Search

We report a case of left essential renal hematuria successfully treated with the instillation of hydrogen peroxide into the renal pelvis. A 68-year-old man was referred to our hospital with the chief complaint of gross hematuria. Our diagnosis was left renal essential hematuria. We could not find the bleeding point using a flexible ureteroscope. Due to prolonged gross hematuria, we performed instillation of hydrogen peroxide into the renal pelvis and the gross hematuria completely disappeared. Retrograde hydrogen peroxide instillation therapy is useful and safe for essential renal hematuria.

A 69-year-old woman was referred to our department for refractory cystitis. Incomplete emptying of the bladder was observed, and symptoms did not improve after medication. Clean intermittent catheterization was initiated. Two years after introduction of catheterization, a mass in the bladder dome was detected by routine abdominal ultrasonography. She was diagnosed with malignant tumor of the bladder diverticulum based on cystoscopy, computed tomography, and magnetic resonance imaging. Partial cystectomy and lymph node dissection was performed following transurethral resection of the bladder tumor. Histopathology revealed squamous cell carcinoma and no signs of lymph node metastasis. She is alive and recurrence-free 28 months after surgery.

A 67-year-old man (case 1) and 65-year-old man (case 2) were incidentally found to have a tumor in theretrovesical region. Computed tomography and magnetic resonance imaging demonstrated a solid tumor atthe right side of the rectum. 2-Deoxy-2-[fluorine-18] fluoro-D-glucose (FDG) -positron emissiontomography revealed uptake at the tumor. Both patients were cured by tumor resection. Histological diagnosis was benign schwannoma. In case 2, it was difficult to diagnose the tumor as schwannoma by imaging studies. We made a histological diagnosis by transrectal needle biopsy of the tumor before theoperation. Schwannoma is located mostly in the limbs and the head and neck, but rarely in the intrapelviccavity. We expect that the transrectal needle biopsy is valuable for diagnosing the retrovesical tumor.

A 77-year-old man was seen at our hospital with the chief complaint of pollakisuria. Magnetic resonance imaging (MRI) showed a 25 mm cystic tumor with solid components behind the prostate. A transrectal biopsy for the prostate showed no evidence of malignancy. Two years later, he complained of weak urinary stream, and the MRI diagnosis demonstrated an increase of the tumor size to 67 mm. Since prostatic sarcoma was diagnosed by the transrectal biopsy for the prostate, a tumor resection and prostatectomy were performed. At 19 months after the operation, there was no evidence of metastasis or recurrence, and he has had no dysuria. The final pathological diagnosis was of a prostatic STUMP.

The patient was a 60 year-old male who first visited a doctor because of back pain on the right side in May 2003. As a result of thorough examination, he was diagnosed with right renal pelvic cancer (cT4, N2, M1), and was referred to our department for treatment. In spite of systemic chemotherapy and radiation therapy in combination with cisplatinum on the primary tumor were performed from May 2003 to December 2005, the number and size of hepatic metastases increased. Consequently, considering hepatic metastasis as the specific prognosis factor, the patient was given a total of 14 cycles of hepatic arterial infusion chemotherapy (HAIC) from January to October 2006. As a result, the hepatic metastases completely disappeared. Then HAIC was tentatively discontinued and the patient was followed up. However, as new lung metastases were found by CT in March 2007, radiation therapy was performed on the lung metastases. As hepatic metastasis was recognized again by CT in April 2007, HAIC was resumed and the patient was given a total of 6 cycles starting from May 2007. During that period, two transurethral resection of bladder tumor were performed against the recurrence within the bladder while transarterial embolization was performed against the bleeding in the right kidney. The patient was regarded as a long-term survivor surviving for about five years after his initial consultation.

Alternative Antiandrogen Therapy with Flutamide in Patients with Castration-Resistant Prostate Cancer : A Single Center Experience We analyzed the clinical effects of flutamide (FLT) as a second-line agent for maximum androgen blockade (MAB) in patients with castration-resistant prostate cancer who received bicalutamide (BCL) as the first-line MAB agent. This study included 44 cases with progressive prostate cancer who had relapsed after first-line MAB, with BCL at 80 mg/day. After checking for antiandrogen withdrawal syndrome (AWS), they were given FLT at 375 mg/day as second-line MAB. A partial response (prostate-specific antigen [PSA] decline ≧50%) and no change (PSA decline of 0-50% or increase ＜25%) by second-line MAB with FLT were achieved in 34.1% (15/44) and 25.0% (11/44), respectively. The median duration of PSA response was 8.2＋/−4.5 months. In multivariate analysis, Gleason score (≦7 vs ≧8), the first-line response (CR vs PR＋NC), and the second-line response (PR＋NC vs PD) were significantly predictive of cause-specific survival from first-line hormonal therapy relapse to cancer death. Our results confirm previous findings that alternative antiandrogen therapy is effective as a second-line hormonal therapy.

We report a case of primary malignant lymphoma of the prostate. An 84-year-oldman was referredto our hospital with a chief complaint of urinary retention. Magnetic resonance imaging showeda large mass below the bladder and in front of the rectum. Histological and immunocytochemical studies of transperineal biopsy of the prostate showedd iffuse large B-cell non-Hogkin's lymphoma. Radiological assessment of the disease confirmed stage IV according to the Ann Arbor classification. Although the tumor was markedly reduced in size after four cycles of combination chemotherapy with cyclophosphamide, adriamycin, vincristine, and prednisolone, he died with brain metastasis 4 months after the diagnosis.

We herein report four cases of sarcomatoid renal cell carcinoma. These cases comprised 4.1% of the 98 patients with renal cell carcinoma treated in our department during the past 13 years. It is confirmed that renal cell carcinoma with a sarcomatoid component often shows local invasion, distant metastasis, rapid growth and poor prognosis. In Mian's series, the percentage of sarcomatoid component ( or = 25%) was associated with decreased survival time, but was independent of stage. The pathological stage was pT3b N0 M0 in case 1, pT1b N0 M1 in case 2, pT3b N0 M1 in case 3 and pT1a N0 M1 in case 4. The pT1 sarcomatoid renal cell carcinoma in case 2 and case 4, who developed poor prognosis, was composed of 60 and 80% sarcomatoid change, respectively. However in case 3 with a pathological stage of pT3, the patient is alive 35 months after resection, because the extent of sarcomatoid component was 25%. The prognosis of patients with sarcomatoid renal cell carcinoma depends on not only disease stage and tumor grade but also the pathological extent of sarcomatoid component., 患者は全例男で、肉腫様腎細胞癌であった。症例1:65歳はINF療法を拒否し肺転移による右背部痛増強で緩和療法を行ったが2ヵ月後癌死した。病理組織学的肉腫様成分(占拠率)は98%以上であった。症例2:44歳は骨転移に伴う疼痛に対しIFN-αbased therapy と緩和療法を先行し、腎摘出後骨転移に放射線外照射したが脳転移が出現した。γナイフ放射線を追加し、肋骨転移、胸壁皮膚転移で術後21ヵ月に癌死に至った。占拠率は60%であった。症例3:55歳は術後のIFN-αbased therapyを、肺転移の増大でIL-2 based therapyに変更したがさらに増大し、sorafenib tosilate投与で縮小して術後35ヵ月現在、生存中であった。腎腫瘍径9.0cm、pT3bの肉腫様成分25%の低占拠率であった。症例4:59歳は術後IFN-αbase therapy 継続後に肺転移が増大しIL-2 based therapy へ変更するも増大し、IFN-αbased therapy に変更したが胸水を伴う肺転移で術後19ヵ月に癌死に至った。腎腫瘍径2.5cm、pT1a、占拠率は80%であった。

症例1(70歳女性).左水腎症の精査目的に著者らの施設へ紹介となった.症例2(59例女性).無症候性肉眼的血尿を主訴とした.いずれも自然尿細胞診はclass IIで, 排泄性尿路造影にて左尿管ポリープと診断し, 尿管鏡下に腫瘍切除術を行った.病理組織学的に線維上皮性ポリープで, 術後7～9ヵ月経過した現在, 再発はなく経過良好である, Two cases of ureteral polyp resected by a transurethral approach are presented. Case 1: A 70-year-old woman was referred to our clinic because of hydronephrosis incidentally found. Excretory urography demonstrated a filling defect with a long and round smooth contour in the left lower ureter without hydroureter. Urine cytology was negative for malignant cells. Under the clinical diagnosis of left ureteral polyp, polyp was resected transurethrally. The pathological diagnosis was fibroepithelial polyp. Case 2: A 59-year-old woman was referred to our clinic with a chief complaint of macroscopic hematuria. Excretory urography revealed a filling defect with a long and round smooth contour in the left upper ureter. Because urine cytology was negative for malignant cells, left ureteral polyp was suspected. After the operation by tranthurethral approach, the pathological diagnosis was fibroepithelial polyp. No intraoperative complication was observed in either case. Ureteral polyps resected by a transurethral approach are relatively rare. We reviewed and discussed 46 cases of ureteral polyp resected transurethrally, reported in Japan including our two cases.

60歳女性.患者は結核性萎縮膀胱に対する尿管回腸膀胱吻合術後43年目に右腰背部痛, 発熱が出現し, 腎盂腎炎の診断で著者らの施設へ入院となった.抗生剤投与にて症状は改善したものの, 血尿と水腎症を認めた.DICでは右腎・尿管・利用回腸近位部の著明な拡張と造影剤の途絶を認め, 尿培養は陰性であったが, 腫瘍マーカーCA19-9はその上昇を認めた.更に腹部造影CT・膀胱鏡所見より, リンパ節転移, 肝転移を伴った利用回腸部悪性腫瘍と診断され, 経尿道的腫瘍切除術を施行した.病理組織学的にはTransitional cell carcinomaで, 術後は化学療法を行ったが, 最終的に死亡となった, A 60-year-old woman visited our hospital complaining of fever up. She had undergone augmentation ileoplasty for tuberculous bladder atrophy 43 years age. Cystoscopy revealed a broadbased tumor on the ileal segment. Histopathological findings of the biopsy specimen demonstrated grade 3 transitional cell carcinoma. She was given 2 courses of chemotherapy (methotrexate, vincristine, adriamicin, cisplatin), but died of metastasis of carcinoma 4 months after diagnosis.

比較的若年の再燃性前立腺癌26例(年齢中央値67歳)に対して, cyclophosphamide(CPM), uracil+tegafur合剤(UFT), estramustine phosphate(EMP)併用療法を行った.PSAが50%以上下降したのは16例で, EMPを前治療とした7例では5例が下降した.骨シンチグラムで改善を示したのは16例中1例で, リンパ節転移3例では2例に部分緩解を認めた.骨痛の17例中5例は消失或いは改善した.骨転移, 貧血合併の37例(年齢中央値74歳)にはdexamethasone(DEX)単独投与を行い, PSA50%以上下降は23例, 骨シンチ改善は21例中4例で, リンパ節転移5例中1例がPRとなった.骨痛18例中11例は消失又は改善し, 血中Hb値は32例中10例で上昇した.他の再燃性前立腺癌44例(年齢中央値69歳)にはDEX, CPM, UFT併用を行い, 前治療はEMP投与19例, DEX単独3例であった.PSA50%以上下降は28例, 骨シンチ改善は30例中1例で, リンパ節転移7例中1例がPRとなった.骨痛は16例中9例が改善した, To our knowledge, no standard chemotherapy for patients with hormone-refractory prostate cancer (HRPC) has been established. Since most patients with HRPC are elderly and have bone metastasis, cytotoxic chemotherapy causes them to be at high risk for myelosuppression. Therefore, chemotherapeutic agents with low toxicity and good compliance should be elected. We conducted three regimens for HRPC on an outpatient basis. Eligibility criteria were defined as serial rising PSA values on 3 or more occasions at least 2 weeks apart or radiological new or extensive lesions under hormonal therapy. The first regimen is comprised of cyclophosphamide (CPM), 100 mg/day, UFT, 400 mg/day, and estramustine phosphate (EMP), 560 mg/day in two daily fractions. The second regimen is comprised of an oral administration of dexamethasone (DEX) (0.5-2 mg/day). The third regimen is comprised of DEX, 1 mg/day, cyclophosphamide, 100 mg/day and UFT, 400 mg/day in two daily fractions. Post-therapy prostate-specific antigen (PSA) level in serum, objective response on bone scan or measurable disease, and symptomatic response on bone pain were assessed. All regimens showed clinical efficacy with mild toxicity. Indications and limitations of these regimens are discussed. Further, the combination trials of taxane and EMP in patients with HRPC are reviewed.

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.

Cases 1 and 2 were a 84-year-old, 64-year-old female relatively. Case 2 had a history of uncontrolled diabetes mellitus. Both cases were referred to our hospital with a chief complaint of high fever. Initial diagnosis was acute pyelonephritis based on the findings of pyuria and right costovertebral angle knock pain.Abdominal computed tomography(CT) scan revealed a gas shadow in the right renal pelvis and calyx with right ureteral stone. The definitive diagnosis was emphysematous pyelonephritis (EPN). We selected transureteral catheterization into the right ureter immediately. Escherichia coli was identified from urine culture. Conservative therapywith antibiotics was also effective and general condition improved. Herein we discussed the etiology, symptomatology, choice of treatment and prognosis of emphysematous pyelonephritis. RecentlyCT is an effective imaging method for diagnosis at an earlystage. Antibiotics therapycombined with transureteral drainage of gas-forming urolithiasis is effective as the initial conservative therapy.

症例は56歳男で, 右陰嚢内容の無痛性腫大を主訴とした.右陰嚢内, 精巣上体に5cm大の表面平滑, 右様硬の腫瘤を触知した.右精巣摘除術を施行した.組織学的に精巣上体腫瘍は非Hodgkin悪性リンパ腫と診断された.精巣・精索には異常はなかった.術後CTにて上腹部横隔膜近傍に傍大動脈リンパ節腫大と左上肺野に2cm大の腫瘤影を認めた.悪性リンパ腫に対し化学療法を施行し, その後左肺上葉切除術を施行した.腫瘍経は3cm大, 病理診断は中分化型腺癌であった.精巣摘除術8ヵ月後に, 原因不明のまま急死した, A 56-year-old man visited our hospital with the complaint of painless swelling of right scrotal contents. Right orchiectomy was performed. Histopathological diagnosis was malignant lymphoma of the epididymis, without involvement of the testis. Bone marrow biopsy and Ga scintigram showed a normal pattern, while a swollen retroperitoneal lymph node (3 cm) was found by computed tomography (CT). The CT also showed a small mass lesion in the left upper lung field. After 2 courses of chemotherapy for malignant lymphoma, left upper lobectomy was performed at another clinic. Pathological diagnosis of the surgical specimen was moderately differentiated adenocarcinoma. The patient died without known causes, 8 months after the orchiectomy.

1)回腸新膀胱を20例に施行した.重篤な術後早期合併症はなく, 再手術を施行した症例もなかった. 2)晩期合併症として尿管回腸吻合部狭窄が2例あり, 1例は尿管回腸新吻合術を施行, 1例は内視鏡的に狭窄部を拡張した.回腸新膀胱内結石が2例に発生し, ESWL及び砕石術をそれぞれ施行した. 3)全例が自然排尿可能であり, 夜間尿失禁を認めたものが2例(全失禁)あった.回腸新膀胱過伸展による回腸新膀胱周囲炎が1例あり創部との間に尿瘻を形成した.残尿や回腸新膀胱容量等の定期的チェックと回腸新膀胱に対する十分な教育的指導が重要と思われた. 4)術後の局所再発を2例に認めたが, 尿道再発はなかった, Between June 1993 and July 1996, an ileal neobladder was created in 20 patients after total cystectomy for bladder cancer. The mean post operative follow-up period was 32 months, with a range of 9 to 47 months. Ureteroileostomy was performed using the Le Duc-Camey procedure. There were 3 (15%) early postoperative complications, which were all of transient urine leakage from the neobladder. Late complications were encountered in 6 patients (30%), which were of stenosis of ureteroileal anastomosis in 2 (10%), stone in the neobladder in 2 (10%), neobladder-cutaneous fistula in 1 (5%) and neobladder-ureteral reflux in 1 (5%). Reoperation was necessary in 4 patients (20%); 2 for stenosis of ureteroileal anastomosis and 2 for removal of a stone in the neobladder. No urethral recurrence has been noted. Local recurrence occurred in 2 patients, who died of tumor progression 16 and 27 months postoperatively. All 20 patients were continent during the day time (100%), while 2 (10%) had nocturnal incontinence.

65歳男。1998年より肉眼的血尿を自覚し、1999年4月の受診時に膀胱後壁から後部にかけて認められた直径4cm大の膀胱腫瘍に対し、経尿道的膀胱腫瘍切除術を行った。術前の画像検査ではリンパ節転移を認めなかった。同年7月に膀胱尿道全摘し、回腸導管造設、両側閉鎖リンパ節郭清術を行った。Urothelial carcinoma、G3>G2、pT1bpNOMOと診断され以後定期的に経過観察した。2002年2月に左下肢腫脹を自覚し、腹部CTで左骨盤壁に沿い7.0×5.6cm大のbulkyな腫瘤性病変を認めた。膀胱癌骨盤内リンパ節転移と診断し、2002年3月に加療目的で入院しM-VAC療法(methotrexate vinblastine、doxorubicin and cisplatin)を4コース行ったところ、治療前に認められた左下肢の腫脹は軽快した。放射線治療を追加し、退院後は外来にて経過観察とした。放射線治療後11ヵ月で骨盤腫瘤はさらに縮小し造影効果を認めなかった。現在腫瘤の増大を認めず他臓器への転移も認めない。, We report a case of bladder cancer with pelvic lymph node metastasis effectively treated by chemotherapy followed by radiotherapy. The patient was a 65-year-old man who had undergone radical cystectomy. Histological findings showed urothelial carcinoma, G3 > G2, pT1b. After 31 months, computerized tomography (CT) revealed a bulky tumor (7.0 x 5.6 cm) along the left pelvic wall, indicating pelvic lymph node metastasis. Five courses of chemotherapy consisting of M-VAC (methotrexate, vinblastine, doxorubicin and cisplatin) was performed. The size of the tumor was reduced to 1.5 x 1.0 cm. Then, external beam radiotherapy (50 Gy) was added to the residual tumor. He has been alive with no evidence of disease progression for 31 months since the radiotherapy.

14歳女.右副腎腫瘍の診断の下, 手術目的で入院した.アルドステロンの軽度高値を示す以外は検査成績において基準値内であった.右副腎に44×20mm大の内部均一な充実性の腫瘍を認め, 肝, 右腎を圧排するが明らかな浸潤は認めず, 内分泌非活性右副腎腫瘍の診断の下で腹腔鏡下右副腎摘除術を施行した.摘出標本は3×4cm, 被膜に覆われ割面は乳白色を呈しており, 病理所見より菲薄化した線維性被膜に覆われた病変で, 既存の副腎組織と連続して神経束及び膠原線維の充実性増生が見られ, 分化した神経細胞が散在しており, 右副腎神経節細胞腫と診断した, A 14-year-old girl was referred to our hospital for examination of a right adrenal tumor, incidentally found by abdominal ultrasound sonography. Computed tomographic scan and magnetic resonance imaging showed a 44 x 20 mm solid tumor in the right adrenal region. Endocrinological examination were within normal limits except for slightly increased serum aldosterone. Laparoscopic adrenalectomy was performed and the tumor was histologically diagnosed as ganglioneuroma originated from the right adrenal medulla.

左側胸部の2ヶ所の無痛性皮下腫瘤を訴えた76歳女で, 組織病理学的診断は淡明細胞癌であった.CT及び血管造影により左腎細胞癌と診断し, 左腎摘除を行った.組織診断は腎細胞癌, 胞状型, 明細胞亜型, グレード1であった.術後間もなく肺転移が認められた.腎摘除後数回皮膚転移を切除した, A case of renal cell carcinoma, found after skin metastasis is presented. A 76-year-old woman came to our hospital complaining of two painless subcutaneous tumors in her left chest. Histopathological diagnosis was clear cell carcinoma. She underwent left nephrectomy and histopathological findings revealed renal cell carcinoma, alveolar type, clear cell subtype, grade 1. Lung metastasis was proved soon after the operation. We removed skin metastasis several times after the nephrectomy.

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.

We report here a case of post-biopsy arterio-venous fistula in a renal allograft which was successfully embolized. Percutaneous needle biopsy of renal allograft is performed when the cause of deteriorating renal function is clinically difficult to diagnose, and the pathological diagnosis obtained by it determines the therapy. An easy and safe biopsy encourages the clinician, but some complications occur after the procedure. Arterio-venous fistula is one of the complications after percutaneous needle biopsy of renal allograft. Color-coded ultrasonography is effective to find it, and transarterial embolization should be tried first to treat it.

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.

1)テラゾシンの前立腺肥大症に伴う排尿障害に対する臨床効果および副作用について, 91例, 18施設の多施設臨床試験を実施した.試験は1週間以上の観察期, 6週間の治療期とし, 観察期および治療2週目, 4週目, 6週目に自覚症状, 他覚所見(尿流量率, 排尿量, 残尿量)の変化を評価した.超音波断層法, 尿道造影, CTスキャンなどで前立腺の推定重量を求め, 前立腺の大きさと本剤の効果についても検討した.観察期にはプラセボ錠を投与し, 治療は塩酸テラゾシン1 mg/日を初期投与量とし2週目で自覚症状が改善以上であれば1 mg/日の投与量を維持し, やや改善以下であれば2 mg/日に増量, 4週目で改善以上であれば2 mg/日の投与量を維持し, やや改善以下であれば4 mg/日に増量し, 6週目に最終効果判定をする.1 mg→2 mg→4 mgの漸増法とした.2)自覚症状の累積改善率は, 1 mg/日では18.5%, 2 mg/日までで55.6%, 4 mg/日までで65.4%であった.観察期の自覚症状の強いものの方が症状の改善度が高く, 治療終了時には自覚症状スコアは観察期のスコアにかかわらずほぼ同じレベルに収束した.3)自排尿量, 最大尿流量率, 平均尿流量率, 残尿率, ノモグラムスコアは, いずれも治療後有意に改善した.残尿量, 排尿開始までの時間については有意差はえられなかった.前立腺重量と最大尿流量率, ノモグラムスコアの改善度の間に有意な相関は認めなかった.他覚所見の累積改善率は, 1 mg/日では13.2%, 2 mg/日までで42.1%, 4 mg/日までで50.0%であった.4)全般改善度の累積改善率は, 1 mg/日14.5%, 2 mg/日までで50.0%, 4 mg/日までで61.8%であった.5)副作用は, ふらつき6件, 立ちくらみ2件, 耳鳴り, むかつき, かすみ目各1件の計11件(10例)で, 発現率は11.6%であった.5例は臨床上問題なく服薬を継続し, 1例は減量して服薬を継続した.服薬を中止したのは4例, 4.7%であった.本薬に起因すると思われる臨床検査値異常は認められなかった.拡張期血圧の有意な低下を認めたが, 収縮期血圧, 脈拍に有意な変動を認めなかった, In this study the multicenter, fixed-flexible dose regimen was taken to evaluate the effective dose range of Terazosin for the treatment of micturition disturbance in benign prostatic hypertrophy (BPH) and to clarify the characteristics of patients who are more responsive to Terazosin therapy. After a 1-week washout (placebo) the first two weeks 1 mg/day of Terazosin was administered, then depending on efficacy of subjective symptoms, Terazosin doses were increased up to 2 mg/day and 4 mg/day at intervals of two weeks. After six weeks the final efficacy and safety were assessed. The subjective symptom improvement rate was 18.5% by 1 mg/day, 55.6% by 2 mg/day and 65.4% by 4 mg/day cumulatively. The objective symptom improvement rate were 13.2% by 1 mg/day, 42.1% by 2 mg/day and 50.0% by 4 mg/day cumulatively. The global improvement rate was 14.5% by 1 mg/day, 50.0% by 2 mg/day and 61.8% by 4 mg/day cumulatively. The patients who had a higher subjective symptom score in the lead-in period were more improved rather than those who had a lower score. In objective symptoms, voided volume, maximum flow rate (MFR), MFR nomogram score and average flow rate improved and the ratio of residual urine volume decreased. There was no relationship between clinical improvement on either subjective or objective symptoms and prostatic weight. Adverse reactions, such as dizziness, vertigo, tinnitus, nausea and blurred vision; were seen in 10 cases. In conclusion Terazosin was effective and well tolerated for the treatment of patients who had micturition disturbance with BPH in the dose range of 2 to 4 mg/day.

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.

前立腺肥大症111例, 膀胱頸部硬化症6例, 前立腺肥大症+膀胱頸部硬化症3例, 女性の排尿困難1例の計121例に対して, α1受容体遮断薬であるYM 617を0.1～0.4 mg/日投与した.1)患者の印象および主治医による自覚症状改善度の改善率は投与期間が増すにしたがって高くなり, 16～20週以降はほぼ一定の値に維持された.他覚所見改善度の改善率は4週以降ほぼ一定の値に維持された.2)患者の印象および自覚症状改善度において増量効果が認められた.3)副作用は3例にみられたが, 重篤なものはなかった.血圧・脈拍, 臨床検査値に影響をおよぼさなかった.以上, YM 617は長期間投与しても効果は維持され, 安全性も高いことから, 前立腺肥大症に代表される下部尿路通過障害患者に対し有用性の高い薬剤である, The efficacy and safety of YM617, a new alpha 1-blocker, were evaluated in 121 patients with urinary obstruction of the lower urinary tract in the long-term administration study for 1 year. A total of 121 patients, i.e., 111 with benign prostatic hypertrophy (BPH), 6 with bladder neck sclerosis (BNS), 3 with BPH with BNS and 1 with female urinary obstruction, were orally administered 0.1 to 0.4 mg of YM617 once daily. Patients showing improvement of patient's impression and of subjective symptoms judged by the physician were increased until the 16th to 20th week, and it had been maintained there after. Objective findings were improved to a constant level after the 4th week. Patient's impression and subjective symptoms were improved in a certain dose-response relationship Side effects were observed in 3 patients but none were serious. YM617 proved to be useful in the treatment of patients with urinary obstruction of the lower urinary tract like BPH because it maintained the efficacy and safety in the long-term administration.

A 32-year-old woman in the 36th week of pregnancy was admitted to obstetrics with a complaint of left flank pain. Magnetic resonance imaging demonstrated a left perinephric hematoma before the cesarean section. Spontaneous rupture of renal angiomyolipoma was suspected by computed tomographic scan and renal angiography after the cesarean section. We attempted partial nephrectomy, but performed nephrectomy because of perinephric adhesion. This is the 11th case of spontaneous rupture of renal angiomyolipoma during pregnancy in the Japanese literature.

A case of a parathyroid cyst associated with an adenoma in a different gland is reported. A 55-year-old female was explored with preoperative diagnosis of primary hyperparathyroidism after endoscopic removal of a right ureteral stone. The operation revealed a cyst, 20 x 10 mm in size at the left lower gland, and a solid tumor, 32 x 12 x 7 mm in size and 1, 300 mg in weight in the left upper gland. Histological examination disclosed a parathyroid cyst and an oxyphilic and chief cell adenoma, respectively. Postoperative course was uneventful including normalized serum Ca level. To our knowledge, 59 cases of parathyroid cysts have been reported in the Japanese literature, of which 31 were in the hyperparathyroid status. The most common causes were cystic degeneration of the adenomas. A parathyroid cyst with a concomitant adenoma in a different gland like our case is very rare. This is the first reported case in Japan and the sixth reported case in the world literature.