Yoji Taki

Orthotopic ileal neobladder in male patients: Functional outcomes of 66 cases

Background : Orthotopic urinary diversion has become the preferred form of bladder reconstruction after cystectomy. We report on our experience with 66 male patients undergoing this procedure from November 1990 to February 1998.

Choriocarcinoma and Undifferentiated Cell Carcinoma of the Bladder with Gonadotropin Secretion

A case of choriocarcinoma and undifferentiated cell carcinoma of the bladder is reported. Transitional cell carcinoma was found initially in the bladder wall and in the terminal stage there was clinical evidence of production of gonadotropin. The concept of choriocarcinoma mimicry would supplant the explanation for the pathological features in this case.

Intracorporeal Lithotripsy with the Swiss Lithoclast

Background: In addition to currently available modalities of intracorporeal lithotripsy (ultrasonic, electrohydraulic, and laser), a new ballistic lithotriptor known as the Swiss Lithoclast has recently gained attention. This study reports our experience with the Swiss Lithoclast in the endoscopic management of urinary calculi.

Amyloid A gastrointestinal amyloidosis associated with idiopathic retroperitoneal fibrosis. Report of a rare autopsy case and review of the literature.

We report a rare autopsy case of secondary gastrointestinal amyloid A (AA) amyloidosis associated with idiopathic retroperitoneal fibrosis (IRF) in a 67-year-old woman. Masses were identified around the aorta and inferior vena cava in her abdomen. Histologically, plasma cell infiltration was observed within fibrotic areas. Because no specific cause for the inflammatory mass was apparent, we diagnosed it as IRF. Steroid therapy, which usually reduces IRF masses, proved ineffective, and malabsorption syndrome developed 4 years later. On autopsy, amyloid protein was present systemically in the vascular walls of several organs, and deposition was highest in the gastrointestinal mucosa. Amyloid protein was identified as AA type, strongly suggesting that the amyloidosis was secondarily induced by IRF. To our knowledge, only 2 other cases of IRF-associated amyloidosis have been reported. Two of the 3 patients of these cases were women who showed resistance to steroid therapy.

Torsion of a benign cyst arising from the tunica vaginalis testis

We describe a rare case of torsion of a benign cyst originating from the parietal layer of tunica vaginalis. This case presented with acute scrotum. Surgical exploration revealed a cyst arising from the parietal layer of tunica vaginalis of which the pedicle was twisted. When a cystic mass is detected in the scrotum of boys with acute scrotum, torsion of a cyst in the cavum tunica vaginalis testis should be considered.

Clear Cell Adenocarcinoma Arising From Abdominal Wall Endometriosis Mimicking Urachal Tumor

A 41-year-old woman presented with severe lower abdominal pain. She had a history of 2 cesarean deliveries. Magnetic resonance imaging (MRI) revealed a 4.3 × 4.6 × 4.8-cm mass on the urinary bladder dome. Preoperative diagnosis was invasive urachal tumor. Wide resection of the tumor was performed. The histopathological diagnosis was clear cell adenocarcinoma with endometriosis. MRI revealed normal-sized ovaries and uterus. The definite diagnosis of clear cell carcinoma arising from abdominal wall endometriosis was made. Adjuvant chemotherapy with paclitaxel and carboplatin (total 6 courses) was planned. The patient has thus far received 4 courses of this treatment.

Recurrence of sigmoid colon carcinoma in the residual urethra after cystectomy

Introduction : We report a case of recurrence of sigmoid colon cancer in the residual urethra after cysto‐prostato‐sigmoidectomy.

Granulocyte colony-stimulating factor (G-CSF) producing bladder cancer subsequently developed from recurrent non-muscle invasive bladder cancer.

Bladder cancer producing granulocyte colony-stimulating factor (G-CSF) is rare. To our knowledge, approximately 50 cases have been reported in Japanese literature. A review of these cases showed bladder cancer producing G-CSF was the invasive or metastatic type at the initial diagnosis. Here, we present a very rare case of G-CSF producing bladder cancer that subsequently developed from recurrent noninvasive bladder cancer. A 91-year-old Japanese woman underwent TURBT seven times and intravesical therapy (mitomycin C, doxorubicin) from April 1993 to April 2004 for recurrence of non-muscleinvasive bladder cancer (pathology: urothelial carcinoma, grade 1–2, pTa-pT1a). For a renal pelvic tumor, left nephroureterectomy was performed in 1994 (pathology: urothelial carcinoma, grade 2, pTa). In September 2007, she underwent her eighth TURBT. The pathological diagnosis was carcinoma in situ (CIS), so intravesical Bacille de Calmette et Guerin (BCG) therapy was performed as the adjuvant therapy. However, the patient complained of macroscopic hematuria in February 2008. Cystoscopy and abdominal computed tomography revealed a large invasive tumor on the right bladder wall and right hydronephrosis (Fig. 1a). The patient underwent her ninth TURBT. The pathological diagnosis was urothelial carcinoma, grade 3, pT2 or more). Only a right cutaneous ureterostomy was performed. Three months later, she was referred to our hospital due to unconsciousness. The laboratory examination showed marked leukocytosis with a maximum of 52 600/ mm in the peripheral blood with no findings of inflammatory disease. Bone marrow puncture revealed no abnormal blood cells were found. A prominent elevation of G-CSF, 223 pg/mL (normal range: 3.7–32.3 pg/mL) was noted in the serum. Her general condition became worse and she died from the disease in June 2008. An autopsy was performed. A sample of the tumor showed urothelial carcinoma, grade 3 and positive immunostaining for G-CSF (Fig. 1b). G-CSF produced by non-hematopoietic malignant cells has been reported to be capable of inducing a leukemoid reaction in the host through intense stimulation of leukocyte production. Furthermore, this is frequently associated with aggressive tumor cell growth and a detrimental clinical outcome. Nishimura et al. have reported that acquisition of the G-CSF gene might accelerate the proliferation of cancer. Tachibana et al. have reported that bladder cancer cells producing G-CSF with expression of the G-CSF receptor, provides direct evidence of autocrine growth of bladder cancer cells induced by G-CSF. Chakraborty et al. have reported that the G-CSF/G-CSF receptor autocrine/ paracrine signaling loop significantly promotes survival and growth of bladder cancer and the G-CSF receptor autocrine signaling loop leads to b1-integrin-dependent increased adhesion and invasion of bladder carcinoma cells. In our patient, recurrent non-invasive bladder cancer developed CIS. The CIS subsequently developed into microinvasive bladder cancer, and the microinvasive bladder

Infection-induced urethral defect treated by urethral reconstruction with a radial forearm flap

Abstract  A 47‐year‐old man was admitted with the chief complaint of a urethral defect. An approximately 17‐cm defect of the urethra seemed to have been occurred by the infection of implanted foreign bodies in the penile skin. Reconstruction of the urethra and the ventral skin was performed with a free radial forearm flap. A fistula formed at the proximal anastomosis after the operation, but was controlled conservatively. Urethral stricture at the proximal anastomosis subsequently developed. A urethral stent made of shape memory alloy was placed with the preservation of voiding function.

Mucinous tubular and spindle cell carcinoma with a high nuclear grade and micropapillary pattern: A case report

Mucinous tubular and spindle cell carcinoma (MTSCC) is rare in renal cell carcinoma (RCC) and usually demonstrates a low nuclear grade and a better prognosis compared with other RCCs. The authors present a case report of MTSCC containing an area of Fuhrman nuclear grade 3, in addition to an area with a micropapillary pattern. An 82-year-old man consulted a hospital due to macrohematuria, and a tumor in the right kidney was detected. The tumor was resected and histologically examined. The tumor consisted of various growth patterns: Elongated tubular structure, a papillary structure containing a micropapillary pattern and solid pattern with spindle cells. The tumor cells demonstrated Fuhrman nuclear grades 2 and 3. Invasion into the lymph vessel and metastasis into the regional lymph node were observed. Thus, the tumor was diagnosed as a high grade MTSCC. Five months following resection, a computed tomography scan suggested metastasis of the tumor into the para-aortic lymph nodes and liver, and the patient succumbed to brain metastasis. When MTSCC of kidney is observed, careful histological observation is important to avoid missing a high nuclear grade area.