Congenital perineal lipoma with accessory scrotum: a case report

A tumor mass covered with scrotum-like skin on its tip was found on the perineal region of 3-year-old boy since his birth. The mass was diagnosed as congenital lipoma, which was resected, because of its gradual enlargement. Histopathological findings of the tumor indicated perineal lipoma, and the scrotum-like portion was diagnosed as an accessory scrotum. In the Japanese literature, 7 congenital perineal lipomas (6 males, 1 female) have been reported and all male cases except 1 case (no description about scrotum) were accompanied with an accessory scrotum. We conclude that there may be a close relationship between congenital perineal lipoma and accessory scrotum

A case of collecting duct carcinoma (Bellini duct carcinoma) producing carcinoembryonic antigen

61歳男.左腎腫瘤性病変の精査加療目的に当科入院した.HE染色像で特徴的所見を有し, 更に近位尿細管のマーカーであるビメンチン, EMA(epithelial membrane antigen)及び高分子サイトケラチンに関しては, 陽性或いは強陽性であったことから腎実質性腫瘍と診断し, 経腹膜的に根治的左腎摘除術及び腎門部リンパ節郭清術を施行した.その後, 外来にて姑息的治療のみで経過観察を行ったが, 転移巣は増大し術後約20ヵ月後に死亡したWe report a case of collecting duct carcinoma (Bellini duct carcinoma) producing carcinoembryonic antigen (CEA). A 61-year-old man visited our hospital because of a left renal mass detected by ultrasonography in an other hospital. Computed tomography showed a low density tumor measuring about 3 cm in the left kidney. Angiography demonstrated a hypovascular tumor. The serum level of CEA was increased to 20 ng/ml. (normal < 7 ng/ml). Left radical nephrectomy was performed. Histological examination revealed collecting duct carcinoma with papillary growth (T1aN1M0). Cancer cells showed a positive immunohistochemical staining for CEA. Under a diagnosis of CEA-producing collecting duct carcinoma of the left kidney, the patient underwent systemic chemotherapy (M-VAC). The serum level of CEA decreased to the normal level after the nephrectomy, but six months postoperatively, metastatic bone tumor at the left pelvic bone was revealed on the plain film and at the same time, the CEA level was increased again

HETEROGENEITY OF ANTI-VON WILLEBRAND FACTOR (VWF) ANTIBODIES WHICH INHIBIT RISTOCETIN-INDUCED VWF BINDING TO PLATELET GLYCOPROTEIN (GP)Ⅰb

The epitopes of four anti-vWF monoclonal antibodies (MoAbs), which inhibit antibiotic ristocetin induced vWF binding to GPⅠb, were investigated and compared with each other. MoAb NMC-4 completely inhibited both the vWF bindings to GPⅠb expressed by ristocetin and snake venom botrocetin at the final concentrations of 10 μg/ml. Another MoAb RFF-VⅢ RAG : 1 also completely inhibited ristocetin-induced vWF binding at the IgG concentration of 10 μg/ml, but showed a partial inhibition (75% at the IgG concentlation of 100 μg/ml) on botrocetin-induced binding. Two other MoAbs, RG46 and 52-K8, inhibited ristocetin-induced vWF binding at the inhibition constant by 50% of 90 μg/ml and 30 μg/ml respectively, but without effect on botrocetin-induced vWF binding. Using the radiolabelled NMC-4 and its binding to vWF immobilized to plastic tubes, the competitive binding assay was performed. In this assay, cold NMC-4 clearly displaced (¹²⁵Ⅰ) NMC-4 binding to solid-phase vWF, and RFF-VⅢRAG : 1 partially blocked the binding (60% at the IgG concentration of 100 μg/ml), whereas neither RG46 nor 52K-8 blocked this binding. These results indicated that the epitopes of NMC-4 and RFF-VⅢRAG : 1 are in close proximity, but those of RG46 and 52K-8 are different, suggesting the epitope heterogeneity of anti-vWF MoAbs which inhibit ristocetin-induced vWF binding

環境アポトジェンを含む環境汚染化学物質の作用動態解析と化学生態学的防除法の開発研究プロジェクト

プロジェクト研究報告概要集　　戦略的研究基盤形成支援事業プロジェクト　研究代表者:土戸哲明　研究担当者:池内俊彦・下家浩二・上里新一・吉田宗弘・福永健治・安原裕紀・長谷川喜衛・岩木宏明・老川典夫・松村吉

An operative technique for parathyroid surgery

A technique of parathyroidectomy based on our experience of fifteen cases with primary hyperparathyroidism was described. The success of the surgery would require an ability of the surgeon to be delicate in technic, but recently this operation itself has become less invasive and complicated. It is emphasized that the urologists should chose parathyroidectomy with priority because treatment of primary hyperparathyroidism is quite important for some patients with urinary calculous diseases

Treatment of Bacillus Calmette-Guerin refractory superficial bladder cancer : further intravesical therapy

膀胱上皮内癌(CIS)診断された93例に, BCG膀胱内注入療法を施行し, 3ヵ月時の治療効果判定で85例にCRを得た.うち17例は平均21.2ヵ月後に再発を来した.初回BCG注入療法で抵抗性があった16例に再注入療法を行ったところ, 初回療法後の残存腫瘍が7例, 再発腫瘍が9例であった.3ヵ月時の治療効果判定で15例がCRを得た.うち6例が平均28.2ヵ月後に膀胱への再発を来したが, 腫瘍進展や上部尿路再発は認めなかった.一方, BCG抵抗性表在性膀胱癌で膀胱全摘出術の適応とならない4例にゲムシタビン膀胱内注入療法を施行したが, 1例は原発性CIS, 2例はCISとT1腫瘍の合併で, BCG療法2～4コース後の再発例であった.残る1例は多発性Ta腫瘍の頻回再発例であるが, 直腸癌に対する化学療法中で, BCG療法の効果が期待できないと判断された.2例でCRが得られ, 15ヵ月および14ヵ月まで無病状態が維持されている.他の2例では乳頭状腫瘍の再発を認めたが, うち1例は高齢と副作用のため注入は6回で中止されていたWe here report our clinical experience with salvage therapy for patients with bacillus Calmette-Guerin (BCG)-refractory superficial bladder cancer and discuss current approaches to the disease, especially focusing on bladder preservation. First, we evaluated the efficacy of an initial 6-week course of intravesical BCG in 93 patients with carcinoma in situ (CIS) of the bladder. Of these, 91% achieved a complete response (CR) at the evaluation at 3 months. The 2- and 5-year recurrence-free rates were 71 and 67%, respectively (mean follow-up 39 months). These results support the intravesical BCG as a first-line therapy for CIS. Next, we assessed the efficacy of a second course of intravesical BCG for 16 patients who failed the initial induction course for CIS. Of these, 94% achieved CR at the evaluation at 3-month, and the 2- and 5-year recurrence-free rates were 62 and 46%, respectively (mean follow-up 28 months). None of the patients who received a second course had disease progression. Thus, a second course of BCG therapy seems to be a reasonable option for CIS patients failing the initial course. We also report our initial experience with intravesical gemcitabine therapy for 3 patients with BCG-refractory CIS of the bladder and 1 patient with recurrent multiple tumors. Gemcitabine (1500 mg in 100 ml saline) was given in the bladder for 1 hour twice weekly for a total of 12 treatments. The treatment was associated with minimal bladder irritation and systemic absorption, and was well tolerated except in a 90-year-old man who discontinued therapy because of grade 2 toxicity. Two patients achieved CR and maintained a tumor-free status beyond 14 months, suggesting that the intravesical gemcitabine is a promising salvage therapy for BCG-refractory superficial bladder cancer

Therapeutic embolization of renal angiomyolipoma: a case report

A case of bilateral renal angiomyolipoma without tuberous sclerosis is reported. A 49-year-old woman was admitted to the general practitioner with a sudden onset of severe left flank pain. An excretory urogram and ultrasonogram revealed an enlargement of the left kidney. She was subsequently referred to our clinic for further investigation and treatment. Computed tomographic scan and magnetic resonance imaging using Tl-weighted image showed several tumors with a fatty, dense area in the bilateral kidney. An arteriogram demonstrated a hypervascular renal mass with aneurysms in her left kidney. Diagnosis of bilateral renal angiomyolipoma was confirmed by percutaneous needle biopsy. Superselective embolization of the tumor was successfully performed, preserving normal renal tissue. Gelatin sponges containing Carboquone (CQ sponge) were used as embolic material. Angiomyolipoma has become relatively easy to diagnose by CT, ultrasound, MRI and so on. However, there are some cases of angiomyolipoma which are indistinguishable from renal cell carcinoma using these modes of testing. Therefore, in selecting a conservative management, we indicated that percutaneous biopsy or open biopsy should be done to confirm the results of the above procedures. Moreover, therapeutic embolization for angiomyolipoma was concluded to be very useful

Radical cystectomy for invasive bladder carcinoma in patients 75 years old or older

過去10年間に膀胱癌と診断され, 根治的膀胱全摘除術を受けた43例を, 40～64歳(12例), 65～69歳(12例), 70～74歳(12例), 75歳以上(7例)の4群に分け, 治療成績を臨床的に比較検討した.1)術前合併症は高血圧, 糖尿病, 冠動脈疾患, 不整脈が多く, 70歳を過ぎると増加傾向がみられたが, 各群間に有意差はなかった.2)2つ以上の合併症を有する割合は, 加齢とともに増加する傾向がみられた.高齢者では他の3群よりも出血量, 輸血量が有意に多かった.3)術後合併症の発生には有意差はなかったが, 術後死亡は75歳以上群で多臓器不全を合併した1例であった.術後補助療法は75歳以上群には1例しか施行されていなかった.4)癌死は75歳以上群ではみられなかったが, 他因死は3例であった.75歳以上群の3年生存率は100%であった.したがって高齢者に根治手術を行うかの最終的な決定は患者の医学的評価に基づいて判定されるべきであり, 歴年齢のみによって決定すべきではないと考えられたBetween 1995 and 2004, 43 patients underwent radical cystectomy and urinary diversion for the treatment of invasive bladder cancer at our institution. Of these patients, seven who were 75 years old or older, were considered elderly. Survival and treatment outcome of these patients were compared to younger counterparts stratified into three groups by age at diagnosis (12 patients younger than 64, 12 patients 65 to 69 years, and 12 patients 70 to 74 years). Preoperative morbidity was encountered in 57% of the elderly patients, and 42% of the elderly patients had two or more complications. There was one operative death (14%) among the elderly patients but no such deaths in the 3 younger groups. The postoperative complication rate for patients age 75 years or older was 86%, compared to 75% for patients younger than 64, 75% for those age 65 to 69 and 83% for those age 70-74. The prevalence did not differ significantly between the older and youger patients. There were no cancer deaths among the elderly patients, but 8 of the 36 younger patients died of cancer. The cancer-specific 5-year survival rate was 100% at 34 months in the elderly population. These findings suggest that radical cystectomy and urinary diversion is a relatively safe procedure and a curative operation is worth attempting in elderly patients with invasive bladder cancer, if they are in generally good health

Efficacy of intravesical bacillus Calmette-Guerin for carcinoma in situ of bladder

膀胱上皮内癌に対する初回BCG注入療法及び残存・再発例に対する再注入療法(セカンドコースBCG療法)について膀胱温存の立場から検討を行った.初回BCG注入療法を行った膀胱上皮内癌104症例(男92例, 女12例)を対象に, 原則的に週1回の注入を計6回行い, 治療効果判定は治療開始3ヵ月後の膀胱鏡検査及び尿細胞診又は膀胱洗浄液細胞診により行った.3ヵ月後にCRが得られなかった残存例や再発例のうちBCG再注入療法を行ったのは23例で, ゲムシタビン膀胱内注入療法を行って効果判定できたのは4症例で, 隆起性病変を伴わなかったのは33例であった.平均観察期間は66.4ヵ月, 中央値は42.2ヵ月であった.3ヵ月での治療効果判定では104例中94例(90.4%)はCRが得られたが, そのうち22例が平均21.1ヵ月, 中央値14.1ヵ月で再発をきたした.初回BCG注入療法後の非再発率は5年で67.2%, 10年で60.4%であった.BCG再注入療法の22例(95.6%)にCRが得られたが, 8例が平均24.9ヵ月で再発をきたした.BCG再注入療法後の非再発率は5年で55.9%, 10年で27.9%であった.ゲムシタビン膀胱内注入療法を行った4例は全て男性で, 3例にCRが得られた.全体では進展例は16例に見られたThree months after an initial 6-week course ofintravesical bacillus Calmette-Guerin (BCG) given between January 1990 and March 2005, 94 (90%) out of 104 patients with carcinoma in situ (CIS) of the bladder achieved a complete response (CR). The 5- and 10-year recurrence-free rates were 67 and 60%, respectively (median follow-up 42 months). Three months after a second course ofintravesical BCG given to 23 patients who failed the initial induction course for CIS was evaluated. Of these, 96% achieved a CR, and the 5- and 10-year recurrence-free rates were 56 and 28%, respectively (median follow-up 23 months). Only one patient who received a second course of BCG therapy showed disease progression. Two of the 4 patients with BCG-refractory CIS of the bladder achieved CR after intravesical gemcitabine therapy and maintained a tumor-free status beyond 6 months. Five of the 16 patients showing disease progression had upper urinary tract cancer, 4 had recurrent or muscle invasive bladder cancer, 6 had prostatic involvement of CIS, and one patient had urethral recurrence. Three of the 16 patients died. Bladder preservation was achieved in 97 of the 104 patients, although 7 patients ultimately underwent radical cystectomy and urinary diversion for aggressive disease. In conclusion, some patients may be managed safely by repeated endoscopic resection and intravesical therapy with cystectomy postponed until objective evidence of progression exists