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In Japan, the incidence of prostate cancer(Pca)has been increasing mainly due to the early detection system by PSA screening. Considering pharmacoepidemiology, the statins and metformin have been recognized to lower the risk of incidence of Pca. Excessive intake of calcium, multivitamin and vitamin E increased the Pca risk. The 5-alpha-reductase inhibitors( 5ARIs)are widely used in the treatment of benign prostatic hyperplasia(BPH)by biological function of inhibiting the conversion from testosterone to dihydrotestosterone. A systematic review and meta-analysis identified that 5ARIs had no impact on overall mortality and Pca-related mortality, nor on high-grade Pca diagnosis. The use of anti-hypertensive drugs was reportedly associated with an increasing risk of Pca. However, as an effect of post diagnostic use of anti-hypertensive drugs, angiotensin Ⅱ receptor blockers(ARBs)was associated with improved overall survival and cause specific survival, which means the second chemoprevention potential for Pca. Our previous investigation demonstrated ARBs can suppress the expression of androgen receptor and affect the proliferative signal transduction system in Pca cells. Based on additional data of our experiment, we confirmed the anti-tumor effect of ARBs for Pca, and further clinical trials to make sure the chemoprevention for pre-diagnostic Pca is needed in future.

A 30-year-old man present with infertility for 2 years. Magnetic resonance imaging (MRI) revealed two right testes in the scrotum and inguinal region, respectively. Semen analysis revealed cryptozoospermia. Polyorchidism was considered to have caused spermatogenic dysfunction and male infertility. We performed right high orchiectomy and simultaneous testicular sperm extraction on the same testis. To our knowledge, this is the first case of testicular sperm extraction performed for patients with polyorchidism.

In patients with castration resistant prostate cancer(CRPC), the most frequent site of metastases is bone particularly with osteoblastic change, which accounts for 90% at the late stage of CRPC and is accompanied by symptomatic skeletal symptoms(SSEs)such as bone pain or pathological fractures. Radium-223(Ra-223)dichloride emits α particles and has been proven to improve overall survival(OS)and QOL by reducing SSEs in metastatic CRPC patients. Although hemotoxic adverse events(AEs)of Ra-223 treatment including anemia, neutropenia and thrombocytopenia, and non-hemotoxic AEs including nausea, diarrhea and bone pain have been reported, they were mild and well tolerated. The completion of 6 injections of Ra-223 is important for prolonging OS. The optimal time of Ra-223 administration is recommended the duration when PSA is increasing regardless of abiraterone or enzalutamide treatment prior to chemotherapy.

We report three patients with frequent febrile urinary tract infections (fUTI) who underwent transurethral injection therapy with Deflux for vesicoureteral reflux (VUR). The first case was in a 52-yearold woman who was initially diagnosed with right grade II and left grade I VUR at 18 years of age. She frequently experienced fUTI due to VUR. The second case was in a 29-year-old woman. At age 23,she was diagnosed with right grade III VUR when she developed fUTI. After that,she repeatedly developed fUTI. The third case was in a 40-year-old woman who had frequently experienced fUTI since 25 years of age and had gradually become antibiotics-resistant. She was diagnosed with right grade III VUR when she was referred to our hospital. No visible reflux was confirmed by postoperative voiding cystourethrography after the patients underwent transurethral injection using Deflux. One patient developed fUTI once after surgery,but there were no perioperative complications and no recurrences. Transurethral injection using Deflux for VUR might therefore be safe and effective for treating VUR in adult female patients.

A 45 year-old-man was admitted to our hospital because of discomfort in his left scrotum. He had a left testicular tumor. We performed high orchiectomy and pathological findings revealed testicular cancer. He was treated with bleomycin, etoposide and cisplatin. Computed tomography showed a new mass in the left lung after 3 cycles of the chemotherapy. Because of its rapid growth, the tumor was thought to be a metastasis lesion of testicular cancer or pulmonary infection. Transbronchial lung biopsy showed an invasion of multinucleated giant cells and granuloma. The culture and polymerase chain reaction of the bronchial sputum were positive for myobacterium avium-complex (MAC). From these findings, the left lung tumor was diagnosed as pulmonary MAC disease. He received partial resection of the left lung and the lesion was diagnosed as granuloma. There was no recurrence of testicular cancer or pulmonary disease after the surgery.

Hyponatremia is one of the common electrolyte disorders associated with cisplatin (CDDP) administration. We report here two cases of hyponatremia associated with CDDP. Case 1 : A 75-year-old man with urothelial carcinoma of bladder (cT3N1M0) underwent neoadjuvant chemotherapy with CDDP and gemcitabine. He lost consciousness on the eighth day after the chemotherapy. Blood tests showed severe hyponatremia (Na 113 mEq/l), low plasma osmolality and high level of plasma vasopressin. Urine tests showed low osmolality. These findings were consistent with the syndrome of inappropriate antidiuretic hormone hypersecretion (SIADH). His consciousness level was improved after saline infusion and fluid restriction. Case 2 : A 54-year-old man with penile cancer (cT3N2M0) underwent neoadjuvant chemotherapy with CDDP, paclitaxel and fluorouracil. He lost consciousness on the seventh day after the chemotherapy. Blood tests showed hyponatremia(Na 121 mEq/l) with renal dysfunction. We concluded that the hyponatremia is due to the renal salt wasting syndrome (RSWS) based on renal dysfunction and high urinary sodium excretion. His consciousness level was improved after saline infusion. Although it is difficult to distinguish between SIADH and RSWS, correct evaluation is necessary for appropriate management of hyponatremia after CDDP administration.

(Introduction) A pheochromocytoma diagnosed during pregnancy is rare, and also its fetal and maternal mortality is high if undiagnosed. We report two cases with successful pregnancy outcome with pheochromocytoma. (Case 1) A 31-years-old previously healthy woman presented at 19 week period of gestation with high blood pressure. High urine catecholamine level and a left adrenal mass recognized by magnetic resonance imaging (MRI) confirmed adrenal pheochromocytoma. The patient had good blood pressure control after we started doxazosin 4 mg daily, and Caesarean section was performed at 35 week period of gestation. Two months after delivery, laparoscopic adrenalectomy was performed and she was discharged in the absence of hypertension. (Case 2) A 31-years-old previously healthy woman presented at 29 week period of gestation with exacerbation of headache and palpitation. High urine catecholamine level and a mass recognized close to the inferior vena cava by MRI confirmed extraadrenal pheochromocytoma. The patient had good blood pressure after we started doxazosin 4 mg daily and labetalol hydrochloride 200 mg daily. Caesarean section was performed at 35 week period of gestation. One month after delivery, laparotomic resection of the tumor was performed. Seven years later, hypertension reoccurred and there was an extraadrenal pheochromocytoma recurrence. We had a laparotomic resection for the recurrent tumor, and now she is in the absence of hypertension. (Conclusion) Pheochromocytoma should be considered as a differential diagnosis in a case of high blood pressure occurred during pregnancy. Early detection and appropriate treatment is crucial to reduce fetal and maternal mortality.

Until 2014, docetaxel chemotherapy had been performed as a castration resistant prostate cancer (CRPC) treatment and continued as long as possible because we had no other option except docetaxel. Recently, several new agents including abiraterone, enzalutamide and cabazitaxel are available for CRPC patients. Although we have several treatment options, they are not curative and most of CRPC patients ultimately develop resistance. Furthermore, because AR targeted agents have cross-resistance each other, the taxane chemotherapy that is expected to have less cross-resistance to AR targeted agents may play an important role in the case of AR targeted agent failure. It is crucial about when to start chemotherapy or to switch from docetaxel to cabazitaxel.

Androgen ablation therapy is performed for prostate cancer patients especially with advanced stage. Nevertheless, outgrowth of hormone independent cancer cells occurs within several years and leads to a lethal condition, so-called castration resistant prostate cancer (CRPC). Even in CRPC cells under low levels of serum androgens, androgen receptor (AR) signaling still functions and is engaged in the establishment of CRPC. Recently, novel AR antagonists have been developed such as enzalutamide or ARN-509. This review focuses on these AR antagonists that have some features including high affinity to AR compared with bicalutamide, preventing nuclear translocation and DNA binding. These new hormonal agents have changed the landscape of CRPC treatment with a promising outcome.

Besides the renin-angiotensin system (RAS) plays a critical role in the regulation of the cardiovascular system, there is accumulating molecular and in vivo evidence to demonstrate that the RAS is implicated in the development or invasion of several kinds of cancer tissue. Recent studies indicate that AT1 receptor blockers have the anti-tumor effect in various cancers by inhibiting angiogenesis. Furthermore, some angiotensin peptides including angiotensin 1-7 have been clarified to influence malignancy, and the insertion/deletion polymorphism in the angiotensin converting enzyme gene is likely to be associated with the risk of cancer. This article provides an overview of important aspects on the cutting edge of RAS in some kinds of cancer.

Angiotensin II and AT1 receptor could be involved in the growth of androgen independent prostate cancer since we found the higher expression of AT1 receptor in prostate cancer tissue than in normal tissue. Angiotensin II directly and indirectly stimulates the growth of prostate cancer cells and stromal cells including angiogenic cells. ARBs experimentally inhibited the proliferation of cancer cells and angiogenesis. The administration of ARBs for castration resistant prostate cancer (CRPC) induced the decline of serum prostate specific antigen (PSA) and the improvement of performance status in cachexic CRPC patients. These results support the hypothesis that an intrinsic RAS exists in the prostate gland and it is likely that ARBs are useful molecular targeting agents for CRPC.

A 82-year-old man was referred to our hospital for treatment of hormone-refractory prostate cancer with liver metastases. The obstruction of intrahepatic bile ducts due to the rapid growth of liver metastases induced liver dysfunction. We administered 25 mg/m(2) docetaxel on day1 and 280 mg/body estramustine phosphate on day 1 to day 3, every 4 weeks. After two courses of this combined chemothrapy, the liver metastases were markedly reduced in size with the rapid improvement of liver function.

Mixed epithelial and stromal tumor of kidney (MEST-K) is a rare benign renal tumor that was first described by Michal and Syrucek in 1998. Its frequency is 0.2-0.28% of all the renal tumors. Here, we report an additional case of MEST-K occurring in a 28-year-old woman. The patient visited a hospital with complaints of lumbago and fever caused by pyelonephritis. The computed tomography revealed hydronephrosis and a cystic tumor in the right kidney, and laparoscopic right nephrectomy was performed. The resected kidney contained a cystic lesion with a grayish-white mural nodule, in the lower portion. The entire lesion measured 5 cm in diameter, and the mural nodule 2.5 cm in diameter. Histologically, the cyst was lined with tall columnar and transitional epithelia. The mural nodule showed microcystic architectures lined with tall columnar and transitional epithelia, scattered in a compact stroma. Immunohistochemically, spindle cells in the stroma were positive for smooth muscle-specific actin, and estrogen and progesterone receptors (ER and PR). Based on these findings, the tumor was diagnosed as MEST-K. MEST-K was newly introduced to the WHO classification of renal tumors, with a pathogenesis related to long-term estrogen exposure, because of ER and PR expression in the stroma. It is important to consider the possibility of this tumor when encountering cases of cystic tumor in middle-aged and older women, and men with a previous history of estrogen administration.

Although a low prevalence of cancer in hypertensive patients receiving angiotensin converting enzyme inhibitors was reported, the molecular mechanisms have not been elucidated. It is known that the Angiotensin- II (Ang- II) plays a fundamental role not only as a vasoconstrictor in controlling blood pressure and electrolyte/fluid homeostasis, but also as a mitogenic factor through the Ang- II type-1 (AT1) receptor in cardiovascular cells. Recently, there has been increasing evidence that the renin-angiotensin system (RAS) is implicated in the development of various cancers. Ang- II has been demonstrated to be a cytokine, especially acting as a growth factor. Of interest, the physiological function of Ang- II seems to be similar in prostate cancer and stromal cells as we previously reported. AT1 receptor blockers (ARBs), a class of anti hypertensive agent, have the potential to inhibit the growth of prostate cancer cells and tumors through the AT1 receptor. We conducted a pilot clinical study to examine whether ARBs were able to elicit an anti proliferative effect on prostate cancer clinically, resulting in a PSA decline of hormone refractory cancer or delaying PSA progression after radical prostatectomy. As a number of investigators have clarified that Ang- II induces oxidative stress in vascular cells, we reported the hypothesis that Ang- II generated in the prostate gland maybe a cause of oxidative stress linked to prostatic carcinogenesis. This review provides an insight into the key role of Ang- II and AT1 receptor, and the possibility of ARBs for molecular targeting of mitogenesis and angiogenesis in prostate cancer.

A 54-year-old woman consulted our hospital for further evaluation of an incidentally detected small renal mass. Abdominal computed tomography (CT) and other imaging showed a right renal mass adjacent to the Riedel's lobe. Laparoscopic right partial nephrectomy was performed under a diagnosis of suspected renal cell carcinoma. Riedel's lobe is an anatomic variant, which is a caudal extension of the right lobe of the liver. Riedel's lobe presented an obstruction during right renal surgery, but we performed the procedure successfully because we retracted the lobe medially. This procedure yielded a clear surgical field, allowing us to perform this delicate operation safely.

A 28-year-old man with adult-onset idiopathic male hypogonadotropic hypogonadism (MHH) is reported. He had been delivered normally and had normal puberty. He was referred to our hospital with a chief complaint of infertility. Serum levels of testosterone, luteinizing hormone, and follicle stimulating hormone (FSH) were low. Semen analysis demonstrated azoospermia. Pituitary hypofunction was suggested by gonadotropin releasing hormone (GnRH) loading test. Magnetic resonance images did not detect any abnormalities in the hypothalamic-pituitary region. After a diagnosis of adult-onset hypogonadotropic hypogonadism was established, the patient received human chorionic gonadotropin (hCG) and recombinant FSH treatment. After 5 months, his sperm count reached 6.9 x 10(6) per ml and his wife became pregnant. Adult-onset HH in most cases is caused by tumors and trauma. To our knowledge 17 cases of adult-onset idiopathic HH have been reported, and there were only 3 cases that were caused by pituitary dysfunction. This report showed that r-FSH and hCG therapy was effective in promoting fertility in a patient with adult-onset idiopathic MHH.

We report a case of colorectal cancer with metastasis to the upper urinary tract. A 56-year-old man had left flank pain. Ultrasonography and computed tomographic (CT) examination demonstrated left hydronephroureter and a soft-tissue structure within the left ureter. Urinary cytology of the left ureter showed class IIIb. We diagnosed him with ureteral cancer and performed left nephroureterectomy. Microscopic examination demonstrated adenocarcinoma located in ureteral and pelvic wall, especially in blood vessels, with intact mucosa and similar to adenocarcinoma of colon cancer. Therefore metastatic upper urinary tract tumor was suspected. Barium enema and positron emission tomography-CT demonstrated sigmoid colon cancer. Biopsy specimen of colon cancer demonstrated adenocarcinoma, which was consistent with the ureteral tumor. Finally we diagnosed him with metastatic upper urinary tract tumor of sigmoid colon cancer.

A 66-year-old woman, who developed pulmonary tuberculosis at 17 years old, had a high fever in December, 2006. Computed tomographic (CT) scan showed a tumor in the left chalked kidney, which measured 7 cm in diameter with very low enhancement. Laboratory data showed the rise of acute phase reactants (erythrocyte sedimentation rate and c-reactive protein) and severe anemia. The cultures of sputum and urine revealed no Mycobacterium tuberculosis. With the diagnosis of left renal cell carcinoma in the chalked kidney, we performed left radical nephrectomy. Histopathological diagnosis was sarcomatoid renal cell carcinoma. Although sarcomatoid renal cell carcinoma is highly malignant and its prognosis is poor, her post-operative condition has been good without any adjuvant treatments and there have been no recurrent or metastatic lesions for 9 months. The supervention of renal cell carcinoma on renal tuberculosis is rare. The possible effects of tuberculous lesions on the development and progression of renal cell carcinoma are discussed.

Since a low prevalence of cancer in hypertensive patients receiving angiotensin converting enzyme inhibitors was reported, a biological action of angiotensin II (Ang-II) on the development or progression of cancer has been drawn attention. Recently, a widespread use of AT1 receptor blockers (ARBs) has contributed more attractive information on the involvement of Ang-II in cancer. Interestingly, there is increasing evidence that the renin -angiotensin system is implicated in the development of various cancers. From basic and clinical data, we believe that ARB has a novel ability to decelerate prostate specific antigen elevation especially in hormone refractory cancer and suppress the incidence of prostate cancer, which implies that ARB may have a chemopreventive activity for prostate cancer.

Silodosin (URIEF), a new so-called 3rd generation alpha-1 blocker, is widely expected to be effective and useful for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), due to its high specificity to alpha-1A receptor. We evaluated the efficacy of Silodosin, on 187 males 50 years old or over with the diagnosis of BPH. Silodosin significantly improved the International Prostate Symptom Score (IPSS) and quality of life (QOL) score from the day after administration was started. Among 166 patients whose data were available for the analysis of efficacy of Silodosin, 77.5% showed apparent subjective improvement. Eighty three patients, who had been taking another alpha-1 blocker but without satisfactory effects, showed almost the same improvements in IPSS and QOL score after switching to Silodosin as the remaining 83 patients who had no preceding treatment with an alpha-1 blocker. The improvements were not only in voiding symptoms but also in storage symptoms. The patients, who had serious storage symptoms, responded rather well to Silodosin and showed significant improvement. Taken together, Silodosin showed a quick effect for improving subjective symptoms and QOL, and was found to be useful for the management of LUTS with BPH.

We reported a case of laparoscopic heminephroureterectomy for ureter cancer in a horseshoe kidney. A 59-year-old woman presented with frequency and diagnosed as left lower ureter cancer with a horseshoekidney. We performed transperitoneal laparoscopic nephroureterectomy. Feeding vessels were four arteries and two veins. Isthmus of the horseshoe kidney was divided using LCS and hemostasis was made using monopolar shears. Operating time was 300 minutes. Total Blood loss was 400 ml. Laparoscopic pyeloplasty or ishmusectomy to benign disease of the horseshoe kidney is often reported, but that of heminephrectomy to malignancy is seldom reported. Laparoscopic Heminephectomy for a horseshoe kidney is difficult surgery for aberrant vessels and isthmus, so it tends to be avoided for safety. But if anatomical consideration about aberrant vessels etc is well done and we operate carfully, so we will be able to do it for safety and small invasive opration.

We report a rare case of uterine corpus metastasis from superficial bladder cancer. A 78-year-old female presented with abnormal vaginal bleeding. She received transurethral resection of bladder tumor (TUR-Bt) two years previously, and the pathological findings were transitional cell carcinoma (TCC) grade 3 pT1. Eight courses of BCG instillation were performed postoperatively. There was no recurrence of bladder cancer when vaginal bleeding occurred. Cytology of vaginal discharge was class V, and transitional cell carcinoma suspected. Pathological finding of transvaginal uterine corpus biopsy was TCC. We diagnosed metastases to uterine corpus from bladder cancer.

To investigate how urinary frequency and incontinence affect the patient's subjective quality of life (QOL) and whether an improvement in objective findings by medical treatment affects his/her subjective QOL, a voiding diary using the King's Health Questionnaire (KHQ) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) was delivered to patients with urinary frequency and/or incontinence before and after treatment with propiverine hydrochloride for 8 weeks. Sixty-eight patients completed the diary and the questionnaires. Objective symptoms decreased significantly with respect to the mean frequency of urination and to the mean incidence of urinary incontinence. The KHQ and ICIQ-SF scores improved significantly with respect to all domains except personal relationships in the KHQ. In the KHQ, furthermore, a significant correlation was found between decreased incidence of urinary incontinence and improvement in role limitations and between decreased incidence of urinary incontinence and improvement in emotional problems. In the ICIQ-SF, a significant correlation was found between decreased incidence of urinary frequency and subjective improvement in quantity of leakage, between decreased incidence of urinary frequency and improvement in subjective QOL scores, between decreased incidence of urinary frequency and improvement in the total ICIQ-SF score, and between decreased incidence of urinary incontinence and improvement in subjective QOL scores. Thirty-two episodes of adverse reactions were observed. None of them were serious. These results suggest that an improvement in objective symptoms with propiverine hydrochloride favorably improves subjective QOL of the patient, and provide further evidence about the safety and efficacy of propiverine hydrochloride.

Purpose: In Japan, sometimes a patient with malignant fatal disease is not informed the diagnosis. We tried to investigate if the informed consent of cancer notification is acceptable and suitable for aged Japanese prostate cancer patients., Materials and Methods: From January to June 2003, we distributed a questionnaire to outpatients who had been followed up for more than 6 months after the diagnosis of prostate cancer. These patients declared a wish to be notified the true diagnosis in their first visit to our department and were informed that they had prostate cancer just after the diagnosis. Ninety-one per cent of patients (54 patients, mean age was 74.8 +/- 6.1 years old) answered to our questionnaire. Clinical stage consisted of 14 cases of B1, 13 cases of B2, 15 cases of C, 3 cases of D1, and 9 cases of D2. The histopathological grade consisted of 6 cases of well differentiated carcinoma, 32 cases of moderately differentiated carcinoma, and 16 cases of poorly differentiated carcinoma. Eleven cases underwent total prostatectomy (B1 and B2) and 44 cases had androgen deprivation therapy., Results: Seventy-six per cent of patients understood and accepted their illness within a few days. However, 11% of patients took more than 3 months to accept their malignant disease. They answered that they could accept their illness given with a relationship of mutual trust between themselves as patients and the medical staff, effective medical treatment, and with the help of their family. They also answered that the most important emotional support was given by their wives (46.3%) and doctors (27.8%). In the early days following the diagnosis, they worried about their remaining days, the risks or side effects of the treatment, their family, and their job. Several months following the diagnosis, they were concerned about recurrence of the disease, their family, medical expenses, and their old age. Those who did not worry at all doubled from 11.1% immediately after the diagnosis to 22.2% several months later. More than 90% of the patients were satisfied with our medical care. And none answered that they might have been happier without cancer notification., Conclusions: Cancer notification is acceptable and suitable in aged Japanese prostate cancer patients who declare a wish to know their malignant illness. A good relationship between the patients and the medical staff, and emotional support from the wife are important.

A 46-year-old man complained of lower abdominal pain, and his abdominal and pelvic computed tomographic scan revealed left hydronephrosis and a huge tumor (9 X 9 cm) in the left distal ureter involving the left iliac vessel that was considered unresectable. Histological diagnosis showed squamous cell carcinoma, and histoculture drug response assay (HDRA) suggested the effectiveness of gemcitabine and nedaplatin. A cycle of adjuvant chemotherapy consisting of MEC (methotrexate 30 mg/ m2: day 1 and 15, epirubicin 50 mg/m2: day 1, and cisplatin 50 mg/m2: day 2 and 3) was performed as a first line chemotherapy, but the size of the ureteral tumor did not change. He was treated with 3 cycles of systematic combination chemotherapy consisting of gemcitabine (1,000 mg/m2: day 1 and 8) and nedaplatin (80 mg/m2: day 1). After 2 courses of chemotherapy, the tumor size was reduced by 50% (PR; RECIST guidelines) and the tumor markers (SCC, CYFRA, NSE, CEA, and CA19-9) dropped to within the normal range. There were no serious adverse events except for grade 3 neutropenia which spontaneously recovered. However, because the tumor size was not reduced after the third cycle of chemotherapy, we applied external beam radiation to the primary lesion and the metastatic retroperitoneal lymph node site. No evidence of residual tumor progression has been found for 6 months after radiation therapy. We concluded that GN chemotherapy may be useful for patients with squamous cell carcinoma of the ureter.

Objective: The prognosis of prostate cancer has been evaluated by clinical stage or pathological grade. PSA parameters including PSA density and PSA doubling time have not always precisely reflected the prognosis of prostate cancer. The aim of this study was to evaluate PSA parameters and extension of disease (EOD) grade as prognostic factors for relapsed prostate cancer., Methods: The relationship between PSA parameters or EOD grade, and survival of 29 stage D patients with relapsed prostate cancer after initial hormone therapy was examined., Results: Only EOD grade was an independent prognostic factor, even for cause-specific survival period and survival period after relapse., Conclusion: EOD grade was a significant prognostic factor, and in particular, very useful as a prognostic factor for patients with bone metastasis. PSA value was not always associated with tumor volume, and therefore it is not an independent prognostic factor.

Two patients with testicular tumors whose serum alpha-fetoprotein (AFP) persisted to show an abnormally high concentration are reported. Case 1 : A 42-year-old male who had been suffering from chronic hepatitis, underwent left high orchiectomy for a left testicular tumor in 1998. Diagnosis was an authentic stage I seminoma. In 2002, chemotherapy was performed for a metastatic seminoma revealed as a solitary mass in the mediastinum by radiographic studies, and histologically confirmed to be a metastatic seminoma. Although lymph nodes were gradually reduced in size, the serum AFP and transaminase levels remained at an abnormally high concentration. The subfraction profile with lens culinaris hemagglutinin (LCA) revealed elevation of only peak 1 which implied that the chronic hepatitis was due to liver dysfunction. After a 10-month follow-up the levels of both AFP and transaminase decreased, and the patient was disease-free. Case 2: In 2002, a 30-year-old male underwent left high orchiectomy for a left testicular tumor, and histological examination revealed seminoma, immature and mature teratoma, embryonal carcinoma. The serum AFP was elevated to 45 ng/ml. Diagnosis was authentic stage I. After 2 courses of chemotherapy, the serum AFP remained at an abnormally high concentration. However, there were no new lesions. The serum AFP level was not elevated in any of the family members. The subfraction profile with LCA revealed elevation of only peak 1, which implied that there were no viable lesions. After a 24-month follow-up AFP was about 20 ng/ml and the patient was disease-free.