(Purpose) To determine the incidence and prognosis of prostatic ductal adenocarcinoma.
(Materials and methods) From November 2002 to December 2005, we performed 122 radical prostatectomies and pelvic lymph node dissections. We further analyzed 64 cases after excluding 56 cases that had received neoadjuvant hormone therapy and two cases for which we were only able to perform limited follow-up examinations. We reviewed all of the surgical specimens and reclassified them according to the 2004 WHO classification system. We differentiated prostatic cases of ductal adenocarcinoma that were larger than 5mm in diameter from cases of acinar adenocarcinomas. We then examined these two groups for the pathological stages of the neoplasms and the incidence of postoperative prostate-specific antigen (PSA) failure. Postoperative PSA failure was defined as a PSA value more than 0.2ng/ml.
(Results) We found eight cases (12%) of prostatic ductal adenocarcinoma among the 64 cases treated with radical prostatectomies. The mean age (±SD) of these patients was 65.3 (±4.3) years old, and the mean PSA level (±SD) was 12.4 (±5.4)ng/ml. Seven of the cases (11%) were mixedtype ductal adenocarcinomas, which contained acinar and ductal components. In addition, one case was identified as pure ductal adenocarcinoma. Seminal vesicle invasion was detected in four cases and lymph nodes metastases were identified in one case. During the follow-up period, four of the eight cases of ductal adenocarcinoma (50%) and twelve of the 56 cases of acinar adenocarcinoma (21%) showed postoperative PSA failure. The median follow-up period was 24 months (range: 12 to 48 months).
(Conclusions) We identified eight cases of ducal adenocarcinoma (12% of the examined cases), which suggests this disease is not as rare as previously reported. Compared to the cases of acinar adenocarcinoma, the cases of ductal adenocarcinoma were at a more advanced pathological stage and resulted in a higher rate of postoperative PSA failure. Therefore, we believe that patients that show even a limited degree of ductal adenocarcinoma should receive aggressive therapy.

View full abstract

(Introduction) A purpose of the surgical treatment for pelvic organ prolapse (POP) is not only the anatomical restoration of the patients but also the improvement of their quality of life (QOL). We have no linguistic validated questionnaire in Japanese to assess it. Therefore we have translated ‘prolapse quality of life questionnaire (P-QOL)’ into Japanese and present it to the thirty POP patients at our institute for evaluating mental and physical condition before and three months after the operation.
(Patients and Methods) We completed SF-36 and a questionnaire of patients' satisfaction on 30 patients besides P-QOL. SF-36 stands for Medical Outcome Study, Short Form 36 and is used for assessing overall QOL. We also completed pelvic organ prolapse quatification (POP-Q) to evaluate physical condition of the patients.
(Results) No recurrent case was observed at three months after the operation. QOL of the patients was much improved based on the results of P-QOL, SF-36 and POP-Q. The results of questionnaire of patients' satisfaction were well correlated with other questionnaires.
(Conclusion) P-QOL can be expected as the linguistic validated questionnaire in Japanese version. Further studies will be needed for making linguistic validated P-QOL in Japanese version.

View full abstract

(Objective) We compared the surgical results between holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TUR-P) for the treatment of men with benign prostatic hyperplasia (BPH).
(Methods) A total of 87 patients with symptomatic BPH were analysed. HoLEP was performed on 46 men (mean age 68.2±7.5 years old) from December 2005 to February 2007, and TUR-P was performed on 41 men (mean age 69.2±7.3 years old) from April 2004 to March 2006.
(Results) Both groups were comparable in terms of age, pre-operative IPSS, QOL index, urodynamic study results and prostate volume. During operation, decrease in hemoglobin was less in the HoLEP group than in the TUR-P group (1.15±1.2 vs 1.91±1.3g/dl p<0.05). The operation time was significantly longer in the HoLEP group than in the TUR-P group (161.9±65.0 vs 118.3±36.9 minutes p<0.001). Mean resected weight was 29.3±13.3g (10-55) in the TUR-P group and 34.8±33.4g (5-148) in the HoLEP group (p=0.337). The catheterization period (52.1±29.6 vs 115.2±27.5 hour p<0.001) and hospital stay (6.6±2.3 vs 9.4±2.2 days p<0.001) were significantly shorter in the HoLEP group than in the TUR-P group. At follow up, Qmax, average flow rate and post void residual urine (PVR) in two groups improved significantly, and these parameters were not significantly different between the groups after 3 months.
(Conclusions) Both TUR-P and HoLEP were effective in relieving BOO. The estimated blood loss, a catheterization time and hospitalization were less or shorter in the HoLEP group. HoLEP may be a good alternative to the conventional transurethral electrocautery resection of the prostate for symptomatic BPH.

View full abstract

CMV infection is uncommon in our practice except kidney transplantation. We report a case of cytomegalovirus enterocolitis during standard chemotherapy for testicular cancer. A 31-year-old male presented to his local urologist in January, 2006 with left scrotal swelling. He was diagnosed as left testicular tumor and underwent radical orchiectomy. Pathological examination showed Mixed germ cell tumor (seminoma, yolk sac, embryonal). Four months later, follow-up CT scan revealed multiple metastasis in lung and para aortic lymph nodes. The patient was referred to our institution for further consultation. During 3^rd cycle of standard BEP chemotherapy, laboratory data showed severe bone marrow suppression and he subsequently presented prolonged spike fever with watery diarrhea. Despite intensive diagnostic examination including colon fiberscopy, those symptoms remained undiagnosed. One month later, the patient recovered with conservative treatment and serological data showed slightly elevated anti-CMV Ig-M, Ig-G antibody. Immunohistological examination demonstrated CMV positive inclusion bodies in colorectal mucosa. Accordingly the patient's complication was finally diagnosed as CMV enterocolitis. Significant immunosuppression leading to severe colitis by CMV infection or reactivation can occur after standard chemotherapy. It is necessary to screen for CMV infection in patients with prolonged fever with diarrhea during chemotherapy.

View full abstract

A 77-year-old man visited our department with a painless mass in the left scrotum. He underwent left high orchiectomy with clinical diagnosis of testicular tumor. The tumor penetrated deeply into the internal inguinal ring. The tumor was resected as proximally as possible with positive surgical margin at the internal ring. Macroscopically, the left testis was intact in the resected specimen. Microscopic examination revealed that the tumor was consisted of myxoid stroma with spindle cells, and there was a large variation in histological findings. Immunohistchemical staining was positive with vimentin, and negative with αSMA, S-100, Myo D1, EMA, keratin, HMB45, and LCA. Accordingly, the tumor was diagnosed as myxofibrosarcoma, high-grade, of the spermatic cord. Postoperative CT scanning revealed multiple retroperitoneal lymph node metastases. He underwent radiation therapy, but soon developed lung metastases and pleural dissemination, and died 2 months after the operation. Myxofibrosarcoma, which had been called myxoid MFH is one of the most common soft tissue sarcomas. Myxofibrosarcoma or myxoid MFH of the spermatic cord is a rare disease. To our knowledge, only 7 cases have been reported in Japan to date.

View full abstract

A 28-year-old woman presented with right flank pain. A large, firm, fixed mass was palpable in the right side of the abdomen. Computed tomography revealed a solid mass of the right kidney with extension into the renal vein and inferior vena cava. The patient underwent right radical nephrectomy with en bloc resection of the inferior vena cava containing tumor thrombus and right adrenalectomy. Histologically the tumor consisted of small tumor cells with rosette formation. Immunohistochemical staining was positive for CD99 and NSE. Analysis with polymerase chain reaction (PCR) demonstrated the EWS/FLI1 fusion products resulting from a chromosomal translocation. These findings were consistent with primary renal primitive neuroectodermal tumor (PNET). Two months after surgery, multiple lung, liver and lymph node metastases were found. The patient received 2 cycles of chemotherapy with cisplatin, ifosfamide, etoposide, resulting in a partial remission. She subsequently received 1 cycle chemotherapy with paclitaxel and carboplatin, resulting in no response. The metastatic lung and liver diseases progressed and she died 5 months after diagnosis.

View full abstract