RESUMEN
BACKGROUND: Because of the small numbers of cases in single centers, the indications for and survival benefits of adrenalectomy for adrenal metastasis remain unclear. We evaluated the outcomes of laparoscopic adrenalectomy for patients with adrenal metastasis. METHODS: We retrospectively analyzed the records of 67 patients who underwent laparoscopic adrenalectomy for metastatic disease from 2003 to 2017 at 11 hospitals. Associations of clinical, surgical, and pathologic features with overall survival (OS) and positive surgical margins were evaluated using univariate and multivariate Cox regression analyses and univariate logistic regression analysis. RESULTS: Lung cancer (30%) and renal cell carcinoma (30%) were the most common primary tumor types. Intraoperative complications were observed in seven patients (10%) and postoperative complications in seven (10%). The surgical margin was positive in 10 patients (15%). The median OS was 3.8 years. Univariate analysis showed that the tumor size, episodes of extra-adrenal metastasis before adrenalectomy, extra-adrenal metastasis at the time of adrenalectomy, and positive surgical margins were significantly associated with shorter OS (p = 0.022, p = 0.005, p < 0.001, and p = 0.022, respectively). Multivariate analysis showed that extra-adrenal metastasis at the time of adrenalectomy and positive surgical margins remained statistically significant (p = 0.022 and p = 0.049, respectively). In the univariate analysis, the tumor size was significantly associated with positive surgical margins (p = 0.039). CONCLUSIONS: Laparoscopic adrenalectomy for adrenal metastasis can be safely performed in selected patients, and patients with isolated adrenal metastasis and negative surgical margins seem to have more favorable outcomes.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/secundario , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía/métodos , Laparoscopía/métodos , Neoplasias de las Glándulas Suprarrenales/mortalidad , Anciano , Carcinoma de Células Renales/patología , Estudios de Factibilidad , Femenino , Humanos , Japón , Neoplasias Renales/patología , Neoplasias Pulmonares/patología , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Selección de Paciente , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
An 84-year-old man was referred to our hospital with swollen right cervical lymph nodes. Computed tomography showed right supraclavicular and mediastinal lymph node enlargement, and fluorodeoxyglucose positronemissiontomography showed multiple areas of abnormally increased radioactivity inthe right supraclavicular and mediastinal lymph nodes, right ninth rib, and left fifth and seventh ribs. Biopsy of the right supraclavicular lymph node revealed metastatic adenocarcinoma with partial immunohistochemical staining for prostate specific antigen (PSA). Serum PSA levels were not elevated (2.01 ng/ml). An 8-core transrectal prostatic biopsy was negative. Thus, we could not determine the primary site of the adenocarcinoma. The patient was diagnosed with carcinoma of an unknown primary site and followed without chemotherapy. Four years later, he was referred to our hospital due to right hydronephrosis. Serum PSA level was 31. 1 ng/ml. The tumor was not palpable by rectal examination. A 12-core transrectal prostatic biopsy revealed a poorly differentiated adenocarcinoma. Computed tomography revealed metastases in the left axilla, para-aortic, and pelvic lymph nodes as well as in the lung. We diagnosed the patient with prostate cancer, and combined androgen blockade (CAB) was administered. Metastases in the lymph nodes, lung, and bone were reduced on imaging after 1 month of therapy. Therefore, a definitive diagnosis of prostate cancer T1cN1M1c was made. Dutasteride had been administered as a benign prostate hyperplasia treatment 2 years before his first visit, which may have made the definitive diagnosis of prostate cancer difficult. In contrast, dutasteride may have delayed the progressionof prostate cancer inthis patient.
Asunto(s)
Adenocarcinoma , Dutasterida , Neoplasias de la Próstata , Adenocarcinoma/tratamiento farmacológico , Anciano de 80 o más Años , Progresión de la Enfermedad , Dutasterida/uso terapéutico , Humanos , Metástasis Linfática , Masculino , Antígeno Prostático Específico , Neoplasias de la Próstata/tratamiento farmacológicoRESUMEN
Seminal vesicle cyst is a rare disease and is often asymptomatic. We present a case of huge seminal vesicle cyst connected to the abdominal wall and observed as a subcutaneous abscess. An 89-year-old man presented with asymptomatic spontaneous rupture of the left lower abdominal subcutaneous abscess. Computed tomography (CT) showed a relatively low intensity cystic mass located in the Retzius' space just below the abscess, surrounding the right bladder wall laterally and connecting to the right seminal vesicle posteriorly. Biopsy of the skin around the subcutaneous abscess and aspiration biopsy of the pelvic cystic fluid showed no evidence of malignancy. We diagnosed the lesion as a seminal vesicle cyst with bacterial infection. The patient was treated with antibiotics and there has been no relapse.
Asunto(s)
Absceso , Quistes , Enfermedades de los Genitales Masculinos , Vesículas Seminales , Absceso/complicaciones , Anciano de 80 o más Años , Quistes/complicaciones , Humanos , MasculinoRESUMEN
We described a 63-year-old man who was diagnosed with clinical T1c prostate cancer, with a Gleason score of 6 (3ï¼3), and a preoperative prostate-specific antigen (PSA) level of 5. 27 ng/ml. Radical prostatectomy(RP) was performed and final pathologyshowed Gleason score 3ï¼4, pT2c with negative surgical margin. In spite of suggested surgical radicality, PSA was 3.32, 4.78, 5.93 ng/ml, at 1, 2, and 3 months after RP, respectively. However, radiological investigation revealed no metastasis. Because of this clinical discrepancy, we checked the PSA-α1-antichemotrypsin level and found it to be â¦0.1 ng/ml. From these results, false PSA elevation caused byinterference of positive heterophilic antibodies was suggested and demonstrated byseveral immunoassays.
Asunto(s)
Anticuerpos Heterófilos/sangre , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico , Anticuerpos Heterófilos/inmunología , Reacciones Falso Positivas , Humanos , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/inmunología , Prostatectomía , Neoplasias de la Próstata/inmunología , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugíaRESUMEN
We compared the usefulness of Eviprostat tablet, a therapeutic agent for benign prostatic hyperplasia (BPH), and EVI-F tablet, a new formulation of Eviprostat containing two times more active ingredients (Chimaphila umbellata extract, Populus tremula extract, Pulsatilla pratensis extract, Equisetum arvense extract and purified wheat germ oil) and consequently designed to reduce the number of tablets per dose by half. In this study, patients with BPH were randomly assigned to either Eviprostat group (6 tabs/day) or EVI-F group (3 tabs/day) using the envelope method. The clinical efficacy of these two drugs were evaluated by the International Prostate Symptom Score (IPSS) and QOL score at the end of the treatment period, and their safety was evaluated by the incidence of side effects. Based on the clinical study guidelines for dysuria, the change in the IPSS total score and QOL score were comparable to the previously reported data for other treatment agents for BPH, and these indices showed gradual improvement with the treatment period. Both treatments were well tolerated. The clinical usefulness of the monotherapy with EVI-F tablet or Eviprostat tablet was reasonably demonstrated in this study. Furthermore, both treatments reduced nocturia, which has an impact on the QOL of patients with BPH.
Asunto(s)
Etamsilato/administración & dosificación , Extractos Vegetales/administración & dosificación , Hiperplasia Prostática/tratamiento farmacológico , Anciano , Combinación de Medicamentos , Humanos , Masculino , Persona de Mediana Edad , ComprimidosRESUMEN
A 71-year-old woman who had undergone a total abdominal hysterectomy and pelvic irradiation for cervical cancer and fecal diversion for adhesive ileus was referred to us for a "left" ureteral stone and intermittent gross hematuria. Bilateral ureteral stents had been indwelled because of lower ureteral strictures for a long time. Hematuria continued after the removal of the ureteral stone, and she once went into hypovolemic shock at the time of exchange of the right ureteral catheter. Selective arteriography revealed a "right" ueteroarterial fistula. Endovascular management alone failed to resolve the fistula, but a subsequent transurethral metal coil embolization was effective, and the hematuria was relieved. She is still free from disease at 7-month followup. As far as we know, there has been no previous report of a transurethrally managed ureteroarterial fistula.