RESUMEN

Introduction: Imaging analysis of foraminal stenosis in the fifth lumbar (L5) nerve root remains to be a challenge because of the anatomical complexity of the lumbosacral transition. T2-weighted three-dimensional (3D) magnetic resonance images (MRI) have been dominantly used for diagnosis of lumbar foraminal stenosis, while the reliability of T1-weighted images (WI) has also been proven. In this study, we aim to compare the reliability and reproducibility of T1- and T2-weighted 3D MRI in diagnosing lumbar foraminal stenosis (LFS) of the L5 nerve root. Methods: In this study, 39 patients with unilateral L5 radiculopathy (20 had L4-L5 intracanal stenosis; 19 had L5-S foraminal stenosis) were enrolled, prospectively. T1- and T2-weighted 3D lumbar MRI were obtained from each patient. T1WI and T2WI were blinded and then separately reviewed twice by four examiners randomly. The examiners were instructed to answer the side of LFS or absence of LFS. The correct answer rate, sensitivity, specificity, and area under the curve were analyzed and compared between T1WI and T2WI. Also, intra- and interobserver agreements were calculated using kappa (κ)-statistics and compared in the same manner. Results: The average correct answer rate, sensitivity, specificity, and area under the curve of the T1WI/T2WI were 84.6%/80.1%, 82.9%/80.3%, 86.3%/81.3%, and 0.846/0.801, respectively. The intraobserver κ-values of the four examiners ranged from 0.692 to 0.916 (average: 0.762) and from 0.669 to 0.801 (average: 0.720) for T1WI and T2WI, respectively. The interobserver κ-values calculated in a round-robin manner (24 combinations in total) ranged from 0.544 to 0.790 (average: 0.657) and from 0.524 to 0.828 (average: 0.652), respectively. Conclusions: As per our findings, T1- and T2-weighted 3D MRI were determined to have nearly equivalent reliability and reproducibility in terms of diagnosing LFS of the L5 nerve root.

RESUMEN

Fat-poor leiomyomatous angiomyolipoma, which is similar to smooth muscle tumors, is positive for smooth muscle markers and melanocytic marker human melanin black 45 (HMB-45). We report a case of fat-poor leiomyomatous angiomyolipoma arising from renal parenchyma negative for HMB-45 diagnosed by combined staining with melanocytic markers HMB-45 and Melan-A.

RESUMEN

BACKGROUND: Transurethral enucleation with bipolar (TUEB) is a safe and effective surgery for benign prostatic obstruction (BPO). However, few data exist concerning the influence of TUEB on erectile function (EF) in patients with BPO. OBJECTIVE: To evaluate the influence of TUEB on EF in patients with BPO at 3- and 12-month follow-up. MATERIAL AND METHODS: We prospectively enrolled 51 patients who underwent TUEB from June 2016 to April 2020. We evaluated maximum urinary flow rate (Qmax), postvoid residual urine (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL), and International Index of Erectile Function-5 (IIEF-5) preoperatively and at 3- and 12-month follow-up. We classified the patients according to their preoperative IIEF-5 score into group 1 (IIEF-5 ≥10; n = 24) and group 2 (IIEF-5 <10; n = 27), and for further evaluation of EF, into subgroups a: severe (IIEF-5 5-7), b: moderate (8-11), c: mild to moderate (12-16), d: mild (17-21), and e: no erectile dysfunction (22-25). Data are displayed as median or median (interquartile range). RESULTS: The study comprised 51 patients with a median age of 75 (70.5-79.5) years. Median prostate and transition zone volumes were 69.5 (46.5-78.8) mL and 30.5 (19-43) mL, respectively. Urinary function improved significantly when comparing respective preoperative, 3-month, and 12-month follow-up values: Qmax (7.6, 12.9, 15.2 mL/s), PVR (50, 0, 0 mL), IPSS (20.5, 9, 6), and QoL (5, 2, 2), respectively. There was no significant change in IIEF-5 score across the three time points: 9, 7, 8. The IIEF-5 score slightly but significantly increased between the preoperative and 12-month follow-up values in group 2 (5, 5, 6) and subgroup a (5, 5, 5). CONCLUSION: TUEB was effective and safe surgery for patients with BPO and showed no significant influence on EF at 12-month follow-up after TUEB in patients with BPO.

Asunto(s)

Disfunción Eréctil , Hiperplasia Prostática , Resección Transuretral de la Próstata , Anciano , Disfunción Eréctil/etiología , Estudios de Seguimiento , Humanos , Masculino , Próstata/cirugía , Hiperplasia Prostática/diagnóstico , Calidad de Vida , Resección Transuretral de la Próstata/efectos adversos , Resultado del Tratamiento

RESUMEN

Mesothelioma is an aggressive tumor originating from mesothelial cells. Mesothelioma of the spermatic cord is a very rare disease, and the most common presentation of this disease is that of aggressive mesothelioma with no description of mesothelioma in situ. We report an extremely rare case of mesothelioma in situ of the spermatic cord arising from a patent processus vaginalis. To our best knowledge, this is the first report of this finding. The identification of a patent processus vaginalis and investigation of single-layered atypical mesothelial cells led to the final diagnosis.

Asunto(s)

Neoplasias de los Genitales Masculinos/patología , Mesotelioma/patología , Cordón Espermático , Anciano de 80 o más Años , Neoplasias de los Genitales Masculinos/cirugía , Humanos , Masculino , Mesotelioma/cirugía , Peritoneo , Testículo

RESUMEN

Renal mucinous tubular and spindle cell carcinoma (MTSCC) is a rare, renal epithelial neoplasm that is an established subtype in the World Health Organization 2004 classification. A 75-year-old-woman was diagnosed as having atypical mycobacterial infection and hepatitis C. Computed tomography showed a hypovascular mass 35 mm in diameter in the left kidney. The renal tumor was diagnosed as MTSCC by pathological examination of the renal biopsy specimen. The patient underwent laparoscopic left radical nephrectomy via a retroperitoneal approach. Pathological findings showed left renal carcinoma (MTSCC, pT3aN0M0), and we did not perform adjuvant therapy. The patient developed lung nodules one month after the operation that were diagnosed as lung metastasis by pathological examination of a bronchoscopic biopsy specimen. She then developed progression of lung metastasis, mediastinal lymph node metastasis and bone metastasis. We explained the necessity of therapy, but she refused therapy and died of disease progression four months after the operation. MTSCC is thought to have a relatively good prognosis, but care must be taken because, as in our case, tumor progression can occur rapidly.

RESUMEN

Primary small cell carcinoma of the urinary tract is a relatively rare disease that is associated with a poor prognosis. The median overall survival time of patients with primary bladder disease is 19.6 month to 1.7 years, and that of patients with small cell carcinoma of the upper urinary tract is 15 months. Generally, curative surgery with chemotherapy according to the type of small cell lung carcinoma is a preferred treatment. However, standard treatment has not been established yet because the number of cases is small. We herein report the clinical features and outcome of four patients with primary small cell carcinoma of the urinary tract between 2007 and 2018 at our institution and review the literature.

RESUMEN

A 75-year-old man with urinary retention was referred to our hospital. Pelvic magnetic resonance imaging showed that his prostate was remarkably enlarged, with an estimated prostate weight of 509 g. He underwent TUEB (transurethral enucleation with bipolar) combined with cystotomy. The surgical specimen weighed 349 g. He did well postoperatively, and his urinary function was improved at 3 months after the operation. Although transurethral methods are effective for resection of adenoma and control of bleeding, effective performance of the procedure with a resectoscope and resection of an adenoma in cases of giant prostatic hypertrophy need to be considered on a case-by-case basis.

Asunto(s)

Cistotomía/métodos , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/métodos , Anciano , Humanos , Masculino , Resultado del Tratamiento

RESUMEN

BACKGROUND: Metastatic renal cancers are relatively common. Most are metastases to the renal parenchyma via a hematogenous route and are derived from lung, breast, and gastrointestinal cancer, malignant melanoma, and hematologic malignant cancer. However, little is known about renal capsule metastasis from other cancers. CASE PRESENTATION: We report a 71-year-old woman with breast cancer who was treated with endocrine therapy. She presented with gross hematuria and was diagnosed as having right renal pelvic cancer and renal cell cancer. She underwent right laparoscopic radical nephroureterectomy. Pathological findings revealed right pelvic cancer and renal capsule metastasis. CONCLUSION: Renal capsule metastasis derived from renal pelvic cancer is very rare. When diagnosing renal capsule cancer, we believe that renal capsule metastasis should also be taken into consideration. Clinical and radiological differential diagnosis of renal capsule metastasis from renal cell cancer and primary renal capsule cancer is difficult. Assessment of the histopathological findings of the surgical specimens seems to be the only realistic approach to achieving the correct diagnosis.

Asunto(s)

Neoplasias Renales/diagnóstico , Neoplasias Renales/cirugía , Anciano , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/cirugía , Femenino , Humanos , Neoplasias Renales/secundario

RESUMEN

Primary small cell neuroendocrine carcinoma of the upper urinary tract is a rare disease that is associated with a poor prognosis. An 81-year-old man was diagnosed with carcinoma of the stomach and underwent laparoscopic distal gastrectomy. Computed tomography (CT) revealed carcinoma of the left ureter and left hydronephrosis. The patient was diagnosed with carcinoma of the left ureter (cT2N0M0) and left laparoscopic radical nephroureterectomy was performed via a retroperitoneal approach. The pathological diagnosis was left ureter carcinoma (small cell neuroendocrine carcinoma, pT3). He was treated with four courses of the CE regimen (carboplatin area under the curve: 5, intravenously [IV] on day 1 and etoposide [80 mg/m2], IV on days 1-3). There is no evidence of disease at 21 months after radical nephroureterectomy.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma Neuroendocrino/terapia , Laparoscopía , Neoplasias Primarias Múltiples/terapia , Nefroureterectomía , Neoplasias Ureterales/terapia , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Carboplatino/administración & dosificación , Carcinoma Neuroendocrino/diagnóstico por imagen , Quimioterapia Adyuvante , Terapia Combinada , Etopósido/administración & dosificación , Gastrectomía , Humanos , Laparoscopía/métodos , Masculino , Nefroureterectomía/métodos , Neoplasias Gástricas/cirugía , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Neoplasias Ureterales/diagnóstico por imagen , Procedimientos Quirúrgicos Urológicos Masculinos/métodos

RESUMEN

The aim of our study is to evaluate the clinical and radiologic outcomes in patients with terrible triad injury, who underwent surgical treatment with or without the medial collateral ligament (MCL) repair. Fourteen patients who underwent surgery with a minimum of 12-month follow-up (mean, 17 months) were reviewed. Based on the systematic treatment protocol, radial head fracture, lateral collateral ligament, and coracoid fracture were treated. Subsequently, torn MCL was repaired in 7 patients, whereas in the remaining 7 patients, the MCL was not treated. Range of motion, elbow function, and radiographs regarding the arthrosis and heterotopic ossification were assessed. At final follow-up, no significant differences were found in elbow motion or function between the groups with and without MCL repair; except the pronation and supination which had superior range in repair group. In contrast, radiologic findings such as the arthrosis were seen more frequently in patients without MCL repair than those with repair. Our results indicate the effect of MCL repair on elbow motion and function might be small, whereas osteoarthritic changes occurred more frequently in elbows without MCL repair.

RESUMEN

A 63-year-old man who presented with asymptomatic gross hematuria was referred to our hospital. Left ureteral tumor (cT3N0M0) was diagnosed and left nephroureterectomy was performed. Pathological examination revealed urothelial carcinoma and small cell carcinoma with local invasion (pT3). The patient was treated with three cycles of adjuvant chemotherapy with gemcitabine and cisplatin. Three months after the chemotherapy, cystoscopy showed an intravesical recurrence of the tumor. Transurethral resection was performed and histopathological examination revealed small cell carcinoma (pT1). We recommended a cystectomy and neoadjuvant chemotherapy with etoposide and carboplatin according to the standard care of small cell carcinoma of bladder. However, the patient refused to undergo cystectomy and desired to preserve his bladder. Therefore, after two cycles of chemotherapy with etoposide and carboplatin, transurethral resection was performed to examine the presence of the residual tumor instead of immediate cystectomy. Because of no residual tumor, another two cycles of chemotherapy were added instead of a cystectomy. There is no evidence of recurrence seven months after the chemotherapy.

Asunto(s)

Carcinoma de Células Pequeñas/secundario , Neoplasias Ureterales/patología , Neoplasias de la Vejiga Urinaria/secundario , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carboplatino/administración & dosificación , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/cirugía , Etopósido/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Nefrectomía , Recurrencia , Neoplasias Ureterales/tratamiento farmacológico , Neoplasias Ureterales/cirugía , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico

RESUMEN

Elastic fibers and proteoglycans are major components of the extracellular matrix and their changes have been reported in some pathological conditions. Further, recent studies have indicated that some glycosaminoglycans and proteoglycans inhibit elastic fiber assembly. The purpose of this study was to investigate changes of the elastic fibers and proteoglycans in the ligamentum flavum and analyze their relationships to thickening of the ligamentum flavum from lumbar spinal canal stenosis (LSCS). Ligamentum flavum samples were collected from 20 patients with LSCS (thickened flavum group) and 10 patients with lumbar disc herniation (non-thickened flavum group) as a control. Elastica-Masson staining and alcian blue staining were used to compare the relationship between the changes in the elastic fibers and proteoglycans. Gene and protein expressions of the elastic fibers and proteoglycans were analyzed by quantitative reverse transcription polymerase chain reaction and immunohistochemistry. Histological changes indicated that proteoglycans mainly increased on the dorsal side of the ligamentum flavum in accordance with the decreased elastic fibers in the thickened flavum group. The gene and protein expressions of fibrillin-2 and DANCE were significantly lower and decorin, lumican, osteoglycin, and versican were significantly higher in the thickened flavum group. Our study shows that elastic fibers decrease and proteoglycans increase in the thickened ligamentum flavum. Decreased gene expression of elastogenesis and disrupted elastic fiber assembly caused by increased proteoglycans may lead to a loss of elasticity in the thickened ligamentum flavum. Decreased elasticity may cause buckling of the tissue, which leads to thickening of the ligamentum flavum. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1241-1247, 2016.

Asunto(s)

Tejido Elástico/metabolismo , Ligamento Amarillo/metabolismo , Proteoglicanos/metabolismo , Estenosis Espinal/metabolismo , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Ligamento Amarillo/patología , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Estenosis Espinal/etiología

RESUMEN

Pediatric septic arthritis is uncommon and has been traditionally treated by joint aspiration or open arthrotomy. There are some reports about arthroscopic surgery in pediatric septic arthritis of the knee, hip, and shoulder. However, there is no report for the case of elbow. We report a case of pediatric septic arthritis of elbow treated with arthroscopically with good clinical condition at 3-year follow-up. This paper is based on a report first published in Japanese (Tojo (2012)).

RESUMEN

An 83-year-old man presented with asymptomatic macroscopic hematuria while being treated for prostate cancer with hormonal therapy in January 2009. Cystoscopy revealed a 5 mm surface-smooth non pedunculated tumor lateral to the left ureteral orifice. Transurethral resection was carried out to examine the histology of the tumor. Histopathologic examination revealed the tumor arranged in a pseudoglandular pattern covered with erosive urothelial cells. The tumor had inconspicuous nucleoli, and abundant eosinophilic cytoplasm. An immunohistochemical study showed the tumor cells were positively stained for chromogranin A, synaptophysin, CD56, and NSE. Ki67 index of the tumor was below 2 %, indicating that the tumor was a carcinoid tumor. He showed no carcinoid syndrome, and neither recurrence nor metastasis has been detected for 66 months.

Asunto(s)

Tumor Carcinoide/diagnóstico , Neoplasias de la Vejiga Urinaria/patología , Anciano de 80 o más Años , Tumor Carcinoide/cirugía , Cistoscopía , Humanos , Masculino , Encuestas y Cuestionarios , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/cirugía

RESUMEN

STUDY DESIGN: A histological, biological, and immunohisto-chemical study of human lumbar ligamentum flavum. OBJECTIVE: To analyze changes in the hypertrophied ligamentum flavum and clarify their etiology. SUMMARY OF BACKGROUND DATA: Hypertrophy of the ligamentum flavum has been considered a major contributor to the development of lumbar spinal canal stenosis (LSCS). Although previous studies have reported some factors related to ligamentum flavum hypertrophy, its etiology is still unclear. METHODS: Ligamentum flavum samples were collected from 20 patients with LSCS (LSCS group) and 10 patients with lumbar disc herniation (LDH group) as a control. The thickness of the ligamentum flavum was measured histologically. The amounts of elastic fibers and proteoglycans were assessed by Elastica-Masson staining and alcian blue staining, respectively. Gene and protein expressions related to fibrosis, inflammation, and chondrogenesis were analyzed by quantitative reverse transcription-polymerase chain reaction and immunohistochemistry. The total genes of the 2 groups were compared by DNA microarray analysis. RESULTS: The ligamentum flavum was significantly thicker in the LSCS group, which had a smaller amount of elastic fibers and a larger amount of proteoglycans. The gene expression related to fibrosis was significantly higher in the LSCS group; however, the immunoreactivities of collagen types I and III were weaker on the dorsal side of the ligamentum flavum in the LSCS group. The gene expression related to chondrogenesis and proteoglycan synthesis was significantly higher in the LSCS group. There was no significant difference in the gene expression related to inflammation between the 2 groups. CONCLUSION: Synthesis of the collagenous fibers and degradation of the elastic and collagenous fibers are both accelerated in the ligamentum flavum of patient with LSCS, which may be the reason for hypertrophy of the tissue. In addition, chondrogenesis and proteoglycan synthesis may have critical roles in the pathogenesis of the ligamentum flavum hypertrophy. LEVEL OF EVIDENCE: 5.

Asunto(s)

Condrogénesis/fisiología , Ligamento Amarillo/patología , Ligamento Amarillo/fisiopatología , Vértebras Lumbares/patología , Estenosis Espinal/patología , Estenosis Espinal/fisiopatología , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Colágeno Tipo I/genética , Colágeno Tipo I/fisiología , Colágeno Tipo III/genética , Colágeno Tipo III/fisiología , Tejido Elástico/patología , Tejido Elástico/fisiopatología , Femenino , Fibrosis , Humanos , Hipertrofia , Degeneración del Disco Intervertebral/patología , Degeneración del Disco Intervertebral/fisiopatología , Desplazamiento del Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/fisiopatología , Masculino , Persona de Mediana Edad , Análisis de Secuencia por Matrices de Oligonucleótidos , Proteoglicanos/genética , Proteoglicanos/fisiología

RESUMEN

A 71-year-old female on hemodialysis was referred to our hospital for a left renal mass which was incidentally found during a medical check-up. Abdominal computed tomography with intravenous contrast enhancement showed an iso-dense enhanced mass. Under the diagnosis of renal cell carcinoma, retroperitoneoscopic radical nephrectomy was performed. Histopathological examination revealed follicular lymphoma. This was the 20th case of primary renal lymphoma in Japan.

Asunto(s)

Neoplasias Renales/diagnóstico , Linfoma/diagnóstico , Diálisis Renal , Anciano , Femenino , Humanos

RESUMEN

Thoracic ossification of the ligamentum flavum (OLF) has been widely recognized as a main cause of thoracic myelopathy in Asia, particularly in Japan. However, thoracic OLF rarely causes radiculopathy. We report a rare case of thoracic radiculopathy caused by OLF. A 67-year-old male presented with a chief complaint of back pain radiating to the right of the abdomen. Neurological examination revealed mild sensory deficit at the right side of the abdomen at the T9-10 level. Magnetic resonance imaging and computed tomography demonstrated OLF at the right T9-10 level. Thoracic radiculopathy caused by OLF was suspected. Because conservative treatment was not effective to this lesion, surgical intervention was performed, and the pain disappeared immediately after the operation. Thoracic OLF rarely causes radiculopathy, but it should be considered as a differential diagnosis of thoracic radicular pain. When conservative treatment is not effective in this lesion, surgical treatment should be considered.

Asunto(s)

Ligamento Amarillo/patología , Osificación Heterotópica/complicaciones , Radiculopatía/etiología , Vértebras Torácicas , Anciano , Humanos , Masculino , Tomografía Computarizada por Rayos X

RESUMEN

A 55-year-old man was hospitalized for pneumonia. His fever did not subside despite administration of antibiotics ; therefore, he was referred to our hospital. A chest radiograph and thoracic computed tomography showed multiple tubercles ; abdominal computed tomography (CT) showed left renal abscess. The patient's temperature fell after antibiotic administration, but inflammation reaction exacerbated. Abdominal CT showed inflammation spreading to the subcutaneous tissues. We considered renal resection, but the patient could not be administered general anesthesia because of low breathing function caused by pneumonia. We attempted open drainage and wedge resection of the left renal under local anesthesia ; but we were not able to identify the infectious bacteria. Four days later, the patient had blood poisoning and died because of deterioration of breathing function. Actinomyces was detected in the lungs and the kidneys by pathological examination.

Asunto(s)

Actinomicosis/diagnóstico , Enfermedades Renales/diagnóstico , Neumonía/complicaciones , Actinomicosis/complicaciones , Humanos , Enfermedades Renales/complicaciones , Persona de Mediana Edad

RESUMEN

A 78-year-old man was referred to our hospital for asymptomatic gross hematuria on April 16, 2007. Cystoscopy and abdominal computed tomography revealed a nonpapillary tumor at the upper area of the bladder. Abdominal and thoracic computed tomography showed no lymph nodes and no metastasis to other organs. Transurethral resection of bladder tumor (TURBT) was performed, and a pathological diagnosis of small cell carcinoma of the bladder at stage pT2N0M0 was made. Considering the patient's age and the location of the tumor, we administered chemotherapy using carboplatin and etoposide after resection of the tumor. After 2 courses of chemotherapy, a second-look TURBT was performed, and pathological examination showed no viable tumor cells. Cystoscopy performed after 3 months revealed recurrence of a nonpapillary tumor at a different area of the bladder. We performed TURBT and made a pathological diagnosis of small cell carcinoma of the bladder at stage pT1N0M0. The patient was free from disease in January 2011.

Asunto(s)

Carcinoma de Células Pequeñas/terapia , Terapia Recuperativa/métodos , Neoplasias de la Vejiga Urinaria/terapia , Anciano , Terapia Combinada , Cistectomía/métodos , Humanos , Masculino

RESUMEN

A 54-year-old man visited our clinic for dysuria. Transabdominal ultrasonography revealed a multilocular cyst at the neck of the bladder, and a cystoscopy revealed obstruction of the neck of the bladder. Dysuria improved after tamsulosin treatment was initiated, and abdominal magnetic resonance imaging (MRI) showed disappearance of the cyst. The patient had urinary difficulty again after 2 years. An MRI and cystoscopy revealed recurrence of the cyst. Tamsulosin administration was reinitiated, but his urinary difficulty did not improve. Transurethral resection of the cystic wall was performed. Histopathological examination indicated a retention cyst.

Asunto(s)

Quistes/complicaciones , Disuria/etiología , Enfermedades de la Próstata/complicaciones , Quistes/patología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Próstata/patología , Obstrucción del Cuello de la Vejiga Urinaria/etiología