Shuichi Koizumi

Fournier’s gangrene caused by candida species as the primary organism

Fourniers gangrene is a rare entity caused by polymicrobial aerobic and anaerobic bacteria. We report a case of Fourniers gangrene caused by Candida as the primary organism. A 65-year-old man presented with perineal soft-tissue infections. He underwent surgical debridement and suprapubic cystostomy with both antifungal and antimicrobial therapy. The histopathologic examination revealed necrotizing fasciitis with Candida species as the sole initial pathogen. The case suggests that primary fungal pathogens should be considered as a causative organism of Fourniers gangrene.

Multipoint methylation analysis indicates a distinctive epigenetic phenotype among testicular germ cell tumors and testicular malignant lymphomas

Hypermethylation of tumor‐suppressor genes has been implicated in the pathogenesis of human cancers. Although a growing number of genes showing hypermethylation is being reported in human cancer, methylation profiles of tumor‐related genes in testicular neoplasms have not been well elucidated. This study was designed to show the methylation profiles of multiple CpG islands in testicular germ cell tumors (TGCTs) in comparison with those in testicular malignant lymphomas. We studied the methylation status of E‐cadherin, CDKN2B, CDKN2A, BRCA1, RB1, VHL, RASSF1A, RARB, and GSTP1 by use of TGCT tissues and testicular malignant lymphoma tissues (25 primary TGCT tissues and three primary testicular lymphoma tissues). Methylation was not observed in E‐cadherin, CDKN2B, CDKN2A, BRCA1, RB1, VHL, RASSF1A, RARB, and GSTP1 in any of the TGCT tissues. In contrast, all three (100%) of the testicular lymphoma tissues demonstrated hypermethylation of E‐cadherin, RASSF1A, and RARB, but not CDKN2B, CDKN2A, BRCA1, RB1, VHL, and GSTP1. These data demonstrate that a distinctive epigenetic phenotype underlies the TGCTs and testicular lymphomas at the CpG sites of E‐cadherin, RASSF1A, and RARB; a distinctive epigenetic phenotype was not observed among seminomatous TGCTs and non‐seminomatous TGCTs at the CpG sites examined.

Primary Heterologous Carcinosarcoma of the Ureter with Necrotic Malignant Polyps

Carcinosarcoma is a rare and aggressive disease characterized by biphasic neoplasms with distinct mesenchymal and epithelial components. We report a case of ureteral carcinosarcoma with malignant necrotic polyps. The patient was a 58-year-old woman with painless hematuria, who was later diagnosed as having ureteral carcinosarcoma. Three long pendulous polypoid-shape tumors consisting of high-grade transitional cell carcinoma with chondrosarcomatous and osteosarcomatous elements were found. Two months after nephroureterectomy, the tumor relapsed in the bladder. Despite anterior exenteration, the patient died of local recurrence 6 months after her initial visit. To our knowledge, only 10 cases of this disease have been reported in the literature.

Surgical management of renal cell carcinoma invading into the liver: radical nephrectomy en bloc with right hepatic lateral sector

Renal cell carcinoma demonstrates expansive growth and invasion of adjacent structures. Direct liver extension, although uncommon, is a dismal prognostic sign. We propose radical nephrectomy en bloc with right lateral sector (segments 6 and 7) of the liver. The operative procedure was performed in 2 male patients, 61 and 81 years of age, both with renal cell carcinoma and direct hepatic extension. The patients had no evidence of disease at 100 and 57 months after resection. This procedure may help cure selected patients with renal cell carcinoma invading the liver.

Idiopathic retroperitoneal hematoma mimicking cystic tumor associated with hemorrhagic renal cyst

A 54-year-old woman was admitted to the hospital for evaluation of a retroperitoneal cystic mass detected incidentally during a complete followup physical examination for hypertension. CT revealed a 3 3 3 cm. cystic tumor between the inferior vena cava and abdominal aorta, and a 1 3 1 cm. enhanced mass in the left kidney (fig. 1). Magnetic resonance imaging showed that the inferior vena cava and abdominal aorta were deviated laterally by the mass in front of the vertebra, and a high density tumor in the left kidney was found (fig. 2). Angiography demonstrated no feeding arteries to the retroperitoneal mass or ruptured vessels. Preoperative diagnosis was cystic retroperitoneal and left renal tumors. To rule out lymphocele and retroperitoneal hematoma resection of the retroperitoneal mass and left partial nephrectomy were performed. The retroperitoneal mass was adherent to the inferior vena cava, abdominal aorta and vertebra, and had more capsular vessels than expected. Fluid collection of the retroperitoneal mass and left renal mass revealed an old hematoma and hematoma clot, respectively. Histologically, there were features of fibrous scar with fibrin and monocyte infiltration, while the left renal mass had no evidence of malignancy. Final diagnosis was idiopathic retroperitoneal hematoma and benign hemorrhagic renal cyst. No history of gastrointestinal upset, surgery or trauma was noted, and the cause of retroperitoneal hematoma and origin of the bleeding could not be identified. Convalescence was uneventful, although hypertension did not subside. The patient was well without evidence of disease recurrence at 1-year followup.

Recurrent rhabdomyosarcoma after adjuvant chemotherapy for stage I non-seminomatous germ cell tumor with malignant transformation

We report a rare case of stage I non‐seminomatous testicular germ cell tumor with malignant transformation. The patient received two cycles of chemotherapy (cisplatin, bleomycin and etoposide) tailored to testicular germ cell tumors as an adjuvant therapy after orchiectomy. However, 22 months later, the patient developed a metastasis in the occipital region that consisted of solely rhabdomyosarcoma through malignant transformation of a teratoma component. This case highlights an issue related to adjuvant chemotherapy for testicular germ cell tumors with components of malignant transformation.