Hida S

Psychosocial Aspects in Long-Term Survivors of Testicular Cancer

PURPOSE We assessed the psychosocial well-being in cured testicular cancer patients who had undergone chemotherapy with or without retroperitoneal lymph node dissection, radiotherapy or surveillance therapy. MATERIALS AND METHODS The sample consisted of 83 cured testicular cancer patients of whom 34 had undergone cisplatin-based combination chemotherapy with or without retroperitoneal lymph node dissection (chemotherapy group), 42 had received infradiaphragmatic radiotherapy (radiotherapy group) and 7 had received surveillance therapy (surveillance group). The questionnaire reported demographic data, psychosocial well-being, working ability, satisfaction with life, relationships, and general health and fitness. RESULTS For questions dealing with psychological distress there were no differences among the groups. However, a significant number of patients in all groups reported greater feelings of anxiety about health and future since treatment. Working ability was significantly better in the chemotherapy and radiotherapy groups than in the surveillance group (p < 0.05 and p < 0.01, respectively). Interestingly, the patients who received the most extensive treatment (chemotherapy plus retroperitoneal lymph node dissection) reported the best working ability. Using the satisfaction with life scale, patients in the chemotherapy and radiotherapy groups showed significantly higher scores than those in the surveillance group (p < 0.05). The majority of the patients reported no significant change in long-term relationships with family, friends and spouse. CONCLUSIONS The development of psychosocial problems during long-term adjustment seems to be low regardless of treatment received. Although a significant number of patients reported a higher incidence of anxiety and depression since the illness, the overall attitude was positive toward life. With regard to treatment type, patients in the chemotherapy and radiotherapy groups had better working ability and greater satisfaction with life than the surveillance group.

Malignant lymphoma of the testis: histological and immunohistological study of 28 cases.

Histological and immunohistological studies were made in 28 patients with testicular lymphoma who presented with a right (15), left (11) or bilateral (2) scrotal swelling. Patient age at hospitalization ranged from 39 to 87 years, with a median age of 64 years. The disease was stage 1 in 12 patients, stage 2 in 11 and stage 3 in 5. Histologically, most of the neoplasms were of the diffuse large cell type, with an immunoblastic type being the most common. Immunohistochemistry revealed that all but 2 cases were of the B cell type. None of the tumors reacted with monoclonal antibody for T cell. These findings suggested that testicular lymphoma exclusively consisted of the B cell type, identical to previous reports of extranodal lymphomas other than those in the skin. The pertinent literature is reviewed and the histogenesis of testicular lymphoma is discussed.

Eosinophilic Sclerosing Lipogranuloma of the Male Genitalia Not Caused by Exogenous Lipids

A type of sclerosing lipogranuloma of the male genitalia that is different from cases caused by injection or application of foreign bodies is reported in 4 patients. The characteristics of the disease are a symmetrical Y-shape of the granuloma, spontaneous regression, severe infiltration of eosinophils in the granuloma, eosinophilia of the peripheral blood and absence of any exogenous lipids by chemical analyses of the granuloma tissue. Ultrastructural study showed intracytoplasmic fat vacuoles of varied size in histiocytes and multinuclear giant cells. This is a new type of sclerosing lipogranuloma of the male genitalia and the pathogenesis of the disease is still unknown.

Primary malignant melanoma of the male urethra

Abstract Background : We describe a rare case of malignant melanoma originating from the male urethra.

Afferent Nipple Valve Malfunction Caused By anchoring Collar: An Unexpected Late Complication of the Kock Continent Ileal Reservoir

In the construction of a Kock continent ileal reservoir for urinary diversion, significantly high rates of late postoperative complications regarding nipple valves, the efferent limb in particular, have been reported. There are only a few reports on afferent nipple valve malfunction. A total of 42 patients who underwent a Kock pouch operation and were observed for more than 12 months (mean 38 months) was evaluated in terms of afferent nipple valve malfunction. Late afferent nipple valve complications were observed in 10 of the 42 patients (24%). These complications included erosion of the polyester fiber fabric used as a collar (5 patients), stenosis of the afferent limb (2) and obstruction of the afferent nipple by a mucous plug or fungus ball (3). The latter 2 complications were due to mechanical or dynamic obstruction of urine flow caused by a nonabsorbable collar. None of the 10 patients had problems with efferent nipple valve function. Our results suggest that the peristaltic direction of the intestine and the use of nonabsorbable material as a collar are primarily responsible for the late afferent nipple valve complications. Further modifications are needed to produce a stable nipple valve. Otherwise, simpler and more reliable alternative techniques of antireflux anastomosis should be considered.

LEIOMYOSARCOMA OF THE SPERMATIC CORD

Abstract Background : A rare case of leiomyosarcoma from the spermatic cord is described. A 72‐year‐old man complained of a hard, golf‐ball sized mass in the right inguinal canal.

VAB-6 Chemotherapy Causes Spurious Elevation of Alpha-Fetoprotein Associated with Liver Dysfunctions

In order to elucidate the mechanism of elevation of alpha-fetoprotein (AFP) which we often observed during VAB-6 chemotherapy, we analyzed sequential changes of AFP, liver enzymes and bilirubin in 10 patients with evaluable disseminated testicular cancer who were treated with VAB-6 chemotherapy. None of the patients had previous liver disease or hepatic involvement. During the early phase of each course of chemotherapy, AFP showed a temporary elevation associated with reversible increase in liver enzymes and bilirubin. These changes returned to normal before the next course of chemotherapy. In each patient, marked tumor regression occurred as a result of VAB-6 chemotherapy. Nine of the 10 patients remain free of disease after treatment. We conclude that during VAB-6 chemotherapy, a temporary elevation of AFP is common, associated with reversible liver dysfunctions, and that this spurious elevation of the tumor marker, most likely caused by a heavy dose of cisplatin, should not be interpreted as related treatment failure.

Advantages in Combination Chemotherapy Using Cisplatin and Its Analogues for Human Testicular Tumor Xenografts

The antitumor effects and toxicities of combination chemotherapies using cisplatin (CDDP) and its analogues were compared with those of single drug therapies. Congenitally athymic nude BALB/c (nu/nu) mice were used to estimate antitumor activities of these compounds against human testicular tumor (Ht‐14) xenografts and hetero‐BALB/c (nu/+) mice were used to evaluate the toxic effects of the drugs. Combination therapy with half dosages of CDDP and carboplatin (JM8) (CDDP: 2, JM8: 20 mg/kg/day for 5 days), or of CDDP and (glycolato‐O, O′)‐diammineplatinum (II) (254S) (CDDP: 2, 254S: 4 mg/kg/day for 5 days), resulted in significant tumor regression. The combination of CDDP and JM8 had the highest therapeutic efficacy while the CDDP and 254S combination had a lower antitumor potency. In addition, the toxicities of the combination therapies were lower than what was produced by the highest dosage of CDDP (4 mg/kg/day for 5 days). These results demonstrated that the antitumor activities of these combination chemotherapies were equal or superior to the activity of CDDP or an analogue alone, and that the toxicities produced by these combinations were more manageable than those produced by single drug therapies.

Accumulation of99mTc-PMT in renal metastasis of hepatocellular carcinoma

We describe here a case in which99mTc-Sn-N-pyridoxy-5-methyltryptophan (99mTc-PMT) scintigraphy was useful in diagnosing renal metastasis of hepatocellular carcinoma (HCC). A 62-year-old man who had undergone hepatectomy for HCC presented 6 years after initial diagnosis with left flank pain and was found on CT and MRI to have a tumor in the left kidney. Hepatobiliary scintigraphy using99mTc-PMT was performed, and99mTc-PMT accumulation was found in the tumor. Nephrectomy was performed and metastasis of HCC was confirmed.

Pulmonary nodules simulating metastasis of germ cell tumor after aggressive chemotherapy.

We describe a patient in whom pulmonary nodules developed without infectious symptoms during treatment with bleomycin, cis-platinum, vinblastine and etoposide combination chemotherapy for metastatic extra-gonadal germ cell tumor. At thoracotomy only fibrosis was found. In this case, false-positive elevation of alpha-fetoprotein and the CT scan appearance made us interpret the pulmonary nodules as new metastatic lesions.