(Purpose) We retrospectively analyzed the preoperative clinical parameters which influence operative time and intraoperative maximum systolic blood pressure in patients undergoing laparoscopic adrenalectomy for pheochromocytoma. (Materials and methods) Between January 1992 and September 2010, we performed 28 laparoscopic adrenalectomies for pheochromocytoma at Hamamatsu University School of Medicine. These 28 cases were characterized based on the following parameters: body mass index (BMI), tumor size, history of hypertension, preoperative blood pressure, serum concentration of catecholamine, and 24-h urinary excretion of catecholamine metabolite. We retrospectively analyzed whether or not these parameters influenced operative time or intraoperative maximum systolic blood pressure. (Results) All 28 cases of laparoscopic adrenalectomy were performed safely and without intraoperative complications and needed neither blood transfusion nor conversion to laparotomy. The median operative time was 203 minutes, and intraoperative hypertension (systolic blood pressure>200 mmHg) occurred in 46% (13/28) of cases. Median day of discharge in all patients was post-operative day 5. Significant positive correlation was shown between tumor size and operative time and between intraoperative maximum systolic blood pressure and serum concentration of catecholamine or 24-h urinary excretion of catecholamine metabolite (p<0.05). (Conclusion) The lengthened operative time for large tumors and elevated intraoperative blood pressure for tumors with high preoperative catecholamine activity necessitate careful perioperative management in patients receiving laparoscopic adrenalectomy for pheochromocytoma.
(Case 1) An 82-year-old man started immunotherapy with interferon because of lung metastasis 5 years after he had undergone radical nephrectomy. Three years later, he developed multiple metastases, and was started on sorafenib (400 mg/day) and nonsteroidal anti-inflammatory drug (NSAID) orally. As his cancer-related pain worsened with time, he was administered 30 Gy radiation therapy for bone metastasis of L4. He was then admitted to our hospital for pain control because of ineffective radiation therapy. One day, he suddenly had abdominal pain and vomiting, and was diagnosed as bowel perforation based on computed tomography. He was managed conservatively by nasogastric suction and antibiotic course. (Case 2) A 62-year-old man diagnosed as metastatic renal cell cancer began immunotherapy soon after undergoing radical nephrectomy in Dec., 2006. Although he was started on oral sorafenib (800 mg/day) in July, 2008, metastatic foci enlarged after 18 months. He was then changed to sunitinib (50 mg/day). Sunitinib had immediate and long-lasting effect on the cancer for about 10 months, but he was then admitted to our hospital for pleural effusion. While under treatment for thoracic cavity drainage, he experienced upper abdominal pain and was diagnosis as bowel perforation based on computed tomography. He underwent emergency laparotomy.Molecular target drugs such as sorafenib and sunitinib have serious adverse effects. Bowel perforation is rare, but among those adverse effects. It should be remembered that caution is required for long-term use or combined radiation therapy and NSAIDs with molecular target drug.
Primary renal carcinoid is an uncommon tumor. We report a case of local recurrence and multiple lymph node metastases of renal carcinoid 4 years after partial nephrectomy in a 64-year-old man. He was incidentally found to have a mass lesion in the right kidney and right partial nephrectomy was performed 4 years ago. Histological examination including immunohistochemical studies confirmed the diagnosis of the atypical primary renal carcinoid. After 4 years of follow up, abdominal ultrasonography and computed tomography demonstrated a local recurrence and multiple lymph node metastases around the inferior vena cava. He underwent right radical nephrectomy with paraaortic and right renal hilum lymphadenectomy. Histological appearance showed that recurrence of the atypical renal carcinoid. Four of the resected five lymph nodes were positive for metastasis. Unexpectedly, two tiny renal cell carcinomas were also found from the right kidney. The patient remains free from disease recurrence for 2 months post re-operation. This case is the 43rd report of renal carcinoid tumor in Japan.
Ductal adenocarcinoma of the prostate is a rare subtype of prostatic adenocarcinoma, defined by morphological criteria as one that has papillary or cribriform architecture composed of high columnar cells with pseudostratified nuclei. We clinically evaluated 7 cases of ductal adenocarcinoma of the prostate in our hospital. The median age was 69 years old and median initial serum PSA level was 22.8 ng/ml. Two cases presented with dysuria, two with macrohematuria and one with abnormality on chest radiograph. Five cases were diagnosed on prostate biopsy, one on TUR-P and one on radical prostatectomy. Two had pure ductal adenocarcinoma and five had mixed ductal adenocarcinoma. Four had metastatic disease, and were treated by hormonal therapy. Among three with non-metastatic desiese, two underwent radical prostatectomy with adjuvant radiotherapy and one underwent external beam radiotherapy with hormonal therapy. Three cases with non-metastatic disease have no biochemical recurrence. Among four with metastatic disease, one underwent chemotherapy of Docetaxel and one had found a new lesion in lung.
We experienced 4 cases of primary carcinoma of the female urethra during 1998 to 2011. All of the cases were diagnosed primary urethral cancer according to tumor biopsy, cystoscopy, and computed tomography (CT) or magnetic resonance imaging (MRI). Patients were between 66 to 92 years of age at the time of presentation. Presenting symptoms included gross hematuria in 1 case, urinary retention in another case, and vulvar bleeding in 2 cases. Pathology showed urothelial carcinoma in 2 cases, adenocarcinoma in 1 case, and squamous cell carcinoma in another case. There were 2 patients with stage D, 1 patient with C, and another with B. Three patients were treated with total cystectomy and ileal conduit. One patient was treated with radiation. Two patients died from urethral cancer, 1 patient is free from disease for 12 months, and another patient became lost during follow-up.