(Purpose) We created an image reconstructing multiparametric MRI system called VIVID (Visualization of Various Integration with Diffusion) and examined the efficacy of VIVID in detecting prostate cancer.
(Methods and materials) The subjects were 80 patients who underwent one target biopsy with reference to MRI images in addition to 8-20 biopsies.
(Results) The significant cancer detection rate was 61%, the significant cancer detection rate of PI-RADS 4 or 5 was 55%, and the significant cancer detection rate of VIVID score 4 or 5 was 55%. Three cases with PI-RADS 4 at TZ lesion with positive T2WI only were evaluated as having VIVID scores 1 or 2. Cancer was not detected with target biopsy from the site.
(Conclusion) Our finding suggest that VIVID correctly excludes TZ lesions with only T2WI positively in multiparametric MRI.
(Introduction & objective) We aimed to evaluate the validity and complications of cutaneous vesicostomy retrospectively.
(Material & methods) We reviewed the charts of 28 patients (9 male, 19 female) who underwent cutaneous vesicostomy between 2003 and 2017 at our center. The validity of the cutaneous vesicostomy was evaluated by estimating the incidence of febrile urinary tract infection (UTI) before and after the operation using the person years method. To estimate the occurrence of complications, the rates of adverse events and reoperation were summed.
(Results) The preoperative and postoperative incidence rate of febrile UTI decreased from 0.058 times/person-years to 0.012 times/person-years, and this decrease was statistically significant (p<0.001). Six (21.4%) patients developed mucosal prolapse of the bladder, which was the most common complication. Most of the patients had refractory constipation. Three patients with mucosal prolapse and 2 with stenosis required repeat vesicostomy by the Lapides technique, after which there was no relapse.
(Conclusions) Cutaneous vesicostomy could significantly reduce the incidence rate of febrile UTI. Severe constipation was considered as a risk factor for prolapse.
The patient was a 33-year-old female who visited the Department of Gastroenterology of this hospital after experiencing lower abdominal pain and nausea. The patient was referred to this department after suspicions of right kidney hemorrhage revealed by non-contrast computed tomography (CT). We also identified hematuria macroscopically, and contrast-enhanced CT scans revealed uneven deep staining in the upper right kidney during the early phase. Furthermore, by the late phase, we identified a 29-mm solid tumor with no staining. There was no clear pseudomembrane and no clear boundary with the kidney parenchyma. Additionally, there was no metastasis to the lymph nodes and other organs. Based on the above findings, we suspected renal parenchymal infiltration of right renal cell carcinoma (RCC) or right renal pelvic carcinoma. Since the patient was young, we considered the risk of the residual tumor and performed total nephroureterectomy and lymph node dissection with an enlarged view. The inside of the resected tumor specimen showed significant necrosis and hematoma spread, which had infiltrated the renal pelvis. Based on the characteristic histological findings and genetic results obtained using the fluorescence in situ hybridization (FISH) approach, we diagnosed the patient with Xp11.2 translocation RCC. No additional treatments were provided after surgery, and even now the patient is being followed-up through outpatient visits, but there has been no recurrence or new metastasis. There have only been a few reported cases of Xp11.2 translocation RCC; therefore, in many cases, treatments and follow-up duration according to the disease stage and disease prognosis have not been determined. In this study, we report a case of Xp11.2 translocation RCC experienced at our hospital, with additional literature considerations.
A 76-year-old woman presented with a left chest ulcer. Computed tomography (CT) showed a 9-cm-sized invasive mass with ulceration in the left breast, along with regional lymph node and distant metastases, and a 4-cm-sized tumor at the upper pole of the left kidney. Needle biopsy of the left breast tumor was performed, and she was diagnosed with breast cancer, cT4cN3M1, Stage IV. She underwent endocrine therapy and chemotherapy. After undergoing treatment for 2 years, CT showed no progression in the primary and metastatic lesions except for increasing renal mass. Primary kidney cancer was suspected, and she underwent laparoscopic nephrectomy. In the surgical specimen, a solid, brown-colored nodule was observed in the upper pole of the left kidney. The pathological diagnosis was clear cell renal cell carcinoma, including a metastatic lesion of breast cancer. She was diagnosed with tumor-to-tumor metastasis of breast cancer within renal cell carcinoma. Two years after the surgery, no recurrence of renal cell carcinoma has been observed, and she is undergoing secondary endocrine therapy against breast cancer.
A 47-year-old female presented to a clinic complaining of right back pain. A CT scan revealed a right retroperitoneal mass and she was referred to our department for further evaluation. Contrast-enhanced CT and MRI revealed a right retroperitoneal mass (6 cm) in the hilum of the right kidney that invaded the right renal vein and inferior vena cava (IVC). Suspecting a tumor arising from retroperitoneal tissues involving the right renal vein and IVC, the decision was made to excise the tumor with the right kidney, renal vein, and a portion of the IVC. The histologic findings indicated that the tumor was a leiomyosarcoma originating from the renal vein wall. The tumor cells were spindle-shaped and stained positive for desmin, caldesmon and HHF35. The post-operative course was uneventful and she was recurrence-free 20 months after surgery. In addition to presenting a case of a leiomyosarcoma of the renal vein, a short review of the literature is provided.
Renal mucinous tubular and spindle cell carcinoma (MTSCC) is a rare, renal epithelial neoplasm that is an established subtype in the World Health Organization 2004 classification. A 75-year-old-woman was diagnosed as having atypical mycobacterial infection and hepatitis C. Computed tomography showed a hypovascular mass 35 mm in diameter in the left kidney. The renal tumor was diagnosed as MTSCC by pathological examination of the renal biopsy specimen. The patient underwent laparoscopic left radical nephrectomy via a retroperitoneal approach. Pathological findings showed left renal carcinoma (MTSCC, pT3aN0M0), and we did not perform adjuvant therapy. The patient developed lung nodules one month after the operation that were diagnosed as lung metastasis by pathological examination of a bronchoscopic biopsy specimen. She then developed progression of lung metastasis, mediastinal lymph node metastasis and bone metastasis. We explained the necessity of therapy, but she refused therapy and died of disease progression four months after the operation. MTSCC is thought to have a relatively good prognosis, but care must be taken because, as in our case, tumor progression can occur rapidly.
Primary small cell carcinoma of the urinary tract is a relatively rare disease that is associated with a poor prognosis. The median overall survival time of patients with primary bladder disease is 19.6 month to 1.7 years, and that of patients with small cell carcinoma of the upper urinary tract is 15 months. Generally, curative surgery with chemotherapy according to the type of small cell lung carcinoma is a preferred treatment. However, standard treatment has not been established yet because the number of cases is small. We herein report the clinical features and outcome of four patients with primary small cell carcinoma of the urinary tract between 2007 and 2018 at our institution and review the literature.
An 80-year-old man was referred to our hospital with a complaint of acute urinary retention due to hematuria. Cystoscopy revealed a broad-based tumor arising in a diverticulum on the right lateral wall of the bladder. Transurethral resection of the bladder tumor (TURBT) was performed immediately. The pathological diagnosis was small-cell carcinoma without any urothelial carcinomas, and clinical examination revealed a clinical stage of T3b, N0, M0. Thus, 3 courses of neoadjuvant chemotherapy with cisplatin and irinotecan were administered. Chemotherapy resulted in tumor shrinkage, and partial cystectomy was performed under a diagnosis of stage pT3aN0M0 bladder cancer in the diverticulum. The patient is alive without any evidence of tumor recurrence at 13 months after the operation. To our knowledge, this is the first case report in Japan of small-cell carcinoma in a diverticulum of the urinary bladder, for which partial cystectomy was performed after chemotherapy.
A 76-year-old man presented with gross hematuria and reported the use of anticoagulant for deep vein thrombosis (DVT). Blood tests revealed eosinophilia and thrombocytopenia. Urine cytology revealed a class I specimen with a few eosinophils in the urine. We performed cystoscopy, which revealed bladder masses with friable mucosa diffusely throughout the bladder. Magnetic resonance imaging revealed possible invasion of the bladder muscle by the masses. We performed transurethral resection of the bladder masses, and histopathological examination revealed eosinophilic infiltration of the bladder wall stroma without cancerous tissue. Therefore, the patient was diagnosed with eosinophilic cystitis.
Eosinophilia and thrombocytopenia promptly resolved, and the bladder masses disappeared following the administration of prednisolone for eosinophilic cystitis. DVT also improved without recurrence of eosinophilic cystitis.
Emphysematous cystitis is a rare disease involving infection caused by gas-producing bacteria is characterized by air storage in the bladder wall and lumen. Approximately 90% of the affected cases are treated using medical therapy alone, and approximately 10% require combined surgical treatment. Here we report a case of emphysematous cystitis with septic shock that could be treated using multimodal therapy with retroperitoneal drainage. A 76-year-old woman was hospitalized at a nearby hospital owing to lumbar compression fracture. She was transferred to our hospital owing to altered consciousness and low blood pressure. She was diagnosed with emphysematous cystitis, and conservative treatment was performed using an indwelling bladder catheter and by administering antibiotics or vasopressors. The patient had septic shock; hence, retroperitoneal drainage was performed. After surgery, the patient's general condition improved. In this study, we review the characteristics of five cases of emphysematous cystitis requiring surgical treatment in Japan.