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Inverted papilloma of the bladder is an uncommon urothelial neoplasm. Although it is traditionally regarded as a benign tumor, there are conflicting data on multiplicity, reccurence rate, and association with urothelial carcinoma. From 2005 to 2011, 14 cases of inverted papilloma of the bladder were diagnosed at our hospital. Clinical features of 14 cases were summarized. These patients ranged in age from 25 to 81 years (mean, 61 years). The most frequently occurring symptom was gross hematuria. Eleven bladder tumors arose from the trigone or near the bladder neck. One case was associated with urothelial carcinoma. One was suspected to be a case of tumor recurrence. All other patients were free of tumor recurrence during the mean follow-up of 16.4 months (range, 0-75 months). This study does not suggest the malignant potential of inverted papilloma. However, since inverted papilloma may correlate with urothelial carcinoma. Post-treatment follow up for inverted papilloma should include cystoscopic follow up.

A 67-year-old man received left radical nephrectomy for left renal cell carcinoma (RCC) (clear cell carcinoma, G2, pT3bN0M0). After 9 months, he presented with an acute onset of left extremity edema. A computed tomographic (CT) scan and magnetic resonance imaging reveal recurrent renal cell carcinoma in the inferior vena cava (IVC) and the left renal fossa, thrombus in the left external vein and acute pulmonary embolism. We performed treatment with sunitinib for 5 months after anticoagulant therapy for 3 weeks. A new CT scan showed disappearance of RCC in the IVC and reduction in the size of RCC in the renal fossa. Only 11 cases are reported as recurrent RCC in the IVC. We report the first case of recurrent intracaval RCC in which sunitinib treatment was effective.

To identify the risk factors for developing subsequent bladder carcinoma in patients undergoing surgical management of urothelial carcinoma (UC) of the upper urinary tract, we retrospectively studied 119 (median age 69, 81 males and 38 females) patients who underwent surgical resection at Yokohama Municipal Citizen's Hospital, Yokosuka Kyousai Hospital and Chigasaki Municipal Hospital from August 1980 to September 2006. After a median follow up of 37.7 months, 42 cases (35.3%) developed recurrent bladder cancer and the intravesical recurrence-free survival rate at 5 years (Kaplan-Meier method) was 57.7%. Bladder cancer was significantly more common in patients who had smaller primary tumors (less than 3 cm: p＝0.0444) by univariate analysis. This factor was also identified as independent predictor for the intravesical recurrence by multivariated analysis (p＝0.0495, Hazard ratio 2.099). In 42 intravesical recurrence cases, invasive recurrence was seen in 9 cases (21.4%). Invasive recurrence appeared to occur in the patients who were older and had longer interval by intravesical recurrence.

A 39-year-old woman, who was followed because of a 4 cm asymptomatic angiomyolipoma (AML) in the left kidney, presented with an acute onset of lower left back pain in the 38th week of her first pregnancy. An ultrasound revealed an 8 cm mass suggestive of AML rupture and retroperitoneal hemorrhage. An emergency caesarean delivery was performed. A post-delivery computed tomographic scan confirmed the AML rupture and selective embolization was performed. This was a case in which the AML grew rapidly during the pregnancy ; therefore, we discuss the relationship between AML and pregnancy.

We report a case of segmental testicular infarction that is a rare and usually idiopathic. The patient is a 36-year-old man who presented with acute right scrotal pain and swelling. Scrotal ultrasound demonstrated a round hypoechoic lesion and magnetic resonance imaging (MRI) findings could not rule out intratesticular hemorrhage or necrotic tissue associated with malignant neoplasm. Therefore right high orchiectomy was performed. The histopathological examination revealed segmental infarction of the testis at the upper and middle pole with coagulation necrosis.

To identify prognostic factors influencing survival in transitional cell carcinoma (TCC) of the upper urinary tract, we retrospectively studied 189 (median age 70, 130 males and 59 females) patients who underwent surgical resection at our 3 hospitals from August 1980 to September 2006. After a median follow up of 47.8 months, 45 cases (23.8%) died of cancer and the 5-year and 10-year disease-specific survival rate (Kaplan-Meier method) was 70.5 and 67.1%. Because lymphatic and vascular involvements, pattern of infiltration and location of tumor had loss of data, only the univariate analysis was done. They were observed to be significantly different by the univariate analysis. The significant prognostic factors for survival using Cox-proportional hazard models were tumor stage, tumor grade, lymph node metastasis, and surgical margin status. Adjuvant chemotherapy was not the prognostic factor in our multivariate analysis., 1980年8月-2006年9月に神奈川県内3施設で治療を行った腎盂尿管癌189例(男130例、女59例、年齢 30-87歳)を対象に生存率と予後規定因子について後向きに検討した。観察期間は平均47.8ヵ月で、癌死は45例、5年生存率は70.5%、10年生存率は67.1%で術前、手術時の膀胱腫瘍の合併症例は48例に認めた。予後規定17因子について予後良好群と予後不良群とに分け単変量解析を行った結果、腫瘍部位(腎盂、上部尿管と中部・下部尿管)、抗癌剤使用の有無、進達度、腫瘍grade、リンパ節転移の有無、切除断端の有無、リンパ管・静脈浸潤の有無、浸潤様式の9因子で生存率に有意差を認めた。抗がん剤使用の有無では抗がん剤を使用しなかった症例が有意に長期生存していた。有意差を認めた9因子のうち全データの揃った症例において抗癌剤の使用の有無、進達度、腫瘍悪性度、リンパ節転移の有無、切除断端の有無の5因子について多変量解析を行った結果、抗癌剤使用の有無を除く4因子に有意な独立予後規定因子を認めた。ハザード比は腫瘍悪性度、切除断端の有無、進達度、リンパ節転移の有無の順に高かった。

30歳女。腹痛・発熱・嘔吐を主訴とした。血液検査で炎症所見を呈し, 腹部CTでは左後腹膜腔に長径8cmの境界明瞭, 辺縁平滑な腫瘤を認め, 内部は樹枝状石灰化を伴っていた。血管造影では大動脈より直接分枝する栄養血管による濃染像を認め, 腹部単純撮影でも樹枝状石灰化を認めた。臨床的症状および炎症所見は保存的加療にて改善し急性胃腸炎が原因と考えられたが, 4ヵ月後に血流豊富な樹枝状石灰化を伴う後腹膜腫瘍を神経原性腫瘍や肉腫などの疑いで手術により一塊として摘除した。腫瘤の大きさは95×70×50mmであり, 組織学的にはリンパ節様構造を示しhyaline vascular型Castleman病と診断した。, A 30-year-old woman was hospitalized in our institute with fever up and abdominal pain. Computerized tomography showed a retroperitoneal mass (8 cm in diameter) with arborizing calcification, which was enhanced homogeneously in the arterial phase. The operation was performed and parthological diagnosis revealed hyaline vascular type Castleman's disease. This characteristic calcification pattern is considered unique to Castleman's disease, and could be useful for future diagnosis.

62歳女性。患者は左背部痛を主訴に近医を受診, 両側腎結石を指摘され, 著者らの施設へ紹介となった。KUB, 腹部超音波, CTにて両側サンゴ状結石を認め, 左腎実質の菲薄化がみられたため, 右腎結石の治療を優先する方針とした。右腎結石に対し体外衝撃波結石破砕術(ESWL)を開始し, 少量の排石を認めたため成分分析した結果, シスチン結石95%であった。更に尿中アミノ酸分析でもシスチンを始めとするアミノ酸が異常高値を示し, シスチン尿症・シスチン結石の確定診断に至った。ESWL開始約2ヵ月後よりクエン酸製剤投与を開始したところ, 尿pHはアルカリ化し, ESWL施行側の多量の残石は完全に溶解した。, A 62-year-old woman was referred to our hospital for bilateral renal stones. Ultrasonography (US) and computed tomography (CT) revealed bilateral staghorn calculi and atrophic left kidney. She had extracorporeal shock-wave lithotripsy (ESWL) for right renal stone during the first 6 months. However, ESWL was not effective and the patient did not want to continue this treatment. Her stone was composed of cystine. We started oral administration of alkaline citrate. Then massive residual stones were completely dissolved during the next 32 months.

症例1は45歳男性で, 左精巣腫瘍, NSGCT(成熟奇形腫, 胎児性癌, 卵黄嚢腫瘍)に対し, 高位精巣摘除術と化学療法PEB3コース, PE2コースを行った結果, 腫瘍の著明な縮小, AFPおよびhCGの陰性化を認めた.しかし, βhCGは低値で変動した.TIP2コースと末梢血幹細胞移植併用大量化学療法1コースを行ったが.βhCGは変化を認めなかった.無治療経過観察とし, 16ヵ月後現在, βhCGは低値変動しているが, 再発は認めない.症例2は19歳男性で, 左精巣腫瘍, NSGCT(胎児性癌, セミノーマ)に対し, 高位精巣摘除術と化学療法PEB3コースを行ったが, βhCGは低値で変動した.3ヵ月後に, 後腹膜リンパ節郭清術を行い, 残腫瘍は壊死組織であった.無治療経過観察とし, 160ヵ月後現在, βhCGは低値変動しているが, 再発は認めない, Some patients with testicular cancer exhibit low human chorionic gonadotropin (hCG) levels even after successful treatment. We report 2 patients with testicular cancer (2 non-seminomatous germ cell tumors [NSGCTs]) and low betahhCG levels with no recurrence after successful treatment. The first patient is a 45-year-old man with pulmonary and retroperitoneal lymph node metastases. During the first chemotherapy the hCG level decreased but remained at a low level. Salvage chemotherapy had no effect on the hCG level, but a low betahCG level persisted for 16 months. The second case is a 19-year-old man with testicular cancer with retroperitoneal lymph node metastases. The patient underwent an operation for residual masses after chemotherapy. Pathological findings showed necrotic tissue, and a low betahCG level persist for 160 months. A low hCG level does not necessarily meen residual malignancy. Patients with a low hCG level should be monaged carefully avoiding needless treatment.

1993～2004年に経験した進行性胚細胞腫瘍患者で, 化学療法により腫瘍マーカーは正常化したが画像上残存腫瘍を認める25例の予後について検討した.症例の内訳は精巣原発20例(SGCT 6例, NSGCT 14例), 精巣外原発5例(すべてNSGCT)であった.残存腫瘍の取扱い方針として, SGCT例は残存腫瘍径にかかわらず経過観察とした.NSGCT例は残存腫瘍径が2cm以下の場合は経過観察, 5cm以上は切除, 2～5cmは奇形腫の有無や縮小率などから症例ごとに判断した.2年非再発率は精巣原発SGCT群で90%, 精巣原発NSGCT群100%, 精巣外原発群40%, 疾患特異生存率は精巣原発SGCT群90%, 精巣原発NSGCT群100%, 精巣外原発群75%であった, Twenty-five patients with germ cell tumors who had marker-free residual masses after undergoing chemotherapy were followed for up to 10 years (median, 21 months). The primary tumor sites were the gonads in 20 patients (6 seminomas [SGCTs] and 14 non-seminomatous germ cell tumors [NSGCTs]) and extra-gonadal regions in 5 patients (5 NSGCTs). All residual masses were observed in patients with SGCT. Residual masses that were 2 cm or less in size were left unresected, while masses that were 5 cm or more in size were resected in patients with NSGCT lesions. The management of other residual masses was decided based on the size, shrinkage, and pathological findings of the tumors. Residual masses were resected in six of the patients with gonadal NSGCTs. Recurrence occurred in one of the six patients with gonadal SGCTs (chemotherapy shrinkage; 11 cm to 3.5 cm) and three of the four cases with extra-gonadal NSGCTs (embryonal cell carcinoma: 3 cm to 1 cm, embryonal cell carcinoma+york sac tumor: 5 cm to 4 cm, embryonal cell carcinoma+chorio carcinoma; 4 cm to 1.2 cm). None of the patients with gonadal NSGCTs experienced a recurrence. Considering the pathologic diagnosis, shrinkage, and international germ cell consensus classification, unnecessary resections of residual masses that were less than 5 cm in size after chemotherapy for gonadal NSGCT should be avoided. However, residual masses in extra-gonadal NSGCTs should be resected.

ホルモン抵抗性前立腺癌に対するDocetaxel(DCT), Cisplatin(CDDP)併用療法について検討した.対象は, プロトコール通りにDCT, CDDP併用療法を2クール行った13例(平均年齢66歳)で, 全例MAB療法に抵抗性であり, 更にエストラムスチン(EMP)に抵抗性なのは9例(69%), DESに抵抗性なのは9例(69%), EMP, DESいずれかに抵抗性であったのは12例(92%)であった.全例でPSAの低下を認め, 成績はCR3例, PR7例, NC3例であった.PSA値50%以上の低下は10例(77%), PSA値再上昇までの期間は中央値3ヵ月であった.骨以外の評価可能病変は2例にリンパ節転移を認めたが, 2例ともPSA値は50%以上低下し, リンパ節転移の縮小効果は1例がPR, 1例はNCであった.疼痛に関しては鎮痛薬使用の5例中4例で鎮痛薬の中止が可能であり, 副作用は2例でgrade 3のヘモグロビンの低下を認めたのみであった.以上, DCT, CDDP併用療法は安全で有用な治療法であると考えられた, We investigated the efficacy of docetaxel and cisplatin for hormone-refractory prostate cancer (HRPC). Thirteen patients with HRPC were treated with 30 mg/m2 docetaxel weekly for 3 weeks and 70 mg/m2 cisplatin on day 1. Treatment was repeated every 21 days. They received 2 cycles and were evaluated for the responses to serum prostate-specific antigen (PSA) and tumor size. Ten (77%) of the 13 patients showed a 50% or greater decrease in PSA with a median time to progression of 3 months. One of the 2 patients with measurable soft tissue disease showed a reduction in disease. No severe toxicity of this regimen was observed. Combination chemotherapy with docetaxel and cisplatin in patients with HRPC was well tolerated and efficatious with a significant decrease in serum PSA and measurable disease.

75歳男.主訴は肉眼的血尿と頻尿であった.膀胱鏡検査で膀胱内腔に凝血塊と壊死組織が付着する有茎性腫瘍を認めたため, TUR-Btを施行した.病理診断はTCC with choriocarcinoma matous differentiation, G3, ≧pT2であり, TCCの部分とこれらの腫瘍細胞から移行するような大型で核異型の著明な細胞がシート状に増殖していた.そこでHGC-β染色を行ったところ, 大型異型核を有する腫瘍細胞を主体に細胞質が強く陽性を示した.以上から, 浸潤性膀胱絨毛癌と診断し, 膀胱全摘+回腸導管造設術を施行した.摘出標本の病理組織学的診断の結果, TCC, G3, pTisの上皮内癌を認めた.術後3ヵ月半にHCG-βの上昇を認め, 左肺舌区に腫瘍陰影を認め膀胱癌の肺転移と診断し, シスプラチン, エトポシドによる化学療法を施行した.その後, HCG-βは一時低下したが, 左肺の腫瘍が増大し, 膀胱全摘術後8ヵ月で死亡した.剖検で膀胱絨毛癌の転移は両肺, 肝, 両腎, 胃, 膵, 甲状腺, 両副腎, 心, 空腸, 椎体とリンパ節では両肺門, 縦隔, 右顎下腺近傍に認めた, A 75-year-old man visited our hospital presenting with gross hematuria. Cystoscopy revealed a bladder tumor with coagulated blood and necrotic tissue at the dome. We resected the bladder tumor transurethrally. Pathologically, the tumor was shown to be a transitional cell carcinoma with choriocarcinomatous differentiation, G3, > or = pT2. Immunohistochemical staining showed human chorionic gonadotropin (HCG)-positive tumor cells. Just after surgery, the serum HCG-beta concentration was less than 0.1 ng/ml. Total cystectomy and an ileal conduit operation were performed. The histological classification was TCC, G3, pTis. In later blood chemistry tests, HCG-beta elevation was observed. Pulmonary metastases appeared on a chest X-ray, and combination chemotherapy with cisplatin and etoposide was administered. Although the serum HCG-beta decreased with one course of chemotherapy, it increased immediately thereafter. The patient died of the disease about 8 months after the total cystectomy. Autopsy revealed multiple metastases in the lungs, liver, kidneys, stomach, pancreas, thyroid gland, adrenal glands, heart, jejunum, and vertebral body (Th10). Lymph node metastases in the pulmonary hilum, mediastinum, and right submaxillary gland were also found.

進行性精巣腫瘍5例(平均24歳)に対し, 自家末梢血幹細胞移植を併用した超大量CEI療法を行った.化学療法のみによる治療効果は全例画像上NCで, 2例は比較的大きな後腹膜リンパ節転移や肺転移が残存し, 外科的切除を行った.外科的治療を含めた成績は, cCRが1例, pCRが2例, cPRが1例, NCが1例であった.3例は最長38ヵ月の非再発を確認しており, 他の1例では13ヵ月後及び24ヵ月後に肺に再発を認めたが, 外科切除及び救済化学療法を施行し42ヵ月生存中である.その他の1例は, 開頭腫瘍切除や全脳照射も含めた包括的治療で脳転移はコントロール良好であったが, その後肺転移の急速な増大で5ヵ月後に死亡した.副作用は, 白血球1000以下の期間が4～9日間あったが, その後回復した.全例に血小板輸血を必要とし, 3例に濃厚赤血球輸血を行った.他に全例悪心, 嘔吐, 食欲不振, 下痢を認め, 1例で胸水貯留を伴う肺炎を併発したが, 致命的な副作用はなかった, Between June 1998 and August 2000, five patients with germ cell tumor were treated with high-dose CEI: carboplatin (1, 250 mg/m2), etoposide (1, 500 mg/m2), and ifosfamide (7.5 g/m2), followed by peripheral blood stem cell transplantation (PBSCT) at Yokohama City University Hospital. All patients were classified into either poor risk group of International Germ Cell Consensus Classification or advanced extent of Indiana University stage, and received one cycle of high-dose CEI after 4-6 cycles of standard PEB (cisplatin, bleomycin, vinblastin) therapy. Three of the patients achieved complete response, one achieved partial response and one achieved no change after whole treatment. There were no fatal complications and no treatment-related deaths.

自施設で経験した腎細胞癌120症例のうち観察期間(中央値3年7ヵ月)中に癌死したのは40例で, 全症例の非癌死率は5年で64.8%, 10年で56.5%であった.癌死は5年以内が36例, 5年以上が4例であった.予後因子として性, performance status(PS), 喫煙, 症状の有無, pT, pV, grade, 組織学的細胞型, 画像所見上の腫瘍最大径, 肺転移, 骨転移, リンパ節転移を検討したところ, PS0とそれ以外, 症状の有無, 腫瘍最大径5.5cm以上と未満, pT1, 2と3a以上, pV0とそれ以外, grade 2と3, 肺・骨・リンパ節転移の有無において, 各々癌死率の有意差を認めた.多変量解析で独立予後因子として認めたのはPS, pT, pV, 肺・骨・リンパ節転移であった.これらの因子のみを用いてhazard ratioを計算した結果, 骨転移, リンパ節転移, 肺転移, pV, pT, PSの順で予後への影響が大きかった, Between January 1986 and August 1996, 120 patients were diagnosed with renal cell carcinoma (RCC) at Kanagawa Cancer Center. In this study, we analyzed these patients in view of the clinicopathological factors, which affect the prognosis of these patients with univariate and multivariate analysis using Cox's proportional hazard model. Of these 120 patients, 40 patients (33%) died of RCC during this period. The cause specific survival rate was 65% after 5 years and 57% after 10 years. Univariate analysis showed some factors, performance status, symptoms, tumor size, histological grade, local invasion (pT), venous involvement (pV), lung metastasis, lymph-node metastasis, and bone metastasis, affected the prognosis. Furthermore, multivariate analysis using Cox's proportional hazard model showed that performance status, pT, pV, lung metastasis, lymphnode metastasis, and bone metastasis independently affected the prognosis. In summary, TMN factors and performance status importantly affect the prognosis of RCC patients.

We report a case of retroperitoneal dedifferentiated liposarcoma treated effectively with high-dose ifosfamide. A 59-year-old man received tumorectomy and right nephrectomy for the retroperitoneal liposarcoma. Twenty-two months after the operation, the liver metastasis was resected incompletely. Three months later, right pleural, retroperitoneal and peritoneal metastases appeared. With 6 cycles of high-dose ifosfamide therapy these tumors were reduced partially. Ten cycles of this chemotherapy were administered. These tumors showed regrowth at 14 months after administration of high dose ifosfamide. The combination chemotherapy of ifosfamide and doxorubicine or etoposide was not effective after regrowth of the tumors.

1)安全性評価症例141例中, 12週以上投与された症例は101例, 半年(24週)以上の症例は81例, 1年(48週)投与された症例は57例であった.投与が中止された症例は84例であり, おもな理由は来院せず40例, 副作用14例, 症状改善11例などであった. 2)副作用は22例26件に認められ, おもな内訳は消化器系(口渇6件, 便秘4件, 嘔吐・嘔気2件, 下痢2件, 胃痛1件)が9.9%, 泌尿器系(排尿困難4件, 残尿1件)が3.5%であり, 副作用発現頻度は15.6%であった. 3)最終全般改善度は著明改善15例, 改善26例で, 改善率は82.0%(41/50例)であった. 4)1年以上投与例の自覚症状の推移は, 昼間排尿回数は投与前10.3±4.0回が投与1年後は7.1±2.9回に, 夜間排尿回数は投与前4.2±1.7回が投与1年後は2.1±1.1回に, 尿失禁回数については投与前2.9±2.1回が投与1年後は0.7±1.0回に有意に改善した.同様に症状改善度の推移も高い結果が得られた, The safety and efficacy of one-year administration of propiverine hydrochloride (BUP-4 tablets) were assessed in facilities affiliated with the Department of Urology of Yokohama City University School of Medicine. Changes in subjective symptoms showed significant improvement in mean frequency of urination in the daytime from 10.3 +/- 4.0 times before administration to 7.1 +/- 2.9 times 1 year after the start of administration, in mean frequency of voiding at night from 4.2 +/- 1.7 times to 2.1 +/- 1.1 times and in mean incidence of urinary incontinence from 2.9 +/- 2.1 times to 0.7 +/- 1.0 times. The final degree of overall improvement rate was 82.0% (41/50 cases). Adverse effects were observed 26 times in 22 patients, the incidence being 15.6% (22/141 cases). They consisted of digestive symptoms in 9.9% (6 events of dry mouth, 4 of constipation, 2 of abdominal discomfort, 2 of diarrhea and 1 of gastritis), urinary tract symptoms in 3.5% (4 of dysuria and 1 of residual urine), abnormal laboratory findings in 1.4% (increase in glutamic-oxaloacetic transaminase, glutamic-pyruvic transaminase or lactate dehydrogenase levels) and others (1.4%). These results provide further evidence of the safety and efficacy of propiverine hydrochloride (BUP-4 tablets) even when administered for a long-term in the treatment of patients with pollakiuria and urinary incontinence.

前立腺癌288例において臨床病期分類, EOD分類と予後について検討した. 1)病期D2においてEOD1はEOD2, 3, 4に比べ有意に予後良好であり, EOD4はEOD1, 2, 3に比べ有意に予後不良であった. 2)病期D2, EOD1の予後はstage C, D1の予後とほぼ同等であった. 3)病期D2症例の治療開始3年後よりの予後には組織学的分化度の重要性が増すことが推測された, We analyzed the prognostic significance of clinical stage using extent of disease (EOD) grading system in 288 patients with prostate cancer between 1970 and 1994. The cause-specific survival rate for EOD4 was significantly lower (p < 0.01) than that for the other EOD categories. On the other hand, the cause-specific survival rate for EOD1 was significantly higher (p < 0.01) than that of the other EOD categories, and moreover, it was similar to the cause-specific survival rates for stage C and D1. The cause-specific survival rate of EOD1 and poorly differentiated cases was higher than that of EOD2 or 3 and well or moderately differentiated cases until 2 years after treatment, but after 3 years, the cause-specific survival rate for EOD1 and poorly differentiated cases was lower than that for EOD2 or 3 and well or moderately differentiated cases. These findings suggest that the volume of cancer is associated with the prognosis of prostate cancer that failed in radical treatment and that in stage D2, histological grade is more closely associated with the prognosis after treatment for 3 years.

前立腺癌60症例について, 生検組織と前立腺全摘標本組織及びリンパ節転移組織を検討した.生検組織と全摘標本組織では6組織型要素の内微小腺管型を除く5組織型要素でそれぞれ有意の相関が認められた.アンドロゲン依存性のある要素小単純腺管型, MIC, 篩状腺管型のみからなる症状と非依存性要素融合腺管型, 充実髄様増殖型, 索状増殖型を含む症例に分けてみると, 78.3%の症例が生検組織と全摘標本組織で一致していた, The histological characteristics were comparatively analyzed among biopsy specimens, surgically removed prostates and metastatic lymph nodes obtained from 60 patients with prostatic adenocarcinoma treated by radical prostatectomy. According to the WHO-Mostifi's classification, the proportion of the 6 histologic components, large and/or small simple glands (LSG), micro-glands (MIC), cribriorm (CRB), fused glands (FUS), medullary/solid (MED) and columns-cords/trabecular (C-C), was determined semiquantitatively. LSG, MIC, and CRB are androgen-sensitive components, while FUS, MED and C-C are androgen-refractory components. The proportions of 5 histologic components excluding MIC were similar in the biopsy and prostate specimens. In 78.3% of the patients, the presence (or absence) of androgen-refactory components in the biopsy specimens coincided with that in the prostate specimens. However, the histologic except for the C-C component. Metastatic lymph nodes contained androgen-refactory components in all cases and tended to have more CRB and FUS and fewer LSG. The histology of the needle biopsy specimens may reflect that of the prostate glands, and may serve as a valuable parameter for determining therapeutic modalities. In addition, androgen-refactory components are frequently present in lymph node metastasis.

58歳男.主訴は体重増加, 浮腫.右後腹膜腫瘍, 両側胸水が認められ, 左胸腔穿刺施行し, 排液が持続した.CT・細胞診では胸腔内に悪性腫瘍を認めず, 胸水の原因疾患は特定できず, 精査加療目的に当院転院となった.腹部CTで右Gerota's fascia内に11×9×9.5cm大の腫瘍を認め, 内部は不均一で, 一部に脂肪成分と思われる低吸収域を認めた.腹部MRIではT1強調像で等信号・T2強調像で高信号の充実成分の分葉状腫瘤として描出された.右後腹膜悪性腫瘍を疑い, エコー下に右後腹膜腫瘍針生検を施行した.Liposarcomaまたはmyxomatous malignant fibrous histiocytomaとの病理学的診断が得られ, 右後腹膜腫瘍, 右腎合併摘除術を施行した.病理学的所見より高分化型脂肪肉腫と診断した.術後, 胸水は減少傾向にあり, 浮腫も消失し, 術後16日目軽快退院した, A case of retroperitoneal liposarcoma with reactive pleural effusion is reported. A 58-year-old male who complained of weight gain and edema had visited another clinic in May, 2002. Computed tomography revealed a retroperitoneal tumor, 11 x 9 x 9.5 cm in size, surrounding his right kidney and bilateral pleural effusion. Complete resection of the tumor and right kidney was performed with a transperitoneal approach. Though the tumor was limited within Gerota's fascia, we noted two liters of abdominal ascites. Surgical specimen was histologically diagnosed as well differentiated liposarcoma. The post operative course was uneventful. The pleural effusion disappeared, and serum total protein level was normalized. He has remained free of disease for one year.

A 72-year-old female patient presented to our clinic with the chief complaint of gross hematuria and urinary frequency on September 6, 1990. Cystoscopic examination revealed a thumb's head size nonpapillary tumor. The tumor was located adjacent to the orifice of the left ureter. Histological findings of the tumor by transurethral resection (TUR) indicated transitional cell carcinoma with partial signet ring cell carcinoma. No other malignant findings in any other organs including the gastrointestinal tract were noted. Total cystectomy was performed and Indiana pouch was constructed. Histopathological staging was pT1 N0 M0. The patient died of multiple metastasis of the signet ring cell carcinoma on June 22, 1992. This is the thirty-second case of signet ring cell carcinoma of urinary bladder reported in the medical literature in Japan. We investigated 19 alive or unknown cases as follow up and briefly discussed the treatment and outcome of the primary signet ring cell carcinoma of the urinary bladder. The outcome appeared to be somewhat better than previous reports. Total cystectomies were performed in 18 of the 32 cases (56.3%). As noted in past reports, the treatment of our patient consisted of total cystectomy. Twenty-two patients died of signet ring cell carcinoma. Recurrence to the pelvic area was observed in 18 of the 22 (81.8%) patients who died. Because of this high rate of recurrence, we recommend a thorough assessment of the pelvic area of the patients diagnosed with signet ring cell carcinoma of urinary bladder.

A 71-year-old female presented with left back pain at our hospital. She had had the same symptom about 1 year previously, but she had been presumed to have undergone stone passage because her symptom had disappeared. At this time a urogram, either excretory or retrograde, showed narrowing of each caliceal infundibulum and dilatation of each calyx in the left kidney, but otherwise normal findings. A cytology of left ureteral urine was class V, and cystoscopy revealed no abnormality. Under the diagnosis of left renal pelvic tumor she underwent nephroureterectomy with resection of a bladder cuff and retroperitoneal lymphadenectomy. The resected specimen had no gross tumor throughout the renal pelvis and ureter, but histological examination revealed transitional cell carcinoma in situ (grade 2) in most of the renal pelvis and infiltration of inflammatory cells in the submucosa. The ureter did not have any cancerous lesion, and no lymph node metastases was found. Four months postoperatively she is thought to have no evidence of disease with negative urinary cytology.

1)腎盂尿管腫瘍38例についてリンパ節転移を中心に検討した。2)リンパ節転移は9例, リンパ節転移のrisk factorはhigh grade, high stage, 尿細胞診class 4・5の症例であり, 尿細胞診のみ有意差を認めた。3)膀胱腫瘍の先行, 併発例は7例で, そのうち6例がG3であるのに対し続発例は7例でそのうち5例はG2であった。4)5年生存率はリンパ節転移陰性例76.7%, 陽性例11.1%で両者に有意差を認めた。5)腎盂尿管腫瘍におけるリンパ節転移の治療的意義については評価できなかった, A clinical study was performed on 38 patients with renal pelvic and ureteral cancers who were treated in our hospital between 1977 and 1992. Nine patients (23.7%) had lymph node metastasis. The risk factors of lymph node metastasis were high grade, high stage and class IV or V or urine cytology. None of the patients with G1 or under pT1 had lymph node metastasis. The 5-year survival rate of the patients without [lymph node metastasis was 76.7% and that of the patients with lymph node metastasis was 11.1%. Although 6 of the 9 patients with G1 or G2 and under pT1 did not have adjuvant therapy, none of them died of the cancer. We concluded that lymph node metastasis in renal pelvic and ureteral cancers was the most important prognostic factor and that regional lymphadenectomy might be useful for the decision of adjuvant therapy.

精巣摘除した13例のうち, 明らかな原因として患者の受診が遅れたことと初診医が適切な診断, 処置ができなかったことがそれぞれ約4割を占めた, We performed surgical treatment in 22 cases of torsion of the spermatic cord during the past sixteen years. Orchiopexy was performed in 9 cases, but in 13 cases orchiectomy was unavoidable. For five patients the visit to a doctor was too late. In five other cases a mistaken diagnosis was made by local medical doctors. Improvement of the success rate of orchiopexy requires that adolescents, their families and teachers should learn to recognize this disease, and doctors of other departments should recognize it as acute scrotum.