Norio Meguro

Ipsilateral adrenal involvement from renal cell carcinoma: retrospective study of the predictive value of computed tomography

OBJECTIVES To compare the radiologic evidence of adrenal involvement on computed tomography (CT) with pathologic reports and to assess the accuracy of CT in the diagnosis of adrenal involvement with renal cell carcinoma. METHODS Between January 1992 and June 2000, we treated 229 patients with renal cell carcinoma. In this study, we retrospectively analyzed 73 patients who had been examined by CT before surgery and had undergone radical nephrectomy, including removal of the ipsilateral adrenal gland. The abnormal integrity of the adrenal glands on CT and the pathologic adrenal involvement of renal cell carcinoma were demonstrated by a radiologist and pathologist, respectively. RESULTS The blinded review by a radiologist of the CT results of 73 patients with renal cell carcinoma identified a normal appearance of the ipsilateral adrenal gland in 54 patients (74%), none of whom had pathologic evidence of malignant involvement. The adrenal gland was diagnosed as abnormal on CT in 19 patients (26%), including enlargement in 7 patients, nodule formation in 7, and an irregular surface in 8. Two of these 19 patients had adrenal involvement. Both were staged at T3M1, and their primary tumors were large, measuring more than 10 cm. In this study, CT demonstrated 100% sensitivity, 76% specificity, 11% positive predictive value, and 100% negative predictive value for ipsilateral adrenal involvement of renal cell carcinoma. CONCLUSIONS Normal adrenal images on CT could exclude adrenal involvement by renal cell carcinoma. However, radical nephrectomy, including removal of the ipsilateral adrenal gland, should be performed in patients with large tumors.

Renal angiomyolipoma with minimal fat

Abstract We report here two patients with angiomyolipoma with minimal fat, who were treated by radical nephrectomy, with a diagnosis of renal cell carcinoma. The tumors in these two patients were hyperattenuated on unenhanced computed tomography (CT) images, but did not show fat components, and were moderately enhanced on contrast-enhanced CT images. The tumor in one patient was homogeneously hypointense on T2-weighted magnetic resonance (MR) images, enhanced during the early phase on dynamic MR images, and, further, showed abundant pulsatile blood vessels on color Doppler examination. These imaging findings of renal tumors suggested the possibility of angiomyolipoma with minimal fat; accordingly, when imaging results suggest this possibility, further careful sampling to identify minimal fat components must be performed by thin-section unenhanced CT.

Significance of Subclinical Varicocele Detected by Scrotal Sonography in Male Infertility: A Preliminary Report

To assess the clinical significance of subclinical right varicocele, we used scrotal sonography for a prospective study of 68 infertile patients with a clinical left varicocele. A significant difference was found in the improvement in postoperative semen characteristics between sonographically diagnosed bilateral and unilateral groups. We conclude that a subclinical right varicocele is also detrimental for spermatogenesis in patients with a clinical left varicocele.

Clinical Outcome and Prognostic Factors of Sorafenib in Japanese Patients with Advanced Renal Cell Carcinoma in General Clinical Practice

OBJECTIVE Effects of sorafenib in general clinical practice, especially those with patients of Asian ethnicity, have been rarely investigated. We assessed efficacy, safety and prognostic factors for progression-free survival in Japanese patients receiving sorafenib for advanced renal cell carcinoma. METHODS We performed a retrospective analysis of 159 Japanese patients with renal cell carcinoma. Progression-free survival was estimated by the Kaplan-Meier method. Objective response (per Response Evaluation Criteria in Solid Tumors) and safety were assessed. Cox proportional hazards model was used to identify independent prognostic factors for progression-free survival. RESULTS The median progression-free survival was 9.0 months (95% confidence interval, 7.5-10.6 months). In 142 patients with measurable lesions, the objective response rate was 21.8%, and disease control was achieved in 85 (59.9%) patients. Adverse events of any grade occurred in 152 patients (95.6%). Most common adverse events causing discontinuation or interruption of sorafenib were hand-foot skin reaction (22%), rash (10.7%) and liver dysfunction (10.7%). Dose reduction or therapy interruption due to adverse events was required in 128 patients (80.5%). Univariate and multivariate analysis revealed that favorable prognosis according to Memorial Sloan-Kettering Cancer Center prognostic factors and relative dose intensity during the first month of treatment of ≥50% were significant factors for predicting superior progression-free survival with sorafenib treatment. CONCLUSIONS Sorafenib was effective in Japanese patients with advanced renal cell carcinoma in general clinical practice and was tolerated although most patients required dose reduction or interruption of therapy. Future studies should establish new strategies for treatment without sacrificing both efficacy and patient quality of life.

Imaging characteristics of papillary renal cell carcinoma by computed tomography scan and magnetic resonance imaging

Abstract

Clinical Evaluation of Serum Prostate‐Specific Antigen‐Alpha1 ‐ Antichymotrypsin Complex Values in Diagnosis of Prostate Cancer: A Cooperative Study

Background We studied the clinical significance of serum prostate‐specific antigen bound to α1‐antichymotrypsin (PSA‐ACT) values determined with a newly developed enzyme immunoassay.

Stage specific follow-up strategy after cystectomy for carcinoma of the bladder

Background : Follow‐up strategies after cystectomy for carcinoma of the bladder should be determined according to the risk of recurrence, which is stage dependent. We aimed to develop follow‐up protocol for monitoring patients with carcinoma of the bladder for tumor recurrence and diverted urinary tract complications after radical cystectomy.

Surveillance following orchiectomy for stage I testicular seminoma: Long-term outcome

Objectives:  To report the long‐term outcome of surveillance for stage I seminoma at a single institution in Japan.

Renal Vein Thrombosis Misdiagnosed as a Renal Cell Carcinoma with a Tumor Thrombus in the Inferior Vena Cava

A 69‐year‐old man was diagnosed with a right renal carcinoma with a tumor thrombus in the inferior vena cava, and underwent a radical nephrectomy. The entire specimen was examined by step‐wise sectioning and found to be a thrombus with extensive hemosiderin deposits and recánalization which contained no malignant cells.

Failure to maintain the suppressed level of serum testosterone during luteinizing hormone-releasing hormone agonist therapy in a patient with prostate cancer

A 75‐year‐old man with metastatic prostate cancer had been treated with goserelin acetate, and prostate specific antigen (PSA) had decreased, but 11/2 years after beginning the treatment of goserelin acetate, PSA was markedly elevated and serum testosterone was at normal level. After castration the serum testosterone was at castrate level and PSA decreased. In the present case, leuprorelin acetate 1‐month depot suppressed the luteinizing hormone level in 1 month, even after the patient underwent castration.