RESUMEN
A 70-year-old man complaining of pain in his right leg presented to the Department of Orthopedics in our hospital. X-ray findings revealed calcifications around the left kidney. He was referred to our department for further examination. Computed tomography revealed a tumor 3 cm in diameter with calcifications and an obscure border that was located on the caudal side of the pancreas, anterior to the left iliopsoas muscle and at the left side of the aorta. Magnetic resonance imaging showed that the tumor had comparatively low intensity in diffusion-weighted images and the cell density was not high. The contrast of the tumor by enhanced computed tomography was weak, and we had difficulty judging whether the tumor was benign or malignant. Each tumor marker, immunity factor, and hormone-like catecholamine were within the normal range. We considered the retroperitoneal tumor with calcifications as Castleman disease or tumor of nerve origin. It is believed that most retroperitoneal tumors are malignant. We performed laparoscopic surgery to resect the retroperitoneal tumor. Histopathological diagnosis was a primary retroperitoneal venous malformation. Vascular malformation derived from the retroperitoneum is rare. Furthermore, very few cases of venous malformation in the retroperitoneum have been reported.
Asunto(s)
Neoplasias Retroperitoneales , Malformaciones Vasculares , Anciano , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/cirugía , Espacio Retroperitoneal/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To investigate the etiology of overactive bladder (OAB) symptoms during secondary treatment following initial unsuccessful therapy with α1-blockers in benign prostatic hyperplasia (BPH)/OAB patients. METHODS: BPH/OAB patients were selected if urinary urgency did not improve with initial α1-blocker therapy and if dose escalation was required as secondary treatment for a period of 8 weeks. The overactive bladder symptom score (OABSS), International Prostate Symptom Score (IPSS), and uroflowmetry were evaluated. On the basis of the OABSS at the end of secondary therapy, we divided patients into two groups: patients in whom OAB symptoms improved ("resolved OAB group") and patients in whom OAB symptoms persisted ("persistent OAB group"). Differences in subjective symptoms and objective parameters between the groups were analyzed. RESULTS: OAB symptoms improved in 33 of 79 patients (42%) after secondary treatment. The changes in the total OABSS and International Prostate Symptom Score from the beginning of the secondary treatment were -2.15 and -3.97, respectively, in the resolved OAB group, indicating a significant decrease in the OABSS compared to that in the persistent OAB group (-0.91 and -1.11, respectively). The change in average flow rate (Qave; +1.34) from the beginning of secondary treatment in the resolved OAB group was significantly greater than the change in the persistent OAB group (+0.58). Improvements in urgency and Qave were significantly correlated (r = -0.264, P = .031). CONCLUSION: Improvement in urinary stream contributed to the resolution of OAB symptoms in BPH/OAB patients. In the management of OAB symptoms in BPH/OAB patients, examination and therapy for both urinary stream and OAB symptoms could be substantially important.
Asunto(s)
Naftalenos/administración & dosificación , Piperazinas/administración & dosificación , Hiperplasia Prostática/complicaciones , Vejiga Urinaria Hiperactiva/tratamiento farmacológico , Micción/fisiología , Antagonistas de Receptores Adrenérgicos alfa 1/administración & dosificación , Anciano , Anciano de 80 o más Años , Relación Dosis-Respuesta a Droga , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Hiperplasia Prostática/fisiopatología , Resultado del Tratamiento , Vejiga Urinaria Hiperactiva/etiología , Vejiga Urinaria Hiperactiva/fisiopatología , Micción/efectos de los fármacosRESUMEN
A 58-year old female was referred to our hospital due to left renal cyst that was pointed out at her health check-up. Abdominal CT scan showed left hydronephrosis with a 20 x 12 x 11cm tumor. The serum CA19-9 level elevated to 4,400 U/ml. Urinary cytology in the left renal pelvis was negative, therefore we could not diagnose whether the mass was renal cell carcinoma or renal pelvic tumor before surgery. She underwent left radical nephrectomy, and frozen section revealed renal cell carcinoma. Immunohistological stain clarified CA19-9 was limited to epithelium lining the renal pelvis and was not contained in carcinoma cells. After the surgery, the serum CA19-9 decreased to the normal range. Serum CA19-9 is known to be sometimes elevated in patients with urothelial carcinoma, but rarely elevated in those with renal cell carcinoma. We thought that hydronephrosis by tumor occlusion caused CA19-9 elevation in our case.
Asunto(s)
Biomarcadores de Tumor/sangre , Antígeno CA-19-9/sangre , Carcinoma de Células Renales/diagnóstico , Hidronefrosis/diagnóstico , Hidronefrosis/etiología , Neoplasias Renales/diagnóstico , Femenino , Humanos , Persona de Mediana EdadRESUMEN
A 74-year-old male was referred to our hospital due to microhematuria that was pointed out at his health check-up. Cystoscopy showed many papillary bladder tumors under 5 mm in size. Intravenous pyelography also showed deformity of the right kidney and shadow defects in the left renal pelvis. Abdominal computed tomography revealed an 8 cm tumor invading the renal vein in the right kidney, and a 3 cm tumor in the left renal pelvis. Prostate biopsy was performed with PSA 3.4 ng/ml, and he was also diagnosed with prostate carcinoma. First, he received right radical nephrectomy, and secondly left nephroureterectomy and cystectomy. Our case should be called triple cancer because bladder cancer was thought to be daughter tumor of renal pelvic tumor. This is, to our knowledge, the 11th case report that occurred in the urinary tact, and the first case that needed total resection of urinary tract.
Asunto(s)
Adenocarcinoma/diagnóstico , Carcinoma de Células Renales/diagnóstico , Neoplasias Renales/diagnóstico , Pelvis Renal , Neoplasias Primarias Múltiples , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Vejiga Urinaria/diagnóstico , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/cirugía , Cistectomía , Humanos , Neoplasias Renales/patología , Neoplasias Renales/cirugía , Masculino , Nefrectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Uréter/cirugía , Neoplasias de la Vejiga Urinaria/patología , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
A 71-year old male visited our hospital with a chief complaint of pollakisuria. The needle biopsies of the prostate were performed with PSA 8.0 ng/ml, and he was diagnosed as moderately differentiated adenocarcinoma. Imaging techniques revealed a right complete duplicated upper urinary system with an ectopic ureter draining to the prostatic urethra. He received radical prostatectomy with concomitant anastomosis of ureter to ureter. There is no evidence of hydronephrosis or tumor recurrence 11 months after operation. This is, to our knowledge, the second case report describing the association of radical prostatectomy and ectopic ureter.