Kondo I

Case of Vesico-Appendiceal Fistula Secondary to Mucinous Adenocarcinoma of the Appendix

We present a rare case of vesico-appendiceal fistula secondary to mucinous adenocarcinoma of the appendix. Transurethral biopsy of the bladder revealed a mucinous adenocarcinoma of probable colonic origin. Adenocarcinoma of the appendix that directly invaded the bladder was diagnosed preoperatively by air-contrast barium enema, colonoscopy and magnetic resonance imaging. When one encounters a case of adenocarcinoma of the bladder suspected to be of colonic origin, one should examine the colon and rectum as well as the appendix and cecum.

Postoperative prophylactic use of progesterone in renal cell carcinoma.

Medroxyprogesterone acetate has been used prophylactically in 35 patients with stages I and IIIA renal cell carcinoma who had undergone radical nephrectomy. Metastasis was noted in 26 per cent (9 of 35) of the patients who had received the drug and in 44 per cent (20 of 45) of those who had not (controls). The incidence of metastasis in patients who had undergone nephrectomy more than 3 years previously was 10 per cent (3 of 31) for patients who received medroxyprogesterone acetate and 35 per cent (15 of 43) for the control group, the difference being statistically significant. Prognosis tended to be better in patients who had received medroxyprogesterone acetate than in the controls, and relative 3 and 5-year survival rates being 99.3 and 87.2 per cent, respectively, in the former group, and 86.8 and 75.0 per cent, respectively, in the latter group. There was no significant difference between these 2 groups. However, it may be concluded that prophylactic medroxyprogesterone acetate seems to be beneficial in the prevention of postoperative metastasis of renal cell carcinoma.

MALIGNANT LARGE CELL CALCIFYING SERTOLI CELL TUMOR WITH ENDOCRINE OVERACTIVITY

We report a case of malignant large cell calcifying Sertoli cell tumor with endocrine overactivity resulting in persistent gynecomastia. Synchronizing with the development of metastatic lesions, the urine titers of 17-ketosteroids and estradiol were markedly increased. To our knowledge our case is the first report of malignant large cell calcifying Sertoli cell tumor demonstrating overt endocrine overactivity. CASE REPORT A 29-year-old Japanese man presented with a left testicular mass and gynecomastia. Familial and personal histories were unremarkable. Imaging studies demonstrated metastatic lesions in the lung and retroperitoneal lymph nodes. The removed left 12 x 8 x 7 cm. testicular tumor revealed solid cut surfaces with scattered calcification, hemorrhage and necrosis. Microscopically the tumor was comprised of atypical polygonal cells with oval nuclei and abundant eosinophilic cytoplasm, which were arranged in tubular fashion (part A of figure). There were various sized calcifications scattered in the tumor, frequently showing concentric, mulberry-like features. The tumor cells demonstrated mitotic activity (a10 high power fields), extratesticular growth and vascular invasion. Diagnosis was malignant large cell calcifying Sertoli cell tumor. The tumor cells were immunoreactive for estradiol (part B of figure) and aneuploid deoxyribonucleic acid was apparent on histogram. No remarkable effect was obtained with systematic radiotherapy and chemotherapy. As the metastatic lesions progressed, urine secretion of 17-ketosteroids (up to 63.5 mg. daily, normal 2.0 to 7.6) and estradiol (up to 230.2 pg. daily, normal 0.1 to 3.0) increased markedly. Gynecomastia continued during the course of the disease. The patient died of lung metastases 27 months after onset of the primary lesion. Autopsy disclosed extensive metastatic lesions in the lung, right kidney, small intestine and systemic lymph nodes. The histopathology was nearly similar to that of the

A phase II study of prophylactic intravesical chemotherapy with 4′-epirubicin in recurrent superficial bladder cancer: comparison of 4′-epirubicin and Adriamycin

Since intravesical recurrence of superficial bladder cancer (Ta, T1) after transurethral resection (TUR) is frequent, adjuvant therapy to reduce the recurrence rate has been extensively investigated. Although intravesical chemotherapy has been employed for 30 years or more, neither the exact effect on the bladder epithelium nor the optimal dose and administration schedule has yet been clarified. In recent years, several derivatives of Adriamycin (ADR) have been developed, and 4′-epirubicin (FARM) is one of them. This drug has been shown to have antitumor effects almost equal to those of ADR and to produce less toxicity when given systemically as chemotherapy. In an attempt to clarify the effect of intravesical FARM in the prevention of recurrence of superficial bladder cancer, we conducted a prospective randomized trial to compare the effects of equal doses of FARM and ADR given by intravesical instillation after TUR in cases of highly recurrent superficial bladder cancer. A total of 73 patients with recurrent superficial bladder cancer were randomized to receive TUR and either 30 mg FARM or 30 mg ADR by intravesical instillation every 2–4 weeks for 1 year. The prophylactic effect on recurrence and the toxic effects of these drugs were investigated. The current results show that FARM provides efficacy almost equal to that of ADR in the prevention of recurrence in these patients. However, FARM also caused almost the same local toxic effects (bladder irritation, among others) as ADR. On the basis of these preliminary results, FARM is surmised to be one of the agents as beneficial as ADR in the prevention of recurrence of superficial bladder cancer.

Do the worst histological elements in needle biopsy specimens of prostate cancer predict prognosis

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Preoperative doxorubicin instillation in recurrent superficial bladder cancer

SummaryFurther recurrence of superficial bladder cancer after transurethral resection is frequent in patients who have already experienced recurrence. In an attempt to prevent or delay further recurrences in such patients, the effect of preoperative doxorubicin instillation was investigated. A total of 51 patients with recurrent superficial bladder cancer were randomized to receive either TUR alone or TUR with preoperative doxorubicin instillation. Doxorubicin was administered twice a week for 3 weeks before TUR surgery. An objective response (CR+PR) of the tumors was observed at operation in 12 of 25 (48%) evaluable doxorubicin-treated patients. Chemical cystitis was seen in 32% of the patients. Further recurrence after TUR was observed in 13 of 25 (52%) patients in the doxorubicin group, as against 15 of 23 (65%) evaluable patients in the control group. The mean disease-free interval was significnatly longer (11.8 as against 7.1 months) in the doxorubicin group. These preliminary results suggest that preoperative doxorubicin instillation might be effective for prolongation of the disease-free interval in patients with recurrent bladder cancer.

Factors influencing the recurrence rate and metastatic rate of bladder cancer

Preservation surgeries have been applied for cancer of the urinary bladder in 202 cases during the past twenty years. We herein report the result of a statistical analysis on the background factors which determine the tumor recurrence rates and metastatic rates. The background factors analysed were as follows: size of tumors, number of tumors, histological staging, grading, lymph vessel permeation (ly) and vessel invasion (v). Each factor was analysed by Kaplan-Meier method and multiple regression analysis. By Kaplan-Meier method, tumor size, stage, grade, ly and v were closely related to the tumor recurrence and metastasis. By multiple regression analysis, tumor size, stage and ly were important for recurrence, while tumor size, stage and v were important for metastasis. In this study, histological grading was not so closely related to tumor recurrence and metastasis.