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Purpose: The aim of this study is to analyze the incidence of involvement of ipsilateral adrenal gland from renal cell carcinoma and assess the actual significance of ipsilateral adrenalectomy at nephrectomy., Patients and Methods: From 1981 to 2007, 588 patients were diagnosed as having renal cell carcinoma pathologically at our institution. Of those patients, we retrospectively reviewed the clinicopathologic data in the 426 renal cell carcinoma patients who were eligible for evaluation. Of the 426 patients, 193 (AD group) and the remaining 233 (AS group) underwent radical or partial nephrectomy with or without adrenalectomy, respectively., Results: Five patients (2.6%) of AD group had adrenal involvement and all of them presented T4 and/or M1 disease. The three patients presented direct involvement of adrenal gland, while metastasis in the remaining 2. All the 5 patients had disease progression after surgery and 4 of them died of disease. The remaining one patient, in whom interferon showed a remarkable response, has been alive with disease for 31 months. The ipsilateral adrenal gland was abnormal on preoperative computed tomography (CT) in 8 patients (1.8%), of whom, 4 had adrenal involvement. One of the five adrenal involvements was overlooked by CT. Thus, in this study, CT showed 80% sensitivity, 98% specificity, 99% negative predictive value and 50% positive predictive value. The 18 patients (7.7%) in AS group later developed nodal and/or visceral metastasis, while no solitary ipsilateral adrenal recurrence was observed in this group., Conclusions: Ipsilateral adrenal involvement from renal cell carcinoma is rare, especially after the adrenal-sparing surgery. It is concluded that concomitant adrenalectomy appears to give a very limited therapeutic benefit in this

A 64-year old female presented with urinary retention. Physical examination revealed a firm mass on the anterior vaginal wall. Magnetic resonance imaging showed a tumor surrounding the urethra, which invaded to the vesical triangle and the anterior vaginal wall. Serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated, but squamous cell carcinoma antigen and prostate specific antigen were within normal limits. Pathological examinations of the transurethral and transvaginal needle biopsy specimen suggested mucinous adenocarcinoma. First, the patient received local chemoradiotherapy and systemic chemotherapy using a fluoropyrimidine drug TS-1 and cisplatin. The tumor markers declined to within normal limits after this preoperative therapy. Then she underwent total cysto-urethrectomy with anterior vaginal wall resection, pelvic lymphadenectomy, and urinary diversion with ureterocutaneous fistula. Histopathological examination of the surgical specimen showed mutinous adenocarcinoma invading to the vesical triangle and the anterior vaginal wall. No metastasis was found in the lymph nodes. The final diagnosis was urethral adenocarcinoma, pT4N0, Stage IV. Five months after surgery, local recurrence and distant metastases appeared, and she died 14 months after surgery.

A 35-year-old man presented with a 17-month history of abdominal distension and left upper quadrant pain. He had no episodes suggesting the presence of hypertension. Hormonal studies were insignificant. Imaging studies demonstrated a bulky tumor with cyst formation measuring 22 cm. Preoperative differential diagnoses included an adrenal tumor, extra-adrenal retroperitoneal tumor and pancreatic mucinous tumor. Intraoperatively, no abnormality was observed in the pancreas. A tight adhesion of the tumor to the left kidney necessitated an en bloc resection of the tumor with the left kidney. The resected specimen, 22 x 20 x 8 cm, weighed 5,050 g. Pathologically, the tumor was ganglioneuroma originating from the left adrenal gland. Convalescence was uneventful, and abdominal symptoms disappeared. The patient has been doing well without evidence of recurrece 48 months after the operation.

A 78-year-old woman was presented with bleeding in the region of the genitalia. The tumor arose from the urinary meatus and biopsy was performed. The pathological examination revealed sarcomatoid carcinoma which was composed of squamous cell carcinoma and spindle cell sarcoma. She underwent urethrectomy and suprapubic cystostomy. She is alive at 26-month follow-up, after local radiation therapy of 50 Gy to the recurrence sites.

We report a case of Leydig cell tumor of the postpubertal cryptorchid testis with the chief complaint of male infertility. A 36-year-old man had consulted another clinic and his semen analysis revealed oligospermia. A solid mass was palpated in the right inguinal undescended testis. He was referred to our hospital for treatment of the testicular tumor. Right inguinal orchiectomy was performed and pathological diagnosis was Leydig cell tumor with no malignant findings. After the surgery improvement was seen in his semen analysis. There was no evidence of recurrence 9 months after surgery.

A 46-year-old man was presented with a firm mass of the spermatic cord. He underwent left radical orchiectomy with clinical diagnosis of spermatic cord tumor. The pathological examination revealed leiomyosarcoma (3.6 x 2.7 x 1.0 cm, pT1bN0M0; 5th TNM, Stage IA; 5th AJCC). He is free of disease 3 year postoperatively.

Although foreign bodies left in the body may remain asymptomatic for long periods, they may also cause various complications. We present a case of a Stamey cuff placed in the retroperitoneal space, which remained asymptomatic for 16 years in a 62-year-old woman. When a vesical calculi formed, it caused voiding pain in the lower abdomen. She underwent transurethral cystolitholapaxy. The nidus of the stone was a Stamey cuff used in the Stamey procedure performed 16 years before. Open cystotomy was needed to remove it. Convalescence was uneventful and she had no complaints on urination. The possibility of calculous formation should be raised when there are symptoms on urination in a female with a history of pelvic surgery.