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Background : Recently, clinical studies of cord blood transplantation (CBT) in adults after myeloablative or nonmyeloablative conditioning regimens showed cord blood (CB) could effectively restore hematopoiesis and was associated with acceptable levels of graft versus host disease (GVHD). / Methods : This study reports the results of cord blood transplantation in 7 adults with hematological malignancies....

対側腎が萎縮した機能的単腎で, 患側不完全重複尿管の上半腎に腎盂癌と腎癌を同時に生じた1例を経験した.症例は70歳男.治療に極めて苦慮したものの, modified MEC療法と半腎切除術により透析に陥ることもなく一応のcancer controlを得た, A case of simultaneous double malignant tumor in the same kidney, associating renal cell carcinoma with renal pelvic transitional cell carcinoma, in a 70 year-old-male was reported. On January 6, 2000 he presented with macroscopic hematuria. There were no remarkable findings on cystoscopic examination. Drip infusion pyelography and multidetector-row computed tomography demonstrated a tumor mass on the upper pole of the left kidney and atrophic right kidney. Systemic chemotherapy with CDDP, MTX and ADR was performed preoperatively. Then, hemi-left nephrectomy underwent with the diagnosis of renal pelvic tumor and renal tumor. The surgical specimen was pathologically diagnosed as transitional cell carcinoma of the renal pelvis and renal cell carcinoma of its upper pole. This is the 32nd case of simultaneous occurrence of renal cell carcinoma and transitional cell carcinoma in the same kidney in the Japanese literature.

67歳女で, 無症候性肉眼的血尿を主訴とした.腎盂造影検査で両側腎盂尿管に辺縁平滑な粟粒大～小豆大の充填欠損像を多数認め, 腹部造影CTで左腎盂内に辺縁整な充填欠損像が認められた.腫瘍も完全に否定できないため両側尿管鏡検査とcold punch biopsyを行い, 悪性所見は認めなかったことから両側嚢胞性腎盂尿管炎と診断された.後療法は施行せず, 術後3年6ヵ月の現在, 増悪の兆候は認めていない, We report here a case of bilateral pyeloureteritis cystica. A 67-year-old woman was admitted to our hospital with asymptomatic macrohematuria in September 1999. Drip infusion pyelography and enhanced computed tomography demonstrated multiple small, round filling defects in both renal pelvises and ureters. Ureteroscopy and cold punch biopsy were performed, and histological examination revealed pyeloureteritis cystica. This patient was not given adjuvant therapy but was carefully followed up for 3 years and 6 months postoperatively.

症例は21歳男で, 右陰嚢部痛を主訴とした.超音波で右精巣中央部に外方に突出する径11mmの辺縁やや不明瞭な低エコーの腫瘤を認めた.Color Doppler Echoでは腫瘤内に血流を認め, CTでは後腹膜リンパ節の腫大は認めなかった.右高位精巣摘除術を施行し, 右精巣中央部の白膜下に10×8×8mmの黄色・充実性の腫瘤を認めた.腫瘤割面は均一で, 出血・壊死は認めなかった.病理組織学的に, HE染色で線維組織を主体とする構築の中に一部索状構造をとる上皮成分があり, 核の腫大や核分裂像はなかった.抗サイトケラチン抗体CAM5.2染色では, 索状構造を呈する上皮細胞は陽性を示し, epithelial membrane antigenは陰性, Vimentinは明らかな陽性所見は得られなかった.術後1年経過し, 再発はない, We report here a case of sclerosing Sertoli cell tumor of the testis. A 21-year-old male, who complained of right testicular pain, visited a Jikei University affiliated hospital on May 30th, 1999. A small nodule with a diameter of 6 to 7 mm was palpable on the central surface of the right testis. No tumor markers for testicular cancer, such as hCG-beta and alfa-fetoprotein, were elevated. However, ultrasound revealed a hypoechoic mass with increased blood flow. Therefore, we performed right high orchiectomy under the diagnosis of right testicular cancer. Pathological diagnosis of this tumor was sclerosing Sertoli cell tumor. Neither recurrence nor metastasis has been found for 12 months postoperatively.

84歳男.腹部超音波検査と腹部単純CT検査にて早期に腎腫瘤の存在を確認していたにも拘わらず, 中等度の腎機能障害を認めたこと, 虚血性心疾患に対する抗凝固剤の内服により強血尿が続いたことの2点により, 造影剤を使用する検査ならびに尿管鏡検査が行えず, 質的診断に至る迄に時間を要した.最終的にはMAG3腎シンチグラフィ検査とMRI検査にて, 腫瘍が腎盂腫瘍ではなく腎癌であるとの結論に至った, An 84-year-old man presented at our hospital with complaints of severe gross hematuria and lower right abdominal pain. A right renal mass was detected by ultrasound sonography and plain computerized tomography (CT) scan, but an exact diagnosis was not obtained. Because the patient presented with moderate renal dysfunction and severe gross hematuria, we were unable to perform imaging studies using contrast material or ureteroscopic instruments. Finally, mercaptoacetylglycyl-glycylglycine (MAG3) scintigraphy and magnetic resonance imaging (MRI) demonstrated renal cell carcinoma, and we performed transarterial embolization (TAE) therapy using ethanol and gel foam. Based on their efficacy and noninvasiveness, we conclude that MAG3 scintigraphy and MRI are the optimal modalities for imaging in patients with renal dysfunction.

症例は44歳の女性で, 健康診断の超音波検査で右腎腫瘤を指摘され精査目的で入院した.腎超音波検査では右腎中部に径3cmの高エコーの充実性腫瘤を認め, カラードップラーエコーで腫瘤内に血流は認めなかった.針生検により高分化な腎細胞癌が疑われ右腎摘出術を行った.組織学的検索において, 特徴的な細胞形態及び配列, Grimelius染色強陽性であること, 更に電子顕微鏡にて神経分泌顆粒を認めたことにより腎カルチノイド腫瘍と診断した, The patient was a 44-year-old woman in whom a mass of the right kidney was found when she underwent abdominal ultrasonography in a physical checkup. The computed tomography of abdomen and the magnetic resonance imaging of abdomen revealed a 3 x 3 cm solid mass at the right kidney. Excretory urograms showed a deformity of the right collecting system due to a mass lesion. The specimen of the resected tumor showed a cellular arrangement specific to carcinoid tumor and positive reaction of Grimelius stain. Electron microscopy confirmed the presence of dense-core granules in the tumor cells. Gastrointestinal investigation after the operation revealed no particular findings suggesting a carcinoid syndrome. No evidence of metastasis or recurrence was noted for 5 months after the operation. This was a very rare case of primary renal carcinoid tumor, representing the 12th case in the literature in Japan.

症例は31歳で, 生下時に臍部の突出が認められ尿様の漿液漏出が観察されたが, 2週間で消失した.22歳時より再度臍から尿の漏出があり, 放置していたところ約6年で消失した.7ヵ月前の健診で膿尿を認め, そのさい施行された腹部超音波検査で尿膜管の遺残が疑われたため, 今回精査目的で自施設を受診した.各種画像所見より右腎臓と右精巣の欠損を伴った尿膜管開存症と診断し, 膀胱頂部と尿膜管の摘出術を行った, A 31-year-old man was referred to our hospital for evaluation of urachal rest. The history of his present illness dated back to birth, when the umbilicus was projected and urinary discharge was noted. At that time, the symptom of discharge had spontaneously subsided. At the age of 22, however, the patient again experienced discharge from the umbilicus. Although he did not seek treatment, after six years this symptom disappeared. Around this time, however, pyuria was revealed during medical examination, and abdominal ultrasonography (US) suggested the presence of urachal rest. At the time of hospitalization, physical examination revealed that the patient's right testis was not palpable. He was diagnosed with patent urachus with hemilateral aplasia and monorchism by US, computed tomography, magnetic resonance imaging and cystoscopy. The patient subsequently underwent radical operation. Patent urachus in adults is very rare, and only a few cases have been reported. To our knowledge, only one previously reported case involved a recurrence after spontaneous healing. Further, this is the first report of a patient with patent urachus with hemilateral aplasia and monorchism. Radical operation is generally recommended, based on the fact that very few cases heal conservatively.

Primary epididymal leiomyoma is relatively rare. We experienced a case of bilateral simultaneous primary epididymal leiomyoma. A 61-year-old man visited our clinic, with the chief complaint of bilateral painless nodules in the scrotum. Each nodule was palpated at the tail of each epididymis (the diameters of these nodules were 12 mm on left and 5 mm on right). We followed the patient for 18 months. Since the nodules were increasing in size, the nodules were surgically removed. Histological examination revealed primary leiomyomas of the epididymis.

A 39-year-old man with schizophrenia and suicide attempt was diagnosed with stage IIb testicular tumor. He was initially admitted to the psychiatry ward and underwent high orchiectomy. After schizophrenia became stable by administration of antipsychopathic drugs, he was transferred to the ordinary urology ward and treated with 3 courses of chemotherapy (bleomycin, etoposide, cisplatin) and retroperitoneal lymph noded dissection. The mental status of the patient remained under good control throughout the course of treatment. He has been free of recurrence for 8 months postoperatively. We discussed general medical issues concerning the treatment of malignant diseases in patients with psychosis.