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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., 本論文の要旨は第232回日本泌尿器科学会関西地方会において報告した．

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., 本論文の要旨は，第70回日本泌尿器科学会中部総会において発表した．

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., 本症例は第228回日本泌尿器科学会関西地方会（奈良）で報告した．

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.

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., 本論文の要旨は第242回日本泌尿器科学会関西地方会において発表した.

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.

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.

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.

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.

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.

58歳男性。S状結腸癌でS状結腸切除術が施行され, 3年後の経過観察中にCTで左尿管腫瘤を認めた。左尿管癌と臨床診断し後腹膜鏡下左腎尿管摘除術を施行, 病理診断はadenocarcinoma of the left renal pelvis, およびadenocarcinoma of the left ureterであった。病理組織所見にて, 腎盂癌は腎実質へ浸潤していた。尿管癌は筋層を超えて浸潤していたが, 大部分の腫瘍は粘膜上皮下結合組織までの浸潤で, 尿管腔内に突出する像を呈しており, また正常尿路上皮から連続している像が見られた。3年前のS状結腸癌と同様の組織型で, 免疫組織染色では尿管癌とS状結腸癌に同様の染色傾向を認めた。術後補助化学療法として, tegafur/uracil配合剤とleucovorin経口剤による化学療法を行い退院となったが, 術後5ヵ月目の尿細胞診でclass Vを認めた。膀胱鏡で多発性非乳頭状有茎性腫瘍を認め, 経尿道的膀胱腫瘍切除術を施行, 病理組織診断はadenocarcinoma of the bladderであった。左腎尿管摘除術後16ヵ月経過し, 以後再発, 転移なく生存中であり, 臨床像から原発性であると考えられた。, 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.

症例1:76歳男。主訴は排尿困難で、PSA高値、画像検査で前立腺の腫瘍、腸骨リンパ節・鼠径リンパ節腫大、両肺野の多発性腫瘤を認めた。経会陰的前立腺針生検を施行し、小型でN/C比が高く、濃染した核を有する腫瘍細胞を認めた。免疫組織染色でNSE陽性であった。以上より前立腺小細胞癌と診断し、LH-RH analog、bicalutamideによるMAB療法を開始した。治療開始1ヵ月後にPSAは低値となり、3ヵ月後の胸部CTでは多発性肺転移は消失していたが、その後再燃を来たし、9ヵ月後に肺転移巣の再発を認め、徐々に全身状態が悪化し12ヵ月後に死亡した。症例2:79歳男。主訴は排尿困難で、PSAおよびNSE高値、画像検査で前立腺の腫瘍、腸骨リンパ節腫大を認めた。経尿道的前立腺切除を施行し、病理組織学的所見より前立腺小細胞癌と診断した。LH-RH analog、bicalutamideによるMAB療法を開始したところ、PSAは低下したが、NSEは上昇し続けた。治療開始1ヵ月後より下血、会陰部痛が出現し、徐々に全身状態悪化し5ヵ月後に死亡した。, 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.

2001年1月～2005年7月に膀胱腸瘻と診断後手術を実施した18例を対象とした。炎症性は12例で内S状結腸憩室炎6例クローン病6例、腫瘍性は5例、外傷性は1例だった。炎症性の主訴は気尿または糞尿が6例、排尿時痛が6例、頻尿が4例で手術までの経過中全例で気尿または糞尿を認めた。検査は膀胱造影を10例に実施し、瘻孔を認めたのはS状結腸憩室炎1例であった。治療は11例で腸管切除を実施し、膀胱と腸管の剥離後膀胱へ手術操作を行わなかった症例4例、膀胱壁と縫合を行った症例6例だった。術後観察期間は3～37ヵ月、全例で気尿糞尿が消失し膀胱炎症状の改善を認めた。腫瘍性の年齢は52～75歳、全例男で主訴は排尿時痛3例、排便困難2例であった。検査で全例に膀胱造影を実施したが膀胱腸瘻は認めず、注腸造影で1例に瘻孔を認め、2例に膀胱腫瘍の疑いで経尿道的生検術が行われた。治療は4例で腸管、腫瘍切除がなされ2例は膀胱部切除術、2例は膀胱全摘術を同時に行った。, 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.

43歳女.患者は全身倦怠感および嘔気を主訴に近医を受診, 過敏性腸症候群として加療されていた.しかし症状が悪化し, 血清Crの上昇, 更に腹部超音波で両側水腎症と診断され, 著者らの施設へ紹介となった.検査所見等により腎後性腎不全を疑い, 逆行性腎盂造影を施行したところ, 両側下部尿管に3～4cmにわたる狭窄を認め, 右側はガイドワイヤーも通過しなかった.腹水は認めず, CTならびにMRIではわずかに腫瘤性病変を認めるのみで, 各種検索でも異常所見を認めなかった.後腹膜線維症と診断し, ステロイド療法を開始したところ, 症状は改善せず, 3ヵ月後, 腹痛, 嘔気が増悪した.そこで, 腹部骨盤CTを施行した結果, 左腎尾側に腫瘤, 肝外側, 直腸腹側に腫瘤性病変を認めた.原発巣再検索では異常はなかったが, 腫瘍マーカーは上昇しており, 免疫組織化学染色により腹膜中皮腫線維形成型と診断された.化学療法を施行するも効果がなく, 患者は初診約9ヵ月後に死亡となった, 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.

前立腺Endometrioid adenocarcinomaの3例を経験した.症例1(71歳男性).排尿困難で受診.肉眼的血尿, PSA上昇, 膀胱尿道鏡で前立腺右葉より尿道へ突出する乳頭上腫瘍を認め, 生検で類内膜腺癌と診断, TAB療法でPSAは低下し, 前立腺全摘除術を行った.しかし約1年3ヵ月後, 排尿困難から膀胱鏡で乳頭状腫瘍を認めて切除, 類内膜腺癌であった.症例2(71歳男性).肉眼的血尿, 膀胱タンポナーデで入院となった.PSA高値, CT・MRIで前立腺左葉より膀胱内に突出し, 精嚢へ浸潤する腫瘍を認め, 生検で前立腺類内膜腺癌と診断, 膀胱前立腺摘除術を施行した.3ヵ月後PSA高値より, CTで多発性肝転移を認め, TAB療法でPSAは低下した.症例3(86歳男性).高血圧, 高脂血症で他院通院中, PSA高値で紹介入院となった.MRIで前立腺両葉に内腺への浸潤を疑うlow intensity areaを認め, 生検で類内膜腺癌と診断, TAB療法でPSAは低下した, 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.

34歳男.検診で肺野の異常陰影を指摘された.精査で右腎腫瘍を認め, 右腎摘除術を施行した.腫瘍と大血管との剥離操作のさい高血圧発作が出現し, 褐色細胞腫を疑った.摘出標本の病理組織学的検査において, 大型で胞体がやや淡明な核の多形性を示す腫瘍細胞が認められたため褐色細胞腫と考えられた, 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.

65歳男性.尿閉状態で受診し内服治療を行うも排尿不可で尿道カテーテルを留置したが, 食欲不振で約1ヵ月間に10kgも体重が減少したため入院となった.膀胱鏡, 尿道・膀胱造影では異常は認めず, 膀胱内圧測定では尿意はあるが無収縮性膀胱を呈し, 胸腰椎MRIでも異常は認めなかった.また, 胸部X線やCTでは肺門部腫瘤陰影と縦隔リンパ節腫大が認められた.これらの所見より, 経尿道的前立腺切除術を施行し残尿率83%で導尿を継続したが, 術後まもなく便失禁, 上肢脱力感などの神経症状が出現し, 神経学的検査所見, 胸部画像所見から肺小細胞癌によるLambert-Eaton筋無力症候群を疑い, 左鎖骨上リンパ節および右肺門部腫瘤の生検を施行し, 肺小細胞癌と診断された.治療として全身化学療法を施行し, さらにその後, 放射線療法を行うことで排尿可能となり, 体重も増加し, 神経症状も改善した, 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.

42歳男.左腎摘出術後, 対側の腎および腎盂へ再発をきたした腎細胞癌の症例について報告した.腹部CTにて左腎下極に腫瘤性病変を認め, 左根治的腎摘出術を施行した.その後, 肉眼的血尿を主訴とし, 画像診断にて右腎盂腫瘍と診断され入院となった.軽度の肝機能異常を認め, 尿細胞診はクラスIIであった.胸腹部骨盤CTにて腫瘤性病変を右腎盂内に認め, 腎細胞癌の腎盂への転移あるいは腎動静脈瘻なんどの血管性病変が疑われた.右腎盂腫瘍の診断にて, 右腎盂摘出術を施行した.腎盂腫瘍は腎実質とは連続性がなく, 粘膜より発生したものと考えられた.免疫療法を施行し, 術後6ヵ月間再発の兆候もない, 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.

24歳男と74歳女の後腹膜線維症の2例について報告した.症例1は24歳男で, 肉眼的血尿, 左腰背部痛を主訴とし, 左下腹部に可動性のない腫瘤を触知した.腹部骨盤CTにて左腎静脈を上縁として後腹膜腔に辺縁不整な腫瘤性病変を認めた.経皮的腫瘍針生検術を施行した結果, 繊維化を認めるのみで悪性所見は認めなかった.プレドニゾロン投与により, 徐々に疼痛は軽減した.10ヵ月を経過した現在, プレドニゾロン5mgの維持療法を施行中である.症例2は74歳女で, 右下腹部痛を主訴とし, 両側水腎症による腎後性腎不全と診断した.後腹膜鏡下生検術を施行した結果, 線維性結合織を豊富に認め, 形質細胞, リンパ球浸潤からなる慢性炎症が認められたが, 悪性所見は認められなかった.プレドニゾロン5mgの維持療法を施行中であり, 腎機能も正常であった, 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.

72歳女.女性尿道に発生した悪性黒色腫の症例について報告した.血性帯下を主訴とし, 外尿道口右側に径2cmの黒色腫瘤を認めた.腹部CTにて明らかなリンパ節腫脹や転移を認めず, Gaシンチにても異常集積を認めなかった.尿道原発悪性黒色腫と診断し, 外陰, 腟前壁を一部含めた腫瘍摘出, 尿道全摘出, 両側鼠径部リンパ節生検, 腟膀胱瘻造設術を施行した.術中の迅速病理診断にて, 鼠径部リンパ節転移は認めなかった.腫瘍細胞は胞体が豊富なメラニン顆粒が豊富で, 高度な核異型が見られた.病巣の深達度は表層から5mmであり, 外尿道口周囲の尿道腺への浸潤み見られた.術後9ヵ月目に局所再発し, 右鼠径部リンパ節の腫脹, 恥骨前面の腫瘤を認め, 現在DAV-feronを療法中である, 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.

74歳男.血尿を主訴に受診し, 膀胱鏡で腫瘤を認めた.腹部骨盤CTで膀胱前壁に径5cm大の, 膀胱左側壁に径1cm大の内腔へ突出する腫瘤を認めた.所見より, 浸潤性膀胱癌T3bN0M0と診断し, 病理組織所見のため, TURBTを施行した.移行上皮癌を併発した, 膀胱平滑筋肉腫で, 術後6ヵ月後に死亡した.剖検で多発性肺転移, 骨盤内を占拠する局所再発を認めた, A 74-year-old man was admitted for asymptomatic macroscopic hematuria. He had undergone transurethral resection of bladder tumor (TURBT) due to transitional cell carcinoma 30 years ago. Pelvic CT showed two invasive bladder tumors. A 5 cm tumor was on the dome and a 1 cm tumor was on the left lateral wall. TURBT was performed. Pathological examination revealed that they were leiomyosarcoma and transitional cell carcinoma. Radical cystectomy plus bilateral cutaneousureterostomy was performed. He died of lung metastases and local recurrence after 6 months.

症例1は56歳男.左下腹部痛を主訴に受診し, 直腸内指診で前立腺癌を疑われ入院した.生検の結果.頸部リンパ節が腺癌であったことから, 遠隔リンパ節転移を伴う前立腺癌stage D2と診断しホルモン療法を行った.その後, 前立腺部の腫脹の再燃による症状の悪化を認め, 更に残存腫瘍の再燃, 骨盤内占拠及び一部体表より突出し癌死した.経過中, PSAは正常化せず, ホルモン不応性に陥っていた.症例2は66歳男.左頸部腫瘤を主訴に受診し入院となった.頸部リンパ節生検により腺癌が疑われ, 左頸部腫瘤摘出術, 経会陰的前立腺針生検を行った.その結果, 進行性前立腺癌stage D2と診断した.両側精巣摘除術後ホルモン療法を開始し, 経過観察となった.治療開始後4ヵ月現在, 傍大動脈リンパ節を含め縮小傾向を認めるが, PSAは正常化していない, We report two cases of prostatic carcinoma presenting as neck lymph node metastases. Case 1: A 56-year-old man was admitted to our hospital with the chief complaint of left lower abdominal pain. A lymph node was palpable on the left side of the neck swollen. Rectal examinations revealed prostatic stony-hard mass. Computed tomography showed a swollen neck and paraaortic lymph nodes on the left side. PSA level was 380 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma, and neck lymph node biopsy also revealed metastatic adenocarcinoma. We diagnosed him with prostatic carcinoma stage D2 (LYM). He underwent hormonal therapy (TAB) but died 13 months later. Case 2: A 66-year-old man was admitted to our hospital with the chief complaint of a large palpable mass on the left side of the neck. Resection of this mass revealed metastatic adenocarcinoma. Rectal examination revealed no malignant lesions, but the PSA level was high, 1, 700 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma. Computed tomography revealed paraaortic and pelvic lymph node metastases and bone scintigram revealed abnormal uptake, bone metastases. We diagnosed him with prostatic carcinoma stage D2 (LYM OSS). We performed bilateral testectomy followed by hormonal therapy (TAB). The lymph node metastases disappeared after 4 months of therapy.

61歳女.肉眼的血尿を自覚した.腹部超音波検査で右腎腫瘍を認め, 精査加療目的で入院した.画像診断により肺腺扁平上皮癌の右腎転移と診断した.肉眼的血尿によると思われる貧血, 右腰部鈍痛, 発熱等が存在し, 転移巣は腎に限局し根治術となりうると考えられることから, 経腹膜的右腎摘除術を施行した.病理組織学的所見は, 腺癌及び扁平上皮癌が混在する腺扁平上皮癌であり, 肺癌の組織像と一致したことから肺癌からの腎転移と診断した.術後, CRP, SCGは正常化し, 自覚症状の腰部痛, 発熱も消失し, 術後18日目に退院した.術後約1年後, 左肺転移が出現し, その後骨転移, 脳転移も出現し, 腎摘除術後2年目に癌死した, A 61-year-old woman, who had undergone total right pneumonectomy 22 months before due to lung cancer (adenosquamous cell carcinoma) was admitted for macroscopic hematuria. Abdominal CT showed two renal tumors in the right kidney. Right radical nephrectomy was performed, because no imaging study showed any other metastasis. Pathological examination revealed adenosquamous cell carcinoma, which was the same pathology as the lung cancer had been. She died of the left lung metastasis 24 months after right radical nephrectomy. Her prognosis was thought to have been prolonged by the operation of right radical nephrectomy.

67歳男.排尿困難を主訴に他院を受診し, 移行上皮癌G3と診断され紹介入院となった.病理組織診断と, 多中心性尿路上皮性腫瘍の除外を目的とした経尿道的膀胱及び前立腺生検術を施行し, 前立腺原発移行上皮癌と診断した.ネオアジュバント療法としてM-VAC全身化学療法を施行し, 効果判定はNCであった.その後, 膀胱前立腺尿道摘除術, 骨盤リンパ節郭清術, 回腸導管造設術を施行した, A 67-year-old male was admitted with a three-month history of voiding difficulty. Prostate specific antigen remained within the normal limit. Under the diagnosis of benign prostatic hypertrophy, transurethral resection of prostate was performed. Pathological examination of the resected specimens of the prostate revealed transitional cell carcinoma. Two courses of systemic M-VAC (methotrexate, vinblastine, doxorubicin, cisplatin) chemotherapy were performed, followed by cystoprostatourethrectomy, pelvic lymphadenectomy, and ileal conduit construction. Now one year has elapsed, with no clinical signs of recurrence.

78歳女。18年前に回腸導管造設術を施行しており, 腹部膨隆の間欠的出現と腹痛, 欠尿で受診した。右横隔膜下にフリーエリアを認め, ストーマ周囲の皮下に拡張した腸管脱出を認めた。以上より, 傍ストーマヘルニア嵌頓, 消化管穿孔と診断し, 緊急手術を施行した。腹水は認めず小腸の拡張を認め上行結腸が肝彎曲付近にて10cmにわたり壊死し, 一部穿孔しており回盲部から上行結腸は後腹膜に固定されていなかった。壊死腸管を含めて上行結腸と横行結腸の一部を切除し, 腹腔内を十分に洗浄し, 大網を充填後に閉鎖し, 回腸人工肛門を左下腹部に造設した。術後, 敗血症, 播種性血管内凝固症候群を発症したが治癒し, 術後78日目に退院し術後5ヵ月経過したがヘルニアの再発は認めていない。, 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.

68歳男.回腸導管出血を主訴とした.浸潤性膀胱癌に対し膀胱全摘除術, 回腸導管造設術を行ったが, 回腸導管から出血を繰り返した.腹壁には静脈の怒張を認め, 造影CT, 上腸間膜動脈の血管造影にて, 静脈相でストマから筋層に至る怒張血管を認めたが, 回腸導管の出血点は不明であった.ストマの周囲を切開して導管の剥離を行った際に血管から血が噴出したため結紮止血し, 静脈瘤を形成する動静脈の結紮・切離し, ストマ再形成術を行った.術後3ヵ月でストマおよび腹壁直下の静脈瘤は消失し, 術後19ヵ月現在, 回腸導管からの出血は認めない, 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.

88歳女性.患者は肉眼的血尿で受診した.尿細胞診陽性(クラス V), 膀胱鏡で左側壁に1cmの隆起性病変を認め, 経尿道的膀胱腫瘍切除術を行い, 病理診断は移行上皮癌(TCC)であった.4ヵ月後尿細胞診が陰性化せず, 生検でTCCと診断された.膀胱内BCG注入療法を拒否され, 約1年後膀胱鏡で全面に発赤拡大を認め, イムノブラダー膀胱内注入療法を行ったが改善せず, 膀胱鏡・CTで腫瘤性病変はなく, 再度の注入療法で尿細胞診は一時クラス IIIとなったが, 患者は腰痛で来院がなく, 3ヵ月後に肉眼的血尿と膀胱タンポナーデで緊急入院した.CT・MRIで膀胱右側壁に4cmの腫瘤を認め, 浸潤性膀胱腫瘍の診断で膀胱全摘除術, 両側尿管皮膚瘻造設術を施行した.病理診断は扁平上皮癌で, 膀胱内にTCCを一部認めた, 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.

76歳男.主訴は排尿困難.前立腺に硬結を認め, PASが高値を示し, 経会陰的前立腺針生検術を施行したところ, 病理組織学的診断は印環細胞癌, Gleason score 5+4であった.骨盤部MRIのT2強調像において前立腺の右葉外腺領域を中心としてlow intensityを示す腫瘤性病変を認め, 前立腺癌が疑われた.前立腺の正中部背側には嚢胞性病変を認めた.前立腺原発の印環細胞癌T2bN0M0, stage B2と診断し, 膀胱前立腺全摘除術, 骨盤内リンパ節郭清術, 回腸導管造設術を施行した.病理組織学的には, 透明な空胞に圧排された偏在核を持つ印環細胞と低分化な腺癌組織を認めた.PSA染色では細胞質が染色された.術後13ヵ月経過した現在, 再発・転移なく, 外来通院中である, 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.

62歳男.腹部CTにて右副腎腫瘍を認め, 腰部斜切開にて右副腎摘出術を施行した.病理組織学的診断は褐色細胞腫であった.13年後, 超音波, CT, MRIにて右腎上極に腫瘤を認め, 131I-MIBGシンチでは腫瘍部位に一致した強い集積がみられた.褐色細胞腫の局所再発と考え腫瘍を摘除した.病理組織学的診断は悪性褐色細胞腫であった.その後, 背部痛, 下肢の知覚・運動麻痺, 膀胱直腸障害が出現し, 胸椎MRIにて第二胸椎への骨転移とそれに伴う胸髄の圧迫所見が, 131I-MIBGシンチでも同部位に集積が認められた.放射線外照射を施行し, 続いてサイクロホスファマイド, ビンクリスチン, ダカルバジンによるCVD療法を計10コース行った.現在, 胸椎への転移巣の28.6%の縮小を認め, 膀胱直腸障害は消失し, 下肢の完全麻痺は杖歩行可能な迄の症状の改善を認めている, 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.

62歳男.57歳時に左腎摘除術後の病理組織検査で腎細胞癌, 明細胞亜型と診断され, 4年後に腎細胞癌の転移による右大腿骨遠位部の骨腫瘍に対し病巣掻破を施行された.その1年後の腹部CTで右腎極下の腫瘤性病変を指摘された.腹部CT, 腹部MRI所見より右腎周囲脂肪組織への転移と診断し, 腫瘤摘出術を施行した.病理学的所見は腎細胞癌, 明細胞癌で, 左腎の病理組織所見とほぼ一致し, 骨転移先行の血行性転移と判断した.術後はインターフェロンとシメチジンによる免疫療法を施行した.術後8ヵ月経過した現在, 再発の徴候はない, 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.

59歳男.51歳時に前立腺部尿道を含めた膀胱内の多発性腫瘍に対し, 膀胱尿道摘除術を受けたが, その8年後, 尿道口よりの排膿を主訴に来院した.陰茎部MRI, 胸腹部CTにより, 残存尿道腫瘍及び左鼠茎部リンパ節転移と診断し, 陰茎部分切除術, 左鼠径部リンパ節切除術を施行した.切除標本の病理組織学的所見は, 8年前と同様の移行上皮癌で, 膀胱癌の転移と考えられた.術後, 補助療法としてM-VAC療法を2コース行った.術後3年2ヵ月の現在, 再発を認めていない, 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.

59歳男.肉眼的血尿を主訴とし, 近医にて前立腺部尿道に腫瘤を指摘され受診した.経直腸的超音波検査, MRIで膀胱頸部付近に腫瘤を認めた.尿道腫瘍として経尿道的腫瘍切除術, 膀胱生検術を施行した.前立腺部尿道に有茎性, 乳頭状の腫瘍があり, 膀胱内に向かって突出していた.病理組織学的に, 腫瘍表面は正常な移行上皮に覆われ, 表層より内方へ上皮層が錯綜しながら増生していた.細胞は異型性や核分裂を認めず, 悪性所見はなかった.以上より, 前立腺部尿道に発生した内反性乳頭腫と診断した.術後経過は良好で, 2年6ヵ月経過した現在, 再発を認めていない, 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.

68歳, 左陰嚢内の無痛性腫瘤を主訴とした.触診の所見は小指頭大, 可動性良好, 弾性硬で, 精巣・精巣上体・陰嚢との連続性は認めなかった.超音波検査では低エコーの内部均一な径1.5cmの病変として描出された.これらの所見から精巣外陰嚢内腫瘍と診断して手術を行った.腫瘤は精巣静脈と接しており, その部位を結紮切断することにより摘除できた.摘出標本は大きさ1.5×1.5×1.0cm, 割面は淡黄色均一で, 辺縁は薄い被膜に覆われていた.HE染色では, 紡錘形で好酸性の胞体に卵円形の核を有する平滑筋に類似した腫瘍細胞が束状に配列し, 互いに錯走する像が観察された.SMA染色, desmin染色とも陽性を示し, 精索平滑筋腫と診断された.術後51ヵ月の現在, 再発の徴候は認めていない, 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.

73歳男.1993年より膀胱移行上皮癌に塩酸エピルビシン30mgの膀胱内注入療法を施行され, 1995年に両側上部尿路及び膀胱の上皮内癌と診断された.DJカテーテルを用い膀胱尿管逆流を誘発し上部尿路にBacillus Calmette-Guerin(BCG)を灌流する方針としたが, 一側の灌流を行った際, BCGによると思われる発熱, 腎機能障害などの副作用が出現したため投与量を漸減し, 反対側に関しては投与を中断した.2000年4月頃より発熱が持続し貧血の進行も強度であったため精査となり, 左膿腎症及び左腎盂腫瘍の診断で左腎尿管摘除術を施行した.病理組織学的所見から, 角化, 線維化, 炎症細胞浸潤を高度に伴った腎盂扁平上皮癌で腎実質への浸潤を認めた.術後18ヵ月で経過観察中である, A 73-year-old man was admitted with high fever. Histopathologically, he was diagnosed with transitional cell carcinoma in situ (CIS) of bilateral upper urinary tracts and urinary bladder in April, 1995. Double J shape ureteral catheter was placed in the left ureter to induce vesicoureteral reflux and Bacillus Calmette-Guerin (BCG) was instilled intravesically every week. Then, the same procedure was performed on the other side. Unfortunately, the treatments could not be completed due to severe complications (high fever and renal dysfunction). Follow-up studies revealed that the left kidney had lost function and right upper urinary tract still had CIS. Therefore, right nephroureterectomy was performed for right renal pelvic cancer (TCC, G3, pT1) followed by permanent hemodialysis in September, 1996. Invasive bladder cancer arose in the abandoned bladder and cystourethrectomy and left ureterocutaneostomy was performed in September, 1999. In April 2000, imaging studies revealed a renal pelvic tumor in his left kidney and left nephroureterectomy was performed. Histopathological diagnosis was squamous cell carcinoma of the left renal pelvis.

67歳男.63歳時に中分化型腺癌に対し根治的前立腺全摘除術, 両側精巣摘除術を受けた.その後, 経過観察となっていたが, 肉眼的血尿を自覚し, 更に腹部骨盤CT, 膀胱鏡で膀胱右側壁に隆起性病変を認め, 精査加療目的で入院となった.遠隔転移を伴う浸潤性膀胱腫瘍と診断し, 経尿道的膀胱腫瘍切除術を施行した.術後も血尿が持続し, 血尿のコントロール目的に単純膀胱摘除術, 両側尿管皮膚瘻造設術を施行した.前立腺癌及び膀胱転移巣は共に血管侵襲, リンパ管侵襲が著明で, PSA染色が一部で陽性であることから前立腺癌の膀胱転移と診断した.内服治療で経過観察していたが, 膀胱摘除術後5ヵ月目に癌死した, We report a case of metastasis of prostatic cancer to urinary bladder. A 67-year-old man was admitted with a complaint of macroscopic hematuria, who had undergone radical prostatectomy and surgical castration for prostatic cancer (pT3N0M0) 53 months before. Computed tomographic (CT) scan revealed an invasive tumor on the right wall of the urinary bladder and swelling of paraaortic and pelvic lymph node metastases. These lesions were diagnosed as bladder tumor with lymph node metastases, and then transurethral biopsy of bladder tumor was performed. Because macroscopic hematuria could not be controlled and severe progressive anemia was found after the biopsy, simple cystectomy and bilateral cutaneoureterostomy were performed on the next day. Histopathological analysis showed that the tumor was adenocarcinoma, which was thought to be a metastatic tumor from the prostatic cancer.

37歳男.生来, 左鼠径部停留精巣を自覚していたが, 腫大を自覚し, 突如疼痛を自覚し手術目的で入院となった.画像所見, 理学的所見では精巣腫瘍は考えられなかったが, 6ヵ月前より無痛性に増大を認めていたことから左鼠径部停留精巣腫瘍の精索捻転症と診断し, 左高位精巣摘除術を施行した.精巣は外観上は腫瘍とは診断できなかった.精索は鞘膜内で360度外転していた.病理では精上皮腫であった.術後は化学療法, 放射線療法は行わず, 経過観察中であるが, 3ヵ月後の現在, 再発は無い, A 37-year-old man was admitted with a painful mass in his left inguinal region. He had an undescended testis on the left side. Six months earlier, he had noted that his left inguinal testis was larger, and he had suddenly developed pain in the left inguinal region. The levels of AFP, hCG beta and LDH were normal. We diagnosed a left undescended testicular tumor and torsion of the left testis. Left inguinal high orchiectomy showed a torsion of the left testis and histopathological examination of the specimen revealed seminoma.

症例は72歳男で, 左腰部痛を自覚し, 排泄性腎盂造影で左無機能腎を指摘され経過観察中であったが, 無尿を来たして両側水腎症, 急性腎不全を疑われた.両側逆行性腎盂造影(RP)及び右double J(DJ)カテーテル留置術を試み, 左は下部尿管で閉塞しカテーテルは通過せず, 洗浄尿細胞診はクラスIVであった.右は下部尿管で狭窄を認めたが, 4.7FrのDJカテーテルは留置可能で, 右腎盂尿細胞診はクラスIIであった.CTではRP像に一致して左下部尿管に腫瘤を認めたが, 右尿管には認めず, 膀胱は全周性に壁が肥厚していた.左尿管鏡で乳頭状腫瘍を認め, 膀胱生検では移行上皮癌pTis G3と診断した.左腎尿管摘除術を施行し, 左腎盂にも腫瘍を認めた.腎実質組織への浸潤も著明で, 尿管においては腹膜浸潤も認めた.術後, 狭窄部位に腫瘤像を認め, 尿細胞診はクラスIVで, 右尿管腫瘍と診断した.肝転移, 骨転移, 左尿管腫瘍局所再発も認めたが化学療法は拒否され, 退院4ヵ月後に癌死した, A 72-year-old male was admitted with a chief complaint of anuria. Clinical examinations showed that he was in uremic state and had bilateral hydronephroses. An endoscopic examination revealed a left ureteral tumor and a bladder tumor. Left nephroureterectomy with partial cystectomy and transurethral resection of the bladder tumor were performed. Pathological examinations showed an invasive left renal pelvic tumor (pT3, G3), an invasive left ureteral tumor (pT4, G3), and a bladder tumor (pTis, G3). Following the operation, roentgenological and urinary cytological findings showed a right ureteral carcinoma. He died of multiple liver and bone metastases and local recurrence at 5 months postoperatively.

症例は14歳男で, 肉眼的血尿を主訴とした.超音波で膀胱前壁頸部よりに1cm大の腫瘤性病変を認め, 膀胱鏡では有茎性乳頭状腫瘍を認めた.排泄性腎盂造影では上部尿路に異常所見を認めず, CT上リンパ節腫大等の異常所見はなかった.表在性膀胱腫瘍と診断し, 経尿道的膀胱腫瘍切除術を施行した.病理組織学的所見は移行上皮癌, Gl, pTa, INFα, ly-, v-であった.他の生検部位には腫瘍性病変を認めず, 術後9ヵ月経過して再発兆候はない, A 14-year-old male patient was admitted with the chief complaint of macroscopic hematuria. Abdominal ultrasonography demonstrated a tumor of the anterior wall of the bladder. Further, cystoscopic examination confirmed a papillary tumor. Transurethral resection of the bladder tumor was performed. Histopathology of the excised tumor showed transitional cell carcinoma (G1, pTa). Recurrence has not been observed for 9 months postoperatively.

症例は59歳の男性で, 頻尿, 排尿時痛, 肉眼的血尿を主訴とし受診した.膀胱内視鏡にて全周性の腫瘍性病変を認め, 腹部超音波で両側性水腎症が存在し, 血清クレアチニン値の上昇を認めたため入院した.1996年10月頃に胃部不快感, 食欲低下から胃内視鏡検査を行い腺癌の診断で胃全摘を行い, 病理組織学的診断はmucinous adenocarcinomaであった.膀胱腫瘍の病理診断を得るためにTUR-BTを施行し, 膀胱の腫瘍は粘液の産生を示すsignet ringcell carcinomaであり, リンパ管侵襲が著明に認められ, 胃の病理組織像と比較して, 胃癌からのリンパ行性転移と診断した, A 59-year-old man was referred to our clinic with a complaint of frequent urination, voiding pain, and macroscopic hematuria. He had undergone total gastrectomy for mucinous adenocarcinoma, 21 months earlier. Pelvic computed tomography revealed a thick bladder wall all around. There were no other metastatic sites except for paraaortic lymph nodes. Transurethral resection of the bladder tumor was performed. The specimen showed signet ring cell carcinoma and revealed the same pathological findings as the primary gastric cancer. We diagnosed him with metastastic bladder tumor lymphogenously disseminated from gastric cancer. Such lymphogenous metastases from gastric cancer at the entire bladder wall without other apparent lesions have rarely been reported in the Japanese literature.

症例:72歳男.右陰嚢内容無痛性腫大および肉眼的血尿を自覚し受診.膀胱内腫瘍にて膀胱腫瘍を指摘され, 経尿道的膀胱腫瘍切除術を行った.当初陰嚢内腫瘤については右鼠径ヘルニアと診断し, 外科にて経過観察されていたが, 骨盤部CTにて陰嚢内腫瘍が疑われ再入院した.なお, 膀胱腫瘍の再発は認めなかった.画像所見より右陰嚢内脂肪腫を疑ったが確定診断には至らず増大傾向にあるため, 手術を行った.病理組織検査では悪性所見を認めず, 脂肪腫と診断した.術後7ヵ月現在外来経過観察中であるが, 陰嚢内脂肪腫, 膀胱腫瘍ともに再発の兆候を認めない, A 72-year-old male was admitted to our hospital with the complaint of right painless swelling of extratesticular scrotal content. Laboratory examinations were unremarkable. Under the diagnosis of an intrascrotal lipoma, the tumor was resected. The removed specimen weighed 115 g. Histopathological findings revealed lipoma. Other cases from the Japanese publications, together with our case, are reviewed.