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A 31-year-old man was referred to our hospital for macroscopic hematuria. An abdominal computed tomography (CT) scan showed a 36×30 mm enhancing left renal tumor with tumor thrombus extending into the left renal vein. Therefore, we diagnosed the tumor as a clinically classified cT3aN0M0 left renal cell carcinoma. Retroperitoneal laparoscopic radical left nephrectomy with renal vein thrombectomy was performed, with removal of the left kidney with the mass and tumor thrombus en bloc. The pathological diagnosis was epithelioid angiomyolipoma (EAML) of the left kidney. EAML is a rare tumor with malignant potential. In this case, although no signs of recurrence or metastasis have been observed for 9 months post-operation, we recommended a careful follow-up regimen.

A 71-year-old woman underwent left radical nephrectomy for renal cell carcinoma (clear cell carcinoma, pT1bN0M0) ten years previously. She noticed a tumor on the tip of her tongue and was admitted for dental and oral surgery. The tumor was about 10 mm in size, and tumor resection was done. It was pathologically diagnosed as clear cell carcinoma, which was metastasis of renal cell carcinoma. Computer tomography scan during the same period revealed left hilar lymph node and bilateral lung metastases. We chose to use sunitinib as the treatment for the metastases. Computer tomography revealed a complete response (CR) after sunitinib treatment was given for 10 months, and we are still continuing the treatment to maintain the CR status.

A 67-year-old woman was referred to our hospital for precise examination and treatment as an abdominal computed tomographic (CT) scan showed a retroperitoneal tumor located below the hilus of the rightkidney. The enhanced CT and magnetic resonance imaging (MRI) revealed contrastenhancementin both early and late phase, which confirmed that the tumor showed abundant blood perfusion and adhered to the duodenum. We performed open surgery in order to remove the tumor and make a precise diagnosis. The tumor was excised en bloc with a part of the gonadal vein because the right gonadal vein was adjacent to the tumor in the craniocaudal direction. The pathological diagnosis was arteriovenous malformation. Arteriovenous malformation located in the retroperitoneum is very rare.

Juxtaglomerular cell tumor (JGCT) is a rare renal tumor, producing renin and behaving almost in a benign fashion. So far, only three cases have been reported as malignant. We report a rare case with atypical JGCT. A 74-year-old male was referred to our hospital due to hypertension, proteinuria, and hematuria. Abdominal CT revealed a mass measured in 9.7×7.0 cm in the lower portion of the right kidney. Right kidney was removed laparoscopically. Grossly, white to tan tumor with massive hemorrhage and necrosis occupied the lower portion of the right kidney. Microscopically, tumor grew in a solid fashion. Tumor cells were polygonal to ovoid cells with round nuclei and clear to eosinophilic cytoplasm. Mitosis was found in 5 per 10 HPF. Immunohistochemically, tumor cells were stained by vimentin and CD34. Some tumor cells were also positive for renin. Electron micrograph showed near rhomboid crystalline structure in the tumor cells. Because of massive necrosis and mitotic figures, diagnosis of atypical (potentially malignant) JGCT was rendered. Gene mutations for IDH1, PIK3CA, K-ras, N-ras, Braf, and EGFR were not found by MBP-QP system.

A 67-year-old uniparous woman had undergone surgery for acute perforated gastric ulcer 10 years prior to the current presentation. Although abdominal computed tomography (CT) performed at that point had revealed a mature cystic teratoma measuring 6 cm in diameter in the right ovary, it was left untreated. She visited the department of surgery at our hospital with chief complaints of appetite loss, nausea, and vomiting that had persisted for the prior two weeks. She was admitted with a diagnosis of ileus attributed to an abdominal incisional hernia. CT performed on admission revealed a tumor measuring 21 cm in diameter with mural nodules in the right ovary. Thus, surgery was performed under suspicion of malignant transformation of the previously detected ovarian mature cystic teratoma. While neither lymphadenopathy nor distant metastasis was detected by imaging studies, bilateral adnexectomy and repair of the abdominal incisional hernia were performed. Cytology of ascites was negative. The postoperative pathological diagnosis was squamous cell carcinoma arising from teratoma, and the postoperative clinical diagnosis was stage IA ovarian cancer. It was assumed that the mature cystic teratoma which had been detected in the right ovary 10 years earlier had undergone malignant transformation.

A 31-year-old man was referred to our hospital for macroscopic hematuria. An abdominal computed tomography (CT) scan showed a 36×30 mm enhancing left renal tumor with tumor thrombus extending into the left renal vein. Therefore, we diagnosed the tumor as a clinically classified cT3aN0M0 left renal cell carcinoma. Retroperitoneal laparoscopic radical left nephrectomy with renal vein thrombectomy was performed, with removal of the left kidney with the mass and tumor thrombus en bloc. The pathological diagnosis was epithelioid angiomyolipoma (EAML) of the left kidney. EAML is a rare tumor with malignant potential. In this case, although no signs of recurrence or metastasis have been observed for 9 months post-operation, we recommended a careful follow-up regimen.

Mature cystic teratoma is one of the most common ovarian neoplasms, but extragonadal teratoma is rare. Teratoma in Douglas’ pouch is extremely rare, and only 12 cases have been reported since the first case was described in 1978. We report a 20-year-old woman with a multicystic mass in Douglas’ pouch that was treated via laparoscopic resection. The tumor consisted of cysts lined by stratified squamous epithelium with an accumulation of keratin debris and various mature tissues. No immature elements or malignancy was found in the tumor, confirming the pathologic diagnosis of a mature cystic teratoma. The teratoma contained no ovarian tissues and both of the ovaries were intact on laparoscopy. These findings suggest that the teratoma originated primarily in Douglas’ pouch rather than being caused by autoamputation of a previously existing ovarian teratoma. This is the first case that simultaneously showed normal ovaries and a teratoma in Douglas’ pouch on laparoscopy.

A 71-year-old woman underwent left radical nephrectomy for renal cell carcinoma (clear cell carcinoma, pT1bN0M0) ten years previously. She noticed a tumor on the tip of her tongue and was admitted for dental and oral surgery. The tumor was about 10 mm in size, and tumor resection was done. It was pathologically diagnosed as clear cell carcinoma, which was metastasis of renal cell carcinoma. Computer tomography scan during the same period revealed left hilar lymph node and bilateral lung metastases. We chose to use sunitinib as the treatment for the metastases. Computer tomography revealed a complete response (CR) after sunitinib treatment was given for 10 months, and we are still continuing the treatment to maintain the CR status.

A 67-year-old woman was referred to our hospital for precise examination and treatment as an abdominal computed tomographic (CT) scan showed a retroperitoneal tumor located below the hilus of the rightkidney. The enhanced CT and magnetic resonance imaging (MRI) revealed contrastenhancementin both early and late phase, which confirmed that the tumor showed abundant blood perfusion and adhered to the duodenum. We performed open surgery in order to remove the tumor and make a precise diagnosis. The tumor was excised en bloc with a part of the gonadal vein because the right gonadal vein was adjacent to the tumor in the craniocaudal direction. The pathological diagnosis was arteriovenous malformation. Arteriovenous malformation located in the retroperitoneum is very rare.