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Introduction: Patients with liver metastases from prostate cancer show poor prognosis. We performed metastases-directed therapy using radiofrequency ablation of liver metastases in an attempt to improve the prognosis in a patient with metastatic prostate cancer. Case presentation: We present the case of a 66-year-old man who was treated for metastatic castration-resistant prostate cancer. Evaluation showed isolated liver metastases together with elevated serum prostate-specific antigen levels. We performed metastases-directed therapy using radiofrequency ablation of the liver tumor. The patient showed no recurrent liver metastases for 42 months and survived for 66 months after diagnosis of metastatic prostate cancer. Conclusion: To our knowledge, this is the first report that describes radiofrequency ablation of liver metastases from prostate cancer. This procedure may be a useful therapeutic option for metastases-directed therapy in patients with liver metastases from prostate cancer.
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(Objectives) To evaluate the safety and oncologic efficacy of laparoscopic radical nephrectomy (LRN) for renal cell carcinoma (RCC) >7 cm, we retrospectively reviewed the clinical outcome and long-term cancer control of patients who underwent LRN in comparison to open radical nephrectomy (ORN). (Patients and methods) The clinical records of 79 patients with RCC >7 cm, who underwent radical nephrectomy (37 LRN; 42 ORN) between 1993 and 2014, were reviewed. (Results) The 2 groups (LRN and ORN) were comparable regarding age, body mass index and mean tumor size (86.5 mm vs. 94.6 mm).The operative time was significantly longer in the LRN group than ORN group (204 min vs. 168 min; p<0.05) and blood loss was significantly lower in the LRN group than in the ORN group (144 ml vs. 930 ml; p<0.05).No statistically significant difference was found in complication rate (10.8% vs. 23.8%) and the 2-year recurrence-free survival rate (85.6% vs. 83.8%). (Conclusion) Despite the longer operative time, LRN for large RCC was associated with lower blood loss. This study provides evidence of the safety and efficacy of LRN for large RCC.
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Prostate-specific antigen screening has significantly increased the percentage of men who are diagnosed with low-risk prostate cancer. All men undergoing retropubic radical prostatectomy for primary treatment of prostate cancer from April 2004 to September 2010 in our hospital were examined in order to determine whether active surveillance criteria could be applied to Japanese men. From pathological data of prostate biopsies, whether these men met five published criteria for active surveillance (Johns Hopkins Medical Institution, Prostate Cancer Research International: Active Surveillance Study, University of California, San Francisco, Toronto and Kakehi criteria) was evaluated. Men who met any of the criteria had a statistically significant lower extracapsular extension rate and organ-confinement rate. From the view of the possibility of Gleason upgrading and organ-confinement rate, the Johns Hopkins Medical Institution and Prostate Cancer Research International: Active Surveillance Study criteria showed to be appropriate for Japanese patients. However, the present study had limitations of selection bias and a limited number of cases.
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Tamizaje Masivo/métodos , Clasificación del Tumor/métodos , Estadificación de Neoplasias/métodos , Vigilancia de la Población , Neoplasias de la Próstata/diagnóstico , Anciano , Estudios de Seguimiento , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias de la Próstata/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
We report two cases of spontaneous urinary rupture caused by primary ureteral or renal pelvic cancer. Case 1: A 76-year-old man presented with macrohematuria and left back pain. Magnetic resonance imaging showed left middle ureteral tumor and rupture of upper ureter. Left nephroureterectomy was performed. Histological findings revealed urothelial carcinoma, G2, pT1, lt-u0, ew0, ly0, v1. At five months postoperatively, he died of lymph node metastases after two courses of adjuvant chemotherapy. Case 2: A 59-year-old man presented with macrohematuria and left back pain. Computer tomography showed left renal pelvic tumor with extravasation of urine. Left nephroureterectomy was performed. Examination of surgical specimen revealed a renal pelvic tumor and rupture hole at the renal pelvis. Histological finding revealed urothelial carcinoma, G3, pT3, lt-u0, ly0, v1. One course of adjuvant chemotherapy was performed. At six months postoperatively, he was free from recurrence.
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Carcinoma de Células Transicionales/complicaciones , Enfermedades Renales/etiología , Neoplasias Renales/complicaciones , Pelvis Renal , Enfermedades Ureterales/etiología , Neoplasias Ureterales/complicaciones , Anciano , Carcinoma de Células Transicionales/cirugía , Quimioterapia Adyuvante , Resultado Fatal , Humanos , Enfermedades Renales/cirugía , Neoplasias Renales/cirugía , Masculino , Persona de Mediana Edad , Nefrectomía , Rotura Espontánea , Resultado del Tratamiento , Uréter/cirugía , Enfermedades Ureterales/cirugía , Neoplasias Ureterales/cirugíaRESUMEN
We report two cases of adult tethered cord syndrome alleviated by untethering surgery. Case 1 was a 35 year-old female who complained of incontinence while exercising. Radiograph revealed spinal disraphism below the L5 level. In addition, magnetic resonance imaging (MRI) showed low placed conus medullaris at the levels of S2 and sacral intradural lipoma. Further urodynamic studies demonstrated normal sphincteric function and autonomous bladder. Diagnosis resulted in the decision to perform an untethering operation. The patient had increased bladder compliance after surgery for untethering and has continued to be continent 16 months post-operatively. Case 2 was a 27-year old female who complained of apprehension to void and straining during urination. Radiograph demonstrated spinal disraphism below the S2 level and MRI revealed low placed conus medullaris at the level of S5 and sacral intradural lipoma. Urodynamic examination verified normal sphincteric function and autonomous bladder. After complete diagnosis, an untethering operation was performed. Post-operatively, bladder compliance and urinary sensation normalized. Furthermore, the patient spontaneously delivered a baby 3 years after having the untethering operation.
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Defectos del Tubo Neural/cirugía , Adulto , Femenino , Humanos , Imagen por Resonancia Magnética , Defectos del Tubo Neural/diagnósticoRESUMEN
Degradation of collagen, or gelatinolysis, by tumor cells is one of the most important events in tumorigenesis. We investigate the possible relationship between the in situ gelatinolytic activities exerted by matrix metalloproteinases (MMPs) and clinico-pathological factors in renal cell tumor (RCT) patients. Using the film in situ zymography (FIZ) method, we determined in situ localization of MMP-like gelatinolytic activities in cancerous and normal tissues in the kidney (n = 51). To clarify the MMP(s) responsible for the gelatinolytic activity in RCTs, we examined the expressions of MMP-2 and MMP-9 in the kidney tissues by means of gelatin zymography (GZG). MMP expression was also detected by RT-PCR and Western blotting analysis. We then investigated the associations of MMP expression, as detected by GZG, with the intensity of gelatinolytic activity, as determined by FIZ. We analyzed the possible relationship of FIZ findings to several clinico-pathological factors such as tumor size, grade, vessel invasion, histologic type, stage and metastasis. FIZ demonstrated that all tumor and normal kidney tissues showed in situ gelatinase activities, and that gelatinolytic activities in RCTs were much stronger than those of normal kidney tissues. There was a statistically significant correlation between the intensity of MMP-like gelatinolytic activity and tumor size, tumor grade and vessel invasion (p < 0.05), but not between it and histological type, tumor stage or metastatic status. FIZ showed that tumor tissues in 5 of the 6 patients with fatal outcome exhibited the intense gelatinolytic pattern. Stronger in situ gelatinolytic patterns were documented in cases with higher MMP-2 expression. The molecular species of MMPs detected by GZG were confirmed by RT-PCR and Western blotting analysis. The FIZ technique enables a direct assessment of in situ gelatinolytic activity in RCT tissues. The intensity of the activity seems to affect the biology of RCT tissues. Our results also indicate a major role for MMP-2 in in situ gelatinolysis in RCT tissues.
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Carcinoma de Células Renales/enzimología , Neoplasias Renales/enzimología , Metaloproteinasa 2 de la Matriz/metabolismo , Metaloproteinasa 9 de la Matriz/metabolismo , Neovascularización Patológica/enzimología , Adenocarcinoma/irrigación sanguínea , Adenocarcinoma/enzimología , Adenocarcinoma/patología , Adenocarcinoma de Células Claras/irrigación sanguínea , Adenocarcinoma de Células Claras/enzimología , Adenocarcinoma de Células Claras/patología , Adulto , Anciano , Anciano de 80 o más Años , Western Blotting , Carcinoma Papilar/enzimología , Carcinoma Papilar/patología , Carcinoma de Células Renales/irrigación sanguínea , Carcinoma de Células Renales/patología , Gelatina/metabolismo , Humanos , Riñón/enzimología , Neoplasias Renales/irrigación sanguínea , Neoplasias Renales/patología , Persona de Mediana Edad , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neovascularización Patológica/patología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Regulación hacia ArribaRESUMEN
PURPOSE: Bilateral renal cell carcinoma has been reported to occur in 1% to 4% of patients with renal cancer. However, whether bilateral renal cell carcinoma involves metastatic lesions of the contralateral kidney or develops as simultaneous primary tumors remains unclear to date. Thus, we investigated chromosomal losses and von Hippel-Lindau (VHL) gene abnormalities in bilateral tumors from patients with nonfamilial bilateral renal cell carcinoma. MATERIALS AND METHODS: Genomic DNA was exacted from 2 tumors in 8 patients each with nonfamilial bilateral renal cell carcinoma, including clinically asynchronous and synchronous disease in 5 and 3, respectively. The DNA was then subjected to microsatellite analysis on 13 chromosomal loci. In addition, polymerase chain reaction-single nucleotide specific conformation polymorphism analysis and direct sequencing of 3 exons of the VHL gene were performed. RESULTS: All 5 asynchronous cases showed loss of the same allele in bilateral tumors, indicating a common clonal origin. In contrast, 2 of the 3 synchronous cases showed different patterns of chromosomal loss in the right and left renal tumors, suggesting bilateral primary origins. The other synchronous case with loss of the same allele in each tumor involved right stage T3b and left stage T1a neoplasms. No VHL gene mutations were detected in any case. CONCLUSIONS: Except for a small number of cases synchronous and asynchronous bilateral renal cell carcinoma may represent the simultaneous appearance of separate primary tumors and metastatic progression from the contralateral kidney, respectively.