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49歳男.右腰背部痛と肉眼的血尿を主訴とした.屋根より転落し, しばらく安静にしていたが疼痛が持続, 血尿が出現したため救急搬送された.既に出血性プレショック状態であり血液検査で著明な貧血を認めたため緊急入院となった.KUB, CT, MRIで著明な右腎盂の拡張を認め, その内部はT1強調像で低信号, T2強調像で高信号を示す不均一な像を認め, 凝血腫を含む血液成分の貯留と考えた.また, 右尿管に1cm大の結石陰影を認め, 左腎盂内にサンゴ状結石陰影を認めた.その後, 輸血を必要とする血尿が再出現し, 止血目的のため腎動脈造影を行ったところ, 2ヶ所にstainがみられextravasationが示唆され, 右腎動脈からスポンゼルによる塞栓術を施行した.しかし術中, 腎温存は困難と判断し, 腎摘除術を施行した.術後は患者が回復するのを待ち引き続きサンゴ結石の治療を開始し, PNLを計3回行った.術後経過は良好で, 腎機能は正常化し, 術後28ヵ月の現在, 結石の再発は認めていない, A case of rupture of giant hydronephrosis due to blunt trauma is reported. A 49-year-old male was admitted to our hospital complaining of right flank pain and gross hematuria after falling from a roof. Radiological evaluation lead to the diagnosis of marked right hydronephrosis with severe parenchymal thinning secondary to ureteral stone, left staghorn calculus and the rupture of right kidney. Right nephrectomy was performed and the postoperative course was uneventful. Three weeks later, percutaneous nephrolithotomy (PNL) was performed for left staghorn calculus. Other articles concerning giant hydronephrosis discovered following trauma are reviewed.

59歳男性.主訴は右陰嚢内腫瘤であった.陰嚢部超音波検査によると右精巣上体は腫脹しており, 右精巣と精巣上体の境界部に精巣実質に比べてやや低エコーの領域を認め, その他陰嚢水腫を認めた.生検をかねた手術を施行し, 固有鞘膜を切開したところ精巣上体は精巣以上に腫大し, 癒着が著しく精巣摘出術を行った.術後の病理組織診で横紋筋肉腫と診断した.また, 術後の腹部造影CTで, 傍大動脈領域にリンパ節腫脹を認めた.ステージ分類としてはグループIVに相当するため, IRS-IIIのレジメン35に基づいた多剤併用化学療法を開始し, 3ヵ月には傍大動脈リンパ節腫脹は消失した.この12日後退院となり, 以降化学療法を4週毎に施行中で, 術後2年6ヵ月以上経過した現在, 明らかな転移, 再発を認めていない, We report a case of intrascrotal rhabdomyosarcoma in a 59-year-old-male. The patient with a mass in the right scrotum was at first diagnosed with epididymitis and treated with antibiotics. The mass however, grew gradually and right orchiectomy revealed intrascrotal alveolar rhabdomyosarcoma. Para-aortic lymph node metastasis was pointed out by abdominal computed tomography. He received multidrug chemotherapy consisting of vincristine, actinomycin-D, cyclophosphamide, adriamycin, and cisplatin (IRS-III regimen 35). A complete response was obtained 3 months after the start of the chemotherapy. The patient is alive without recurrence 2 years after the surgery.

72歳男.無症候性肉眼的血尿を自覚したため受診し, 直腸診で鶏卵大, 弾性硬の前立腺を触知し, 表面平滑で圧痛, 硬結は認めず, 表在リンパ節も触知しなかった.腫瘍マーカーのうちPSAのみが高値で, 尿沈渣で極度の血尿と軽度の膿尿を認めた.膀胱鏡で膀胱三角部後方に有茎性, 乳頭状の腫瘍と凝血塊突出を認めた.DIPでは左中下腎杯の圧排と陰影欠損を, ダイナミックCTで左腎中部から下極に腫瘤を認めた.左腎腫瘍, 膀胱腫瘍と診断し, 前立腺癌を疑った.全身麻酔下, 左腎尿管摘出術, 腎門部リンパ節郭清, 経尿道的膀胱腫瘍切除術, 経会陰的前立腺針生検を施行した.病理組織学的所見より泌尿器同時性三重複癌(腎細胞癌・膀胱移行上皮癌・前立腺癌)と診断した, A case of synchronous triple urogenital cancer, which was comprised of renal cell carcinoma of the left kidney, transitional cell carcinoma of the urinary bladder, and adenocarcinoma of the prostate, is reported. A 72-year-old Japanese male patient was referred to our outpatient clinic with the complaint of asymptomatic hematuria. At that time, his serum of level of PSA was elevated to 20 ng/ml. Cystourethroscopy showed a papillary bladder tumor and coagula through the left urinary orifice. Ultrasonography, computed tomography and magnetic resonance imaging showed a mass lesion measuring about 6 cm by 5 cm in the left kidney. Angiography showed a hypervascular lesion measuring about 6 cm by 5 cm at the same site. Double cancer, consisting of renal cell carcinoma and transitional cell carcinoma of the urinary bladder, was suspected and we performed left total nephroureterectomy, hilar lymphadenectomy, and transurethral rection of the bladder tumor, one month later. At the same time, we performed a biopsy of the prostate. Histological diagnosis was renal cell carcinoma, clear cell carcinoma and transitional cell carcinoma of urinary bladder. Histological diagnosis of the prostate biopsy was moderately differentiated adenocarcinoma. Since this case fulfilled the criteria of Warren and Gates, it was classified as synchronous triple urogenital cancer. A review of the literature revealed 17 authentic cases of triple urogenital cancer, of which 14 and 10 cases were reported as a combination of renal cancer, bladder cancer and prostatic cancer, in the world and in Japan, respectively. Furthermore, he had been exposed to the atomic bomb explosion in Hiroshima in 1945. This carcinogenic precursor may be related to the development of the triple cancer.

62歳男性.腹部膨満を自覚したが放置していた.他病で入院した際の腹部造影CTで, 著明な腹水貯留と右腎に径1.5cmの腫瘤を指摘された.腹腔穿刺細胞診では大型異型細胞を多数認め, 明細胞癌が疑われた.腹部の造影CT, MRI, 血管造影の画像所見を合わせて, 右腎細胞癌による癌性腹膜炎と診断した.治療は外来通院で腹腔穿刺による腹水コントロールとインターフェロンα, シメチジン投与を開始した.その後一旦は腹水の貯留は軽減したが, 全身状態が悪化し初診の約2年後に死亡した.病理解剖が行われ, 組織学的に腎原発の乳頭状腎細胞癌G3>G2と診断された.腹膜, さらには胸部から下腹部にかけて広範囲に転移を認めた, A 62-year-old man was referred to our department because of a small mass (1.5 cm in diameter) in the right kidney. His physical examination revealed a remarkably distended abdomen due to ascites. Paracentetic cytology of the ascites was suggestive of clear cell carcinoma. Under the diagnosis of renal cell carcinoma, interferon alpha and gamma were given subcutaneously and intraperitoneally, but his clinical status became worse gradually and he died 2 years after the diagnosis. An autopsy revealed papillary renal cell carcinoma. Ascites due to peritoneal carcinomatosis is a rare presentation, especially for such a small renal cell carcinoma.

Megaureters are common in children but are rarely found in adults, probably due to the scarcity of clinical symptoms. Reconstruction surgery in adults has been performed only exceptionally up to a few years ago. We encountered 7 adults with 7 megaureters in the recent 6 years. The underlying pathologic entities responsible for the megaureters were non-peristaltic lower segment, ectopic ureter and ureterovesical junction stenosis. Six adults with 6 megaureters were treated by complete surgical reconstruction and reimplantation of the ureter. The outcome of all the reported cases was excellent.

A case of Mondor's disease of the penis in a 40-year-old man is reported. The patient complained of a small subcutaneous induration (0.5 x 1.0 cm) with slight tenderness in the dorsal region of the penile shaft. On examination, the linear cord was palpated running both distally and proximally from the induration. This lesion was removed under local anesthesia, and the induration and the cord were found to be part of the superficial dorsal vein of the penis. The venous wall was thick and the thrombus was packed in it. Histological findings showed the proliferation of connective tissue of the vessel wall and partially granulating thrombus in the canal. From these findings, we confirmed the diagnosis of Mondor's disease of the penis. The etiology of this disease, especially in comparison with non-venereal sclerosing lymphangitis of the penis (N.S.L.P.) is discussed.

腎細胞癌19例の血清につき, ヒト腎細胞癌培養株OUR-10に対する抗腫瘍抗体を51Cr release法によるcomplement-dependent cytotoxicity (CDC)とantibody-dependent cell-mediated cytotoxicity (ADCC)の各assayで検討した.19例中8例に抗RCC抗体を認め, OUR-10に対する殺細胞性抗体は補体依存性抗体とし同定した.抗RCC抗体陽性患者では理学的にlow grade例に陽性率が有意に高く臨床的stageとの関係はなかった, The circulating anti-RCC cytotoxic antibodies of eighteen RCC patients, preoperatively, and one inoperable case were studied by 51Cr release CDC and ADCC assays, using the cultured human RCC cell line, OUR-10. Circulating cytotoxic anti-RCC antibodies were detected in eight patients as CDC antibodies. The patients with a low pathological grade had a significantly higher percentage (P less than 0.05) of positive antibody responses.

A case of chronic hematocele with calcification of the tunica vaginalis is reported. A 65-year-old male was referred to our clinic because of painless swelling of left scrotal contents. Examination revealed a heavy hard mass, 18 cm in diameter, in left scrotum, which started to enlarge 5 years earlier. He had a history of having been kicked by a cow about 10 years previously. The scrotum did not transmit light. Ultrasonography demonstrated hematocele with calcified shell. As it was impossible to exclude a testicular tumor completely, we performed high orchiectomy. Upon opening the mass an old hematocele was formed, which contained old brownish black clotted blood and a normal testis. The thick shell of the mass was found to be a calcified tunica vaginalis. Only 2 cases of chronic hematocele have been reported in the Japanese literature.