Makoto Morozumi

Spermatic cord metastasis from colon cancer: Report of a case

We herein report an extremely rare case of a solitary metastasis to the spermatic cord from colon cancer. A 71-year-old man who had undergone a right hemicolectomy for stage II cecal cancer 12 months prior, and who had not received adjuvant chemotherapy, was found to have a mass in the right groin region. Computed tomography (CT) revealed that the right spermatic cord was involved in a heterogeneously enhanced mass that measured 37 mm in diameter. A right high orchiectomy was performed. Histological examination of the resected tumor revealed well-differentiated adenocarcinoma compatible with a metastasis from colon cancer. The patient has been doing well, without recurrence, for 15 months postoperatively. To our knowledge, this is the 9th case of a solitary metastasis to the spermatic cord from colon cancer to be reported in the Japanese literature. The survival data of the collected cases suggest that resection of the solitary metastasis to the spermatic cord from colon cancer improves the patient prognosis.

Renal cell carcinoma originating in a renal cyst in a 12-year-old girl

We report a 12-year-old girl with renal cell carcinoma originating in a cyst of the left kidney. Ultrasonography revealed 2 small hyperechoic masses in the luminal side of a cyst. Although hypervascularity was not detected in the cyst by computed tomography, the possibility of malignancy could not be ruled out because of the presence of 2 solid masses. Therefore, partial left nephrectomy was performed. On histopathologic examination, the 2 solid masses within the cyst were found to be renal cell carcinoma. This patient remains disease-free at 4 years after partial nephrectomy.

Percent decrease of serum prostate‐specific antigen after dutasteride administration is equivalent in men with clinical benign prostatic hyperplasia having baseline prostate‐specific antigen >10 ng/mL and those having baseline prostate‐specific antigen 2.5–10 ng/mL

DOI: 10.1111/iju.13284 Dutasteride, a dual inhibitor of type 1 and type 2 5a-reductase, is used widely along with a1-adrenoceptor antagonists for treating men with moderate-to-severe lower urinary tract symptoms secondary to BPH. The Reduction by Dutasteride in Prostate Cancer Events study showed that the PSA level in men with BPH treated with dutasteride for >6 months decreases to approximately 50% of the baseline level. Because of the inclusion criteria of the study, however, the finding is valid only for men with a baseline PSA level of 2.5–10 ng/mL. A PSA value >10 ng/mL is not necessarily definite evidence of the presence of PCa. It is well known that the PSA value is a better indicator of BPH than of PCa. Men with a PSA >10 ng/mL usually undergo MRI of the prostate and/or a prostate biopsy. It should be noted, however, that MRI and/or prostate biopsy fail to show PCa in a significant number of men with clinical BPH with a PSA >10 ng/mL. Although these men would be good candidates for dutasteride treatment, there is scarce knowledge about PSA changes after dutasteride treatment in these men. Thus, we investigated the change of PSA value after dutasteride administration in men with BPH having a baseline PSA >10 ng/mL, in whom PCa had been excluded by either a negative prior biopsy or negative MRI findings. Between 2009 and 2015, 508 men with lower urinary tract symptoms/BPH were treated with 0.5 mg daily dutasteride for >6 months at our institutions. Among these, 102 men with acute urinary retention, 225 without a prior biopsy or MRI examination and 12 with serum PSA <2.5 ng/mL were excluded (Fig. S1). Finally, 169 men were included in the current retrospective study. Clinical diagnosis of BPH was made according to criteria including an IPSS of ≥8 points, QOL score of ≥3 and transabdominal ultrasound-estimated prostate volume of ≥20 mL. MRI study was carried out with a 1.5-Tesla body scanner (Avanto; Siemens, Erlangen, Germany) with a 33-mT/m maximum gradient capability using an eight-channel phased-array body coil. The MRI protocol is shown in Table S1. PSA was measured at 6-month intervals after dutasteride administration. When a serial PSA increase from the nadir PSA value was seen, a repeat MRI and/or prostate biopsy was carried out. PSA changes from the baseline were evaluated as percent baseline PSA (%PSA) calculated by dividing the PSA value after dutasteride administration by the baseline PSA value. Changes in %PSA over time were compared between the men with baseline PSA >10 ng/mL and those with baseline PSA 2.5–10 ng/mL. The %PSA and the patients’ age, serum PSA, prostate volume, IPSS scores and QOL scores were compared between the two groups using the Wilcoxon rank sum test. All the analyses were carried out using JMP 12.0.2 (SAS Institute, Cary, NC, USA). The institutional review board approved the current study (No. 1185). We identified 59 men with PSA >10 ng/mL and 110 men with PSA 2.5–10 ng/mL. Their median baseline PSA values were 6.0 ng/mL (range 2.6–9.9 ng/mL) and 14 (range 10–44 ng/mL), respectively. Patient characteristics are shown in Table S2. The median follow-up period was 37 months (range 6–65 months). Two-thirds (114/169) of the patients used a1-blockers along with dutesteride; 55 men used tamsulosin, 31 used silodosin and 28 used naftopidil. The %PSA 6 months after dutasteride administration showed no difference between the groups (45% vs 51%,

Improved survival of men with metastatic prostate cancer treated with androgen deprivation therapy plus radiotherapy to the prostate

Abbreviations & Acronyms 3D-CRT = three-dimensional conformal radiation therapy ADT = androgen deprivation therapy ALP = alkaline phosphatase CAB = combined androgen blockade CI = confidence interval CSS = cancer-specific survival ECOG PS = Eastern Cooperative Oncology Group performance status HR = hazard ratio IMRT = intensity modulated radiation therapy LDH = lactate dehydrogenase LHRH = luteinizing hormone-releasing hormone (m)PCa = (metastatic) prostate cancer OS = overall survival PSA = prostate-specific antigen RT = radiotherapy

Receptive field characteristics of stretch-insensitive mechanosensitive units in the rat urinary bladder

INTRODUCTION The pelvic, hypogastric and pudendal nerves carry sensory information from the urinary bladder. The pelvic nerve is reported to be the most important one of these afferent nerves in producing urinary bladder sensation. The primary types of mechanoreceptors in the bladder can be divided into stretch-sensitive and stretch-insensitive units. The former is considered to be more important in producing bladder sensation. However, little is known about the precise receptive field properties of the stretch-insensitive mechanoreceptors in the urinary bladder. Therefore, in this study, we systematically investigated the receptive field characteristics of the pelvic single unit innervating the rat bladder wall. MATERIALS AND METHODS Functional single unit recordings were made from the pelvic nerve afferent filaments of anesthetized rats. A von Frey device was used for quantitative mechanical stimulation of the bladder surface. In addition, electrical stimulation was used for estimating conduction velocities of the nerve fibers in the receptive field. RESULTS The threshold value for mechanical stimulation was statistically lower at the caudal portion of the bladder body (sites IV and V) than the other bladder sites. The bladder neck (site I) had the highest mechanical stimulation threshold value for the bladder stretch-insensitive mechanoreceptors. In most cases, the pelvic nerve had bilateral receptive fields. The majority of the pelvic nerve afferents had conduction velocities in the slow A-δ or C fiber range. Mechanical stimulation threshold values were higher in males than in females in a portion of the bladder sites. DISCUSSION The pelvic stretch-insensitive bladder mechanoreceptors are 1) higher threshold at the bladder base, 2) contain large bilateral receptive fields and 3) demonstrate relatively slow conduction velocities. These characteristics indicate a non-uniform distribution of stretch-insensitive mechanoreceptors in the rat urinary bladder wall.

An infected thoracoabdominal aortic aneurysm mimicking the symptoms of urinary tract infection: A case report

Infected aortic aneurysms are rare, accounting for about 0.7%e 3.4% of all aortic aneurysms.1,2 They have high morbidity and mortality because of the difficulty of making the diagnosis and rapid progress to the late stage, with fulminant sepsis and aneurysm rupture. A case of an infected aortic aneurysm with left hydronephrosis and hydroureter that was difficult to differentiate from a urinary tract infection is reported.

Limited influence of dutasteride on individual prostate-specific antigen variability in men with clinical benign prostatic hyperplasia

DOI: 10.1111/iju.13557 The individual variability of PSA in men with BPH could interfere with the accurate evaluation of PCa risk. A better understating of PSA variability can aid in the differentiation between a significant PSA elevation suggesting the presence of PCa from biological variability that might be associated with age, inflammation or other conditions that do not directly relate to PCa. Although PSA levels in men treated with dutasteride are known to decrease to approximately 50% of the baseline level, the impact of dutasteride on PSA variability remains unknown. Thus, we investigated whether dutasteride influences not only the PSA value, but also the individual variability of PSA. Between 2009 and 2015, 508 men with lower urinary tract symptoms and/or BPH were treated with 0.5 mg daily dutasteride for ≥6 months at Saitama Medical Center, Kawagoe, Saitama, and Harada Hospital, Iruma, Saitama, Japan. We defined the period before dutasteride administration as the pretreatment period, and the period after 6 months of dutasteride administration as the post-treatment period. Inclusion criteria for the current study were: (i) clinically diagnosed BPH (International Prostate Symptom Score ≥8 points, quality of life score ≥3 and transabdominal ultrasound-estimated PV ≥20 mL); (ii) baseline PSA ≥2.5 ng/mL; (iii) PCa ruled out through a negative biopsy and/or negative MRI (the MRI protocol was described previously); (iv) no history of urinary retention; and (v) at least three PSA measurements during both the preand post-treatment periods. Finally, 87 men were included in the present retrospective study (Table S1). Chronological changes in PSA values were linearized using the least squares method during pretreatment and post-treatment periods. The magnitude of PSA variability was evaluated as a PSA residual, an original indicator obtained by the difference between the measured PSA and the least squares estimated PSA. As PSA values are decreased by approximately 50% of the baseline value after >6 months of dutasteride administration, we evaluated PSA variability as %PSA residual, the percentage of the PSA residual to the least squares estimated PSA value. Details are shown in Figure 1. To evaluate the consecutive PSA variation from the least squares estimated PSA line, the coefficient of determination (R) was calculated. Median %PSA residual and R values during the pretreatment period were compared with those during the post-treatment period using the Wilcoxon rank-sum test. All analyses were carried out using JMP 12.0.2 (SAS Institute, Cary, NC, USA). The institutional review board approved the current study (No. 1185). The median values (interquartile range) of patient age and PV were 70 years (67–75 years) and 54 mL (42–68 mL), respectively. Serum PSA was measured a median of six times (4–9 times) during a median of 39 months (20–75 months) of the pretreatment period, and a median of six times (4–8 times) during a median of 50 months (28–58 months) of the posttreatment period. The median PSA values during the preand post-treatment periods were 7.9 ng/mL (5.5–11.0 ng/mL) and 3.8 ng/mL (2.6–5.4 ng/mL), respectively. The median PSA residual values were 0.61 ng/mL (0.35–1.19 ng/mL) during the pretreatment period and 0.40 ng/mL (0.20–0.63 ng/mL) during the post-treatment period (P < 0.001). The median %PSA residual showed no significant change between the preand post-treatment periods, as shown in Figure 2a (7.7 [4.5–13.0] vs 9.0 [6.2–14.1], P = 0.199). Likewise, R values showed no specific trend between the two periods (Figure 2b, P = 0.880). The current results show that the administration of dutasteride has an effect on the absolute value of PSA residual in proportion to baseline PSA, but does not affect PSA variability itself. To the best of our knowledge, this is the first report to investigate the influence of dutasteride on PSA variability. Biological PSA variability is known to be <20–46%, based on an intensive repeated PSA testing study. Previous studies have shown that age and PV correlate with PSA value, but not with PSA variability. In the management of BPH patients with significant PSA variability, it would be helpful to bear in mind that dutasteride reduces PSA values by approximately 50% without having an influence on biological PSA variability itself. Continuous surveillance for de novo occurrence of PCa during dutasteride treatment for BPH would be required even after initial negative biopsy and/or

Foreign-body granuloma mimicking post-chemotherapy residual seminoma: A case of true-negative findings using diffusion-weighted whole-body magnetic resonance imaging with background suppression

Diffusion-weighted whole-body magnetic resonance imaging with background suppression (DWIBS) is increasingly used in cancer imaging. However, little is known about its usefulness in the management of metastatic seminoma, in which evaluation of the viability of postchemotherapy residual nodules is pivotal. To date, 2–18fluoro-deoxy-d-glucose positron emission tomography (FDG-PET) has been recommended for post-chemotherapeutic assessment. We describe a case of metastatic seminoma in a 27-year-old man in which the viability of post-chemotherapy residual nodules tested false-positive on FDG-PET, but true-negative on DWIBS. DWIBS may be a good alternative technique to evaluate post-chemotherapy seminoma, although further studies are required to determine its usefulness.

Retroperitoneal Cystic Nodal Metastasis of Renal Cell Carcinoma

Cystic nodal metastasis of renal cell carcinoma is very rare. The pathogenesis of cystic nodal metastasis is thought to involve obstruction of a lymphoid vessel draining the kidney by tumor cells and retrograde metastasis from the primary site to the lymph node along the lymphatic vessels. In this study, a surgical case of small renal cell carcinoma with retroperitoneal cystic nodal metastasis is reported.

HUGE RENAL ANGIOMYOLIPOMA COMPLICATED WITH COMMON ILIAC VEIN THROMBUS BECAUSE OF THE TUMOR PRESSURE

A 47-year-old woman was transferred to our hospital in June 2014 in hemorrhagic shock due to rupture of a huge right renal angiomyolipoma (AML). Selective right renal arterial embolization performed that same day reversed the shock immediately. Despite the huge abdominal tumor, the patient was discharged 2 weeks later after refusing any further treatment.Two weeks later she noticed the abdominal tumor growing. One month after discharge, she was readmitted due to dyspnea caused by restriction of her breathing by the growing tumor mass. A CT revealed a massive increase in tumor size with internal liquefaction, a thrombus in the left common iliac vein, and a 12 mm aneurysm in the right renal artery. The patient requested removal of the abdominal tumor since her ADL had deteriorated. We decided to perform a right nephrectomy with consideration of the left common iliac vein thrombus and right renal arterial aneurysm.As a precaution against pulmonary embolism in case the left common iliac vein thrombus dislodged, a retrievable inferior vena cava (IVC) filter was inserted before surgery. We were also concerned about possible rupture of the right renal aneurysm, so the right renal artery was embolized before surgery. After these procedures, a right nephrectomy was performed via a transperitoneal approach.The surgery was uneventful. The tumor weighed about 11 kg including 7,000 mL of bloody fluid. The IVC filter was removed the day after surgery, but the thrombus in the left common iliac vein remained, and an anticoagulant was started. Three months later, the thrombus had disappeared, and the anticoagulant was discontinued six months after surgery.According to the treatment guidelines for deep vein thrombosis, anticoagulants are the drugs of choice. IVC filters are seldom used to prevent pulmonary embolism. We initially administered an anticoagulant for the thrombus in the left iliac vein. However, an increase in abdominal tumor size suggested the drug had caused internal rebleeding and it had to be discontinued. Ultimately, we used a temporary retrievable IVC filter during the right nephrectomy with success.There is currently no consensus on when to use an IVC filter. Moreover, very little data exists on the use of an IVC filter during the perioperative period. Therefore, given the risk of potential thromboembolism, although we were able to use it successfully in our surgery, it should not be employed without a thorough benefit-risk assessment.