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A 40-year-old Japanese female was referred to our institution with a high serum lactate dehydrogenase level. Computed tomography (CT) showed a large right adrenal tumor, 14 cm in size without distant metastases. The patient was clinically diagnosed with T2N0M0 adrenocortical carcinoma and underwent right adrenalectomy. The pathological diagnosis was adrenocortical carcinoma with negative surgical margin. The patient was administered mitotane for 2 years as adjuvant therapy. Subsequently, CT revealed asynchronous multiple metastases, including liver, lung, left kidney, and right acetabulum. The patient received 15 courses of EDP (a combination of etoposide, doxorubicin, and cisplatin) plus mitotane therapy, and had stable disease without new lesions.

A 34-year-old woman underwent total hysterectomy for management of uterine leiomyoma. At the same time, a paraurethral tumor (2 cm in size) was diagnosed based on magnetic resonance imaging (MRI). However, the patient was not treated for the tumor considering its small size. Eight years later, the patient was referred to our institution with a chief complaint of urethral bleeding. Computed tomography revealed a paraurethral mass at the same location, which was 13 cm in size. A percutaneous needle biopsy was performed and the tumor was diagnosed as leiomyoma. Tumor extirpation was performed and immunohistochemical analysis of the specimen demonstrated positive estrogen and progesterone receptors. Recurrence was not observed on MRI taken 6 months after the surgery. Paraurethral leiomyoma is rare, but relatively common in young women.

A 70-year-old man visited a private hospital with the chief complaint of right lower limb pain. Fluorodeoxyglucose-emission tomography (FDG-PET) showed abnormal uptake in the pubic bone, right femur, and ascending colon. The patient was referred to our hospital for further evaluation. The following tumor marker levels were found : prostate-specific antigen (PSA) 20.57 ng/ml, carcinoembryonic antigen (CEA) 108.5 ng/ml, carbohydrate antigen 19-9 (CA19-9) 1, 002.1 U/ml. An open pubic bone biopsy was performed. The pathological diagnosis was metastatic adenocarcinoma from prostate cancer. Prostate and ascending colon cancers were clinically diagnosed as T2bN0M1b and T2N0M0, respectively. Laparoscopic colectomy was performed. Androgen deprivation therapy started immediately and the serum PSA level was maintained at

Ten years ago, a seventy-year-old female underwent extirpation of a left retroperitoneal tumor that was 58×36 mm in size. The pathological diagnosis was malignant peripheral nerve sheath tumor (MPNST) at that time. The patients visited our hospital with the chief complaint of back pain at ten years after surgery. Computer tomography (CT) showed recurrent tumors at the pancreas and the left kidney. Fine-needle aspiration biopsy was performed because of the possibility of pancreatic tumor. The pathological diagnosis was the recurrence of MPNST. The patient underwent extirpation of the recurrent tumors along with the pancreatic body and tail, transverse colon, spleen and left kidney. The definitive diagnosis was dedifferentiated liposarcoma with murine double minute 2 (MDM2) gene amplification and positive of p16Ink4 (p16). The previously resected tumor also revealed MDM2 gene amplification and positive of p16. Based on these results, our diagnosis in this case was recurrence of dedifferentiated liposarcoma. At 6 months after surgery, the patient had no local recurrence or distant metastases.

The patient underwent laparoscopic left radical nephrectomy for clear cell renal cell carcinoma (ccRCC). After surgery, the patient had multiple lung metastases and underwent the combination therapy of radiofrequency ablation, interferon-alpha, and inteleukin-2. Thereafter, computed tomography showed multiple lymph node and brain metastases. The patient was administered targeted therapy and radiation. Eventually, the patient suddenly complained of dyspnea. An echocardiogram, coronary angiography and magnetic resonance imaging suggested acute heart failure and pericardial effusion due to a metastatic tumor in the cardiac anteroseptal and posterior wall. Nivolumab was administered for cardiac metastases. The patient has been in stable condition with no progression of cardiac metastases after the administration of nivolumab for 22 months.

Sorafenib is a tyrosine kinase inhibitor (TKI) of the vascular endothelial growth factor receptor (VEGFR) used for advanced renal cell carcinoma. Treatment with sorafenib prolongs progression-free survival in patients with advanced clear-cell renal cell carcinoma. However, in spite of its therapeutic efficacy, sorafenib causes a wide range of adverse events. Cardiovascular adverse events have been observed when sorafenib was used with targeted agents. Although these adverse events like hypertension, reduced left ventricular ejection fraction, cardiac ischemia or infarction were manageable with standard medical therapies in most cases, some had a poor clinical outcome. We report three cases of acute myocardial infarction associated with sorafenib in patients with metastatic renal cell carcinoma.

The management of urinoma after blunt renal trauma is still controversial, ranging from percutaneous drainage or ureteral stent placement for the symptomatic urinoma and waiting for spontaneous vanishment of the asymptomatic urinoma. We present two cases of symptomatic urinoma and a case of asymptomatic urinoma after renal laceration. All patients underwent selective renal arterial embolization for vascular complications, including active bleeding, pseudoaneurysm and arteriovenous fistula. Urinomas, which had been observed in all cases gradually reduced and vanished 1-24 months later. All cases were successfully managed without catheterization or percutaneous drainage for urinoma.

A 72-year-old Japanese man was referred to a hospital because of urinary retention. Digital rectal examination revealed a stony, hard nodule in the prostate. A high level of serum PSA was not detected. Prostatic biopsy was performed, and pathological examination indicated adenocarcinoma of the prostate. He was referred to our hospital for treatment. Imaging examinations revealed no metastases (T4N0M0), so we re-evaluated the biopsy specimens. Immunohistochemical examination revealed prostatic small cell carcinoma. His levels of neuron-specific enolase (NSE) and pro-gastrin-releasing peptide (Pro-GRP) were high. We treated him with combination chemotherapy comprising irinotecan and cisplatin, and the treatment waseffective. After four coursesof the chemotherapy, levelsof NSE and Pro-GRP had decreased, and the prostatic mass had decreased in size. Needle rebiopsy of the prostate demonstrated no evidence of malignancy. Adjuvant external beam radiation therapy wasals o performed. The patient iss till alive at 18 month after diagnosis with no evidence of relapse or metastasis of the disease.

A 41-year-old woman with an incidental tumor of the urinary bladder was referred to our hospital. Computed tomography and magnetic resonance imaging showed a tumor in the urinary bladder wall with expansive growth. Under the suspicion of leiomyoma, we performed transurethral resection of the tumor. Pathological examination of tumor specimens revealed patternless arrangements of spindle cells. Immunochemical analysis revealed tumor cells positive for CD34 and bcl-2. The final diagnosis was a solitary fibrous tumor.

A 59-year-old woman with end-stage renal disease of diabetic nephropathy who had been on maintenance hemodialisis for 4 years, underwent a living-unrelated renal transplantation 6 years ago. She was admitted to our hospital, because of a low grade fever and edema. Ultrasonography revealed the cyst with heterogeneity structure in the upper pole of the transplanted kidney. Magnetic resonance imaging showed a high-intensity cystic mass measuring 68×53 mm. As fever and laboratory data did not improve sufficiently by the treatment with antibiotics, echo-guided puncture and drainage were performed for the abnormal structure in the upper pole of the transplanted kidney. In the culture of the purulent aspirate drained from renal cyst, Escherichia coli was isolated. To our knowledge, this is the first report of infected renal cyst of the graft in a renal transplant recipient in the world.

We report a case of huge renal arteriovenous malformation treated with superselective endovascular embolization in two treatments using N-butyl-2-cyanoacrylate (Hystoacryl)., 症例は40歳, 女性。膀胱タンポナーデを主訴に近医受診した。膀胱鏡にて右尿管口からの出血を認めた。造影3D-CT所見から右腎中央から下極に渡る3×4cmの巨大な腎動静脈奇形と診断した。造影にて早期から流出静脈が認められ, high flow typeと診断した。無水エタノールでの塞栓は無効であったため, N-butyl 2-cyanoacrylate(hystoacryl)を用いて, 2期的に塞栓術を施行した。術後, 3ヵ月後の腹部MRIではnidusの開存は認めず, 右腎の大部分の血流は保たれていた。顕微鏡的血尿も消失した。(著者抄録)

58歳男.患者は突然の下腹部痛, 冷汗を認め, 疼痛は次第に左側腹部へと変位した.近医で左尿管結石の診断で鎮痛剤を処方されたが, 痛みが持続した.腹部単純CTでは左腎盂に石灰化を伴う直径40mmのmassを認め, 左腎腫瘍が疑われた.一方, 腹部造影CTでは左腎盂に早期に造影されるhigh density areaを認め, 紹介となった.持続する腹痛と腹部CT所見から, 腎動脈瘤切迫破裂と診断し, 緊急腎動脈塞栓術を施行した.動脈瘤頸部に着脱式coil, マイクロコイルを置き, 更に瘤内の血流を根絶するため, フェザータイプのcoil, トルネードマイクロコイルを瘤内部に留置した結果, 術後, 腹部痛は消失し, 合併症もなく経過, 軽快退院となった, Previously, renal arterial aneurysms were thought to be extremely uncommon. However, these lesions are now being detected more frequently as incidental findings on computed tomography (CT) and magnetic resonance imaging (MRI). The incidence of ruptured renal artery aneurysms is very low. A 58-year-old man presented to a physician complaining of left flank pain and was diagnosed as having a left kidney stone. Abdominal CT scan demonstrated a mass in the left renal pelvis. The mass measured 40mm in diameter and showed calcification. The patient was referred to our hospital 5 days after the first attack. Left renal mass was diagnosed as renal aneurysm based on clinical signs and perirenal findings on CT. Emergent endvascular embolization was performed. The postoperative course was uneventful. Hypertension improved after embolization.

71歳女。多発性膀胱癌の経尿道的膀胱腫瘍切除術後に筋層浸潤を疑われ, 当科紹介となった。術前評価により腫瘍が膀胱内に残存し筋層浸潤を考えたがステロイド内服中のため膀胱摘除術, 一側尿管皮膚瘻造設術を施行し, 病理所見よりpT1N0M0と診断した。術後第5病日の腹部CTで右腎周囲血腫を認め, 第7病日のダイナミックCTでは右腎門部の2ヶ所に仮性動脈瘤を疑った。第11病日の右腎動脈3D-CT血管造影で右腎周囲血腫は縮小していたが, 右仮性動脈瘤の1つが増大しており, 再破裂の危険性を考え, TAEを施行した。多発仮性動脈瘤より分節性動脈中膜融解を考慮して行った血管造影により, 左腎動脈腹側下極枝, 左胃動脈, 短胃動脈, 右胃大網動脈および空腸の辺縁動脈に連珠サインと動脈瘤を認めた。これらの動脈瘤は主要臓器の栄養血管であるため, 無治療経過観察とした。経過は順調で, 術後23病日に退院し, その後の頭部MRI, MRAで脳の主要血管に動脈瘤は認めず, 臨床経過および多発する連珠サインと動脈瘤によりSAMと臨床診断した。, We present a 71-year-old woman with spontaneous perinephric hematoma due to a rupture of pseudoaneurysm of the right renal artery on the fourth day after radical cystectomy and bilateral ureterocutaneostomy for bladder cancer. This patient received steroid therapy for chronic rheumatoid arthritis for several years. The digital subtraction angiography of the right renal artery showed two pseudoaneurysms in the anterior inferior segmental branch and the posterior inferior segmental branch. Transarterial coil embolization of the right renal artery proximally and distally to the two aneurysms was performed without complications. Moreover, the additional angiography showed typical string-of-beads appearance and small aneurysms in abdominal visceral arteries, suggesting segmental arterial mediolysis (SAM) as a possible etiology. Differential diagnoses of SAM are discussed.

62歳女.主訴は右側腹部痛であった.CTにて右腎腫瘍を指摘され入院となった.精査によるCTで, 右腎結石, 右腎実質の菲薄化と右腎盂内に腫瘍性病変を認め手術となった.腰部斜切開したところ, 右腎と十二指腸の癒着が強く, 腎臓を摘出すると, 腎盂と十二指腸との瘻孔を認めた.又, 尿管も下大静脈壁と強く癒着していた為, 尿管摘除術は断念し, 瘻孔部の十二指腸を腹部正中切開にて部分切除し, 手術を終了した.病理では, 腫瘍は乳頭状腺癌で周囲への浸潤は認められなかった.瘻孔部及び十二指腸側への浸潤も認められず, 瘻孔の原因は急性及び慢性の腎盂腎炎による炎症と考えられた.術後7日目に創部感染を合併した為, 再縫合術を施行し, 7日後に退院となった.現在, 厳重に経過観察中である, A 62-year-old woman visited our hospital complaining of fever and right flank pain. On excretory pyelography the right kidney containing three renal stones was not visualized. Retrograde pyelography revealed an irregular filling defect in the right renal pelvis. Computed tomography revealed renal stones and a tumor mass in the right renal pelvis. From these findings, the pelvic tumor of the right kidney complicated by renal stones was diagnosed. Right nephrectomy was performed. Because a fistula between the renal pelvis and the second portion of the duodenum was found in the operation, partial resection of the duodenum was also performed. Pathological diagnosis was adenocarcinoma of the renal pelvis and pyeloduodenal fistula due to chronic pyelonephritis. Postoperative chemotherapy was not given. This is the first case report of adinocarcinoma of the renal pelvis coexisting with a pyeloduodenal fistula.

症例は46歳男性.交通事故で近医に入院し, 右陰嚢部の有痛性腫脹を認めた.抗生剤投与でも改善を認めないため当科を受診した.右精巣上体炎及び右精巣腫瘍の疑いで手術目的で入院した.右高位精巣摘除術を施行した.病理組織診断で腫瘍は皮膚附属器・軟骨・骨・脂肪組織を伴った成熟組織成分からなり, 毛髪も大量に認められたが, 他の精巣腫瘍の組織成分は認めず, 単一組織型のpure mature teratomaと診断した.病理組織からも精巣上体炎の存在が確認された.術後経過は良好で術後10日で退院した.術後6ヵ月を経過した現時点で再発は認められない, A 46-year-old man visited our hospital, complaining of fever and painful swelling of the right scrotum contents. The symptoms and signs suggested epididymitis, but testicular tumor could not be excluded. Therefore, high inguinal orchiectomy was performed. Macroscopic findings were compatible with the testicular teratoma, containing hair, and epididymitis. Histological findings revealed that the tumor was composed of mature epidermis with skin appendages, cartilage, hair, bone and adipose tissue, and that many leucocytes infiltrated in the epididymis, resulting in the diagnosis of pure mature teratoma with epididymitis. For 6 months after the operation, no evidence of recurrence has been observed. Despite its histologically benign appearance, primary pure teratoma of the testis has a metastatic and recurrent potential. Therefore, primary pure teratoma should be man aged in the same way as other nonseminomatous germ cell tumors.