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前立腺Endometrioid adenocarcinomaの3例を経験した.症例1(71歳男性).排尿困難で受診.肉眼的血尿, PSA上昇, 膀胱尿道鏡で前立腺右葉より尿道へ突出する乳頭上腫瘍を認め, 生検で類内膜腺癌と診断, TAB療法でPSAは低下し, 前立腺全摘除術を行った.しかし約1年3ヵ月後, 排尿困難から膀胱鏡で乳頭状腫瘍を認めて切除, 類内膜腺癌であった.症例2(71歳男性).肉眼的血尿, 膀胱タンポナーデで入院となった.PSA高値, CT・MRIで前立腺左葉より膀胱内に突出し, 精嚢へ浸潤する腫瘍を認め, 生検で前立腺類内膜腺癌と診断, 膀胱前立腺摘除術を施行した.3ヵ月後PSA高値より, CTで多発性肝転移を認め, TAB療法でPSAは低下した.症例3(86歳男性).高血圧, 高脂血症で他院通院中, PSA高値で紹介入院となった.MRIで前立腺両葉に内腺への浸潤を疑うlow intensity areaを認め, 生検で類内膜腺癌と診断, TAB療法でPSAは低下した, We report three cases of endometrioid adenocarcinoma of the prostate. Case 1: A 71-year-old male was admitted with a complaint of micturition pain. Serum prostatic specific antigen (PSA) was 12 ng/ml. Radical prostatectomy following needle biopsy was performed in May 1998. Histopathological diagnosis was prostatic endometrioid adenocarcinoma (pT2bpN0M0). Case 2: A 71-year-old male was admitted with a complaint of macrohematuria. PSA was 18 ng/ml. Cystoprostatectomy and ileal conduit construction following needle biopsy were performed in July 2002. The tumor that was diagnosed as endometrioid adenocarcinoma, invaded the bladder neck (pT4pN0M0). Case 3: An 86-year-old male was referred to our department for elevated PSA (16.8 ng/ml). Prostatic needle biopsy was performed and histopathological diagnosis was endometrioid adenocarcinoma with a part of well differentiated adenocarcinoma (T2bN0M0). PSA dropped to an undetectable range after total androgen blockade therapy.

34歳男.検診で肺野の異常陰影を指摘された.精査で右腎腫瘍を認め, 右腎摘除術を施行した.腫瘍と大血管との剥離操作のさい高血圧発作が出現し, 褐色細胞腫を疑った.摘出標本の病理組織学的検査において, 大型で胞体がやや淡明な核の多形性を示す腫瘍細胞が認められたため褐色細胞腫と考えられた, A 34-year-old man was referred to our hospital for small lung nodules. An imaging study including a computed tomographic scan and magnetic resonance imaging showed bilateral lung tumors and huge mass arising from the lower pole of the right kidney as well. The patient underwent right radical nephrectomy in May 2002. Pathological examination revealed that the tumor was pheochromocytoma, which developed from extra-adrenal tissue. In 6 cycles of CVD systemic chemotherapy (Cyclophosphamide 750 mg/m2, Vincristine 1.4 mg/m2, Dacarbazine 600 mg/m2), the lung tumors were decreasing in size, and were removed by a surgical procedure in January 2003. Pathological examination revealed that the lung tumors were pheochromocytomas metastasized from the primary tumor. He is alive without evidence of disease 5 months after the lung operation.

65歳男性.尿閉状態で受診し内服治療を行うも排尿不可で尿道カテーテルを留置したが, 食欲不振で約1ヵ月間に10kgも体重が減少したため入院となった.膀胱鏡, 尿道・膀胱造影では異常は認めず, 膀胱内圧測定では尿意はあるが無収縮性膀胱を呈し, 胸腰椎MRIでも異常は認めなかった.また, 胸部X線やCTでは肺門部腫瘤陰影と縦隔リンパ節腫大が認められた.これらの所見より, 経尿道的前立腺切除術を施行し残尿率83%で導尿を継続したが, 術後まもなく便失禁, 上肢脱力感などの神経症状が出現し, 神経学的検査所見, 胸部画像所見から肺小細胞癌によるLambert-Eaton筋無力症候群を疑い, 左鎖骨上リンパ節および右肺門部腫瘤の生検を施行し, 肺小細胞癌と診断された.治療として全身化学療法を施行し, さらにその後, 放射線療法を行うことで排尿可能となり, 体重も増加し, 神経症状も改善した, A 65-year-old male was admitted with the chief complaint of voiding difficulty on 28 October, 2001. He was in the state of urinary retention. Urological investigation including cystosocopy, urethrocystography, and urodynamic study revealed an areflex-type bladder, according to the new International Continence Society (ICS) classification with no prostatic urethral obstruction. He was diagnosed with neurogenic bladder although the cause of detrusor areflex was unknown. Because all medication was ineffective, transurethral resection of prostate was performed on 11 January, 2002, but urinary retention could not be relieved. After operation, he complained of muscle weakness of upper extremities and poor control of bowels. He was diagnosed with Lambert-Eaton myasthenic syndrome associated with small cell lung carcinoma. His myasthenic symptoms, including autonomic symptoms were relieved after chemotherapy and radiation for small cell lung carcinoma.

42歳男.左腎摘出術後, 対側の腎および腎盂へ再発をきたした腎細胞癌の症例について報告した.腹部CTにて左腎下極に腫瘤性病変を認め, 左根治的腎摘出術を施行した.その後, 肉眼的血尿を主訴とし, 画像診断にて右腎盂腫瘍と診断され入院となった.軽度の肝機能異常を認め, 尿細胞診はクラスIIであった.胸腹部骨盤CTにて腫瘤性病変を右腎盂内に認め, 腎細胞癌の腎盂への転移あるいは腎動静脈瘻なんどの血管性病変が疑われた.右腎盂腫瘍の診断にて, 右腎盂摘出術を施行した.腎盂腫瘍は腎実質とは連続性がなく, 粘膜より発生したものと考えられた.免疫療法を施行し, 術後6ヵ月間再発の兆候もない, Extremely rarely renal cell carcinoma metastasizes to the contralateral renal pelvis or ureter. A 42-year-old man had undergone left radical nephrectomy for renal cell carcinoma (pT1b, grade 2) in March, 2000. Fifteen months later, he complained of macroscopic hematuria. Computed tomographic scanning and retrograde pyelography showed a right renal pelvic tumor. Enucleation of pelvic tumor was performed and a parenchyma mass incidentally identified in the right kidney was also resected. Histopathological examination of each tumor revealed renal cell carcinoma identical to the primary tumors in the left kidney suggesting metastasis to renal pelvis and de novo tumor or metastasis in the right kidney.

24歳男と74歳女の後腹膜線維症の2例について報告した.症例1は24歳男で, 肉眼的血尿, 左腰背部痛を主訴とし, 左下腹部に可動性のない腫瘤を触知した.腹部骨盤CTにて左腎静脈を上縁として後腹膜腔に辺縁不整な腫瘤性病変を認めた.経皮的腫瘍針生検術を施行した結果, 繊維化を認めるのみで悪性所見は認めなかった.プレドニゾロン投与により, 徐々に疼痛は軽減した.10ヵ月を経過した現在, プレドニゾロン5mgの維持療法を施行中である.症例2は74歳女で, 右下腹部痛を主訴とし, 両側水腎症による腎後性腎不全と診断した.後腹膜鏡下生検術を施行した結果, 線維性結合織を豊富に認め, 形質細胞, リンパ球浸潤からなる慢性炎症が認められたが, 悪性所見は認められなかった.プレドニゾロン5mgの維持療法を施行中であり, 腎機能も正常であった, In case 1, a 24-year-old man was admitted with left lumbago. Abdominal computed tomographic (CT) scan showed the huge mass (8 x 10 x 13 cm in diameter) in the left retroperitoneal space, which lack enhancement and had a irregular margin. Percutaneous needle biopsy guided by ultrasonography was performed. In case 2, a 74-year-old woman was admitted with right lower abdominal pain. Laboratory data showed the renal failure. Imaging study revealed bilateral hydronephroses and bilateral masses at both common iliac vessels. A retroperitoneoscopic biopsy was performed. We diagnosed both cases as retroperitoneal fibrosis and administered prednisolone for 10 months. The masses decreased in size and the symptoms disappeared in both cases.

72歳女.女性尿道に発生した悪性黒色腫の症例について報告した.血性帯下を主訴とし, 外尿道口右側に径2cmの黒色腫瘤を認めた.腹部CTにて明らかなリンパ節腫脹や転移を認めず, Gaシンチにても異常集積を認めなかった.尿道原発悪性黒色腫と診断し, 外陰, 腟前壁を一部含めた腫瘍摘出, 尿道全摘出, 両側鼠径部リンパ節生検, 腟膀胱瘻造設術を施行した.術中の迅速病理診断にて, 鼠径部リンパ節転移は認めなかった.腫瘍細胞は胞体が豊富なメラニン顆粒が豊富で, 高度な核異型が見られた.病巣の深達度は表層から5mmであり, 外尿道口周囲の尿道腺への浸潤み見られた.術後9ヵ月目に局所再発し, 右鼠径部リンパ節の腫脹, 恥骨前面の腫瘤を認め, 現在DAV-feronを療法中である, A 72-year-old female with a complaint of hemorrhagic leucorrhea was referred to our department. She had a black tumor on her urethral meatus suspected as a malignant melanoma. Urethrectomy, vulvectomy, partial vaginectomy, bilateral inguinal lymphadenectomy, and cystostomy were performed. Pathological diagnosis was malignant melanoma of the urethra. Local recurrence and lymph node metastasis were found 9 months later, and she has been given DAV-feron combined therapy.

74歳男.血尿を主訴に受診し, 膀胱鏡で腫瘤を認めた.腹部骨盤CTで膀胱前壁に径5cm大の, 膀胱左側壁に径1cm大の内腔へ突出する腫瘤を認めた.所見より, 浸潤性膀胱癌T3bN0M0と診断し, 病理組織所見のため, TURBTを施行した.移行上皮癌を併発した, 膀胱平滑筋肉腫で, 術後6ヵ月後に死亡した.剖検で多発性肺転移, 骨盤内を占拠する局所再発を認めた, A 74-year-old man was admitted for asymptomatic macroscopic hematuria. He had undergone transurethral resection of bladder tumor (TURBT) due to transitional cell carcinoma 30 years ago. Pelvic CT showed two invasive bladder tumors. A 5 cm tumor was on the dome and a 1 cm tumor was on the left lateral wall. TURBT was performed. Pathological examination revealed that they were leiomyosarcoma and transitional cell carcinoma. Radical cystectomy plus bilateral cutaneousureterostomy was performed. He died of lung metastases and local recurrence after 6 months.

症例1は56歳男.左下腹部痛を主訴に受診し, 直腸内指診で前立腺癌を疑われ入院した.生検の結果.頸部リンパ節が腺癌であったことから, 遠隔リンパ節転移を伴う前立腺癌stage D2と診断しホルモン療法を行った.その後, 前立腺部の腫脹の再燃による症状の悪化を認め, 更に残存腫瘍の再燃, 骨盤内占拠及び一部体表より突出し癌死した.経過中, PSAは正常化せず, ホルモン不応性に陥っていた.症例2は66歳男.左頸部腫瘤を主訴に受診し入院となった.頸部リンパ節生検により腺癌が疑われ, 左頸部腫瘤摘出術, 経会陰的前立腺針生検を行った.その結果, 進行性前立腺癌stage D2と診断した.両側精巣摘除術後ホルモン療法を開始し, 経過観察となった.治療開始後4ヵ月現在, 傍大動脈リンパ節を含め縮小傾向を認めるが, PSAは正常化していない, We report two cases of prostatic carcinoma presenting as neck lymph node metastases. Case 1: A 56-year-old man was admitted to our hospital with the chief complaint of left lower abdominal pain. A lymph node was palpable on the left side of the neck swollen. Rectal examinations revealed prostatic stony-hard mass. Computed tomography showed a swollen neck and paraaortic lymph nodes on the left side. PSA level was 380 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma, and neck lymph node biopsy also revealed metastatic adenocarcinoma. We diagnosed him with prostatic carcinoma stage D2 (LYM). He underwent hormonal therapy (TAB) but died 13 months later. Case 2: A 66-year-old man was admitted to our hospital with the chief complaint of a large palpable mass on the left side of the neck. Resection of this mass revealed metastatic adenocarcinoma. Rectal examination revealed no malignant lesions, but the PSA level was high, 1, 700 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma. Computed tomography revealed paraaortic and pelvic lymph node metastases and bone scintigram revealed abnormal uptake, bone metastases. We diagnosed him with prostatic carcinoma stage D2 (LYM OSS). We performed bilateral testectomy followed by hormonal therapy (TAB). The lymph node metastases disappeared after 4 months of therapy.

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.

68歳男.回腸導管出血を主訴とした.浸潤性膀胱癌に対し膀胱全摘除術, 回腸導管造設術を行ったが, 回腸導管から出血を繰り返した.腹壁には静脈の怒張を認め, 造影CT, 上腸間膜動脈の血管造影にて, 静脈相でストマから筋層に至る怒張血管を認めたが, 回腸導管の出血点は不明であった.ストマの周囲を切開して導管の剥離を行った際に血管から血が噴出したため結紮止血し, 静脈瘤を形成する動静脈の結紮・切離し, ストマ再形成術を行った.術後3ヵ月でストマおよび腹壁直下の静脈瘤は消失し, 術後19ヵ月現在, 回腸導管からの出血は認めない, A 68-year-old man visited our department with a complaint of persistent hemorrhage from ileal conduit. He had undergone total cystourethrectomy and ileal conduit construction for invasive bladder cancer in April 2000. He had been suffering from persistent stomal bleeding, although he received ligation of varices as well as occasional transfusions. Revision of the ileal conduit was performed in September 2002. Stomal bleeding has not recurred for 19 months.

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.

76歳男.主訴は排尿困難.前立腺に硬結を認め, PASが高値を示し, 経会陰的前立腺針生検術を施行したところ, 病理組織学的診断は印環細胞癌, Gleason score 5+4であった.骨盤部MRIのT2強調像において前立腺の右葉外腺領域を中心としてlow intensityを示す腫瘤性病変を認め, 前立腺癌が疑われた.前立腺の正中部背側には嚢胞性病変を認めた.前立腺原発の印環細胞癌T2bN0M0, stage B2と診断し, 膀胱前立腺全摘除術, 骨盤内リンパ節郭清術, 回腸導管造設術を施行した.病理組織学的には, 透明な空胞に圧排された偏在核を持つ印環細胞と低分化な腺癌組織を認めた.PSA染色では細胞質が染色された.術後13ヵ月経過した現在, 再発・転移なく, 外来通院中である, A 76-year-old male was admitted with a complaint of dysuria. Serum prostatic specific antigen was 28 ng/ml. Transperineal prostatic biopsy was performed and histopathological diagnosis was signet ring cell carcinoma with a part of poorly differentiated adenocarcinoma. Imaging studies showed that the tumor was localized in a large part of the prostate, and no abnormality was found in the stomach, the intestine, or the colon. Cystoprostatectomy and ileal conduit construction were performed in November 2002. Immunohistochemistry revealed that the specimen included the signet ring cells, which were stained for prostate specific antigen antibody, but not with periodic acid schiff. He is alive with no evidence of disease in 13 months after the operation.

62歳男.腹部CTにて右副腎腫瘍を認め, 腰部斜切開にて右副腎摘出術を施行した.病理組織学的診断は褐色細胞腫であった.13年後, 超音波, CT, MRIにて右腎上極に腫瘤を認め, 131I-MIBGシンチでは腫瘍部位に一致した強い集積がみられた.褐色細胞腫の局所再発と考え腫瘍を摘除した.病理組織学的診断は悪性褐色細胞腫であった.その後, 背部痛, 下肢の知覚・運動麻痺, 膀胱直腸障害が出現し, 胸椎MRIにて第二胸椎への骨転移とそれに伴う胸髄の圧迫所見が, 131I-MIBGシンチでも同部位に集積が認められた.放射線外照射を施行し, 続いてサイクロホスファマイド, ビンクリスチン, ダカルバジンによるCVD療法を計10コース行った.現在, 胸椎への転移巣の28.6%の縮小を認め, 膀胱直腸障害は消失し, 下肢の完全麻痺は杖歩行可能な迄の症状の改善を認めている, A 62-year-old man underwent right adrenalectomy for pheochromocytoma in May 1987. He was referred to our department for a right renal tumor suggested by ultrasound sonography in December 2000. Computated tomography and MRI showed a 10 cm mass arising from the upper pole of the right kidney. 131I-MIBG scintigram showed strong radio isotope accumulation consistent with the tumor. Right nephrectomy and subsegmental hepatectomy were performed. Histological findings led to the diagnosis of malignant pheochromocytoma. In February 2001, he complained of paraplasia due to Th2 bone metastasis. Radiation and CVD (cyclophosphamide, vincristine, dacarbazine) chemotherapy resulted in tumor regression and marked improvement of clinical symptoms.

62歳男.57歳時に左腎摘除術後の病理組織検査で腎細胞癌, 明細胞亜型と診断され, 4年後に腎細胞癌の転移による右大腿骨遠位部の骨腫瘍に対し病巣掻破を施行された.その1年後の腹部CTで右腎極下の腫瘤性病変を指摘された.腹部CT, 腹部MRI所見より右腎周囲脂肪組織への転移と診断し, 腫瘤摘出術を施行した.病理学的所見は腎細胞癌, 明細胞癌で, 左腎の病理組織所見とほぼ一致し, 骨転移先行の血行性転移と判断した.術後はインターフェロンとシメチジンによる免疫療法を施行した.術後8ヵ月経過した現在, 再発の徴候はない, Extremely rarely renal cell carcinoma metastasizes to the contralateral perirenal fat. A 57-year-old male was admitted with macroscopic hematuria and lower left abdominal pain in December 1994. He was diagnosed with left renal cancer, and underwent left radical nephrectomy (RCC pT2, grade 1) in January 1995. Followup imaging studies showed a tumor arising from the right perirenal fat in 5 years. Tumor excision was performed in May 2000. Pathological findings revealed renal cell carcinoma growing in the fat, which had the same, pathology as the left renal cancer.

59歳男.51歳時に前立腺部尿道を含めた膀胱内の多発性腫瘍に対し, 膀胱尿道摘除術を受けたが, その8年後, 尿道口よりの排膿を主訴に来院した.陰茎部MRI, 胸腹部CTにより, 残存尿道腫瘍及び左鼠茎部リンパ節転移と診断し, 陰茎部分切除術, 左鼠径部リンパ節切除術を施行した.切除標本の病理組織学的所見は, 8年前と同様の移行上皮癌で, 膀胱癌の転移と考えられた.術後, 補助療法としてM-VAC療法を2コース行った.術後3年2ヵ月の現在, 再発を認めていない, A 59-year-old man had undergone total cystourethrectomy for bladder cancer (TCC G2 > G3 pT1) in July, 1991. Eight years later, he visited our department complaining of bleeding from external urethral meatus. Imaging study including computed tomographic (CT) scan and magnetic resonance imaging (MRI) showed a tumor arising from the urethral remnant and left inguinal lymph node involvement. Partial penectomy and left inguinal lymphadenectomy were performed. Histopathological examination revealed that both tumors were transitional cell carcinomas suggesting recurrence of bladder cancer. Two courses of M-VAC chemotherapy were given as adjuvant therapy.

女子急性単純性膀胱炎の126例に対し, OFLX 300mg 1日1回3日間投与と, 同薬100mg 1日3回3日間投与の比較検討をした。UTI薬効評価可能のそれぞれ, 42例と43例とでは, ともに総合臨床効果の98%を呈するなど, 自覚症状・膿尿・細菌尿に対する効果も主治医による効果判定にも, あるいは第7病日における再発検討にても, ほとんど両群に差をみとめなかった。自覚的副作用は両群あわせてもわずかに1.2%であり, 全例に臨検値を検討しなかったため, 概括安全度に対する検討は不十分であった, A comparative study of ofloxacin (OFLX), a new oral quinolone, was carried out at the Department of Urology, Osaka University Hospital and its eighteen affiliated hospitals to evaluate the clinical efficacy and safety of daily dose of 300 mg, given either once daily dose (SID group), or in three divided doses (TID group), in the treatment of acute uncomplicated cystitis in women. Clinical efficacy was evaluated in 42 cases from the SID group, and 43 cases from TID group, respectively, according to the criteria by the Japanese UTI Committee. In the SID group, the clinical efficacy was evaluated as excellent in 29 cases, moderate in 12 and poor in 1, with an overall clinical effectiveness rate of 98%. In the TID group, it was evaluated as excellent in 25 cases, moderate in 17 and poor in 1, with an overall clinical effectiveness rate of 98%. Safety was monitored only by subjective complaints. In the SID group, no subjective side effects appeared (0%). In the TID group, one of the 43 women (2.3%) complained of borborygmus. These findings suggest that there was no significant difference between the two groups in the safety and efficacy of ofloxacin.

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.

A primary extra-adrenal retroperitoneal ganglioneuroma was found incidentally in a 17-year-old boy during a series of examinations for hematopyuria. Computed tomography and magnetic resonance imaging revealed a homogenous mass located between the right proximal ureter and the inferior vena cava just below the right kidney. Subtotal resection of the tumor was performed through a transabdominal approach. The resected specimen measured 8.5 x 6 x 5.5 cm and weighed 70 g. Histological examination showed that the lesion was an extra-adrenal retroperitoneal ganglioneuroma composed of mature ganglion cells and nerve fibers without any malignant features. The patient has shown no signs of recurrence in the 4 months after surgery. We provide a review of the Japanese literature on extra-adrenal retroperitoneal ganglioneuroma and also discuss the clinical features of this tumor.

A 68-year-old man visited our department with a complaint of persistent hemorrhage from ileal conduit. He had undergone total cystourethrectomy and ileal conduit construction for invasive bladder cancer in April 2000. He had been suffering from persistent stomal bleeding, although he received ligation of varices as well as occasional transfusions. Revision of the ileal conduit was performed in September 2002. Stomal bleeding has not recurred for 19 months.

We report three cases of endometrioid adenocarcinoma of the prostate. Case 1: A 71-year-old male was admitted with a complaint of micturition pain. Serum prostatic specific antigen (PSA) was 12 ng/ml. Radical prostatectomy following needle biopsy was performed in May 1998. Histopathological diagnosis was prostatic endometrioid adenocarcinoma (pT2bpN0M0). Case 2: A 71-year-old male was admitted with a complaint of macrohematuria. PSA was 18 ng/ml. Cystoprostatectomy and ileal conduit construction following needle biopsy were performed in July 2002. The tumor that was diagnosed as endometrioid adenocarcinoma, invaded the bladder neck (pT4pN0M0). Case 3: An 86-year-old male was referred to our department for elevated PSA (16.8 ng/ml). Prostatic needle biopsy was performed and histopathological diagnosis was endometrioid adenocarcinoma with a part of well differentiated adenocarcinoma (T2bN0M0). PSA dropped to an undetectable range after total androgen blockade therapy.

A 76-year-old male was admitted with a complaint of dysuria. Serum prostatic specific antigen was 28 ng/ml. Transperineal prostatic biopsy was performed and histopathological diagnosis was signet ring cell carcinoma with a part of poorly differentiated adenocarcinoma. Imaging studies showed that the tumor was localized in a large part of the prostate, and no abnormality was found in the stomach, the intestine, or the colon. Cystoprostatectomy and ileal conduit construction were performed in November 2002. Immunohistochemistry revealed that the specimen included the signet ring cells, which were stained for prostate specific antigen antibody, but not with periodic acid schiff. He is alive with no evidence of disease in 13 months after the operation.

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.

A 34-year-old man was referred to our hospital for small lung nodules. An imaging study including a computed tomographic scan and magnetic resonance imaging showed bilateral lung tumors and huge mass arising from the lower pole of the right kidney as well. The patient underwent right radical nephrectomy in May 2002. Pathological examination revealed that the tumor was pheochromocytoma, which developed from extra-adrenal tissue. In 6 cycles of CVD systemic chemotherapy (Cyclophosphamide 750 mg/m2, Vincristine 1.4 mg/m2, Dacarbazine 600 mg/m2), the lung tumors were decreasing in size, and were removed by a surgical procedure in January 2003. Pathological examination revealed that the lung tumors were pheochromocytomas metastasized from the primary tumor. He is alive without evidence of disease 5 months after the lung operation.

A 59-year-old man had undergone total cystourethrectomy for bladder cancer (TCC G2 > G3 pT1) in July, 1991. Eight years later, he visited our department complaining of bleeding from external urethral meatus. Imaging study including computed tomographic (CT) scan and magnetic resonance imaging (MRI) showed a tumor arising from the urethral remnant and left inguinal lymph node involvement. Partial penectomy and left inguinal lymphadenectomy were performed. Histopathological examination revealed that both tumors were transitional cell carcinomas suggesting recurrence of bladder cancer. Two courses of M-VAC chemotherapy were given as adjuvant therapy.

A 65-year-old male was admitted with the chief complaint of voiding difficulty on 28 October, 2001. He was in the state of urinary retention. Urological investigation including cystosocopy, urethrocystography, and urodynamic study revealed an areflex-type bladder, according to the new International Continence Society (ICS) classification with no prostatic urethral obstruction. He was diagnosed with neurogenic bladder although the cause of detrusor areflex was unknown. Because all medication was ineffective, transurethral resection of prostate was performed on 11 January, 2002, but urinary retention could not be relieved. After operation, he complained of muscle weakness of upper extremities and poor control of bowels. He was diagnosed with Lambert-Eaton myasthenic syndrome associated with small cell lung carcinoma. His myasthenic symptoms, including autonomic symptoms were relieved after chemotherapy and radiation for small cell lung carcinoma.

A 62-year-old man underwent right adrenalectomy for pheochromocytoma in May 1987. He was referred to our department for a right renal tumor suggested by ultrasound sonography in December 2000. Computated tomography and MRI showed a 10 cm mass arising from the upper pole of the right kidney. 131I-MIBG scintigram showed strong radio isotope accumulation consistent with the tumor. Right nephrectomy and subsegmental hepatectomy were performed. Histological findings led to the diagnosis of malignant pheochromocytoma. In February 2001, he complained of paraplasia due to Th2 bone metastasis. Radiation and CVD (cyclophosphamide, vincristine, dacarbazine) chemotherapy resulted in tumor regression and marked improvement of clinical symptoms.

In case 1, a 24-year-old man was admitted with left lumbago. Abdominal computed tomographic (CT) scan showed the huge mass (8 x 10 x 13 cm in diameter) in the left retroperitoneal space, which lack enhancement and had a irregular margin. Percutaneous needle biopsy guided by ultrasonography was performed. In case 2, a 74-year-old woman was admitted with right lower abdominal pain. Laboratory data showed the renal failure. Imaging study revealed bilateral hydronephroses and bilateral masses at both common iliac vessels. A retroperitoneoscopic biopsy was performed. We diagnosed both cases as retroperitoneal fibrosis and administered prednisolone for 10 months. The masses decreased in size and the symptoms disappeared in both cases.

Extremely rarely renal cell carcinoma metastasizes to the contralateral perirenal fat. A 57-year-old male was admitted with macroscopic hematuria and lower left abdominal pain in December 1994. He was diagnosed with left renal cancer, and underwent left radical nephrectomy (RCC pT2, grade 1) in January 1995. Followup imaging studies showed a tumor arising from the right perirenal fat in 5 years. Tumor excision was performed in May 2000. Pathological findings revealed renal cell carcinoma growing in the fat, which had the same, pathology as the left renal cancer.

Extremely rarely renal cell carcinoma metastasizes to the contralateral renal pelvis or ureter. A 42-year-old man had undergone left radical nephrectomy for renal cell carcinoma (pT1b, grade 2) in March, 2000. Fifteen months later, he complained of macroscopic hematuria. Computed tomographic scanning and retrograde pyelography showed a right renal pelvic tumor. Enucleation of pelvic tumor was performed and a parenchyma mass incidentally identified in the right kidney was also resected. Histopathological examination of each tumor revealed renal cell carcinoma identical to the primary tumors in the left kidney suggesting metastasis to renal pelvis and de novo tumor or metastasis in the right kidney.

A 72-year-old female with a complaint of hemorrhagic leucorrhea was referred to our department. She had a black tumor on her urethral meatus suspected as a malignant melanoma. Urethrectomy, vulvectomy, partial vaginectomy, bilateral inguinal lymphadenectomy, and cystostomy were performed. Pathological diagnosis was malignant melanoma of the urethra. Local recurrence and lymph node metastasis were found 9 months later, and she has been given DAV-feron combined therapy.

A 64-year-old man was admitted with dyspnea and edema of the left lower extremity to the Department of Medicine, and referred to our department presenting with anuria and scrotal edema. Physical examinations revealed a large nodular tumor extending from his penis to the lower abdomen. He was diagnosed with penile tumor that had invaded into the retroperitoneal space. Histological findings revealed extramammary Paget's disease. Radiation therapy, low dose chemotherapy, and hormone therapy were performed, but he died of invasion and multiple metastasis of the tumor 5 months later.

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.

A 74-year-old man was admitted for asymptomatic macroscopic hematuria. He had undergone transurethral resection of bladder tumor (TURBT) due to transitional cell carcinoma 30 years ago. Pelvic CT showed two invasive bladder tumors. A 5 cm tumor was on the dome and a 1 cm tumor was on the left lateral wall. TURBT was performed. Pathological examination revealed that they were leiomyosarcoma and transitional cell carcinoma. Radical cystectomy plus bilateral cutaneousureterostomy was performed. He died of lung metastases and local recurrence after 6 months.

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.

We report two cases of prostatic carcinoma presenting as neck lymph node metastases. Case 1: A 56-year-old man was admitted to our hospital with the chief complaint of left lower abdominal pain. A lymph node was palpable on the left side of the neck swollen. Rectal examinations revealed prostatic stony-hard mass. Computed tomography showed a swollen neck and paraaortic lymph nodes on the left side. PSA level was 380 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma, and neck lymph node biopsy also revealed metastatic adenocarcinoma. We diagnosed him with prostatic carcinoma stage D2 (LYM). He underwent hormonal therapy (TAB) but died 13 months later. Case 2: A 66-year-old man was admitted to our hospital with the chief complaint of a large palpable mass on the left side of the neck. Resection of this mass revealed metastatic adenocarcinoma. Rectal examination revealed no malignant lesions, but the PSA level was high, 1, 700 ng/ml. Transperineal prostatic biopsy revealed moderately differentiated adenocarcinoma. Computed tomography revealed paraaortic and pelvic lymph node metastases and bone scintigram revealed abnormal uptake, bone metastases. We diagnosed him with prostatic carcinoma stage D2 (LYM OSS). We performed bilateral testectomy followed by hormonal therapy (TAB). The lymph node metastases disappeared after 4 months of therapy.

A comparative study of ofloxacin (OFLX), a new oral quinolone, was carried out at the Department of Urology, Osaka University Hospital and its eighteen affiliated hospitals to evaluate the clinical efficacy and safety of daily dose of 300 mg, given either once daily dose (SID group), or in three divided doses (TID group), in the treatment of acute uncomplicated cystitis in women. Clinical efficacy was evaluated in 42 cases from the SID group, and 43 cases from TID group, respectively, according to the criteria by the Japanese UTI Committee. In the SID group, the clinical efficacy was evaluated as excellent in 29 cases, moderate in 12 and poor in 1, with an overall clinical effectiveness rate of 98%. In the TID group, it was evaluated as excellent in 25 cases, moderate in 17 and poor in 1, with an overall clinical effectiveness rate of 98%. Safety was monitored only by subjective complaints. In the SID group, no subjective side effects appeared (0%). In the TID group, one of the 43 women (2.3%) complained of borborygmus. These findings suggest that there was no significant difference between the two groups in the safety and efficacy of ofloxacin.