(Purpose) We retrospectively analyzed our therapeutic results of advanced male germ cell tumors in terms of efficacy and feasibility of our treatment strategy. (Patients and methods) Fifty-one new cases were treated in Saitama Cancer Center between April 1997 and August 2007. Patients age ranged from 16 to 58 (median 33). Primary site of the tumor was testis in 41 (80%) patients, retroperitneum in 6 (12%), and mediastinum in 4 (8%). Histology of the primary germ cell tumor was pure seminoma in 14 (27%), and non-seminoma in 30 (59%). Twenty (39%), 14 (27%) and 17 (33%) were classified as good-, intermediate-, and poor-risk, retrospectively, based on The International Germ Cell Consensus Classification (IGCCC) criteria. The initial treatment for good-risk patients was BEP×3. Intermediate- or poor-risk patients were treated by VIP from 1997 to 2000, VIPVB from 2001 to 2004, and BEP from 2005 to 2007. Second line salvage treatments were high-dose VIP or ICE from 1997 to 2000. TIP×4 has been employed since. Marker-negative cases with residual tumors underwent surgical resection of the mass lesion. (Results) Five-year survival rate was 100%, 74%, and 76% in patients with good-, intermediate- and poor-risk characteristics, respectively. After two courses of initial chemotherapy, tumor marker decline was satisfactory in 37 patients (73%) and unsatisfactory in 14 (27%). Of these 14 patients, 12 (86%) had unsatisfactory hCG decline, 4 (29%) had unsatisfactory AFP decline, and 2 (14%) had unsatisfactory decline in both markers. Five-year overall survival was 94% in cases with satisfactory maker decline and 71% in those with unsatisfactory marker decline (p=0.03). (Conclusions) In this IGCCCG era, 5 year survival rates of the advanced germ cell tumors have improved by the earlier administration of second line chemotherapies based on both the prognostic factor-based staging system and the tumor marker decline in initial chemotherapy. Development of effective treatment for cases with unfavorable tumor maker decline is the most challenging issue to be addressed.
(Objective) We evaluated the efficacy and outcome of one-stage oral mucosa graft urethroplasty, which is currently the procedure of choice for treating lengthy and complicated urethral strictures not amenable to excision and primary end-to-end anastomosis. (Patients and methods) Seven patients 33 to 74 years old (mean age=53.7) underwent one-stage oral mucosa graft urethroplasty for a stricture in either the bulbar urethra (four patients), penile urethra (two patients), or pan-anterior urethra (one patient). Three of the strictures were due to trauma, one was due to inflammation, and one was due to a failed hypospadia repair. The other two were iatrogenic. All patients had previously undergone either internal urethrotomy or repeated urethral dilation. Three patients received a tube graft, three received a ventral onlay, and one received a dorsal onlay. A free graft of oral mucosa was harvested from the inside of each patient's left cheek, and if necessary to obtain a sufficient length, the harvest was extended to include mucosa from the lower lip and the right cheek. The graft lengths ranged from 2.5 to 12cm (mean=4.6cm). A urethral catheter was left in place for 3 weeks postoperatively. (Results) While no severe complications at the donor site were observed during follow-up periods ranging from 3 to 55 months (mean=14 months), two patients who had received a tube graft developed distal anastomotic ring strictures that were managed by internal urethrotomy. The other five required no postoperative urological procedure even though one who had received a ventral onlay developed a penoscrotal fistula. (Conclusion) Oral mucosa is an ideal urethral graft, and oral mucosa graft urethroplasty is an effective procedure for repairing complicated urethral strictures involving long portions of the urethra.
(Objectives) We investigated the actual status of post micturition dribble (PMD) after transurethral resection of the prostate (TURP). (Patients and methods) We surveyed 388 patients who underwent TURP to determine whether they experienced urinary incontinence one year after the procedure. If they reported it, its frequency, degree and the type of urinary incontinence (stress urinary incontinence, urge incontinence, PMD) were investigated using a questionnaire. (Results) Of the 270 patients who responded to the questionnaire, 78 (29%) reported urinary incontinence. Although most of them experienced incontinence infrequently (less than once or twice a week) with a mild degree (tiny spot on the underwear), a few reported frequent (every day) or severe (wet pants or need a pad) urinary incontinence. PMD was the most common type of urinary incontinence, and was found in 48 patients (62%). (Conclusion) PMD occurred in half or more of the patients with urinary incontinence after TURP.
(Purpose) We reviewed 193 patients of renal cell carcinoma treated at Osaka Police Hospital between 1990 and 2006. (Methods) The patients consisted of 140 males and 53 females. The median age was 62 years, ranging from 26 to 88 years. Median follow-up period was 53 months. TNM system and pathologic findings were classified in accordance with the Japanese General Rules for Clinical and Pathological Studies on Renal Cell Carcinoma. Survival rates were calculated using the Kaplan-Meier method, and differences in survival curves were estimated with the log-rank test. Independent prognostic factors were analyzed using the Cox proportional hazards model. (Results & conclusions) The overall 3, 5, 10 and 15-year cause-specific survival rates were 92.6, 91.1, 86.1, 72.2%, respectively. Univariate analysis indicated age, chief complaint, performance status, tumor size, anemia, CRP, tumor extent, grade, infiltrating pattern, venous involvement, lymph node metastasis, distant metastasis, stage to be significant prognostic factors. Moreover, multivariate analysis with Cox's proportional hazard model revealed high age (60≤), positive CRP, and T4 to be independent poor prognosticators for cause specific survival. Using these three risk factors, patients with 0, 1, 2, and 3 poor risk factors were classified as 0, 1, 2, and 3 risk groups, respectively. The overall 5 and 10-year cause specific survival rates in 0, 1, 2, and 3 risk groups were 100 and 100%, 90.8 and 83.8%, 71.6 and 34.1%, 0 and 0%, respectively. The overall 5 and 10-year cause specific survival rates (69.2 and 33.0%) especially in 2 and 3 risk groups were significantly poor prognosis, comparing with those (94.8 and 91.9%) in 0 and 1 risk group (p<0.0001). Thus, the intensity of the follow up period and the necessity of postoperative adjuvant therapy for a patient are recommended for 2 and 3 risk groups.
A 37-year-old man with the chief complaints of lumbago and fever is presented. Laboratory data showed the extreme elevation of alfa feto-protein (AFP), human chorionic gonadotropin (hCG) and lactate dehydorgenase (LDH). Computed tomography (CT) scan revealed a huge retroperitoneal tumor with multiple pulmonary nodules as well as left supraclavicular and left axillary lymph nodes enlargement. Although he was suspected the testicular tumor with metastasis, he had no testicular abnormalities including tumor and microlithiasis. Therefore, he was diagnosed as a retroperitoneal extra-gonadal germ cell tumor, which had poor prognosis because of multiple metastasis and the tremendous increase of hCG. Although he was treated with three cycles of bleomycin, etoposide, and cisplatin (BEP), he achieved partial response and no normalization of tumor markers. After three cycles of BEP, he was treated with four cycles of paclitaxel and ifosfamide plus cisplatin (TIP) immediately. During chemotherapy, he was treated with his peripheral blood stem cell transplantation (PBSCT) as well. After the completion of two regimens' chemotherapies, all his tumor markers returned to be normal. However, retroperitoneal tumor, left supraclavicular and axillary lymphnodes still remained. He underwent three operations including retroperitoneal lymphnode dissection with nephrectomy, left supraclavicular and axillary lymphnodes removal, respectively. All specimens had no viable cells, histologically, The patient has been quite well and free of disease for 24 months. It is concluded that even if far-advanced germ cell tumor is discovered, a more promising prognosis could be expected with intensive and aggressive treatment such as our case.
A 50-year-old man visited our hospital with a complaint of painful masses in bilateral scrotums for 2 months. Ultra sonography shows isoechoic mass in both scrotum. Antibiotic was treated for 2 weeks but had no effects on scrotal swelling and testicular neoplasm cannot ruled out, so we performed bilateral high orchiectomy. Pathological examination shows necrotizing vasculaitis surrounded by glanulomas and pathologically diagnosed as Polyarteritis Nodosa in bilateral epididymis. After orchiectomy, blood examination of immunity was revealed no specific findings, that made us diagnosed as isolated PN. 2 years after operation, he had no reccurence.
A 29-year-old man was admitted to our hospital due to bilateral testicular tumors. The bilateral testicular tumors were palpated and visualized by ultrasound and magnetic resonance imaging (right 8cm, left 6cm in diameter). Bilateral high orchiectomies were performed after frozen storage of the sperm. Pathological examination revealed seminoma and immature teratoma in the right testis and seminoma in the left testis. Three months later, computed tomography (CT) showed multiple metastatic lung nodules. In addition, positron emission tomography (PET)-CT examination revealed peri-caval lymph node metastasis together with the lung metastases. Lung metastases disappeared, but the lymph node metastasis reduced and remained after 3 courses of combination chemotherapy with bleomycin, etoposide and cisplatin. PET-CT examination revealed that no uptake of FDG was seen in the lung and lymph nodes. Retroperitoneal lymph node dissection was performed. No viable tumor cells were histologically present in the excited lymph nodes. The postoperative course was good and uneventful at 10 months under androgen replacement therapy without disease recurrences.