(Background) Vascular endothelial growth factor (VEGF) is known as one of the key molecules in molecular targeting therapy for patients with renal cell carcinoma (RCC). Several studies have shown that VEGF might be useful for predicting prognosis in RCC. We examined whether pretreatment serum VEGF can be used as a predictor of recurrence-free survival in non-metastatic RCC. (Materials and methods) We studied 85 patients with non-metastatic clear cell RCC who underwent nephrectomy between 2001 and 2010. Serum samples were collected for VEGF before operation. We evaluated the recurrence-free survival by univariate and multivariate analysis. (Results) 9 patients (10.6%) showed recurrence. Serum level of VEGF in patients with recurrence showed significantly higher than those in patients without recurrence (p=0.0310). A cutoff level of 416 pg/mL for the separation of low and high serum VEGF levels was established based on the receiver operating characteristic (ROC) curve. The recurrence-free survival rate was significantly lower in patients with a high serum VEGF level (p=0.0039). Multivariate analysis showed that pretreatment serum VEGF value was a significant predictor of postoperative recurrence in non-metastatic clear cell RCC (p=0.0062). (Conclusions) Pretreatment level of serum VEGF might be useful for prediction of postoperative recurrence in non-metastatic clear cell RCC.

View full abstract

(Purpose) Because of a higher incidence in dialysis patients, regular screening for renal cell carcinoma (RCC) is considered beneficial in this population. RCC is associated with a high incidence of acquired cystic disease of the kidney (ACDK), and it has been suggested that these conditions are related. This study was designed to examine the efficacy of RCC screening for dialysis patients and the relationship between RCC and ACDK. (Patients and methods) This study enrolled 624 dialysis patients treated between August 2005 and June 2011 at our hospital. Screening for RCC was performed by annual abdominal ultrasonography. Factors analyzed were as follows: RCC morbidity, incidence, diagnostic method, and survival rate; and the RCC and ACDK comorbidity rate. (Result) RCC was diagnosed in 12 patients. RCC morbidity and incidence rates were 2.08%and 0.33%, respectively. Diagnosis of RCC was made by abdominal ultrasonography screening (N=7, Group A), abdominal ultrasonography or computed tomography for other disease (N=2, Group B) or detailed examination after appearance of symptoms (N=3, Group C). With the exception of one death from other disease, all Group A and Group B patients survived the follow-up period. In contrast, all Group C patients died of RCC within 6 months of diagnosis; only one of these patients underwent RCC screening. The RCC/ACDK comorbidity rate was 91.7% (p=0.0026). (Conclusion) Results indicate that regular screening of dialysis patients for RCC is beneficial. RCC was associated with a high incidence of ACDK, indicating that there is a relationship between these two diseases.

View full abstract

A 18-year-old man presented with fever and periumbilical nodule. Computed tomography (CT) showed complicated abscess of urachal remnant and laparoscopic surgery was performed transperitoneally via 3 ports. Laparoscopic excision of urachal remnant was first demonstrated in 1992 by Neufung et al, and in Japan first case was reported in 1998 by Ohmori et al. Some cases of laparoscopic surgery for urachal remnant were reported, but the surgical techniques, including port configuration, have not been standardized. In this case, we performed laparoscopic surgery with camera port in the umbilicus and two working ports in the bilateral positions. Our port configuration may be promising in ensuring good viewing during surgery and excising urachal remnant completely including umbilicus.

View full abstract

A 58-year-old man presented with nausea and left flank pain. The patient was referred to our hospital based on clear detection of anemia and computed tomography findings of bilateral adrenal tumors with hemorrhage and a mass in the apex of the left lung. Right adrenal artery embolization had no effect on enlargement of the right adrenal hematoma or advanced anemia. Right adrenalectomy was then performed in an attempt to control hemorrhaging and make a definitive diagnosis, and the patient's anemia improved following the operation. Histopathological diagnosis suggested adrenal metastasis of lung adenocarcinoma, which was subsequently diagnosed given similarities in transbronchial biopsy findings to those in the right adrenal gland. Adrenal hemorrhage due to metastasis of lung cancer is an extremely rare condition; indeed, to our knowledge, the present case is only the 26th reported worldwide. However, prognosis for this mortal condition may be improved should patients receive adrenalectomy followed by an appropriate treatment regimen.

View full abstract

A 78-year-old man visited a hospital with a complaint of painful and swelling scrotums for 7 months. Although left epididymitis was suspected, antibiotic and non-steroidal anti-inflammatory drugs (NSAIDs) had no effects. After visit to our department, we performed left orchiectomy for the diagnosis and pain control. Pathological examinations showed necrotizing vasculitis in the epididymis, so he was diagnosed as polyarteritis nodosa (PN) in the left epididymis. He had no systemic symptoms, which made the diagnosis of isolated PN. One and a half years after operation, he felt the same pain in the right scrotum. We performed right orchiectomy. Pathological findings showed necrotizing vasculitis in the epididymis. Blood examinations revealed negative for myeloperoxidase anti-neutrophil cytoplasmic antibody (ANCA) and proteinase 3-ANCA, and computed tomography revealed that other organs were not involved. One year later, he had no recurrence.

View full abstract

We reported the experience with a case of plasmacytoid variant of urothelial carcinoma of urinary bladder. A 75-year-old woman complained of gross hematuria. She was hospitalized to be diagnosed as the bladder tumor on abdominal CT. TUR-BT was performed and pathological finding was invasive urothelial carcinoma. But she refused radical cystectomy. 2 months later, she was hospitalized again with worsening hematuria. Simple cystectomy was performed. Histological examination revealed a plasmacytoid appearance of the infiltrating tumor cells. Immunohistochemical stains for lymphoid markers were negative. Those findings lead to the diagnosis of plasmacytoid variant of urothelial carcinoma. She died due to local recurrence for 1.5 months after simple cystectomy.

View full abstract

A 71-year-old woman presented with lower abdominal pain and urinary incontinence 18 days after low anterior resection for rectal cancer. Computed tomography and magnetic resonance urography revealed right hydronephrosis, cystic mass in the right pelvic cavity and hydrometra. Positron emission tomography showed dilated right upper urinary tract communicating with dilated right fallopian tube and uterine body, and the finding was quite characteristic. Laboratory studies revealed that the serum and the fluid from hydrometra levels of creatinine were 1.06 mg/dL and 6.15 mg/dL, respectively. We diagnosed this case as uretero-fallopian fistula. Since the conservative management of uretero-fallopian fistula with ureteral stent was not accomplished, she underwent right ureteroureterostomy and adnexectomy. The intraoperative findings included dilated right ureter and fallopian tube adherent to the stenotic right ureteral segment ligated by suture during prior surgery. The histopathological findings showed endometriosis and inflammatory changes of uterine appendages. Follow-up at 3 months demonstrated resolution of the urinary incontinence and the ureteral obstruction and fistula.

View full abstract

A 61-year-old man was referred to our hospital with the chief complaint of right leg weakness. Abdominal magnetic resonance imaging (MRI) and computed tomography (CT) demonstrated a ureteral tumor and a neighboring massive retroperitoneal tumor in addition to retroperitoneal lymph node and right renal metastases. The tumor was diagnosed as upper tract urothelial carcinoma (cT4N1M1) by percutaneous tumor biopsy. As the patient achieved a partial response after three courses of combination chemotherapy with gemcitabine and cisplatin, he received total nephroureterectomy and lymph node dissection. The pathology showed no viable cancer cells, demonstrating a pathological complete response. He remains alive after 26 months with no evidence of disease.

View full abstract