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A total of 100 patients were retrospectively analyzed with magnetic resonance imaging-ultrasonography (MRI-US) fusion biopsy(KOELIS, TRINITY®) at our institution between October 2019 and May 2020. The median patient age was 71 years, median prostate specific antigen (PSA) level was 7.4 ng/ml, and median PSA-density was 0.183 mg/ml. Sixty-one of the patients were positive for cancer ; 14 of them were positive by targeted biopsy only, 9 were positive by systematic biopsy only, and 38 were positive by both. Clinically significant prostate cancer (CPSC ; Gleason Score ≥3＋4 and % core ≥50%) was detected by target biopsies in 46 patients and by systematic biopsies in 33 patients. The positive core detection rate for CSPC was 32.5% for targeted biopsies and 7.0% for systematic biopsies(P＜0.0001), with a significantly higher rate for targeted biopsies. These results indicate that in MRI-US fusion biopsy, targeted biopsy has a higher detection rate for cancer and a significantly higher detection rate for clinically significant prostate cancer compared with systematic biopsy.

Solitary fibrous tumor (SFT) of the kidney is a rare entity and usually displays a favorable prognosis. We herein report a second case of renal SFT developing local recurrence. A 50-year-old man was referred to our hospital because of a left renal mass. An abdominal CT detected a large renal tumor and radical nephrectomy was performed with a possible diagnosis of renal cell carcinoma. The resected tumor size was measured at 17 × 11 × 8 cm. Grossly, necrosis was observed in central lesion of the tumor but hemorrhage was not observed. Microscopically, the tumor consisted of spindle-shaped cells with scant cytoplasm accompanied by hyalinized collagenous tissue, which displayed hemangiopericytomatous patterns. The cellularity was normal and nuclear pleomorphism was not observed. Ki-67 labeling index was less than 3%. The pathological diagnosis of SFT was made without obvious malignant findings. Three years after the surgery, a follow-up CT scan detected a mass lesion in the tumor bed. Surgical resection was performed and the resected tumor was compatible with local recurrence of the SFT without obvious malignant findings. Renal SFT should be carefully monitored even in the absence of obvious malignant findings.

We report the first case in Japan of paraneoplastic dermatomyositis with pure seminoma, a tumor that extremely rarely accompanies dermatomyositis. The patient presented to the hospital with muscle weakness and erythema and was diagnosed with dermatomyositis from skin biopsy. Routine radiological screening revealed testicular tumor and massive lymph node metastases. We initially performed orchiectomy along with conventional immunotherapy. However, muscle weakness gradually worsened, and he eventually showed dysphagia and forced respiration and became bedridden. Although he seemed close to being too unstable to tolerate further treatment, we started carefully adjusted chemotherapy comprising 4 courses of etoposide plus cisplatin, which proved highly successful. Lymph node metastases completely disappeared and swallowing and respiration fully normalized after completing chemotherapy. We believe that this clinical success was due to our decision to initiate chemotherapy even in such a weak patient.

男性更年期障害(LOH)で暫定的指標として定めた値である血中総テストステロン(TT)3.18ng/ml, 遊離型テストステロン(FT)10.0pg/ml未満を示した50名(年齢34～81歳)を対象としたが解析可能は36名であった。調査項目のCut off値を定め, 男性更年期障害の症状スコア(AMS)総得点50点未満の軽/中等症25名と50点以上の重症11名, TT3.18ng/ml以上の高値12名と未満の低値24名, FT7.3pg/ml(YAM値の50%)以上の高値20名と未満の低値16名, FT9.1pg/ml(YAM値の60%)以上の高値7名と低値20名を重症度分類で2分割し比較した。男性ホルモン軟膏使用前後におけるAMS, 国際勃起機能スコア(IIEF5), 健康調査票(SF-36)変化ではAMSの心理ドメイン, SF-36の体の痛み(BP), 社会生活(SF), RE日常的役割においてAMSスコアが高い重症群に, より改善が見られ有意差を認めた。また, TT値の高値群においてSF-36のBPに, より改善が見られたがその他に有意差は認められなかった。, The most basic treatment for late-onset hypogonadism (LOH) is hormone replacment therapy (HRT). In Japan, intra-muscular injection of testosterone (T) has been used for LOH treatment as HRT. Testosterone ointment (Glowmin) has been available for HRT from 1965 as an over-the-counter drug, and the profile of serum T levels and efficacy of testosterone ointment for LOH patients has been reported. In this study, we analyzed the relationship between the efficacy of testosterone ointment and LOH severity. Fifty LOH patients were treated with 6 mg of testosterone ointment per day. After 12 weeks of treatment, they were divided into 2 groups according to the severity of their LOH, serum total T and free T levels, measured by such means as total aging males' symptoms (AMS) score. The improvements of total AMS score, international index of erectile function 5 score and MOS 36-Item Short-Form Health Survey (SF-36) score were observed and analysis of variation was performed. Results showed that the symptoms in the more severe patients had a total AMS score improvement in 4 domains, AMS (psychological), SF-36 body pain (BP), social function (SF), role-emotion, compared to patients with slight LOH. While patients with normal serum T levels felt BP improvement as opposed to patients with low serum T levels, there was no significant difference in the other domains. In conclusion, testosterone ointment is considered to be effective in improving several elements of AMS and SF-36 in patients with a high AMS score.