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An ectopic kidney is a common congenital anomaly of the urogenital system, but malignant tumor in an ectopic kidney has been rarely reported. We report a case of ureteral carcinoma arising from an ectopic kidney in an 83-year-old male. He visited a hospital complaining of gross hematuria. Computed tomography revealed right ectopic kidney, right ureteral tumor and bladder tumor around the right ureteral orifice. Transurethral resection of the bladder tumor was performed and histopathological diagnosis was urothelial carcinoma. He was referred to our clinic for surgery of the right ureteral tumor. We performed open right nephroureterectomy and partial cystectomy. The histopathological diagnosis was a high grade urothelial carcinoma of the right ureter, pT3N0. Four months postoperatively, there was no evidence of recurrence. We discuss the clinical and pathological features of the malignancy in an ectopic kidney.

A 67-year-old man presented at our hospital with severe edema on the left side of his neck, chest and brachial regions. He had a history of right radical nephrectomy due to renal cell carcinoma (RCC, clear cell subtype, stage II) 15 years earlier. Thereafter, metastases to the pancreatic tail and right lung, and left lung metastasis were removed at 8 years and 11 years, respectively, after the nephrectomy. Four years earlier, he had also undergone total gastrectomy for gastric carcinoma (poorly differentiated adenocarcinoma, stage IV) and subsequent maintenance chemotherapy for gastric carcinoma. Follow-up computed tomography (CT) disclosed bilateral lung metastases and a pancreatic head metastasis. Cytology of pleural effusion on admission suggested pleuritis carcinomatosa from RCC. Clinical diagnosis was bilateral lung and pancreatic head metastases, pleuritis carcinomatosa and left subclavian vein thrombosis due to RCC metastasis. Maintenance chemotherapy for gastric carcinoma was replaced by Sunitinib 50 mg for RCC but he died of progressive disease 20 days later. Immunohistochemical study of the tissue from autopsy revealed lung metastasis and pancreatic head metastasis from both RCC and gastric carcinoma as well as multiple visceral metastases, pleuritis carcinomatosa and left subclavian vein thrombosis due to gastric carcinoma. Cause of death was acute respiratory failure due to pulmonary tumor embolism and pulmonary edema. Immunohistochemical study from autopsy was able to reveal the exact diagnosis, and immunohistochemical studies may be helpful in diagnosing the exact origin of metastasis and selecting appropriate treatmentsin patientswith multiple cancers.

Leiomyoma is a benign smooth muscle tumor which is rarely found in the paraurethral region. We report a case of paraurethral leiomyoma in a 44-year-old female who visited a clinic complaining of urinary retention. Magnetic resonance imaging revealed a 9cm mass adjacent to the urethra. She was referred to our department. Transvaginal needle biopsy was performed and the histopathological diagnosis was leiomyoma. The mass was completely excised transperitoneally and transvaginally. The resected specimen was 8×7×4.5cm in size and 194g in weight. Histopathological diagnosis was leiomyoma andthe tumor cells demonstrated immunoreactivity for estrogen receptors and progesterone receptors. Herpostoperative course was uneventful and she gained normal voiding function. In a follow-up after 3 months, there was no evidence of recurrence. We discuss the clinical and pathological features of the paraurethral leiomyoma.

Six regional medical associations in Shiga prefecture agreed to cooperate in an investigation of medical care for male gonococcal and chlamydial urethritis. In June 2011, we sent a questionnaire to 372 medical offices in Shiga prefecture, and analyzed replies of respondents. Ten urologists and 175 non-urologists responded to the survey (response rate 49.7%). Among 185 physicians, 52 (10 urologists and 42 nonurologists) have treated male patients with gonococcal and chlamydial urethritis. More than 20% (42/175) of non-urological clinics are involved in the medical management. At initial diagnosis for sexually transmitted male urethritis, all urologists select the nucleic acid amplification method (100%), whereas many non-urologists do not (35%). For the treatment of chlamydial urethritis, non-urologists select levofloxacin (LVFX, 52.8%) rather than azithromycin (AZM, 22.0%), whereas urologists use AZM (78.0%) mostly but do not use LVFX (0%) (p＝0.023). For the treatment of gonococcal urethritis, non-urologists prefer oral new quinolones (53.1%) compared to urologists (25.0%) (p＝0. 74). For cure judgment of gonoccocal and chlamydial urethritis, many non-urologists rely on the improvement of subjective symptoms (50 and 47%), but urologists do not (10 and 0%) (p＝0.022 and 0.026, respectively). As for recognition of the clinical guideline for sexually transmitted disease, most urologists (90%) know it, but few non-urologists (13%) do (p ＜0.001). We found that non-urological clinics make a great contribution to the medical treatment for male gonococcal and chlamydial urethritis in Shiga prefecture. It is important to standardize the medical care for sexually transmitted male urethritis by familiarizing non-urological practitioners with the clinical guideline.

A 52-year-old man who had been treated with sorafenib for lung metastasis of renal cell carcinoma (RCC) presented to our hospital with iron-deficiency anemia. He had undergone right nephrectomy for RCC (clear cell carcinoma, pT1bN0M0) 11 years ago and lung metastasis developed 6 years after the surgery. Although upper gastrointestinal endoscopy and colonoscopy were performed on suspicion of gastrointestinal bleeding, no abnormality was detected. Capsule endoscopy and single balloon small bowel endoscopy disclosed a hemorrhagic submucosal tumor in the jejunum. Laparoscopic partial jejunectomy was performed, and pathological examination indicated metastatic RCC to the small intestine. After the operation, anemia improved but he died 8 months later because of intrabronchial bleeding from the metastatic lesion of the lung. Metastatic RCC of the small intestine is relatively rare, its diagnosis is difficult. Recently, new diagnostic tools such as capsule endoscopy and balloon-assisted endoscopy have been developed, and they are useful in diagnosing gastrointestinal bleeding (OGIB) which can not be detected by traditional enteroscopy. If patients with advanced RCC show gastrointestinal bleeding of uncertain etiology, we should perform aggressive examination of the digestive tract with these diagnostic tools.

Chemotherapy with docetaxcel (DTX) plus estramustine (EMP) for castration-resistant prostate cancer (CRPC) was started 30 months after the patient, a 65-year-old man, was diagnosed as having advanced prostate cancer cT3aN1M1 (OSS) with an initial PSA of 490 ng/ml. Prostate biopsy specimens revealed moderately differentiated adenocarcinoma, Gleason’s sum 4＋5. He was treated with DTX 30 mg/m2 on day 2 and oral EMP 560 mg/day days 1-3 weekly for 3 out of 4 weeks. PSA at start of DTX plus EMP was 81.7 ng/ml, and that after 59 months was 66.6 ng/ml. No objective change in computed tomography and bone scan were observed. He also had no cancer-related symptoms and activity of daily life was good. Chemotherapy was interrupted twice because of pleural effusion and dyspnea by DTX, at 3 and 4 months, respectively, long-term disease stabilization was obtained by this treatment. Other adverse events including interstitial pneumonia, cardiovascular disorders and myelosuppression were not observed. He was maintained on the same chemotherapy. DTX plus EMP chemotherapy is an effective treatment for CRPC patients. Continuing this therapy it is important to survey and control adverse events caused by DTX and EMP carefully.

We report a case of renal arteriovenous fistula (RAVF) following blunt renal trauma. An 84-year-old woman who presented with massive gross hematuria after striking her right flank region on the corner of a table was transferred to neighboring hospital on October 24, 2006. Plain computerized tomography (CT) revealed a small subcapsular hematoma on the right kidney, corresponding to a type I renal injury according to the classification of the Japanese Association for the Surgery of Trauma. However, subsequent enhanced CT demonstrated the migration of injected contrast material from the main trunk of the right renal artery to the inferior vena cava in the early phases. Because these findings suggested the occurrence of RAVF, the patient wasreferred to our hospital for further evaluation and therapy. Selective right renal arteriography enabled observation of trauma-induced RAVF in the upper pole of the affected kidney. Consecutively, transcatheter arterial embolization was performed with a metal coil, after which the shunt blood flow was successfully stopped. RAVF associated with blunt renal injury is extremely rare : only four cases have been previously reported in the literature.

前立腺小細胞癌3例について報告した。症例1(29歳男)。1998年1月に右側腹部痛で受診し、腹部CTで骨盤内腫瘍、両側水腎症を認めた。両側尿管ステント留置後腹部CTで小骨盤腔を占拠し径7cm大の腫瘍と両側骨盤リンパ節腫大も認めた。生検を行いNSE、NCAM染色で前立腺原発小細胞癌と確定した。治療開始から17ヵ月後癌死した。症例2(65歳男)。2004年4月に尿閉で受診し前立腺肥大症を疑われた。尿道カテーテル留置10日後乏尿と浮腫が現れ、両側水腎症及び急性腎不全と診断された。直腸診で石様硬の前立腺に触れ、経皮的腎瘻造設術を行い腎機能の改善後CDDP+VP-16を投与した。肺転移は消失したが16ヵ月後癌死した。症例3(73歳男)。2004年9月に前立腺生検で低分化腺癌と診断され、MAB療法開始後、10月に高度全身倦怠感が現れた。生化学検査で異常値を認め、腹部CT/MRIでは骨盤腔を占拠し膀胱直腸に湿潤する巨大な腫瘍と骨盤リンパ節転移を認め、15ヵ月目に癌死した。, Small cell carcinoma (SCC) originating from the prostate is rare. We report three cases of SCC of the prostate. Case 1: A 29-year-old man with large pelvic mass and pelvic lymph node metastases was diagnosed as having pure SCC of the prostate. Chemo-radiotherapy resulted in a great reduction of the tumor volume. However, the disease recurred immediately, and he died of disease 17 months after diagnosis. Case 2: A 65-year-old man presented with pure prostatic SCC with lung metastases. Although cystoprostatectomy combined with pre- and post-operative chemotherapy ended with no evidence of disease, he died after 16 months because of multiple metastases and local recurrence. Case 3: A 73-year-old man was diagnosed as having SCC and poorly differentiated adenocarcinoma of the prostate simultaneously. Chemo-endocrine therapy and pelvic irradiation were performed, achieving partial remission. However, he developed multiple distant metastases, and died of disease 15 months after diagnosis. We reviewed 82 cases previously reported in Japan. Patient's ages ranged from 24 to 86 years (mean 68.7 years). Many patients had lymph node or distant metastases (stage D, 73%). Thirty-seven (45%) were pure SCCs and 45 (55%) were associated with adenocarcinoma. The prognosis after the recognition of SCC is very poor, and the 1- and 2-year survival rates were 27% and 10%, respectively. Survival did not differ in patients with pure SCC or mixed glandular and small cell carcinoma. Higher elevation of pretreatment serum NSE value was associated with the poor prognosis.

A 65-year-old man presented with gross hematuria in 2004. Computed tomography (CT) showed a left renal mass, and he underwent laparoscopic radical nephrectomy. Pathological diagnosis was clear cell carcinoma (pT2N0M0, G2＞G3). Four years later, a right adrenal tumor was disclosed by follow-up CT. Then laparoscopic adrenectomy was performed. Histology showed metastasis of the renal clear cell carcinoma. In 2009, he noticed gross hematuria, and cystoscopy revealed a 2cm solitary, non-papillary tumor at the anterior wall of the bladder. At the same time, small solitary liver metastasis (6 mm) was observed on abdominal CT. Transurethral resection of the bladder tumor and resection of liver tumor was performed, and pathological diagnosis was clear cell carcinoma both in vesical and hepatic masses. Nine months after the last surgery, he is living with no obvious tumor recurrence. To our knowledge this case is the 34th case of bladder metastasis from renal cell carcinoma in the Japanese literature. We reviewed literature and discuss the clinical features of bladder metastasis of renal cell carcinoma.

1997年1月から2年間に尿管結石に対してin situ ESWLで治療を開始した388例を対象にESWL不成功についての予測因子を検討した.ESWL有効群(317例)と無効群(71例)にロジスティック回帰分析による多変量解析を行ったところ, 1)中下部尿管結石, 2)結石の大きさ9mm以上, 3)中等度以上の水腎症及び 4)初回ESWL無効が予測因子として有意であった.1)～4)の全ての予測因子を満たす場合, 85.0%と高い確率でESWL不成功が見込まれた.これらの予測因子は, 治療方針についての患者の意思決定のための臨床的根拠として有用になると考えられた, In this study, we attempted to determine which patients with ureteral calculi are likely to have an unsuccessful outcome for extracorporeal shock wave lithotripsy (ESWL). The records of 388 patients with ureteral calculi treated with ESWL at Ijinkai Takeda General Hospital between January 1997 and December 1998 were retrospectively reviewed. Three hundred seventeen patients had been treated with ESWL alone (single session 156, multiple sessions 161) and 71 with transurethral ureterolithotripsy (TUL) due to failure of ESWL. We compared these two groups by multivariate logistic regression analysis, which revealed that (1) middle and lower ureteral calculi, (2) stones > 8 mm, (3) moderate to severe hydronephrosis and (4) failure of the first session ESWL were factors associated with poor outcome of ESWL. Although each predictive value of these factors was relatively low (29.6-38.6%), the rate of failure of ESWL was 85.0% when patients had all four factors. We therefore recommend an early change in treatment modality to TUL for patients with ureteral calculi when all four risk factors listed above are present.

We report a case of retroperitoneal schwannoma treated by laparoscopic surgery. A 32-year-old woman presented with a mass in the retroperitoneal space that was incidentally revealed by abdominal echography. Computed tomography and magnetic resonance imaging showed a mass 95 mm in diameter in the retroperitoneal cavity which had a cystic component. With a diagnosis of retroperitoneal tumor, laparoscopic resection was performed. Pathological diagnosis was retroperitoneal benign schwannoma consisting of Antoni A and B types. Our case is the largest retroperitoneal schwannoma tumor which was removed by laparoscopic surgery.

塩酸テラゾシン単独投与(2mg/day)による前立腺肥大症9例の血清脂質の変動を評価した.1)血清脂質は5例で評価可能であった.総コレステロール値は低下傾向(12週後で平均6.6%の低下)を示した.特に総コレステロール値200mg/dL以上の2例で平均低下率は大きく, 脂質異常例に特に有効と考えられた.2)HDL, アポ蛋白A1, A2の有意な低下を認めたがいずれも正常範囲内での変動であった.他の脂質に有意な変動はなかった.3)排尿障害では4例が評価可能であったが, 全例に自覚症状の改善を認め, 3例に最大尿流率の改善を認めた.4)Pressure-flow study上, 1例に著明な閉塞の改善を認めた.他の3例はweak detrusor症例であり閉塞の改善は著明でないが, 全例で自覚症状の改善を認めた.5)塩酸テラゾシンは高血圧及び高脂血症治療薬として, 冠動脈疾患予防効果を併せ持つ有用な前立腺肥大症治療薬である, Nine clinical benign prostatic hyperplasia (BPH) patients were treated with oral terazoin monotherapy (2 mg daily) for 12 weeks. Serum lipid levels (total cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, apoproteins) were estimated prior to and every 4 weeks during treatment in 5 patients. International Prostate Symptom Score (IPSS) and pressure-flow study were evaluated before and 12 weeks after treatment in 4 patients. The total cholesterol level decreased from a baseline of 210 +/- 36.6 mg/dl by 6.6% at the 12th week. This result was not significant but suggested a favorable effect of terazosin on diminishing the risk of coronary heart disease. This effect was marked especially in patients with a total cholesterol level over 200 mg/dl. On the other hand, IPSS improved in all cases. The mean change ranged from 19.5 to 10.0 and the mean peak flow rate from 9.0 to 15.7 ml/s. On Shaffer's nomogram, 1 patient showed improvement of obstruction and the other 3 patients were diagnosed as having week detrusor without obstruction. Clinical BPH patients with hyperlipidemia may markedly benefit from terazosin, which is a safe and useful initial treatment for BPH.

27歳男。患者は疼痛を伴わない不完全勃起の持続を主訴とした。作業中, 直径1cmの鉄筋で会陰部を打撲し, 当日の性交後から主訴が出現した。画像所見等により右陰茎海綿体に流入する動脈が会陰部打撲で破綻し, 海綿体洞との間に瘻孔ができたことで発症した動脈流入過剰型持続勃起症と診断された。更に右内陰部動脈造影検査により右内陰部動脈から分枝する陰茎深動脈の末端に破綻と陰茎海綿体洞への造影剤の溢流が認められた。治療として自己凝血塊を用いた超選択的動脈塞栓術が施行された結果, 塞栓術によって右内陰部動脈分枝からの造影剤の溢流は消失し, また勃起状態の改善も認められ, 3日後に退院となった。目下, 術後2年経過で, 再発ならびに勃起不全は認められていない。, Priapism is rare and usually unpredictable. High-flow priapism is caused by unregulated arterial inflow. Antecedent trauma is the most commonly described etiology. This condition does not require emergent treatment. The initial management of high-flow priapism should be observation, because treatment-related erectile dysfunction may appear. We report a case of high-flow priapism by perineal trauma in a 27-year-old man. His corpora were typically tumescent, but not completely rigid. He could not have sexual intercourse. Blood from the corpus cavernosum was normally oxygenated. Color duplex ultrasonography was performed in the lithotomy position, scanned at the perineum, showed pseudoaneurysmal appearance. Selective internal pudendal arteriography showed a right cavernous arterial extravasation. Superselective embolization of right internal pudendal arteries was performed with an autologous clot. After the procedure, detumescence was achieved as well as erectile function. We recommend superselective arterial embolization as the management of high flow priapism to patients who request treatment.

1979年からの15年間に滋賀医科大学泌尿器科において膀胱全摘除術を行った105例の膀胱移行上皮癌症例を臨床的に検討した. 1)全例の5年生存率は68.9%であった. 2)異型度ではG2, G3例間の生存率に有意差を認めた. 3)深速度ではpT3例がpTa例に, pT4例がpTa, pT1, pT2例に比べ, それぞれ有意に不良な転帰を示した. 4)pN(+)例はpN0例に比べ有意に不良な転帰を示した, We assessed the treatment outcome of 105 patients with transitional cell carcinoma of the bladder treated by total cystectomy at our university hospital, between 1979 and 1993. The patients consisted of 84 men and 21 women (male to female ratio : 4:1), between 45 and 82 years old (mean, 65.5 years old). The overall cancer-specific survival rate at 3 and 5 years was 76.3% and 68.9%, respectively. The 5-year survival rate was 85.2% for grade 2 and 59.9% for grade 3 tumors with a significant difference in the survival curves between the two groups (p < 0.05). The 5-year survival rate according to pathological stage was 100% for pTa, 75.6% for pT1, 78.4% for pT2, 54.0% for pT3 and 39.8% for pT4. A significant difference was observed between pTa and pT3 (p < 0.05), and between pTa-2 and pT4 (p < 0.05). The 5-year survival rate was 72.3% for patients without lymph node involvement and 11.9% for those with lymph node involvement, the difference being significant (p < 0.01). Nineteen patients who received pre- and/or post-operative chemotherapy did not show a higher 5-year survival rate than those who did not.

肉眼的血尿, 左下肢しびれ感を主訴とした62歳男で, 画像診断は左水腎症, 骨盤骨に浸潤している左尿管下端の大きい腫瘤, 及び左閉鎖リンパ節転移を示し, 生検では未分化SCC(扁平上皮癌)であった.経皮的左腎瘻を造設した.CDDP/5FU療法により, 画像上38%縮小, 血中SCG抗原の64%減少をきたした為, 照射を追加し, 膀胱左壁部分切除を含め可及的腫瘍切除を行った.腫瘍切除後4ヵ月に肝転移が出現した.初診から14ヵ月後に死亡した, A case of primary squamous cell carcinoma of the ureter is reported. A 62-year-old male presented with gross hematuria and paralysis of the left leg. Abdominal computed tomographic (CT) scan and ultrasonography revealed left hydronephrosis, a massive tumor (8 x 7 cm) in the left distal ureter which invaded the pelvic bone (T4), and left obturator lymph node metastasis (N2). Pathologic examination of the biopsy specimen revealed poorly differentiated squamous cell carcinoma. Cisplatin (100 mg/m2, day 1) and 5-fluorouracil (960 mg/m2/day, days 2-6) were administered systemically in accordance with biochemical modulation regimen for head and neck squamous cell carcinoma, and a minor response was obtained (tumor regression rate 38%, serum SCC antigen regression rate 64%). Thereafter, resection of residual tumor was performed, resulting in noncurative operation because of direct invasion to the pelvic bone. Four months after tumorectomy, liver metastasis appeared, and the patient died of disease 14 months after the initial visit. Combination therapy with cisplatin and 5-fluorouracil is widely used for head and neck squamous cell carcinoma, and the response rate has been reported to be 46-94%. This regimen may also be effective against urological squamous cell carcinoma.

1)Kock pouch(K群) 124例, Indiana pouch(I群) 51例, 虫垂臍ストーマMainz pouch(M群) 4例について検討した. 2)手術関連死はK, I群各2例であった.早期合併症は創感染15例, イレウス5例にみた. 3)晩期合併症は, K群(108例)で輸出脚不全18例, 輸入脚不全23例, ストーマ狭窄7例等, I群(47例)では, ストーマ狭窄3例, パウチ変形, 導尿困難各2例であった. 4)晩期合併症に対する修復再手術は, それぞれ22例, 5例に施行された. 5)結石形成は, K, I群でそれぞれ30例, 3例であった. 6)M群では晩期合併症は認めていない. 7)尿禁制はK, I, M群でそれぞれ90.2, 93.0, 100%で得られ, 水腎症はそれぞれ41.0, 9.5, 0%にみられた, A self-catheterizable continent urinary reservoir has become one of the major options for urinary diversion in patients with invasive bladder cancer or other pelvic malignancies. We performed the Kock pouch, the Indiana pouch and the appendiceal Mainz pouch in 124, 51 and 4 patients with the mean followup periods of 50, 33, and 10 months, respectively. In the Kock pouch, the efferent and afferent nipple valve malfunction was seen in 16.7 and 21.3 percent each, requiring repair surgery, such as fixation of the efferent nipple to the pouch wall, reconstruction of an isoperistaltic nipple valve in the former, and removal of the Dacron fabric collar or re-anastomosis of the ureter to the pouch using LeDuc technique in the latter. In the Indiana pouch, stomal stenosis, an hourglass-like pouch deformity, difficult catheterization occurred in 3, 2 and 2 patients, respectively. Among the 4 patients with the appendiceal Mainz pouch, there were no major late postoperative complications except for mild stenosis of the conduit, handled with bougienage. As a whole, surgical revisions, related to urinary diversion, was done in 20.3, 10.6, 0 percent in the Kock, Indiana, Mainz pouch patients, respectively. Stone formation, mostly multiple and recurrent, occurred in 27.8, 6.4, 0 percent in the Kock, Indiana, Mainz pouch, respectively. Most of the stones were removed endoscopically via a stoma or by percutaneous approach. Acidosis was seen in 3 patients in both the Kock and Indiana pouch, and 3 patients with the Kock pouch suffered from symptomatic choleithiasis. At the time of the latest observation, continence was achieved in 90.2, 93.0, and 100 percent, whereas excretory urograms showed normal collecting systems in 64.5, 90.4, and 100 percent in the Kock, Indiana, and Mainz pouch, respectively. In conclusion, the Kock pouch, performed by an original method using unabsorbable polyester fabric collars and metallic staples, has an intolerably high rate of late complications, and either the modified Indiana pouch with ileal patch or the appendiceal Mainz pouch using the umbilicus as a stoma is recommended for a self-catheterization continent urinary diversion.

A 60-year-old man visited our hospital with a chief complaint of penile tumor on November 13, 1984. Circumcision of true phimosis was performed and biopsy of the 27 x 27 mm fixed tumor on the glans revealed well differentiated squamous cell carcinoma. Seventy Gy of electron irradiation to the penis revealed a complete response. On February 1, 1985 bilateral inguinal lymph node dissection was performed and revealed metastasis to a left inguinal node. In May 1990, erosive changes occurred on the irradiated region, and local recurrence was confirmed. Since 2 courses of MBD (methotrexate, bleomycin, cisplatin) chemotherapy was not effective, additional wedge dissection was performed. In January 1992, local recurrence was found. Four courses of intra-arterial chemotherapy (cisplatin, vincristine, methotrexate, adriamycin) was performed with a complete response. No evidence of disease has been recognized for more than two years after completion of the treatment.

We present a case report of a relapse to the mediastinal lymph node alone, 38 months after orchiectomy on surveillance for stage I typical seminoma. The patient, a 63-year-old man, was treated with high inguinal orchiectomy for left testicular tumor and close follow-up. After 38 months from the initial treatment, the chest X-ray film and CT scan revealed mediastinal tumor. Fine needle aspiration cytology performed under the bronchoscopy showed seminoma cells. Complete remission was achieved after three courses chemotherapy of cisplatin, vincristine, methotrexate, peplomycin and etoposide (COMPE). He has continued to be clinically disease-free 8 months after completion of the treatment. According to the available data in the literature, 94% of the recurrences was detected within 3 years after orchiectomy, and 92% involved retroperitoneal lymph node metastases. This is a rare case who had a late relapse in the mediastinum alone.

58歳男, 初診時T3N2M1 (OSS, LYM) Stage D2の中分化型前立腺癌に対してホルモン療法を中心とした各種治療を行い, 14年経過した現在NEDと思われる1例, A 58-year-old male complaining of pollakisuria, miction pain and back pain visited us Dec. 26, 1979. Rectal examination revealed the prostate enlarged by 5 digital width, stony hard and irregular. Transrectal needle biopsy revealed moderately differentiated adenocarcinoma of the prostate. Bladder neck invasion, pelvic and mediastinal lymph node metastases and multiple bone metastases were found. The case was diagnosed with prostatic adenocarcinoma T3N2M1 (OSS, LYM) stage D2. Three courses of chemotherapy using ifosfamide applied from Feb. 2, 1980 showed no marked effect except for partial pain relief. Hormonal treatment with diethylstilbestrol diphosphate was started from May 28 and arterial infusion chemotherapy using CDDP and 5-FU was performed 2 months later, resulting in size reduction of the prostate and pelvic lymph node metastases and disappearance of mediastinal lymph node metastases. Needle biopsy of the prostate was negative for cancer cells. After 8 months, Tegafur was started, and 12 months later radiotherapy was added to the prostate and pelvic lymph nodes. The abnormal accumulation in bone scan began to decrease after 14 months and achieved complete remission 28 months after the initial therapy. We discontinued the hormonal therapy 31 months later because of his complaint of chest discomfort and palpitation. At the present time, 14 years after the initial therapy, the prostate was 35 x 29 x 19 mm in size on transrectal ultrasonography with undetectable serum PSA level and no tumor cells but only mass fibrosis has been seen by pathological examinations. We considered this patient to be with no evidence of disease.

右腰背部仙痛を呈した26歳女で, 逆行性腎盂造影で右腎盂からの造影剤溢流, 及び尿管口の近位側4.5cmの右尿管に陰影欠損を認めた.尿細胞診は悪性陰性であった.右尿管部分切除術及び膀胱尿管新吻合術を行った.切除遠位側尿管に灰白色の表面平滑な3mmのポリープ及びポリープの直ぐ遠位側に長さ2cmの尿管狭窄を認めた.病理診断は線維上皮性ポリープであった, A 26-year-old woman presented with a colicky right flank pain. Retrograde pyelogram showed extravasation of the contrast medium from the right renal pelvis and a filling defect in the right ureter 4.5 cm proximal to the ureteral orifice. Urinary cytology was negative for malignancy. A partial ureterectomy with a vesicoureteroneostomy was performed. Gross inspection of the resected distal ureter revealed a 3-mm polyp with a grayish-white smooth surface as well as a ureteral stenosis of 2 cm in length just distal to the polyp. Pathological diagnosis was a fibroepithelial polyp. In our case, urinary extravasation probably resulted from an impacted polyp in the stenotic ureter.