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We report a case of bilateral testicular tumor after bilateral orchiopexy. A 42-year-old man who underwent bilateral orchiopexy in early childhood consulted our hospital due to right testicular enlargement in February 2012. Blood tests revealed elevation of human chorionic gonadotropin β, and a right testicular tumor was suspected. No metastasis was found on contrast-enhanced computed tomography. Although there was no swelling in the left testis, a heterogeneous hypoechoic mass was detected on left scrotal ultrasonography, and bilateral testicular tumors were supected. Left testis biopsy was performed and an intraoperative rapid diagnosis of a testicular tumor was made. Bilateral high orchiectomy was performed. No recurrence has been found over follow-up for 36 months after surgery.

33歳女。患者は右後腹膜腫瘤の精査加療を主訴とした。血管造影検査では右腎頭側の腫瘍への血管は中副腎動脈と下副腎動脈をfeederとしており, 副腎由来の腫瘍が疑われた。腎実質との交通はほとんど認めず, Hypovascularな腫瘍で, 造影剤の腫瘤部へのpoolingも軽度であった。非機能性副腎腫瘍と考え, 悪性病変も否定できないため手術を施行し, 右腎と一塊に摘出した。その結果, 病理組織学的所見では腎頭側部の腫瘍を主体としてhyperchromaticな核を有し, N/C比の高い充実性増殖が認められ, 一部はロゼット様, あるいは腺管構造を示していた。更に紡錘形の間葉系細胞様の分化や, 核の偏在傾向を示すrhabdoid tumorも含まれていた。また, 線維化, 硝子化, 石灰化, 骨化等, 多彩な病変を伴っていた。以上より, 本症例は成人腎芽腫と診断され, National Wilms' Tumor Study分類病期II・Unfavorable Histology群に相当したため, 再入院の上, 化学療法を施行したが副作用が強く中止となった。目下, 術後17ヵ月が経過しているが, 再発は認められていない。, A 33-year-old woman was referred to our hospital for further examination of a right adrenal mass 4.5 cm in diameter. Hormonal findings were normal. Computed tomography, magnetic resonance image and angiograpy demonstrated non-functioning adrenal tumor. Right nephrectomy was performed, because the tumor adhered firmly to the upper pole of the right kidney. The pathological diagnosis was nephroblastoma (nephroblastic type, complex subtype). Postoperative chemotherapy was started for stage III Wilms' tumor. However, peripheral neuropathy such as numbness of the fingers developed. Therefore, chemotherapy was discontinued in the fifth week. The patient is currently alive without recurrence 17 months postoperatively. In adult patients, postoperative chemotherapy for nephroblastoma is often interrupted due to side effects. Further studies on the protocol for adults is necessary.

19歳男性。患者は精巣の発育不良を主訴に著者らの施設にある小児外科を受診したところ, 性腺機能低下症を疑われ, 泌尿器科へ紹介となった。精査の結果, 視床下部性の特発性低ゴナドトロピン性性腺機能低下症と診断され, 20歳時よりLH-RH療法を開始したが, 1年後も男性機能面からは明らかな変化は認めなかった。そのため21歳時より週2回のHCG+HMG療法に切り替えたところ, 4ヵ月後には陰毛の増加, 精巣および陰茎の増大, にきび, 声が低くなる, 少量ながら射精可能となるなどの変化がみられた。内分泌学的にも総テストステロン値も正常化し, 1年4ヵ月後の精液検査では, 精液量0.5ml, 精子数0.7×10^6/ml, 運動率43%となった。以後, HCG+HMG療法を継続し, 26歳時に結婚, 28歳時にICSIにて挙児を得ることができた。, A 19-year-old male, who had undergone bilateral orchiopexy at 5 years of age in the Department of Pediatric Surgery, was referred to our clinic presenting with bilateral small testes. Bilateral testis volume was 4 ml involving a small penis and scant pubic hair per Tanner Stage 2. Serum luteinizing hormone, follicle stimulating hormone and testosterone levels were low. Results of hormonal loading tests, including luteinizing hormone-releasing hormone (LH-RH) and human chorionic gonadotropin (HCG), were positive. Brain computed tomographic scan revealed no abnormal findings. The diagnosis of male hypogonadotropic hypogonadism was rendered based on these data. Administration of LH-RH for 1 year was ineffective. Subsequently, HCG and human menopausal gonadotropin (HMG) treatments were initiated. The symptoms of male insufficiency improved; moreover, sperm formation was apparent following HCG and HMG treatments. The patient has received HCG and HMG injections for eight years; furthermore, his wife delivered a boy consequent to the first intracytoplasmic sperm injection.

We report a rare case of adenocarcinoma developing in an ileal conduit. A 78-year-old woman was referred complaining of abdominal pain. She had undergone radical cystectomy and ileal conduit formation for invasive bladder cancer 8 years previously. The pathological diagnosis was urothelial carcinoma, and distant metastasis was not found. She was lost to follow-up over 2 years postoperatively. Computed tomography at this time showed bilateral hydronephrosis. Metastasis was not revealed. Because renal failure progressed and gross hematuria developed, endoscopic examination through the stoma was performed. A mass adjacent to the ureteroileal anastomosis site was found. Biopsy led to a diagnosis of moderately differentiated adenocarcinoma. She died of renal failure 1.5 months after admission. To our knowledge, 9 cases of adenocarcinoma arising in an ileal conduit have previously been reported.

前立腺疾患が疑われる81症例でTandem PSAをMarkit-M PA, γ-seminoproteinと同時に測定し, Tandem PSAの前立腺癌の診断における有用性について検討した.81症例の診断は前立腺癌16例, 前立腺肥大症56例, その他9例であった.前立腺癌16例中にはTlC症例が2例含まれていた.Tandem PSA, Markit-M PA及びγ-seminoproteinの感度はそれぞれ81.3%, 62.5%, 68.8%であり, 特異度はそれぞれ67.7%, 81.5%, 72.3%であった.又, Tandem PSAとγ-seminoproteinの比を比較検討すると, Tandem PSAが4.0ng/mlより大きい前立腺肥大症と前立腺癌症例において, この比は, それぞれ1.53±0.966, 3.21±1.811(平均±標準偏差)であり, 有意差を認めた, The Tandem PSA test was performed simultaneously with assay of Markit-M PA and gamma-seminoprotein to determine its usefulness for the diagnosis of prostate cancer in a total of 81 patients with prostate diseases. The diagnosis was untreated prostate cancer in 16 patients including 2 with T1c tumor, benign prostatic hyperplasia in 56 patients, and other diseases in 9 patients. Tandem PSA, Markit-M PA, and gamma-seminoprotein showed a sensitivity of 81.3, 62.5, and 68.8%, respectively, while the specificity was 67.7, 81.5, and 72.3%, respectively. Tandem PSA had the highest sensitivity, although the specificity and accuracy were the lowest. These results were considered to be due to the fact that the PSA level becomes significantly higher with an increase in the weight of benign prostatic hyperplasia. This indicates that the PSA density should be considered to improve the specificity of Tandem PSA. Use of the Tandem PSA/gamma-seminoprotein ratio was also examined as a possible method which might improve the specificity. Patients with benign prostatic hyperplasia and prostate cancer had a ratio of 1.53 +/- 0.966 and 3.21 +/- 1.811 (mean plus standard deviation), respectively, and these 2 groups showed a significant difference (p = 0.0008). This indicates that calculation of the Tandem PSA/gamma-seminoprotein ratio may be useful to improve the specificity of Tandem PSA for the diagnosis of prostate cancer.

1986年4月からの9年2ヵ月間に前立腺癌と診断された169例の治療結果を示し, 予後因子と患者の年齢がそれらに与える影響について検討した.予後因子として臨床病期と組織学的分化度が重要であるが, 他因死が多いことからは年齢を考慮して治療法を選択することが必要である.今後は早期診断の為のスクリーニングが必要であろう, At Matsumoto National Hospital, 169 patients with prostate cancer were diagnosed between April 1986 and May 1994. The prostate cancer incidence was the highest in the latter half of the seventies, with an average age of 74.3 years. The clinical stage was defined as A1, A2, B, C, and D2 in 24 (14.2%), 38 (22.5%), 39 (23.1%), 23 (13.6%) and 45 (26.6%) patients, respectively. The clinical stage was not correlated with the patient's age. Incidental carcinoma was discovered in 5.8% of the patients who underwent prostatectomy for benign prostatic hypertrophy (BPH). At initial diagnosis, the tumor was well, moderately, and poorly differentiated adenocarcinoma in 71 (42.0%), 64 (37.9%), and 34 (20.1%) patients, respectively. The median follow-up period was 38.7 months. The over all five-year crude survival rate was 54.8%, while the cause-specific five-year survival rate was 80.0%. The five-year crude survival rate was 58.4, 82.0, 55.2, 42.5 and 37.4%, for patients with cancer at stage A1, A2, B, C, and D. The survival rate was higher for patients with cancer at clinical stage A and shorter for those with cancer at clinical stage D than in other stages. Prognosis was also worse in patients with moderately or poorly differentiated adenocarcinoma than in those with well-differentiated adenocarcinoma. The clinical stage and the pathological grade are important as prognostic factors, although the high incidence of death from other diseases shows that the patients' age should be considered to choose the modality of therapy. These findings indicate that intensive treatment of the patients in clinical stage A2, B and C prostate cancer in combination with screening for the men between 50 and 75 years old for early cancer detection is required.

膀胱全摘除術後の尿路再建の際, 10例でValtracを腸管吻合に用いた.原疾患は膀胱腫瘍が8例で, 神経因性膀胱が1例, 膀胱に浸潤したS状結腸癌が1例であった.吻合の種類は回腸回腸が8例, 回腸上行結腸が2例であった.縫合不全や吻合部からの漏れを起こした例はなかった.術後15日目及び16日目に3例が軽度閉塞を経験し, 嘔吐がみられたが, 保存的療法で速やかに軽快した.これら以外には, 術後1ヵ月～1年(平均7.3ヵ月)の観察期間中に腸閉塞症状を呈した例はなかった, Valtrac, a biofragmentable anastomosis ring, was used in 10 patients who underwent total cystectomy and urinary tract reconstruction. The primary disease was bladder tumor, neurogenic bladder, and sigmoid colon cancer invading the bladder in 8, 1, and 1 of the patients, respectively. There were 8 ileo-ileostomies and 2 ileo-colostomies. No patient developed anastomotic leakage or insufficiency. Symptoms of mild bowel obstruction were observed in 3 patients, but they improved with conservative management. The outcome was good in all the patients without further ileus during a follow-up period of 1 to 12 months (median: 7.3 months). The most important advantage of this device is that precise bowel anastomosis is standardized and can be achieved safely and quickly. Our findings indicate that the Valtrac system offers a reliable and reproducible alternative to conventional anastomotic techniques in urologic surgery.

65歳女.副腎に大きな腫瘤を形成した為に副腎腫瘍と診断され, 摘出組織の病理組織学的検索から副腎原発悪性リンパ腫と診断された症例を経験した.更に術後に出血傾向がみられた為, 骨髄生検を行い, 骨髄浸潤が証明された, A 65-year-old woman visited our hospital complaining of general fatigue and nausea. CT scan revealed a homogeneous mass in the left adrenal gland, which was seven centimeters in diameter. Mild swelling of the right adrenal gland was also suspected. We failed to find the primary tumor, although a metastatic non-functioning adrenal tumor was suspected. Adrenalectomy was performed under the diagnosis of a non-functioning adrenal tumor. Pathological examination showed a non-Hodgkin's lymphoma. Since a bleeding tendency gradually developed following the operation, a bone marrow biopsy was done, revealing an invasion by tumor cells. Patients with a malignant lymphoma involving the bone marrow should not be operated on because fatal complications may develop postoperatively. A malignant lymphoma should be considered as a possible diagnosis of adrenal tumors, although it is very rare.

A 76-year-old man was seen at this hospital for the treatment of asymptomatic gross hematuria. Retrograde pyelography revealed a filling defect in the left lower calyx. The diagnosis was left renal pelvic carcinoma by urinary cytology. The patient underwent left nephrouretectomy with partial cystectomy. Hemosiderin accumulation on histological examination demonstrated an arteriovenous malformation in the left lower calyx. Transitional cell carcinoma was confirmed apart from the arteriovenous malformation, and no relation between the two was seen. These findings suggest the coexistence of a renal arteriovenous malformation with a renal pelvic and ureteral carcinoma. Hematuria was due probably to rupture of the renal arteriovenous malformation.

残尿感を主訴とする14歳男児で, 超音波検査及び膀胱鏡検査で前立腺部尿道に腫瘤(1.5×1.8cm)を認めた.経尿道的切除を行い, 組織学的に線維性ポリープと診断された.術後1年に再発の徴候はない, A case of posterior urethral polyp in a child is reported. A 14-year-old boy presented to our hospital with the chief complaint of a sense of residual urine. Ultrasound sonography and cystoscopy showed a posterior urethral tumor (1.5 cm x 1.8 cm). Transurethral resection was performed, and the pathological diagnosis was a fibrous polyp. One year after transurethral resection, the patient showed no signs of recurrence. Only 8 cases of posterior urethral polyp in children have been previously reported in the Japanese literature.

An 81-year-old man on chronic hemodialysis was referred to our hospital with urinary difficulty. Transperineal needle biopsy of a hard nodule in the prostate revealed moderately differentiated adenocarcinoma. He was diagnosed to have stage C prostate cancer. A standard dose of luteinizing hormone-releasing hormone (LH-RH) analogue, leuprorelin acetate (3.75 mg), was administered every 4 weeks for 15 months. No adverse effects were observed throughout the period. The clinical response to LH-RH analogue was excellent, with normalization of serum prostate-specific antigen level and relief of dysuria. Thus the standard dosage of LH-RH analogue is considered to be adequate for hemodialysis patients.

An 8-year-old boy presented with asymptomatic gross hematuria. Clinical investigation revealed an 8-cm left renal tumor accompanied with marked calcification. Radical nephrectomy with lymph node dissection was performed. Pathological diagnosis was Wilms' tumor without lymph node metastasis. He has been free of recurrence 20 months postoperatively. Our case features prominent calcification on radiological examination, which is uncommon in Wilms' tumor. We reviewed the literature on the relationship between renal tumors and calcification.

1. Effects of A-322312 (alpha(1B)-adrenoceptor (AR) antagonist), A-119637 (alpha(1D)-AR antagonist), prazosin (non-selective alpha(1)-AR antagonist), and yohimbine (alpha(2)-AR antagonist) were studied in rat corpus cavernosum (CC) and cavernous artery (Acc) preparations. Effects of intracavernous (i.c.) or intraperitoneal (i.p.) administration of alpha(1)-AR antagonists on apomorphine-induced erections were investigated. 2. A-119637 attenuated electrically induced contractions in isolated CC (-logIC(50); 8.12+/-0.15), and relaxed noradrenaline (NA)-contracted preparations by more than 90% at 10(-7) M. At the same concentration, the -logEC(50) value for NA in Acc was altered from 6.79+/-0.07 to 4.86+/-0.13. In the CC and Acc, prazosin similarly inhibited contractile responses. 3. Inhibitory effects of A-322312 (10(-7) M) in electrically activated CC were 32.3+/-5.1%, whereas no effect on concentration-response curves for NA was observed in the Acc. Yohimbine (10(-8) M and 10(-7) M), enhanced electrically-induced contractions in isolated CC by 20 to 50%. At 10(-6) M, inhibitory effects of yohimbine were obtained. 4. A-119637 (0.3 micromol kg(-1), i.p.) tripled the number of erections, and produced a 6 fold increase in the duration of apomorphine-induced erectile responses. A-322312, prazosin, or yohimbine did not enhance erections induced by apomorphine. None of the alpha(1)-AR antagonists significantly increased ICP upon i.c. administration. Decreases in blood pressure were seen with A-119637 and prazosin. 5. The present findings show that there is a functional predominance of the alpha(1D)-AR subtype in the rat erectile tissue, and that blockade of this receptor facilitates rat penile erection induced by a suboptimal dose of apomorphine.