 (5%). Reoperation was necessary in 4 patients (20%); 2 for stenosis of ureteroileal anastomosis and 2 for removal of a stone in the neobladder. No urethral recurrence has been noted. Local recurrence occurred in 2 patients, who died of tumor progression 16 and 27 months postoperatively. All 20 patients were continent during the day time (100%), while 2 (10%) had nocturnal incontinence.

左側胸部の2ヶ所の無痛性皮下腫瘤を訴えた76歳女で, 組織病理学的診断は淡明細胞癌であった.CT及び血管造影により左腎細胞癌と診断し, 左腎摘除を行った.組織診断は腎細胞癌, 胞状型, 明細胞亜型, グレード1であった.術後間もなく肺転移が認められた.腎摘除後数回皮膚転移を切除した, A case of renal cell carcinoma, found after skin metastasis is presented. A 76-year-old woman came to our hospital complaining of two painless subcutaneous tumors in her left chest. Histopathological diagnosis was clear cell carcinoma. She underwent left nephrectomy and histopathological findings revealed renal cell carcinoma, alveolar type, clear cell subtype, grade 1. Lung metastasis was proved soon after the operation. We removed skin metastasis several times after the nephrectomy.

71歳女.約20年前他院にて右水腎症の診断を受け, 穿刺吸引を施行された.腹満感の増強, 食欲不振を主訴に受診し, 右巨大水腎症の診断を受けた.腹部造影CTでは, 20×20×25cm大で正中を超えて広がる右巨大水腎症を認め, 右腎剔除術を施行した.腎盂の広範囲にflast typeの扁平上皮癌を認め, 一部では腎実質に浸潤しており, 病理診断はpT3, G2>G3, INFβであった.本人の希望により術後化学療法は施行せず, 退院となった.術後12ヵ月より血清SCC値上昇, 腹部CTにて多発性肝転移および腹部リンパ節転移を認めたため, 抗癌剤化学療法(M-VAC療法)を施行中である, We report a case of squamous cell carcinoma of renal pelvis associated with giant hydronephrosis. A 71-year-old woman presented to our hospital with a complaint of abdominal fullness due to the right giant hydronephrosis. Although the diagnosis of her hydronephrosis was made about 20 years ago at another hospital, it had been left untreated. Computed tomography showed the right hydronephrosis of 20 x 20 x 25 cm in diameter and no evidence of tumor or calculus in the right urinary tract. For relief of her complaint, right nephrectomy was performed. The fluid content was bloody and 4, 200 ml in volume. Histological examination revealed a flat type squamous cell carcinoma of the renal pelvis. This is the 30th case of renal pelvic malignant tumor associated with giant hydronephrosis reported in Japan. The literature was reviewed and the management of giant hydronephrosis was discussed.

前立腺肥大症9例を対象に, 尿道ステント留置を施行し, 治療成績を検討した.材料は永久型タイプであるアンジオメッド社製ニチノール形状記憶合金製尿道ステント・メモサームを使用した.方法は, 麻酔は3例にサドルブロックを, 6例に仙骨ブロックを施行した.体位は載石位とし, 膀胱瘻造設後, 膀胱頸部から精阜迄の前立腺部尿道の長さを測定し, 5mm短いステントを選択, 透視下に留置を行った.手術時間は平均69分で, 出血は殆どなく, 術中合併症も認めなかった.また, 術後随伴症状として, 尿失禁2例, 排尿困難1例, 膀胱刺激症状3例, 疼痛2例を認めた.疼痛が激しかった1例では抜去を行った.経過観察のため術後1ヵ月目にUCG・VCGを施行した1例では, 膀胱頸部が十分に開いていることが確認できた.また, 術後2ヵ月・半年・1年経過した症例では膀胱鏡を施行し, 結石形成や感染徴候を認めず, ステントの上皮化が確認できた.現在, 観察可能な全症例において残尿なく自排尿良好である, We used a urethral stent for management of high-age and high-risk patients with benign prostatic hyperplasia (BPH) who needed surgical therapy. Nine patients were treated by this method. Chief complaints were urinary retention in 6 patients, dysuria with much residual urine in 2 and dysuria in 1. Blood loss and complications of the method were minimal. Postoperatively, 8 of the patients were able to void and on the average, residual urine of the patients was approximately 10 ml. Implantation of the urethral stent is a safe and non-invasive therapy for the patients who are unsuitable for invasive therapy.

63歳男.下腹部違和感を主訴とし, 顕微鏡的血尿を認め膀胱鏡が施行され, 膀胱腫瘍の疑いで精査となった.膀胱鏡検査, 静脈性腎盂造影検査, 骨盤部CT, MRIの検査所見から, 膀胱右側壁の腫瘤と壁外浸潤が疑われ, 経尿道的膀胱腫瘍切除術を施行した.免疫組織化学的に肉腫様増殖部分は非上皮性マーカーが陰性であったことから, 膀胱肉腫様癌, G3, cT3以上と診断し, 膀胱全摘除術, 回腸導管造設術を施行した.化学療法, 放射線治療などの追加治療は行わなかった.術後4ヵ月を経過しているが再発を認めていない, A 63-year-old man was admitted to our hospital for a bladder tumor. Drip infusion pyelography, computerized tomography (CT) and magnetic resonance imaging suggested the presence of a large invasive tumor in the right wall of the bladder. Histopathological findings by transurethral resection of bladder tumor showed the presence of sarcomatous and carcinomatous elements. Immunohistochemical examination showed that the sarcomatous component did not stain for S-100 protein or for smooth muscle actin but it stained for epithelial markers. Under the diagnosis of sarcomatoid carcinoma, we performed a total cystectomy and ileal conduit without chemotherapy or radiation. A follow-up CT taken at four months postoperatively showed no evidence of recurrence.

48歳男.15歳時に夜尿症で受診し, 矮小陰茎, 精巣短縮を指摘され, 40歳頃両下腿潰瘍を生じ, 右足背・右内果潰瘍が治癒しないため受診, 外性器萎縮と再発潰瘍で入院した.体毛は非常に薄くターナーの分類恥毛PH3, 陰茎G3に相当し, 残存する左精巣容量は1mlであった.X線で両側第5中手骨短縮を認めたが, その他の異常は認めなかった.潰瘍瘢痕は両下腿広範にみられ前立腺は正常大であった.内分泌学的検査では血中テストステロン異常低値, 血中FSH・LH異常高値を認め精液検査では精液量0.5以下, 精子数0であった.hCG負荷試験で血中テストステロンの若干の増加を認めたが正常域に達せず低値であった.末梢血によるGバンド染色体分析で48XXYYを示しクラインフェルター症候群であった.48XXYYクラインフェルター症候群は我が国24例目, 下腿潰瘍合併では5例目であった, A case of 48XXYY Klinefelter's syndrome diagnosed with foot ulcers, in a 43-year-old man, is reported. He presented to the Department of Dermatology in our hospital with the chief complaint of recurrent foot ulcers. He was referred to us because of atrophic external genitalia. The present condition and endocrinological examination suggested Klinefelter's syndrome. Chromosomal analysis revealed that his chromosomal type is 48XXYY. This is the 24th case of Klinefelter's syndrome with 48XXYY chromosome and is the 5th case associated with foot ulcers in Japan. Here we report this case together with a brief review of the previously reported cases.

A 32-year-old woman in the 36th week of pregnancy was admitted to obstetrics with a complaint of left flank pain. Magnetic resonance imaging demonstrated a left perinephric hematoma before the cesarean section. Spontaneous rupture of renal angiomyolipoma was suspected by computed tomographic scan and renal angiography after the cesarean section. We attempted partial nephrectomy, but performed nephrectomy because of perinephric adhesion. This is the 11th case of spontaneous rupture of renal angiomyolipoma during pregnancy in the Japanese literature.