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Bladder cancer is the most common urinary tract cancer. Patients diagnosed with advanced T-stage/muscle-invasive bladder cancer through transurethral resection of bladder tumors (TURBT) are treated with total radical cystectomy; however, there is a high chance of recurrence. Nevertheless, markers for predicting this recurrence are not currently available. Here, we evaluated the chronological change of ephrin type-A receptor 2 (EPHA2) expression, a molecule known for its role in cell adhesion, to predict bladder cancer recurrence after cystectomy, using TURBT and cystectomy specimens.An immunostaining evaluation method that combines whole-slide images and image analysis software was developed to quantify and evaluate stainability objectively. We assessed the correlation between EPHA2 expression and bladder cancer recurrence using this novel immunostaining method and chronological changes in target protein expression in TURBT and radical cystectomy samples.In TURBT specimens, the number of cases with a high N-terminal/C-terminal EPHA2 ratio in the group with recurrence was significantly higher than in the non-recurrent group (p=0.019). The number of cases with a high level of C-terminal EPHA2 positivity in the radical cystectomy specimen when compared to the TURBT specimen obtained from the same patient was significantly higher in the recurrent group than in the non-recurrent group (p=0.0034).EPHA2 appears to be a promising marker for bladder tumor recurrence after cystectomy and its evaluation may enable the selection of appropriate cases for adjuvant therapy among patients undergoing radical cystectomy. Further studies, including mass-scale analysis, are required to confirm these results.

Background: Doege-Potter syndrome presents as solitary fibrous tumors and non-islet cell tumor hypoglycemia (NICTH). Here, we report a case of Doege-Potter syndrome in which retroperitoneal tumor resection was performed with continuous intraoperative blood glucose monitoring. Case Presentation: The patient was a 37-year-old healthy man with no relevant medical history. They were brought to the emergency room because of defecation difficulties and incontinence caused by hypoglycemia, and a tumor measuring 10 × 12 × 9 cm was found in the right kidney. High-molecular-weight insulin-like growth factor-II (IGF-II) was detected in the blood, indicating an IGF-II-producing tumor with NICTH. The patient underwent tumor resection, and the pathological results indicated a solitary fibrous tumor of retroperitoneal origin. Thus, retroperitoneal primary Doege-Potter syndrome was diagnosed. Continuous blood glucose monitoring was performed intraoperatively, and no hypoglycemic attacks occurred; insulin secretory abnormalities improved immediately after surgery. Previous studies suggest that IGF-II is metabolized in a few hours. Therefore, serum IGF-II levels were analyzed one week and one month postoperatively; the levels were within the normal range at both time points. Two years have passed since the surgery without recurrence. Conclusions: Doege-Potter syndrome of retroperitoneal primary origin is rare. Furthermore, continuous intraoperative blood glucose monitoring was performed during surgery; thus, we report blood glucose level trends for the first time. This case highlights that this type of surgery can be performed safely without special blood glucose adjustments and that insulin secretion resumes soon after surgery.

A 76-year-old male was previously found to have a renal cyst at the center of the right kidney, on a computed tomography (CT)scan for examination of another disease. The patient was admitted to the hospital because of fever. The CT scan showed an enlarged mass at the center of the right kidney and an increase in the density of peripheral fat tissue, suggesting an infection of the right renal cyst. In spite of conservative treatment with antibiotics, CT scan on the sixth day of admission revealed an increase in the size of the mass, and penetration in the ascending colon was suspected. An ultrasound-guided abscess puncture was performed, and a pigtail catheter (PC)was placed. Injection of contrast agent through the PC showed communication with the colon. The fistula site was identified using colon fiberscopy, and it was clipped. PC was removed after the closure of the fistula was confirmed by imaging. This is a rare case of renocolic fistula caused by an infected renal cyst, which was diagnosed by colon fiberscopy, and was treated by clipping the fistula.

An 82-year-old man visited our department with a chief complaint of penile pain and swelling. He was receiving maintenance dialysis for chronic renal failure and was catheterized because of urinary retention associated with prostatic hypertrophy. The penis was reddened with swelling extending to the root and marked tenderness. Blood tests indicated inflammation and imaging revealed an abscess with emphysematous changes in the cavernous region of the penis. The diagnosis was purulent penile cavernitis. His symptoms improved after decompression with incision and drainage. There has been no recurrence of the abscess in the 4 months since treatment.

We retrospectively evaluated the efficacy of immediate single instillation (SI) of pirarubicine hydrochloride (THP) in the chemoprevention of intermediate and high risk patients with non-muscle-invasive bladder cancer (NMIBC). The study population consisted of 256 intermediate and high risk patients with NMIBC who underwent Bacillus Calmette-Guerin (BCG) induction therapy or delayed intravesical chemotherapy between 1999 and 2014. We introduced SI of 30 mg THP in 30 ml normal saline for all cases in 2010, and thus earlier cases could be considered as historical controls. As BCG induction therapy, patients received 80 mg of BCG Tokyo strain 2 weeks after transurethral resection of bladder tumor (TURBT), and the instillations were repeated weekly for 8 weeks. On the other hand, as delayed intravesical chemotherapy, patients received 30 mg THP in 30 ml normal saline over a period of 6 months starting 2 weeks after TURBT. The instillation schedule was once a week for 1 month, every other week for 1 month and once a month for 4 months. The patients were followed with cystoscopy and urine cytology every 3 months for the first 2 years and every 6 months thereafter. The 3-, and 5-year non-recurrence rates were 80. 3 and 80.3%, respectively, in the single immediate instillation group and 69.7 and 64.5%, respectively, in the control group. Univariate analysis revealed a significant difference between the SI group and the control group (P=0. 025). Multivariate analysis showed that there was an independent and significant recurrence risk factor in selecting chemotherapy instead of BCG in additional intravesical instillation therapy and not to perform SI. Limitations of our study are its retrospective and nonrandomized nature with a limited number of patients.

Kidney transplantation with an Indiana pouch is very rare, and a case report about it has not been found. This is our report about a successful case of kidney transplantation in a patient with an Indiana pouch. A 32 year-old woman with end stage renal failure was referred to our hospital for living related kidney transplantation. She had undergone an Indiana pouch diversion, due to a neurogenic bladder with spina bifida and renal dysfunction, 11 years ago. However, her kidney function gradually deteriorated, and finally she was started on hemodialysis six months ago. We performed living related kidney transplantation from her mother. We transplanted a graft into her right fossa iliaca and made an anastomosis between a graft ureter and an Indiana pouch. Her postoperative course was uneventful with good graft function. Now 1 year after transplantation, she maintains good graft function without urinary tract infection dor rejection.

We evaluated the efficacy of single-dose instillation of pirarubicine hydrochloride (THP) in the chemoprophylaxis of non-muscle-invasive bladder cancer(NMIBC). In a retrospective study, 135 evaluable patients were assigned to three groups after transurethral resection of bladder tumors (TURBT). In group 1, patients received no adjuvant therapy after TURBT. In group 2, patients received a single-dose of 30 mg THP in 30 ml normal saline immediately after TURBT. In group 3, patients received 30 mg THP in 30 ml normal saline 2 weeks after TURBT , and the instillations were repeated for 4 weeks, then every other week twice and successively monthly for 6 months. Patients were followed with cystoscopy and urine cytology every 3 months for the first 2 years and every 6 months thereafter. The 3- and 5-year non-recurrence rates were 66.9%, and 66.0%, respectively, in group 1, 85.6%, and 85.6%, respectively, in group 2, and 93.6%, and 77.9%, respectively, in group 3. There was a significant difference only between group 1 and group2 (P ＝0.048). With respect to the recurrence per month, there was a significant difference between the 3 groups (P＝0.014) for the first 2 years. However, there was no significant difference thereafter. Limitations of our study are its retrospective and nonrandomized nature with a limited number of patients.

Introduction. The neutrophil-to-lymphocyte ratio (NLR), which can be easily calculated from routine complete blood counts of the peripheral blood, has been suggested to serve as a prognostic factor for some solid malignancies. In the present study, we aimed to determine the relationship between NLR in prostate cancer patients undergoing radical prostatectomy (RP) and their prognosis.Materials and Methods. We assessed NLR in 73 men (patients) who received RP for their prostate cancer. We also performed immunohistochemistry for CD8 and CD66b in a separate set of RP specimens.Results. The median NLR in the 73 patients was 1.85. There were no significant correlations of NLR with tumor grade (p=0.834), pathological T stage (p=0.082), lymph node metastasis (p=0.062), or resection margin status (p=0.772). Based on the area under the receiver operator characteristic curve (AUROC) to predict biochemical recurrence after RP, potential NLR cut-off point was determined to be 2.88 or 3.88. However, both of these cut-off points did not precisely predict the prognosis. There were no statistically significant differences in the number of CD66b-positive neutrophils or CD8-positive lymphocytes between stromal tissues adjacent to cancer glands and stromal tissues away from cancer glands and between different grades or stages of tumors.Conclusions. There was no association between NLR and biochemical failure after prostatectomy.

We report a case of renal cell carcinoma with intertrabecular vertebral metastases detected by F-18 fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT) and magnetic resonance imaging (MRI). The patient was a 40-year-old female, referred to our hospital for fever of ＞ 38°C, and loss of body weight. Examination showed anemia and elevated C-reactive protein (CRP). Abdominal enchanced CT showed a mass 3 cm in diameter, located on left kidney. She was diagnosed with left renal cell carcinoma (cT1aN0M0). Laparoscopic radical nephrectomy with a transabdominal approach was performed. Histological findings showed clear cell renal cell carcinoma G2＞G3. Although after operation, she presented with fever of ＞38°C, anemia, and elevated CRP and alkaline phosphatase. Systemic bone scan could not detect any bone metastases, but FDG-PET/CT and lumber MRI revealed cancer invasion to the bone of the whole body. Histological findings at bone biopsy showed clear cell carcinoma infiltrating the marrow space. We diagnosed the case as bone metastases of intertrabecular vertebral type. She was treated with temsirolimus,but died about five months after her first visit. Intertrabecular vertebral metastases that infiltrate the marrow space without trabecular bone alteration are not visible on radiographs or bone scans. FDG-PET/CT and MRI are more useful for diagnosis of intertrabecular vertebral metastases such as in this case.