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A 63-year-old man was referred to our department because of painless hard mass in the right inguinal region. Abdominal computed tomography (CT) showed right spermatic cord mass measuring 25 mm in diameter. We performed right high orchiectomy. Histopathological diagnosis was dedifferentiated liposarcoma, which included myofibroblast components. He was alive 3 years postoperatively without recurrence.

Eight elderly patients (average age 76.1±4.3 years) with balanitis xerotica obliterans (BXO) accompanied by phimosis presented with difficulty in urination. Preoperative average international prostate symptom score, average maximum urinary flow rate, and average volume of residual urine were 20.7±6.3 points (n＝8), 5.1±3.6 ml/s (n＝5), and 85.4±77.3 ml (n＝8), respectively. Some of the patient’s complaints, such as severe dribbling of urine, urinary stream division, and ballooning of the foreskin, were not included in the items of the major questionnaire on urination. Dorsal incision and circumcision was performed in all patients, and all were pathologically diagnosed with BXO. Meatoplasty was performed in one patient with a meatal stenosis. No coexistence of penile cancer was observed. Statistically significant improvements were observed in subjective and objective findings after treatment. In conclusion, BXO with phimosis in elderly patients should be considered as a cause of lower urinary tract symptoms.

A 63-year-old man was referred to our department because of painless hard mass in the right inguinal region. Abdominal computed tomography (CT) showed right spermatic cord mass measuring 25 mm in diameter. We performed right high orchiectomy. Histopathological diagnosis was dedifferentiated liposarcoma, which included myofibroblast components. He was alive 3 years postoperatively without recurrence.

A 31-year-old man presented with edema in left lower leg and dyspnea. Computed tomographic scanning detected a right testicular tumor, multiple lung nodules, and inferior vena cava (IVC) thrombus. After insertion of an IVC filter, high inguinal orchiectomy was performed after the first combination chemotherapy. Pathological examination demonstrated an embryonal carcinoma with vascular invasion and direct tumoral extension into the right spermatic cord. According to our survey, this is the 14th case of testicular tumor with IVC thrombus in Japan.

1995年1月～2005年12月に新規前立腺癌と診断された206例(年齢49～99歳)を74歳以下(92例), 75歳以上(114例)に分けて検討 した。観察期間は4～517週であった。受診年齢に大きな変化はなく, 受診動機は有症状例が多く75歳以上ではその傾向が顕著で尿閉や転移症状など重篤な 症状も多く認めた。75歳以上ではPSA中央値も高くGleason Score(GS)7以上の症例が多く, 病期C, Dの進行例の割合も高かった。初期治療は待機治療4例, 手術療法32例, 放射線療法3例, ホルモン療法 167例で, リスク分類では待機療法可能な症例は74歳以下が32例(34.8%), 75歳以上が21例(18.4%)であった。尿閉をきたした症例23 例に対するホルモン療法での改善率は60.9%で治療内容別の改善率に有意差はないが, 74歳以下は全例で自己排尿可能となり75歳以上では47.1%と 不良で重篤な有害事象を4例認めた。観察中の死亡は55例で74歳以下が18例, 75歳以上が37例と有意差を認め75歳以上の19例は他因死であり2群 間の疾患特異的生存率に有意差はなかった。ホルモン療法は良好な治療効果の反面, 血栓症や認知症の有害事象を認め, 74歳以下で2例, 75歳以上で8例が QOLを大きく影響する認知症を発症した。以上から, 合併症の多さや社会的問題から高齢者前立腺癌の個別治療の確立および包括的医療の必要性が示唆され た。, To evaluate the present status of prostate cancer in patients 75 years of age or older, we reviewed clinical characteristics of prostate cancer in patients from the Kitamurayama Hospital. The number of symptomatic advanced cases was greater in patients > or = 75 years old compared with patients < or = 74 years old. However, no significant difference in cause-specific survival rate was found between the two groups. In the cases examined, the difference in biological characteristics between groups did not affect the prognosis. On the other hand, for patients > or = 75 years old, improvement of urinary retention was low, and the incidence of adverse drug responses to endocrine therapy, such as dementia and thrombosis, was high. We recognize the necessity of a comprehensive medical plan that attaches importance to quality of life and safety for the treatment of patients over 75 years old with prostate cancer.

症例は70歳男性で無痛性右陰嚢腫脹を主訴とした.超音波パワードプラ法(PDU)で陰嚢部腫瘤の大半は大小不同の嚢胞で, 腫瘤の辺縁にやや低エコーを示す精巣上体と思われる部位を認めた.PDUにおいては血流増加は認められなかった.右精巣腫瘍が否定できなかったため右高位精巣摘除術を施行した.病理組織学的所見で精巣上体に中心壊死及びラングハンス巨細胞を含む結核結節を認めたため精巣上体結核と診断した.精巣上体結核は稀な疾患であり術前に診断することは困難なことが多いと考えられる.高齢者の再燃など結核総数の増加が報告されており, 日常診療で念頭におかなければならない疾患の1つである, A 70-year-old man complaining of painless right scrotal swelling was referred to our hospital. He had a past history of left nephrectomy for renal tuberculosis at the age of 28. Power Doppler ultrasonography revealed a hypoechoic and hypovascular tumor with septa in the scrotum. We suspected a right testicular tumor and therefore, performed a right high inguinal orchiectomy. On macroscopic findings, the fluid of the tumor was yellowish and mucinous and the ipsilateral testis was remarkably atrophic. The pathological diagnosis was tuberculous epididymitis with central necrosis. In recent years, tuberculous epididymitis is rare, and this case was considered to be the first report of power Doppler ultrasonographic findings in tuberculous epididymitis.

1)過去13年間に精巣胚細胞腫瘍52例53腫瘍を治療した.Stage Iはおもに経過観察, 進行例はVAB-6療法3コースで治療し, PR例には追加療法を行った. 2)Stage Iの経過観察とした31腫瘍中6腫瘍に再発を認め, seminoma 23腫瘍中2腫瘍, NSGCT 8腫瘍中4腫瘍とNSGCTに高率であった.NSGCT中における脈管浸潤及び胎児性癌の存在が, 再発の危険因子と考えられた. 3)Seminoma stage II及びIII4腫瘍, 再発例2腫瘍計6腫瘍に施行したVAB-6療法の結果は, CR 3腫瘍, PR 3腫瘍で集学的治療により全例生存中である.NSGCTのstage II及びIII 11腫瘍, 再発例4腫瘍計15腫瘍においてもCR 8腫瘍, PR 7腫瘍で追加治療により全例一旦はCRを獲得した.1例の治療関連死を除き14例が癌なし生存中と良好な結果を得た, Between August 1983 and April 1996, 53 testicular germ cell tumors in 52 patients were treated at Toranomon Hospital. The average age of the patients was 36.1 years (range 21-89). The affected side was the right side in 24, left in 27 and bilateral in 1 case. Of the 53 tumors 34 (64.2%) were seminoma and 19 (35.8%) were non-seminomatous germ cell tumor (NSGCT). High ligation orchiectomy was performed in all cases. Of 29 stage I seminomas, post-operative adjuvant radiotherapy was performed in 6 cases prior to 1991. None of these tumors recurred. Two cases of relapses (8.7%) were found among the 23 stage I seminomas followed by surveillance. Of 8 stage I NSGCTs followed by surveillance, 4 (50.0%) tumors which contained embryonal carcinoma element and vascular invasion relapsed within 12 months after orchiectomy. A case of stage IIA seminoma was treated successfully by irradiation. Seven cases of stage II (3 seminomas and 4 NSGCTs) and 8 cases of stage III (1 seminoma and 7 NSGCTs) as well as cases of 6 stage I patients who developed relapse during surveillance were treated by VAB-6 chemotherapy. Of these 21 cases, 11 (52.4%) achieved complete response (CR) and 10 (47.6%) partial response (PR). Salvage surgery and/or additional chemotherapy was successful to bring the 10 PR cases into CR condition. One NSGCT patient, however, died of electrolyte imbalance during the maintenance chemotherapy for disease progression after achieving CR. All 34 patients with seminomas and 18 of the 19 with NSGCTs were alive without evidence of disease after a mean follow up period of 61.1 months (range 4-150 months).

Eight elderly patients (average age 76.1±4.3 years) with balanitis xerotica obliterans (BXO) accompanied by phimosis presented with difficulty in urination. Preoperative average international prostate symptom score, average maximum urinary flow rate, and average volume of residual urine were 20.7±6.3 points (n＝8), 5.1±3.6 ml/s (n＝5), and 85.4±77.3 ml (n＝8), respectively. Some of the patient’s complaints, such as severe dribbling of urine, urinary stream division, and ballooning of the foreskin, were not included in the items of the major questionnaire on urination. Dorsal incision and circumcision was performed in all patients, and all were pathologically diagnosed with BXO. Meatoplasty was performed in one patient with a meatal stenosis. No coexistence of penile cancer was observed. Statistically significant improvements were observed in subjective and objective findings after treatment. In conclusion, BXO with phimosis in elderly patients should be considered as a cause of lower urinary tract symptoms.

A 31-year-old man presented with edema in left lower leg and dyspnea. Computed tomographic scanning detected a right testicular tumor, multiple lung nodules, and inferior vena cava (IVC) thrombus. After insertion of an IVC filter, high inguinal orchiectomy was performed after the first combination chemotherapy. Pathological examination demonstrated an embryonal carcinoma with vascular invasion and direct tumoral extension into the right spermatic cord. According to our survey, this is the 14th case of testicular tumor with IVC thrombus in Japan.

66歳男。2005年12月に梯子より転落し頸椎骨折で入院した。2006年1月に発熱し抗生剤投与で軽快したが、右陰嚢内容の腫脹を自覚し入院した。陰嚢表面に発赤等は見られず、右精巣は軽度腫脹し弾性硬で軽度圧痛があった。血液生化学所見は炎症所見、腫瘍マーカー上昇は認めず、尿沈渣も異常を認めなかった。超音波検査で右精巣は軽度腫脹するも低エコーを示す様なSOLは認められず、ドプラー超音波では右精巣周囲を中心に血流の増大を認めた。当初受診前の経過所見から炎症性疾患を考え抗生剤投与したが、1週間後圧痛は消失するも腫脹は増大した。悪性リンパ腫の腫瘍マーカー可溶性IL-2レセプターが527U/mlと正常上限であり、精巣腫瘍が否定出来ず右高位精巣摘除術を行った。精巣はびまん性に強い慢性炎症がみられ、浸潤細胞はリンパ球、形質細胞、組織球で線維化を伴い精細管は炎症で大半が消失していた。肉芽腫性精巣炎と診断され現在外来にて経過観察中である。, A 66-year-old man came to us with a chief complaint of painful right scrotal swelling. The right testis was enlarged on the ultrasound gray scale, but the inside was homogeneous. A power Doppler ultrasound showed slightly increased vascular flow in the periphery of the right testis. As the soluble IL-2 receptor was 527 U/ml (normal: 220-530 U/ml), we considered malignant lymphoma and performed high orchiectomy. On pathological examination, the tumor was diagnosed as granulomatous orchitis. To our knowledge, this is the 21st case in Japan.

Bilateral nephron-sparing surgery was performed on a 56-year-old man with von Hippel-Lindau disease as initial therapy for renal cell carcinoma (RCC). Two years after the surgery, an abdominal computerized tomography (CT) scan revealed local recurrence of RCC. The patient was admitted to our hospital after another CT scan three years later that indicated aggravation of the cancer. On physical examination, he complained of swelling of the scrotum. The patient was diagnosed with an intra-scrotal malignant tumor and local recurrence of RCC. We performed high orchiectomy and nephrectomy. The testicular tumor was diagnosed as testicular metastasis of RCC on pathological examination.

To evaluate the present status of prostate cancer in patients 75 years of age or older, we reviewed clinical characteristics of prostate cancer in patients from the Kitamurayama Hospital. The number of symptomatic advanced cases was greater in patients > or = 75 years old compared with patients < or = 74 years old. However, no significant difference in cause-specific survival rate was found between the two groups. In the cases examined, the difference in biological characteristics between groups did not affect the prognosis. On the other hand, for patients > or = 75 years old, improvement of urinary retention was low, and the incidence of adverse drug responses to endocrine therapy, such as dementia and thrombosis, was high. We recognize the necessity of a comprehensive medical plan that attaches importance to quality of life and safety for the treatment of patients over 75 years old with prostate cancer.

A 66-year-old man came to us with a chief complaint of painful right scrotal swelling. The right testis was enlarged on the ultrasound gray scale, but the inside was homogeneous. A power Doppler ultrasound showed slightly increased vascular flow in the periphery of the right testis. As the soluble IL-2 receptor was 527 U/ml (normal: 220-530 U/ml), we considered malignant lymphoma and performed high orchiectomy. On pathological examination, the tumor was diagnosed as granulomatous orchitis. To our knowledge, this is the 21st case in Japan.

A 70-year-old man complaining of painless right scrotal swelling was referred to our hospital. He had a past history of left nephrectomy for renal tuberculosis at the age of 28. Power Doppler ultrasonography revealed a hypoechoic and hypovascular tumor with septa in the scrotum. We suspected a right testicular tumor and therefore, performed a right high inguinal orchiectomy. On macroscopic findings, the fluid of the tumor was yellowish and mucinous and the ipsilateral testis was remarkably atrophic. The pathological diagnosis was tuberculous epididymitis with central necrosis. In recent years, tuberculous epididymitis is rare, and this case was considered to be the first report of power Doppler ultrasonographic findings in tuberculous epididymitis.