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膀胱または大腸などの膀胱周辺臓器に浸潤が認められ, 強い膀胱刺激症状を呈した8例と腸閉塞症状も合併した4例の計12例のstage D2前立腺癌に, surgical neoadjuvant chemohormonal therapyを施行した。9例に社会復帰を伴う生存がえられ(CR 4例, PR 3例, NC 2例), 骨盤内臓器全摘出術例は全例生存がえられた(CR 2例, PR 2例)。癌死は3例で生存期間は平均25ヵ月であった, To improve the therapeutic results as well as the patient's quality of life (QOL) in advanced prostatic carcinoma, total cystprostatectomy or pelvic exenteration was performed in combination with chemo-hormonal therapy before and after operation on twelve patients with stage D2 prostatic carcinoma who had infiltration in the periprostatic organs including urinary bladder and large intestine and showed strong bladder irritation, gross hematuria and ileus symptoms. Eight patients with severe cystic infiltration underwent total cystprostatectomy, urinary division and lymph node dissection, and four with ileus symptoms had pelvic exenteration, urinary division, proctostomy and lymph node dissection. As a rule of dosing schedule for chemo-hormonal therapy, 30-60mg/sq m of etoposide was continuously administered for 5 days before operation in addition to 250-500 mg of diethylbestrol diphosphate given for 30 days after operation. Furthermore, 2-3 courses of 30-60 mg/sq m of etoposide was administered for successive days, at 3-week intervals and then 30-60 mg/sq m of etoposide at 6-to-8-week intervals for 2 years together with 75-100 mg of chrolmadinone acetate as maintenance treatment. Nine of the 12 patients survived, including 4 patients with complete response, 3 patients with partial response and 2 patients with no change. These findings, suggested that the combination of surgical treatment and chemo-hormonal therapy is of use not only for providing an effective therapeutic means but also for improving the QOL in patients with advanced prostatic carcinoma.

A 78-year-old man visited our department for macroscopic hematuria in June, 1989. On the basis of the diagnosis of tumor of the bladder and right afunctional kidney, total right nephro-uretero-cystectomy and skin grafting of the left ureter were performed on August 2. The patient continued to have fever of unknown origin postoperatively. Repeat laparotomy, which was performed for rectal fistula on August 25, revealed that the abdominal wall, colon, small intestine and mesenterium adhered to one another, producing a mass and that two sites in the rectum were perforated. A part of the small intestine was excised, the perforated sites were sutured, and an artificial anus was created at the transverse colon. Since the patient had intermittent fever and continued to complain of abdominal pain after creation of the artificial anus, nosotropic therapy was continued. However, the patient died from cardiac insufficiency on October 10. Erosion and ulcer were histologically observed over a wide range in the excised small intestine. In addition there was a defect in one area of the small intestine, penetrating the tunca muscularis propria, in which many cytomegalovirus (CMV) inclusion bodies were observed. CMV inclusion bodies were also detected in the bladder with re-examination of specimens from the excised bladder. From these findings, it appears that endogenetic CMV may have been reactivated in the present case.

腎細胞癌骨転移15例の治療内容を検討した.外科切除は6例に施行し, 広範囲切除は2例に実施したが, 1例は6年4ヵ月CR生存, 1例は14年2ヵ月の長期生存を得た, Eighty-six patients with renal cell carcinoma underwent radical nephrectomy in Chiba Cancer Center Hospital. Fifteen of the 86 patients developed bone metastases. Seven of the 15 patients with bone metastases had received chemotherapy and radiotherapy. Six of the 15 patients underwent surgical treatment and two received radiotherapy alone. Of the six patients treated surgically for bone metastases, two patients were treated with wide resection and the remaining four patients underwent excision of the metastatic lesions in combination with radiotherapy, chemotherapy or immunotherapy. One of the two patients who underwent wide resection of a pelvic bone lesion is alive without evidence of disease for 6 years and 4 months. Another patient who underwent wide resection of femoral bone lesion survived for 14 years and 2 months but died of recurrent cancer. Pathologic findings of renal cell carcinoma in the long-time survivors showed adenocarcinoma of alveolar type of clear cell subtype and in grade 1. Wide resection of bone metastases of renal cell carcinoma can significantly prolong the survival time and improve the quality of life of the patients.

A 54-year-old male visited our cancer center with the chief complaint of penile tumor in May, 1992. Magnetic resonance imaging (MRI) demonstrated a penile tumor and showed that this tumor invaded the submucosa but neither corpora cavernosa nor corpus spongiosum. Partial penectomy was performed in June, 1992. Histopathological examination of the resected tumor showed verrucous carcinoma. MRI was useful to investigate the degree of invasion of the penile tumor.

To improve the therapeutic results as well as the patient's quality of life (QOL) in advanced prostatic carcinoma, total cystprostatectomy or pelvic exenteration was performed in combination with chemo-hormonal therapy before and after operation on twelve patients with stage D2 prostatic carcinoma who had infiltration in the periprostatic organs including urinary bladder and large intestine and showed strong bladder irritation, gross hematuria and ileus symptoms. Eight patients with severe cystic infiltration underwent total cystprostatectomy, urinary division and lymph node dissection, and four with ileus symptoms had pelvic exenteration, urinary division, proctostomy and lymph node dissection. As a rule of dosing schedule for chemo-hormonal therapy, 30-60mg/sq m of etoposide was continuously administered for 5 days before operation in addition to 250-500 mg of diethylbestrol diphosphate given for 30 days after operation. Furthermore, 2-3 courses of 30-60 mg/sq m of etoposide was administered for successive days, at 3-week intervals and then 30-60 mg/sq m of etoposide at 6-to-8-week intervals for 2 years together with 75-100 mg of chrolmadinone acetate as maintenance treatment. Nine of the 12 patients survived, including 4 patients with complete response, 3 patients with partial response and 2 patients with no change. These findings, suggested that the combination of surgical treatment and chemo-hormonal therapy is of use not only for providing an effective therapeutic means but also for improving the QOL in patients with advanced prostatic carcinoma.

A 54-year-old male visited our cancer center with the chief complaint of penile tumor in May, 1992. Magnetic resonance imaging (MRI) demonstrated a penile tumor and showed that this tumor invaded the submucosa but neither corpora cavernosa nor corpus spongiosum. Partial penectomy was performed in June, 1992. Histopathological examination of the resected tumor showed verrucous carcinoma. MRI was useful to investigate the degree of invasion of the penile tumor.

A 78-year-old man visited our department for macroscopic hematuria in June, 1989. On the basis of the diagnosis of tumor of the bladder and right afunctional kidney, total right nephro-uretero-cystectomy and skin grafting of the left ureter were performed on August 2. The patient continued to have fever of unknown origin postoperatively. Repeat laparotomy, which was performed for rectal fistula on August 25, revealed that the abdominal wall, colon, small intestine and mesenterium adhered to one another, producing a mass and that two sites in the rectum were perforated. A part of the small intestine was excised, the perforated sites were sutured, and an artificial anus was created at the transverse colon. Since the patient had intermittent fever and continued to complain of abdominal pain after creation of the artificial anus, nosotropic therapy was continued. However, the patient died from cardiac insufficiency on October 10. Erosion and ulcer were histologically observed over a wide range in the excised small intestine. In addition there was a defect in one area of the small intestine, penetrating the tunca muscularis propria, in which many cytomegalovirus (CMV) inclusion bodies were observed. CMV inclusion bodies were also detected in the bladder with re-examination of specimens from the excised bladder. From these findings, it appears that endogenetic CMV may have been reactivated in the present case.

Eighty-six patients with renal cell carcinoma underwent radical nephrectomy in Chiba Cancer Center Hospital. Fifteen of the 86 patients developed bone metastases. Seven of the 15 patients with bone metastases had received chemotherapy and radiotherapy. Six of the 15 patients underwent surgical treatment and two received radiotherapy alone. Of the six patients treated surgically for bone metastases, two patients were treated with wide resection and the remaining four patients underwent excision of the metastatic lesions in combination with radiotherapy, chemotherapy or immunotherapy. One of the two patients who underwent wide resection of a pelvic bone lesion is alive without evidence of disease for 6 years and 4 months. Another patient who underwent wide resection of femoral bone lesion survived for 14 years and 2 months but died of recurrent cancer. Pathologic findings of renal cell carcinoma in the long-time survivors showed adenocarcinoma of alveolar type of clear cell subtype and in grade 1. Wide resection of bone metastases of renal cell carcinoma can significantly prolong the survival time and improve the quality of life of the patients.

Twenty-one patients with renal pelvic carcinoma and eighteen patients with ureteral carcinoma were treated with surgical therapy. In 14 of the 39 patients, we performed nephroureterectomy with a bladder cuff (NUpB), nephroureterectomy with total cystectomy (NUtB) in 12, nephrectomy with partial ureteric resection (NpU) in 8 and others in 5. Following surgery, 8 had recurrences and metastasis and 21 died with carcinoma and 10 survived without evidence of disease. The 5-year survival rate of the patients with renal pelvis carcinoma is 33.5% and 52.0% in ureteral carcinoma.

One hundred and twenty-nine patients with prostatic carcinoma were treated in our hospital. They were between 49 and 88 (average, 70.3) years old and histological diagnosis was adenocarcinoma in all 129 patients; 42 had well differentiated, 55 moderately differentiated, 31 had poorly differentiated carcinomas, and one undeterminated type. Twenty two patients had stage A carcinoma, 18 stage B, 14 stage C and 75 stage D. As the therapeutic principle no castration was done, radiation therapy was delivered to cases with carcinoma more advanced than stage B in combination with estrogen or alone, and antimetabolites were given to some patients. Cryosurgical procedure to prostate was adjunctively used in patients with dysuria. Since 1986, total prostatectomy was carried out in patients with stage B disease and younger than 60 years old, and total combined resection of the urinary bladder and prostate was performed in patients with more advanced than stage C disease. Etoposide was given to patients with recurrent or metastatic lesions. Twenty-two of the 124 patients who did not receive castration surgery were categorized in stage A, 17 in stage B, 14 in stage C, and 71 in stage D. The 5-year survival rate in each stage group was 100%. 56.2%, 70.0%, and 28.8%, respectively, and the statistical difference between stage A and B, and between stage C and D was respectively significant. The relative 5-year survival rate among the total patient group, 71 patients in stage D, 40 patients in stage D treated with hormone therapy, and 15 patients in stage D treated with radiation therapy was 44.5, 28.7, 18.4 and 36.1%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

A 69-year-old male patient visited our clinic with complaints of dysuria and bleeding at the glans of penis on May 2, 1985. At the first presentation the tumor mass with necrotic and hemorrhagic character was localized around the urethral orifice and the entire glans of penis had a hard consistency. Moreover, numerous soft cutaneous nodules ranging from a small bean to a hen's egg in size spread over the total body surface. The nodules varied in property from even in height on the skin surface, half-spherical, and pedunculated. His family history was not contributory as far as neurofibromatosis was concerned. On May 15, the glans of penis was amputated and histological diagnosis was malignant melanoma with marked vascular and neural permeation. Review of the literature showed that our patient is the third case of malignant melanoma associated with neurofibromatosis in Japan.

Twenty-one patients with renal pelvic carcinoma and eighteen patients with ureteral carcinoma were treated with surgical therapy. In 14 of the 39 patients, we performed nephroureterectomy with a bladder cuff (NUpB), nephroureterectomy with total cystectomy (NUtB) in 12, nephrectomy with partial ureteric resection (NpU) in 8 and others in 5. Following surgery, 8 had recurrences and metastasis and 21 died with carcinoma and 10 survived without evidence of disease. The 5-year survival rate of the patients with renal pelvis carcinoma is 33.5% and 52.0% in ureteral carcinoma.

One hundred and twenty-nine patients with prostatic carcinoma were treated in our hospital. They were between 49 and 88 (average, 70.3) years old and histological diagnosis was adenocarcinoma in all 129 patients; 42 had well differentiated, 55 moderately differentiated, 31 had poorly differentiated carcinomas, and one undeterminated type. Twenty two patients had stage A carcinoma, 18 stage B, 14 stage C and 75 stage D. As the therapeutic principle no castration was done, radiation therapy was delivered to cases with carcinoma more advanced than stage B in combination with estrogen or alone, and antimetabolites were given to some patients. Cryosurgical procedure to prostate was adjunctively used in patients with dysuria. Since 1986, total prostatectomy was carried out in patients with stage B disease and younger than 60 years old, and total combined resection of the urinary bladder and prostate was performed in patients with more advanced than stage C disease. Etoposide was given to patients with recurrent or metastatic lesions. Twenty-two of the 124 patients who did not receive castration surgery were categorized in stage A, 17 in stage B, 14 in stage C, and 71 in stage D. The 5-year survival rate in each stage group was 100%. 56.2%, 70.0%, and 28.8%, respectively, and the statistical difference between stage A and B, and between stage C and D was respectively significant. The relative 5-year survival rate among the total patient group, 71 patients in stage D, 40 patients in stage D treated with hormone therapy, and 15 patients in stage D treated with radiation therapy was 44.5, 28.7, 18.4 and 36.1%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)