Sun-Yran Chang

Spontaneous Bilateral Renal Subcapsular Hematoma as a Possible Complication of Myeloproliferative Disorders

A 64-year-old male had bilateral renal subcapsular fluid accumulation evident on abdominal sonography performed during postoperative follow-up after surgery for a hepatoma. There were no clinical symptoms, and he had no history of trauma or receiving anticoagulant medication. Spontaneous bilateral renal subcapsular hemorrhage was diagnosed after a series of examinations. He did have an underlying myeloproliferative disorder (MPD), and had received incomplete cytoreductive treatment. Platelet aggregation in MPD is often abnormal, and both bleeding and hypercoagulation complications have been reported. Here we report a rare case of MPD with possible thrombohemorrhagic complications presenting as spontaneous bilateral renal subcapsular hematomas.

Abdominal Subcutaneous Metastasis from Sarcomatoid Renal Cell Carcinoma

Subcutaneous metastases originating from genitourinary tract cancers are rare, especially for renal cell carcinomas. The most common sites for such metastases are the lung, liver, brain and bone. Subcutaneous metastases are considered ominous. We report a 78-year-old man who presented with a huge solitary mass over the suprapubic region of the abdominal wall. He had been diagnosed as a renal cell carcinoma with multiple pulmonary metastases. Treatment for the mass consisted of wide excision and continuing systemic interferon therapy. The patient died three months after the surgery, following a rapid local recurrence and general deterioration.

Metastatic Ureteral Tumor from Adenocarcinoma of Colon

Metastatic tumors of the ureter are rare. In most published cases the diagnosis was not made until postmortem examination or when gross metastases were present. A 69-year-old female was found to have colonic adenocarcinoma with liver metastases 17 months before she was admitted to our ward. After she underwent right hemicolectomy her liver metastases were wellcontrolled by adjuvant chemotherapy. Ureteral stricture over the upper third of the right ureter with hydroureteronephrosis was noted incidentally on abdominal computed tomography 9 months after the completion of postoperative chemotherapy. Metastatic evaluation including subsequent biopsies under ureteroscopy revealed urothelial hyperplasia with reactive atypia. Subsequently, segmental resection of the upper third of the right ureter was performed and histologic examination confirmed metastatic adenocarcinoma of the ureter from the colon. The patient is alive with disease and has been undergoing subsequent chemotherapy up to the present. The differential diagnosis of ureteral lesions causing stricture cannot be achieved by radiographic study only. Pathologic confirmation remains necessary for the diagnosis of malignancy, especially of metastatic nature. If a patient with ureteral stricture has a history of a primary neoplasm, a secondary ureteral tumor, although rare, must be maintained in the differential diagnosis.

Changes in Serum Prostate-Specific Antigen after Orchiectomy and Complete Androgen Blockade in Patients with Stage D Prostatic Carcinoma

Prostate-specific antigen (PSA) is a unique serum marker highly sensitive to any form of therapy for prostatic cancer. Based on the character of hormonal dependence of the cancer cell, and rogen ablation is one of the best therapies for advanced prostatic cancer. From April 1990 to April 1995, 74 patients with the diagnosis of stage D prostatic cancer had received bilateral orchiectomy. Twenty-four of them had completed regular follow-up at our out-patient clinic. Serum PSA level was checked every two to three months and analyzed. Twelve patients who had no adjuvant anti-androgen therapy were categorized as group I. Another twelve patients who received post-operative anti-androgen medication were categorized as group II. In the group I patients, the serum PSA level reduced to the minimum 7.3±5.2 months after orchiectomy but relapsed 10.6±10.6 months later. In the group II patients, the post-operative PSA level reduced to the minimum in 9.9±6.6 months and raised 7.8±5.7 months later. There were no statistic differences between both groups (p＞0.05, Student’s t test). Our preliminary results, warranted no conclusion on the role of adjuvant complete androgen blockade therapy for stageD prostatic adenocarcinoma.

Retroperitoneal Ganglioneuroblastoma – A Case Report

Ganglioneuroblo.stoma originates from neural crest tissue; it is the intermediate type between mature neuroblastoma to ganglioneuroma. Its frequency is about one-fifth that of the neuroblastoma, with half of the cases is younger than 14 years of age. From 1983 to 1995, two ganglioneuroblastomas were diagnosed by pathology at Tri-Service General Hospital. One of the two cases had tumor recurrence three times postoperatively during a 44-month follow-up period. In addition to similar histopathological features, DNA flow cytometric analysis revealed the same DNA stemlines in tumor specimens from different locations. This indicates that these metachronous tumors could be a serial peritoneal implantations of tumor cells from the original huge retroperitoneal tumor. Multicentricity of different stem lines is unlikely in this case. Extraperitoneal radical excision of the tumor and delicate manipulation to prevent intraperitoneal seeding is advised.

Flow Cytometric Analysis of Spermatogenesis in Varicocele Patients

The effect of varicocele on spermatogenesis continues to elude investigators. Conventional pathological examination of testicular biopsy is time-consuming, qualitative and subjective. The ability to use deoxyribonucleic acid (DNA) flow cytometry on testicular biopsy material has been shown to be a rapid, reproducible and objective modality to quantify spermatogenesis. This technique has been used here to quantify spermatogenic activity in 20 patients with severe varicocele. By histologic examination, 13 patients (65%) demonstrated alternations in spermatogenesis with various degree of hypospermatogenesis. The DNA histogram revealed that 14 patients (70%) with 23 units of testicular biopsy had an abnormal ploidy ratio with partial maturation arrest (Type 2) in 16 testicular units, earlier complete maturation arrest (Type 3a) in 2 units and late complete maturation arrest (Type 3b) in 5 units. No Sertoli-cell-only syndrome (Type 4) was seen in this study. The senstitivity of DNA flow cytometry for diagnosis of spermotogenesis impairment of varicocele was 84. 6% and specificity was 92. 8%. Testicular size is not an independent parameter for evaluation of spermatogenic activity affected by varicocele and might be a late outcome of varicocele in a certain percentage of patients. Semen analysis had the highest abnormality rate (80%), possibly because of a combination of influences by testicular and extratesticular factors. Results suggested that DNA flow cytotnetric analysis of testis can provide an adjunctive study for rapid and quantitative characterization of spermatogenesis in varicocele patients.

Fibroepithelial Polyp of the Ureter: Its Presentation, Diagnosis and Treatment Modality

Fibroepithelial polyp is the most common mesodermal tumor in the ureter, although its incidence is low. A total of only 23 cases, including 6 cases in this hospital, have been reported from the English literature after 1981, with the development of ureteroscopic techniques, for comparison with previous reports on presentation, diagnosis, and treatment modalities . The poylp was usually single (65%), and more commonly seen in males with a ratio of 1.3 to 1; usually it was seen in the upper third of the ureter (74%), in the left ureter (65%), and in the second to third decade of age. The symptoms were most commonly recurring loin pain (83%) and hematuria (48%). Usually intravenous urography could demonstrate an intraluminal, thin mass with smooth borders arising from a long stalk (mean 5.1 cm in length) and contrast medium could be seen passing alongside the polyp. Some degree of hydronephrosis and hydroureter might be seen (56%). The incidence of associated urinary.stone was 17.4%. With the introduction of ureteroscopy, preoperative diagnosis of the benign tumor has dropped the nephroureterectomy rate from 49% to 22%. Although segmental resection with reanastomosis is still the mainstay treatment method, long polyps located in the distal part of the ureter can be easily removed using a ureteroscope, without any complication or recurrence. In conclusion, it is important for the surgeon to be aware of the disease and its benign nature in order to have an accurate preoperative diagnosis, followed by renal-sparing surgery.

The Effects of Sex Hormones on Mouse Epididymal Cells Cultured in Vitro

Epididymis provides an environment for post-testicular maturation of sperm. Studies have shown that epididymal secretions are essential for sperm maturation. In BALB/c mice, we found that two wheat- germ agglutinin (WGA)-binding proteins, GP-49 and GP-83, secreted by principal cells of the epididymis were closely related to sperm maturation. This study investigated the effects of sex hormones on principal cells of corpus epididymis cultured in vitro. Principal cells were recovered from corpus epididymides of 4-week-old mice by digestion with try psin and collagenase. The cells were cultured in RPMI 1640 medium supplemented with dihydrotestosterone (DHT) or estradiol (E2) for 4 days. Cytochemical localization revealed apparent WGA-binding sites in the cytoplasm of cultured cells. Protein biosynthesis was evaluated with 35S-methionine and deoxyribonucleic acid (DNA) synthesis was investigated with 3H-thymidine. Western blots of cells extracts were autoradiographed which revealed no apparent differences in quality of newly synthesized proteins and WGA-binding proteins in principal cells cultured in DHT and E2. There was no significant difference in proliferation of principal cells cultured in varying concentration of DHT. However, total protein production and DNA synthesis of principal cells cultured in E2 were inhibited. Thereafter, bilateral orchiectomy were performed on BALB/c male mice for 4 weeks. The epididymides were atrophied. The attachment and proliferation of cultured principal cells which recovered from castrated mice were very poor. These results indicated that the morphology and function of epididymis i.e. glycoprotein synthesis were influenced by long term and rogen withdrawal. The principal cells cultured in vitro were able to secrete sperm maturation-related proteins. But testosterone had little effect on protein synthesis and proliferation of cultured principal cells in a short term duration.

Renal Calcified Pseudocyst with Extramedullary Hematopoiesis - A Case Report and Literature Review

Pseudocyst is defined as a cystic lesion with no lining epithelium. It is rearely found in the kidney. Extramedullary hematopoiesis is usually secondary to hematological problem as a compensatory mechanism for insufficient erythrocyte formation. It is even rare in the renal pseudocyst with extramedullary hematopoiesis. To our knoweledge, there was no report of such combination in the English literatures. Herin, we present a case.

Coincident Renal Cell Carcinoma and Angiomyolipoma in the Same Kidney – A Case Report and Review of Literatures

Renal angiomyolipomas are found in more than half of the patients with tuberous sclerosis. We report a case of angiomyolipoma and renal cell carcinoma occurring in the same kidney without stigmata of tuberous sclerolsis. (J Uorl R.O.C., 1: 233-240,1990)