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Lymphoepithelioma-like carcinoma (LELC) of the ureter is very rare and only 14 previous cases have been reported. Here, we report a case of LELC of the ureter. A 76-year-old woman was admitted to our hospital complaining of gross hematuria. Left ureteral cancer was suspected by the imaging examination, and laparoscopic left total nephroureterectomy was performed. Histopathological examination showed pure type of LELC in the ureter. She is alive without disease recurrence at fifteen months after surgery.

Lymphoepithelioma-like carcinoma (LELC) of the ureter is very rare and only 14 previous cases have been reported. Here, we report a case of LELC of the ureter. A 76-year-old woman was admitted to our hospital complaining of gross hematuria. Left ureteral cancer was suspected by the imaging examination, and laparoscopic left total nephroureterectomy was performed. Histopathological examination showed pure type of LELC in the ureter. She is alive without disease recurrence at fifteen months after surgery.

A 62-year-old woman underwent laparoscopic radial nephrectomy for the left renal cell carcinoma in September 2008. In July2016, the patient developed asymptomatic gross hematuria. Computed tomography (CT) revealed the enlargement of the left ureteral stump and an 11mm nodule in the superior lobe of the right lung. Since [F-18] fluoro-D-glucose-positron emission tomography-CT FDG PET-CT demonstrated a lung tumor, we decided to perform right upper lobectomybyvideo-assisted thoracoscopic surgeryin September. The patient was diagnosed with metastatic renal cell carcinoma. We then removed the left ureteral stump and performed partial cystectomy in November. A pathological examination revealed that the tumor was metastatic clear cell renal cell carcinoma invading the muscle layer. Two months later, the patient developed gross hematuria again. Cystoscopy revealed a 1cm tumor around the scar of partial cystectomy. Transurethral resection was performed, and a pathological examination revealed metastatic renal cell carcinoma. We herein report this case of renal cell carcinoma in which recurrence occurred in the ureteral stump, 8 years after radical nephrectomy.

A 74-year-old man underwent transurethral resection for a bladder tumor (TURBT). The pathological diagnosis was urothelial carcinoma, grade 3 pT2 at least. He desired preservation of the bladder. Thus, MEC (methotrexate 100-150 mg/body (day 1), etoposide 100 mg/m2 (day 2-4), cisplatin 20 mg/m2 (day 2-6)) chemotherapy was administered for 2 courses. The next year, he had a relapse in the bladder, and the pathological diagnosiswasurothelial carcinoma, grade 2 pTa and pTis. He underwent Calmette-Guerin Bacillus (BCG) immunotherapy for 6 courses that resulted in a complete response without recurrence for 6 years. Six months after the latest examination, he complained of difficulty in voiding. An 8 cm tumor in the bladder and enlargement of obturator lymph node were detected. The pathological diagnosis by TURBT was small cell carcinoma. He rejected cystectomy, so we applied MEC therapy again. After 2 courses of MEC therapy, the bladder tumor and lymphadenopathy markedly shrunk in image and almost disappeared subsequently. The patient refused further therapy, but he had been followed without recurrence for 48 monthsafter the chemotherapy.

We describe a case of testicular tumor with multiple metastasis to the lung, retoroperitoneal lymph node, and brain. After chemotherapy the retroperitoneal lymph node and brain metastasis disappeared, but the multiple pulmonary metastases but not disappear, although they were reduced in size. Since the human chorionic gonadotoropin (HCG) was persistently dected at a low level, we performed a testosterone tolerance test. The HCG level became undetectable for a while, but was detected at a low level again. Then the patient underwent residual tumor removal of some of the residual pulmonary disease, which was diagnosed as tumor necrosis. The patient has been followed on an ambulatory basis after surgery for 12 months without recurrence. In this case a definitive diagnosis was difficult, because of the low positive level of HCG.

Figure S1. The expression of PD-L1 in human bladder cancer cell lines. (PPTX 71 kb)

A 56-year-old man was admitted to our hospital for urachal carcinoma with peritoneal dissemination. He received first-line chemotherapy with gemcitabine and cisplatin. After the fifth cycle, a computed tomography (CT) scan revealed abdominal fluid, and his serum tumor marker levels were increased. The patient was started on second-line therapy with FOLFIRI. After 11 cycles, his tumor decreased in size and no new metastatic lesions were detected. The patient underwent complete tumor resection with partial cystectomy and pelvic lymph node dissection. The tumor was removed, along with adhering surrounding organs, including the omentum, peritoneum, abdominal rectus muscle, and vermiform appendix. Although pathological examination confirmed peritoneal dissemination, his tumor markers normalized soon after surgery. The patient has survived 62 months after surgery without any adjuvant therapy and with no evidence of recurrence. To our knowledge, this is the longest duration of survival without recurrence of a patient with urachal carcinoma with peritoneal dissemination who received multimodal therapy.

A 62-year-old woman underwent laparoscopic radial nephrectomy for the left renal cell carcinoma in September 2008. In July2016, the patient developed asymptomatic gross hematuria. Computed tomography (CT) revealed the enlargement of the left ureteral stump and an 11mm nodule in the superior lobe of the right lung. Since [F-18] fluoro-D-glucose-positron emission tomography-CT FDG PET-CT demonstrated a lung tumor, we decided to perform right upper lobectomybyvideo-assisted thoracoscopic surgeryin September. The patient was diagnosed with metastatic renal cell carcinoma. We then removed the left ureteral stump and performed partial cystectomy in November. A pathological examination revealed that the tumor was metastatic clear cell renal cell carcinoma invading the muscle layer. Two months later, the patient developed gross hematuria again. Cystoscopy revealed a 1cm tumor around the scar of partial cystectomy. Transurethral resection was performed, and a pathological examination revealed metastatic renal cell carcinoma. We herein report this case of renal cell carcinoma in which recurrence occurred in the ureteral stump, 8 years after radical nephrectomy.

A 90-year-old female patient presented with dysuria. She was treated with partial excision of the mass protruding from the urethral meatus. Pathological examination revealed non-Hodgkin's malignant lymphoma of the B-cell type. The patient received a total of 42.4 Gy extrabeam irradiation. Our patient was disease-free for 14 months. We reviewed 25 cases of this rare entity reported previously.

A 5-month-old-male was brought to our hospital in April 2004 with left scrotal swelling. His serum alpha-fetoprotein AFP and human chorionic gonadotropin-β levels were 6, 862.9 and ＜ 0.1 ng/ml, respectively. Computed tomography (CT) revealed no metastasis. Left high ligation of testis was performed. Pathological examination demonstrated Yolk sac tumor. He is alive without evidence of recurrence for 53 months postoperatively.

Silodosin (URIEF), a new so-called 3rd generation alpha-1 blocker, is widely expected to be effective and useful for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), due to its high specificity to alpha-1A receptor. We evaluated the efficacy of Silodosin, on 187 males 50 years old or over with the diagnosis of BPH. Silodosin significantly improved the International Prostate Symptom Score (IPSS) and quality of life (QOL) score from the day after administration was started. Among 166 patients whose data were available for the analysis of efficacy of Silodosin, 77.5% showed apparent subjective improvement. Eighty three patients, who had been taking another alpha-1 blocker but without satisfactory effects, showed almost the same improvements in IPSS and QOL score after switching to Silodosin as the remaining 83 patients who had no preceding treatment with an alpha-1 blocker. The improvements were not only in voiding symptoms but also in storage symptoms. The patients, who had serious storage symptoms, responded rather well to Silodosin and showed significant improvement. Taken together, Silodosin showed a quick effect for improving subjective symptoms and QOL, and was found to be useful for the management of LUTS with BPH., 2006年11月～2007年10月の前立腺肥大症166例(年齢69.9±6.4歳)を対象にシロドシン服用後超早期での有効性を検討した。シロドシン8mg/日を2週間処方し、排尿症状日誌に国際前立腺症状スコア(IPSS)、QOLスコア、BPH impact indexを記入してもらい、効果判定を行った。その結果、IPSSは服用開始後1、2、3日目と低下し、いずれの観察日も開始時と有意差を認め、14日目は更に低下した。QOLスコアも同様に有意な低下を示し、IPSSとQOLスコアの相関関係を認めた。また、α1遮断薬から切り替えた患者とα1遮断薬を初めて服用した患者との比較では、両群とも服用後1日目からIPSSは有意に低下して14日目まで低下し続け、2群間に有意差は認めなかった。14日目の治療判定ではExcellent 25例、Well 99例、Poor 36例であり、Poor例はいずれの観察日もIPSSの低下を認めなかった。IPSSのサブスコアの排尿、蓄尿症状の変化量は服用後1日目より有意に改善し、蓄尿症状重症例においても同様に1日目より有意に改善効果を認めた。副作用は187例中23例(12.3%)に認め、下痢が11例5.9%と最も多く、重篤な副作用は認めず、高齢により高くなる傾向は認めなかった。以上よりシロドシンの早期からの効果が判明し、無効な症例では早い時点で適した薬剤・治療法の提供が可能になると考えた。

65歳男性, 71歳男性。患者は腎癌根治的腎摘出術後8年目, 9年目のCTにて左横隔膜下の腫瘍を認めた。いずれも局所再発の可能性も考えられたが, 術中の脾損傷により脾臓摘出術が施行されていたため, 脾臓シンチグラフィーを行った結果, 脾症と確定診断された。, Splenosis is autotransplantation of splenic tissue and usually follow traumatic or surgical rupture of the spleen. We report two cases of splenosis which presented as a local recurrence after radical nephrectomy for left renal cell carcinoma (RCC). The patients were a 65- and a 71-year-old male, who had been operated for RCC including splenectomy because of disrupture of the splenic capsule 8 and 9 years earlier respectively. In both cases, follow up computed tomographic scans showed small nodules under the left diaphragm. Although we initially suspected local recurrence, we considered the possibility of splenosis. Both patients underwent technetium-99m Sn colloid scans and were diagnosed with splenosis successfully. Therefore, we could avoid unnecessary surgical explorations.

18年間に浸潤性膀胱癌で膀胱全摘除術および骨盤内リンパ節郭清術が施行され, 3ヵ月以上経過観察が可能であった膀胱原発移行上皮癌104例を対象に, 生存率と予後規定因子について統計的に解析した.1)N(リンパ節転移を示す病理分類)-症例で, 郭清リンパ節数が多ければ予後の保証が得られ, 不十分なリンパ節郭清では正確な診断も得られず, 治療できるチャンスも少なくなると考えられた.2)単変量解析で有意差が存在した予後因子は, 腫瘍の大きさ, 腫瘍の形態, pT, N, pvであった.これら5因子について多変量解析すると, 腫瘍の形態とN因子が有意であり, N因子に最も予後因子としての重みが存在していた, The objective of this study was to know the effects of pelvic lymph node dissection on the survival of the patients who received radical cystectomy without neoadjuvant chemotherapy or radiotherapy. Between 1984 and 2000, 104 patients underwent operation at our institution for tumors clinically diagnosed as locally invasive bladder cancer (T2-4NxM0). Survival rates and 8 prognostic factors (age, sex, size, multiplicity, type, pT, N, pv) were analyzed by uni- and multivariate analysis. The significant factors were size, type, pT, N, pv by univariate analysis. Of these 5 factors, N factor was the most significant by multivariate analysis. Patients (N-) who had more than 20 lymph nodes retrieved showed better survival than the others.

A 74-year-old man underwent transurethral resection for a bladder tumor (TURBT). The pathological diagnosis was urothelial carcinoma, grade 3 pT2 at least. He desired preservation of the bladder. Thus, MEC (methotrexate 100-150 mg/body (day 1), etoposide 100 mg/m2 (day 2-4), cisplatin 20 mg/m2 (day 2-6)) chemotherapy was administered for 2 courses. The next year, he had a relapse in the bladder, and the pathological diagnosiswasurothelial carcinoma, grade 2 pTa and pTis. He underwent Calmette-Guerin Bacillus (BCG) immunotherapy for 6 courses that resulted in a complete response without recurrence for 6 years. Six months after the latest examination, he complained of difficulty in voiding. An 8 cm tumor in the bladder and enlargement of obturator lymph node were detected. The pathological diagnosis by TURBT was small cell carcinoma. He rejected cystectomy, so we applied MEC therapy again. After 2 courses of MEC therapy, the bladder tumor and lymphadenopathy markedly shrunk in image and almost disappeared subsequently. The patient refused further therapy, but he had been followed without recurrence for 48 monthsafter the chemotherapy.

We describe a case of testicular tumor with multiple metastasis to the lung, retoroperitoneal lymph node, and brain. After chemotherapy the retroperitoneal lymph node and brain metastasis disappeared, but the multiple pulmonary metastases but not disappear, although they were reduced in size. Since the human chorionic gonadotoropin (HCG) was persistently dected at a low level, we performed a testosterone tolerance test. The HCG level became undetectable for a while, but was detected at a low level again. Then the patient underwent residual tumor removal of some of the residual pulmonary disease, which was diagnosed as tumor necrosis. The patient has been followed on an ambulatory basis after surgery for 12 months without recurrence. In this case a definitive diagnosis was difficult, because of the low positive level of HCG.

A 19-year-old woman was admitted to our hospital with a complaint of residual feeling, frequency and pain on urination. Laboratory analysis revealed an elevated eosinophilia count in peripheral blood and white blood cell count in urine. Lymphocyte stimulation test of Chinese herb named "Seijoh-bohhuh-toh" showed a positive reaction. Bladder symptoms were improved after ceasing this Chinese herb. From these points, we considered that the Chinese herb might have caused eosinophilic cystitis. We report this rare case witha review of the literature.