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We report a case of squamous cell papilloma of the urinary bladder, which is an extremely rare disease with only 15 cases reported in the Japanese and English literature. The case was in a 76-year-old woman. She was referred to the department of urology because multifocal tumors of the urinary bladder were found by computed tomographic scan during an examination for acute enteritis. Cystoscopy showed a nonpapillary flat tumor with whitish plaque on the left posterior wall, measuring 3 cm. Urinalysis and urine cytology revealed no abnormalities. Transurethral resection was performed. Histology revealed a papillary noninvasive squamous cell tumor with extensive keratinization on its surface. There were no nuclear atypia or evidence of koilocytotic change. Immunohistochemically, the tumor cells were negative for both p16 and p53. Based on the pathological findings, the tumor was diagnosed as squamous cell papilloma. The tumor recurred three month after the operation and she is being followed with no change observed for two and a half years.

We report a case of squamous cell papilloma of the urinary bladder, which is an extremely rare disease with only 15 cases reported in the Japanese and English literature. The case was in a 76-year-old woman. She was referred to the department of urology because multifocal tumors of the urinary bladder were found by computed tomographic scan during an examination for acute enteritis. Cystoscopy showed a nonpapillary flat tumor with whitish plaque on the left posterior wall, measuring 3 cm. Urinalysis and urine cytology revealed no abnormalities. Transurethral resection was performed. Histology revealed a papillary noninvasive squamous cell tumor with extensive keratinization on its surface. There were no nuclear atypia or evidence of koilocytotic change. Immunohistochemically, the tumor cells were negative for both p16 and p53. Based on the pathological findings, the tumor was diagnosed as squamous cell papilloma. The tumor recurred three month after the operation and she is being followed with no change observed for two and a half years.

A 49-year-old man was demonstrated to have two tumors in the right kidney by computed tomographic scan during an examination for cholelithiasis. One was a fat rich solid tumor which was clinically diagnosed as angiomyolipoma, and the other was an unconfirmed cystic tumor. Cholecystectomy and radical nephrectomy were performed. Based on pathological findings, the solid tumor was diagnosed as common angiomyolipoma and the cystic tumor as angiomyolipoma with epithelial cysts (AMLEC). The cystic tumor consisted of 3 components : an epithelial cyst lined with single flat to cuboidal cells, a subepithelial compact stroma and an external layer of muscle predominant angiomyolipoma. Immunohistochemical examinations showed strong intense staining of pan-cytokeratin in the epithelium lining the cyst. The subepithelial compact stroma was stained with both CD10 and HMB45. The muscle predominant angiomyolipoma exhibited expression of HMB45. AMLEC is a recently recognized rare variant of angiomyolipoma.

We report two cases of spontaneous urinary rupture caused by primary ureteral or renal pelvic cancer. Case 1: A 76-year-old man presented with macrohematuria and left back pain. Magnetic resonance imaging showed left middle ureteral tumor and rupture of upper ureter. Left nephroureterectomy was performed. Histological findings revealed urothelial carcinoma, G2, pT1, lt-u0, ew0, ly0, v1. At five months postoperatively, he died of lymph node metastases after two courses of adjuvant chemotherapy. Case 2: A 59-year-old man presented with macrohematuria and left back pain. Computer tomography showed left renal pelvic tumor with extravasation of urine. Left nephroureterectomy was performed. Examination of surgical specimen revealed a renal pelvic tumor and rupture hole at the renal pelvis. Histological finding revealed urothelial carcinoma, G3, pT3, lt-u0, ly0, v1. One course of adjuvant chemotherapy was performed. At six months postoperatively, he was free from recurrence., 自然上部尿路破裂を契機に発見された腎盂・尿管腫瘍の2症例を報告した。症例1は76歳男性で、肉眼的血尿、左側背部痛を主訴とした。MRIで20mm大の左中部尿管腫瘍を認め、上部尿管での破裂による造影剤の溢流を認めた。膀胱鏡で右後壁に20mm大の有茎性乳頭状腫瘍を認めた。膀胱腫瘍および左尿管腫瘍と左尿管破裂と診断し、左腎尿管全摘術、膀胱部分切除術を施行した。術後傍大動脈リンパ節、左総腸骨リンパ節に転移を認め、MVAC療法を施行したが死亡した。症例2は59歳男性で、肉眼的血尿、下腹部痛を主訴とした。造影CTで腫瘤が腎盂尿管移行部を閉塞しており、溢流した尿が嚢腫を形成していた。左腎盂尿の細胞診はクラスIVで、左腎尿管全摘、膀胱部分切除を施行した。術中、腎盂に破裂部位を確認し、上腎杯に腎盂腫瘍と、溢流した尿路外にも変性したコアグラを認めた。術後MEC療法を1コース施行した。術後6ヵ月が経過し、再発は認めなかった。

症例1:35歳女。主訴は体動時の尿失禁で、DIPで肉柱膀胱および第5腰椎以下の脊椎披裂と仙骨の変形を認め、MRIで第2仙骨上線の低位脊髄円錐とそれに続く肥厚性終糸および脂肪腫を認めた。膀胱内圧測定では最大尿意355ml時の排尿筋圧58cmH2Oで、コンプライアンス3.6ml/cmH2Oであった。排尿は完全な腹圧排尿で残尿は185mlであり、低コンプライアンスをともなう排尿筋無収縮であった。以上より、脊椎披裂、仙骨硬膜内脂肪腫に伴う低位脊髄円錐および脊髄係留症候群(TCS)と診断した。係留解除術を施行し、術後28ヵ月で蓄尿機能の改善、排尿筋の収縮を認めた。症例2:27歳女。主訴は腹圧排尿で、画像検査所見にて肉柱膀胱および第2仙椎以下の脊椎披裂を認め、第5腰椎下端の低位脊髄円錐とそれに続く肥厚性終糸および脂肪腫を認めた。最大尿意255ml時の排尿禁圧50cmH2Oでコンプライアンス3.6ml/cmH2O、完全な腹圧排尿で残尿150mlで、低コンプライアンスを伴う排尿筋無収縮であった。脊椎披裂と仙骨硬膜内脂肪腫に伴う低位脊髄円錐およびTCSと診断し、係留解除術を施行した。術後24ヵ月で蓄尿機能は正常化したが、排尿筋収縮は改善しなかった。, We report two cases of adult tethered cord syndrome alleviated by untethering surgery. Case 1 was a 35 year-old female who complained of incontinence while exercising. Radiograph revealed spinal disraphism below the L5 level. In addition, magnetic resonance imaging (MRI) showed low placed conus medullaris at the levels of S2 and sacral intradural lipoma. Further urodynamic studies demonstrated normal sphincteric function and autonomous bladder. Diagnosis resulted in the decision to perform an untethering operation. The patient had increased bladder compliance after surgery for untethering and has continued to be continent 16 months post-operatively. Case 2 was a 27-year old female who complained of apprehension to void and straining during urination. Radiograph demonstrated spinal disraphism below the S2 level and MRI revealed low placed conus medullaris at the level of S5 and sacral intradural lipoma. Urodynamic examination verified normal sphincteric function and autonomous bladder. After complete diagnosis, an untethering operation was performed. Post-operatively, bladder compliance and urinary sensation normalized. Furthermore, the patient spontaneously delivered a baby 3 years after having the untethering operation.

シュウ酸分解菌を保有する健康成人男性12例に乳果オリゴ糖を1日10g、14日間、就寝前に服用させた。服用開始日・終了日に24時間尿中ショウ酸排泄量測定、糞便培養を行い、更に糞便中の総嫌気性菌数、総シュウ酸分解菌数を測定した。糞便培養検査では、12例中1例でシュウ酸加PYG寒天培地でのシュウ酸分解菌発育はみられたが、PYG寒天培地での菌発育はみられず、総嫌気性菌数は測定不可であった。糞便中の総嫌気性菌数はオリゴ糖投与後増加し、総シュウ酸分解菌数も投与後増加した。24時間尿中シュウ酸排泄量は投与前後で有意差はなかった。ショウ酸分離菌として分離同定された細菌は、細菌生化学的検査にてBifidobacterium adolescentisと判明した。そこで、Bifidobacterium adolescentisのtype strainの1つであるYIT 4011を用いてシュウ酸分解能の有無を調べた結果、YIT 4011にはシュウ酸分解能を認めず、全てのBifidobacterium adolescentisがシュウ酸分解能を有しているわけではないことが明らかとなった。, A variety of oxalate-degrading bacteria including Oxalobacter formigenes and some species of Bifidobacterium are known to colonize the human intestinal tract. Oral lactosucrose supplementation promotes the growth of Bifidobacterium in the human intestine. Therefore, we investigated the effect of oral lactosucrose supplementation on enteric oxalate-degrading bacteria in twelve healthy men (age ranging from 25 to 39 years). Lactosucrose was orally administered 10 g daily for 2 weeks without restriction of dietary intake. The total number of oxalate-degrading bacteria in feces and the 24-hour urinary excretion of oxalate were examined before and after lactosucrose supplementation. The total number of oxalate degrading-bacteria was significantly increased by lactosucrose supplementation (9.20 +/- 0.44 versus 9.77 +/- 0.46, p

20～70代の健康人92名(男性55名, 女性37名)を対象に糞便のOxalobacter formigenes(OxB)の有無を調査した.PCR法によるOxBの検出率は男性が80%, 女性62%, 培養法では男性62%, 女性50%であった.同時に検出された蓚酸分解菌(Bifidobacterium breve)の遺伝子解析を行った結果, OxB株に存在する三つの遺伝子(frc, oxc, OxlT)を全て保有していることが示唆された, The first objective of the present study was to examine the presence of Oxalobacter formigenes (an oxalate-degrading bacterium in the human intestine) according to sex in a large number of Japanese. The second objective was to study the presence of three related genes in Bifidobacterium breve, which is considered to be a new oxalate-degrading bacterim. Fecal samples were collected from 55 male and 37 female healthy volunteers. O. formigenes was detected by a polymerase chain reaction (PCR) and a culture-based method. DNA was amplified by the PCR method including the site of important base sequences of each gene in order to detect oxc, frc, and OxlT. O. formigenes was present in 80% of 54 male and 62% of 34 female subjects in the PCR-based assay, while it was present in 62% of 40 male and 50% of 24 female subjects in the culture-based assay. The partial base sequences of the three related genes in B. breve were determined. The RNA polymerase-binding site in promoters and the rho-independent termination sequence were preserved in oxc and frc. In conclusion, the rate of the presence of O. formigenes was the same as in previous reports. Female subjects showed a 15% lower rate than males. B. breve is considered to be an oxalate-degrading bacterium since it was found to have oxalic acid-degrading ability and three genes involved in oxalate degradation.

A 49-year-old man was demonstrated to have two tumors in the right kidney by computed tomographic scan during an examination for cholelithiasis. One was a fat rich solid tumor which was clinically diagnosed as angiomyolipoma, and the other was an unconfirmed cystic tumor. Cholecystectomy and radical nephrectomy were performed. Based on pathological findings, the solid tumor was diagnosed as common angiomyolipoma and the cystic tumor as angiomyolipoma with epithelial cysts (AMLEC). The cystic tumor consisted of 3 components : an epithelial cyst lined with single flat to cuboidal cells, a subepithelial compact stroma and an external layer of muscle predominant angiomyolipoma. Immunohistochemical examinations showed strong intense staining of pan-cytokeratin in the epithelium lining the cyst. The subepithelial compact stroma was stained with both CD10 and HMB45. The muscle predominant angiomyolipoma exhibited expression of HMB45. AMLEC is a recently recognized rare variant of angiomyolipoma.

Spontaneous rupture of the kidney is uncommon. We report a case of spontaneous rupture of the kidney due to a renal cell carcinoma. A 53-year-old man presented with right renal tumor. Computed tomography demonstrated a 70 mm right renal tumor which involved the entire upper pole of the kidney and extended into the renal vein. A few days later, the patient had sudden severe right flank pain. Computed tomography of the abdomen revealed a large perirenal hematoma of the right kidney. Angiography demonstrated no vascular abnormality. Nephrectomy was performed. The histological examination showed rupture of a renal cell carcinoma in the right kidney.

A 53-year-old woman was referred for further examination of a left renal cyst detected ultrasonographically during a health checkup. Computerized tomography (CT) scan and magnetic resonance imaging revealed an irregular cystic mass at the center of the left kidney as well as a calcified lesion at the left upper pole. Angiography and cyst puncture confirmed the cystic mass to be unilocular and benign. However, followup CT scan after 22 months demonstrated enlargement of the calcification into a ring-like configuration 3 cm in diameter. Since the lesion showed neovascularity on angiography, radical nephrectomy was performed. Histopathological diagnosis was renal cell carcinoma, alveolar type, common type at the center, but solid type, spindle cell type at the periphery.

Ta G1又はG2の膀胱移行上皮癌107例を対象に, その再発と進展, T1へのstage-upとG3へのgrade-upについて検討した. 1)5年及び10年非再発率は47.3%, 29.8%であり, 腫瘍径1cm以上の群で有意に再発しやすかった. 2)5年及び10年非進展率は93.3%であり, 広基性腫瘍の群で有意に進展しやすかった. 3)T1へのstage-upを13例(12%)に, G3へのgrade-upを7例(6.5%)に認めたが, T1へのstage-upのみでは進展の危険因子とはいえず, 一方, G3へのgrade-upは進展の危険因子であった. 4)G3へのgrade-upの危険因子はG2腫瘍であった, We treated 107 new patients with stage Ta, grades 1 and 2 transitional cell bladder carcinoma by transurethral resection during the past 23 years. The clinicopathological factors evaluated were grade, size, number and form of tumor. Fifty-five patients (51%) had recurrent tumors after initial resection and progression (muscle invasion or metastasis) occurred in four patients (3.7%). The 5-year and 10-year recurrence free rates were 47.3 and 29.8%, respectively. Seven patients (6.5%) had grade 3 tumor (grade-up) at recurrence. An increase in T category to T1 (stage-up) occurred in 13 patients (12%), only one of whom later developed an invasive tumor (pT4). The size of tumor significantly affected the rate of recurrence (p < 0.01). Sessile tumor were at a significantly greater risk for progression (p < 0.05). Stage-up did not have a significant effect on progression, but grade-up was significantly risky for progression (p < 0.01). Initial grade 2 tumors were highly related to grade-up (p < 0.05).

A 77-year-old man was admitted to our hospital complaining of gross hematuria. Cystoscopy showed an approximately 4-cm non-papillary tumor in and out of the diverticulum of the left posterior wall. Total cystectomy was performed. Histopathological diagnosis was pleomorphic leiomyosarcoma. According to TNM classification of bladder cancer, the stage of this tumor was pT3bpN0M0. The patient had local recurrence two months after the operation, and died a month later. This is the second case of leiomyosarcoma of the diverticulum of urinary bladder reported in Japan.

A case of retroperitoneal fibrosarcoma is reported. A 52-year-old man with the complaint of left abdominal mass was referred to our hospital. Computed tomography showed a left retroperitoneal tumor surrounding the left kidney in the perirenal space. Angiography showed some feeding vessels from the branch of the posterior segmental artery of the left kidney. The tumor was completely resected with the left kidney, but para-aortic lymph node metestases were found. Histopathological diagnosis was a retroperitoneal fibrosarcoma with lymph node metastases. The patient died of the disease 3 months after the operation.

We report two cases of spontaneous urinary rupture caused by primary ureteral or renal pelvic cancer. Case 1: A 76-year-old man presented with macrohematuria and left back pain. Magnetic resonance imaging showed left middle ureteral tumor and rupture of upper ureter. Left nephroureterectomy was performed. Histological findings revealed urothelial carcinoma, G2, pT1, lt-u0, ew0, ly0, v1. At five months postoperatively, he died of lymph node metastases after two courses of adjuvant chemotherapy. Case 2: A 59-year-old man presented with macrohematuria and left back pain. Computer tomography showed left renal pelvic tumor with extravasation of urine. Left nephroureterectomy was performed. Examination of surgical specimen revealed a renal pelvic tumor and rupture hole at the renal pelvis. Histological finding revealed urothelial carcinoma, G3, pT3, lt-u0, ly0, v1. One course of adjuvant chemotherapy was performed. At six months postoperatively, he was free from recurrence.

We present a very rare case of retroperitoneal extrarenal angiomyolipoma (AML) with spontaneous rupture. A 67-year-old woman without tuberous sclerosis was admitted to our hospital complaining of sudden right flank pain. We suspected right renal AML with rupture by imaging analysis, but the diagnosis was extrarenal AML by surgery and pathological examination.

A variety of oxalate-degrading bacteria including Oxalobacter formigenes and some species of Bifidobacterium are known to colonize the human intestinal tract. Oral lactosucrose supplementation promotes the growth of Bifidobacterium in the human intestine. Therefore, we investigated the effect of oral lactosucrose supplementation on enteric oxalate-degrading bacteria in twelve healthy men (age ranging from 25 to 39 years). Lactosucrose was orally administered 10 g daily for 2 weeks without restriction of dietary intake. The total number of oxalate-degrading bacteria in feces and the 24-hour urinary excretion of oxalate were examined before and after lactosucrose supplementation. The total number of oxalate degrading-bacteria was significantly increased by lactosucrose supplementation (9.20 +/- 0.44 versus 9.77 +/- 0.46, p<0.05), although there was no significant change in the urinary oxalate excretion. The oxalate degrading-bacteria isolated from feces was biochemically identified as Bifidobacterium adolescentis. In conclusion, oral supplementation of 10 g lactosucrose daily for 2 weeks was effective in multiplying oxalate-degrading bacteria, but not in reducing urinary oxalate excretion under free non-restricted dietary intake. In addition, it was suggested that various species of Bifidobacterium were related to degradation of oxalate in the human intestine.

We report two cases of adult tethered cord syndrome alleviated by untethering surgery. Case 1 was a 35 year-old female who complained of incontinence while exercising. Radiograph revealed spinal disraphism below the L5 level. In addition, magnetic resonance imaging (MRI) showed low placed conus medullaris at the levels of S2 and sacral intradural lipoma. Further urodynamic studies demonstrated normal sphincteric function and autonomous bladder. Diagnosis resulted in the decision to perform an untethering operation. The patient had increased bladder compliance after surgery for untethering and has continued to be continent 16 months post-operatively. Case 2 was a 27-year old female who complained of apprehension to void and straining during urination. Radiograph demonstrated spinal disraphism below the S2 level and MRI revealed low placed conus medullaris at the level of S5 and sacral intradural lipoma. Urodynamic examination verified normal sphincteric function and autonomous bladder. After complete diagnosis, an untethering operation was performed. Post-operatively, bladder compliance and urinary sensation normalized. Furthermore, the patient spontaneously delivered a baby 3 years after having the untethering operation.

The first objective of the present study was to examine the presence of Oxalobacter formigenes (an oxalate-degrading bacterium in the human intestine) according to sex in a large number of Japanese. The second objective was to study the presence of three related genes in Bifidobacterium breve, which is considered to be a new oxalate-degrading bacterim. Fecal samples were collected from 55 male and 37 female healthy volunteers. O. formigenes was detected by a polymerase chain reaction (PCR) and a culture-based method. DNA was amplified by the PCR method including the site of important base sequences of each gene in order to detect oxc, frc, and OxlT. O. formigenes was present in 80% of 54 male and 62% of 34 female subjects in the PCR-based assay, while it was present in 62% of 40 male and 50% of 24 female subjects in the culture-based assay. The partial base sequences of the three related genes in B. breve were determined. The RNA polymerase-binding site in promoters and the rho-independent termination sequence were preserved in oxc and frc. In conclusion, the rate of the presence of O. formigenes was the same as in previous reports. Female subjects showed a 15% lower rate than males. B. breve is considered to be an oxalate-degrading bacterium since it was found to have oxalic acid-degrading ability and three genes involved in oxalate degradation.

Spontaneous rupture of the kidney is uncommon. We report a case of spontaneous rupture of the kidney due to a renal cell carcinoma. A 53-year-old man presented with right renal tumor. Computed tomography demonstrated a 70 mm right renal tumor which involved the entire upper pole of the kidney and extended into the renal vein. A few days later, the patient had sudden severe right flank pain. Computed tomography of the abdomen revealed a large perirenal hematoma of the right kidney. Angiography demonstrated no vascular abnormality. Nephrectomy was performed. The histological examination showed rupture of a renal cell carcinoma in the right kidney.

We treated 107 new patients with stage Ta, grades 1 and 2 transitional cell bladder carcinoma by transurethral resection during the past 23 years. The clinicopathological factors evaluated were grade, size, number and form of tumor. Fifty-five patients (51%) had recurrent tumors after initial resection and progression (muscle invasion or metastasis) occurred in four patients (3.7%). The 5-year and 10-year recurrence free rates were 47.3 and 29.8%, respectively. Seven patients (6.5%) had grade 3 tumor (grade-up) at recurrence. An increase in T category to T1 (stage-up) occurred in 13 patients (12%), only one of whom later developed an invasive tumor (pT4). The size of tumor significantly affected the rate of recurrence (p < 0.01). Sessile tumor were at a significantly greater risk for progression (p < 0.05). Stage-up did not have a significant effect on progression, but grade-up was significantly risky for progression (p < 0.01). Initial grade 2 tumors were highly related to grade-up (p < 0.05).

A 53-year-old woman was referred for further examination of a left renal cyst detected ultrasonographically during a health checkup. Computerized tomography (CT) scan and magnetic resonance imaging revealed an irregular cystic mass at the center of the left kidney as well as a calcified lesion at the left upper pole. Angiography and cyst puncture confirmed the cystic mass to be unilocular and benign. However, followup CT scan after 22 months demonstrated enlargement of the calcification into a ring-like configuration 3 cm in diameter. Since the lesion showed neovascularity on angiography, radical nephrectomy was performed. Histopathological diagnosis was renal cell carcinoma, alveolar type, common type at the center, but solid type, spindle cell type at the periphery.

A case of retroperitoneal fibrosarcoma is reported. A 52-year-old man with the complaint of left abdominal mass was referred to our hospital. Computed tomography showed a left retroperitoneal tumor surrounding the left kidney in the perirenal space. Angiography showed some feeding vessels from the branch of the posterior segmental artery of the left kidney. The tumor was completely resected with the left kidney, but para-aortic lymph node metestases were found. Histopathological diagnosis was a retroperitoneal fibrosarcoma with lymph node metastases. The patient died of the disease 3 months after the operation.

A 77-year-old man was admitted to our hospital complaining of gross hematuria. Cystoscopy showed an approximately 4-cm non-papillary tumor in and out of the diverticulum of the left posterior wall. Total cystectomy was performed. Histopathological diagnosis was pleomorphic leiomyosarcoma. According to TNM classification of bladder cancer, the stage of this tumor was pT3bpN0M0. The patient had local recurrence two months after the operation, and died a month later. This is the second case of leiomyosarcoma of the diverticulum of urinary bladder reported in Japan.