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ABSTRACT: Pheochromocytoma occurs in 0.1-5.7% of patients with neurofibromatosis type 1 (NF1), while dopamine-secreting pheochromocytoma is rare. We report here a rare case of dopamine-secreting pheochromocytoma in a patient with NF1. A 46-year-old woman with NF1 was referred to our hospital with epigastralgia. The patient had no history of hypertension. Abdominal sonography incidentally revealed a left adrenal tumor, while abdominal computed tomography and magnetic resonance imaging findings showed a left adrenal tumor, sized 63×58 mm. Laboratory evaluations revealed exclusively elevated urine dopamine levels in addition to elevated serum adrenaline and noradrenaline levels. Laparoscopic left adrenalectomy was performed and the dopamine levels and other cathecolamine levels returned to normal postoperatively.
Hinyokika kiyo. Acta urologica Japonica 10/2012; 58(10):543-7.
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ABSTRACT: CKD-MBD in kidney transplant recipients (KTRs) is multifactorial. Although it is characterized by drastic changes in laboratory parameters just after transplantation and uncoupling bone mineral metabolism induced by immunosuppressive drugs and progressive renal dysfunction, its pathophysiology starts before transplantation such that CKD-MBD in dialysis patients arises from predialysis CKD stages. The legacy effect of CKD-MBD gained during dialysis period is rather remarkable, and thus a long-term management of CKD-MBD as a continuum is essential.
Clinical calcium 07/2012; 22(7):1050-8.
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ABSTRACT: BK virus nephropathy (BKVN) is one of the factors that reduces renal graft function after transplantation. However, BKVN and rejection present similar pathological findings, as both are accompanied by cellular infiltration to the interstitium and tubulitis, thus they are difficult to distinguish for diagnosis and medical treatment. In the present study, we examined immunohistochemical pathological features of BKVN in four cases treated in our hospital from 2007 to 2010. Common immunohistological finding is that tubulitis in these cases was primarily EMA and 34βE12-positive and existed predominantly from the collecting duct to the distal convoluted tubule. The majority of infected cells existed in EMA and 34βE12-positive tubules, which were also located mainly from the collecting duct to the distal tubule. In addition, a large number of SV40-positive infected cells were similarly seen. Dylon staining clearly revealed eosinophils. We concluded that the main pathological features of BKVN are the presence of tubulitis and infected cells predominantly from the collecting duct to distal tubule and the appearance of eosinophils.
Clinical Transplantation 07/2012; 26 Suppl 24:20-4. · 1.67 Impact Factor
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ABSTRACT: A 67-year-old man had pain and swelling in the bilateral inguinal region. His past medical history included non-alcoholic steatohepatitis and liver cirrhosis. A clinical examination revealed a solid mass that was palpable along with the bilateral spermatic cord from the external inguinal ring to the root of the scrotum. Other than a hydrocele in the right testis, the epididymis and testes were intact. Abdominal computed tomography showed ascites and a solid tumor of the bilateral spermatic cord. Magnetic resonance imaging findings did not suggest malignancy, while antibiotics showed no effects. The patient wanted relief from the inguinal pain and a bilateral high orchiectomy was performed, during which time the spermatic cord was found firmly adhered to the surrounding tissue, and could not be completely resected. A histopathological examination showed epithelial mesothelioma. For additional examination of the ascites, the patient underwent paracentesis, which revealed an extremely high level of hyaluronic acid. Our working diagnosis was peritoneal malignant mesothelioma that had infiltrated the bilateral spermatic cord. We began systemic chemotherapy treatment with pemetrexed and cisplatin, but, the patient died 3 months after the operation.
Hinyokika kiyo. Acta urologica Japonica 03/2012; 58(3):177-80.
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Transplantation 07/2011; 92(2):e8-9. · 4.00 Impact Factor
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ABSTRACT: A 63-year-old man on hemodialysis for chronic renal failure developed a metastatic urothelial carcinoma and was treated with combination chemotherapies. For first line therapy, gemcitabine (GEM) and carboplatin (CBDCA) were given in combination. CBDCA was administered in a target area under the curve of 5.0 mg x min/ml according to the Calvert formula, followed by infusion of GEM at 1,000 mg/m(2), with hemodialysis started 1 hour after the end of CBDCA administration. Treatment-related adverse effects were severe, with grade 4 thrombocytopenia and neutropenia. Following two cycles of that therapy, partial response (PR) was obtained for lung metastasis, while progressive disease (PD) was noted in the liver. For second line therapy, GEM and paclitaxel (PAC) were given in combination. PAC was administered at 110 mg/m(2) before GEM at 1,000 mg/m(2) with hemodialysis given on the interval days. The adverse effect was grade 3 neutropenia, which was considered acceptable. After two cycles of second line therapy, PR was obtained for both lung and liver metastases, and maintained for 6 months. We concluded that GEM/PAC combination therapy is safe and effective for urothelial carcinoma patients undergoing concurrent hemodialysis.
Hinyokika kiyo. Acta urologica Japonica 01/2010; 56(1):29-34.
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ABSTRACT: A 63-year-old man was admitted to our hospital with gross hematuria. Abdominal computed tomography showed an 80mm right renal tumor, 31mm left renal tumor, and 30 mm splenic tumor. Cystoscopy revealed a papillary tumor around the left orifice. Right radical nephrectomy and splenectomy were performed. Histological examination findings showed that the right renal tumor was a renal cell carcinoma, clear cell type, G1, INFalpha, pT2, ly0, v0, and that the splenic tumor was an arteriovenous fistula. Next, transurethral resection of the bladder tumor was performed and a histological examination showed urothelial carcinoma. Magnetic resonance imaging indicated that the left renal tumor was a renal pelvic cancer. Left total nephroureterectomy and cystectomy were performed, and the histological diagnosis was urothelial carcinoma, G3, pT3, ly1, v2. Following the operation, hemodialysis was introduced. It is rare for a renal cell carcinoma and contralateral renal pelvic cancer to occur simultaneously, as only 15 cases including the present have been reported in Japan.
Hinyokika kiyo. Acta urologica Japonica 08/2009; 55(8):491-4.
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ABSTRACT: We analysed whether pre- and post-transplant serum adiponectin levels in renal transplant patients were associated with new-onset diabetes after transplantation (NODAT). The mean post-transplant follow-up duration was 47.9 months. Of 98 previously non-diabetic renal transplant patients, 12 were diagnosed with NODAT and 86 without (non-NODAT). There was a significant inverse correlation between mean post-transplant serum adiponectin level and homeostasis model assessment for insulin resistance (HOMA-IR) (r = -0.22, P = 0.03), and a positive correlation between follow-up duration after transplantation and HOMA-IR (r = 0.28, P = 0.005). The mean pre- and post-transplant serum adiponectin levels in NODAT patients were significantly lower than those in non-NODAT patients (13.3 vs. 21.0 microg/ml and 13.0 vs. 16.4 microg/ml, P = 0.01 and 0.03 respectively). In addition, the post-transplant serum adiponectin level in patients treated with tacrolimus (TAC) was significantly lower than that in patients with cyclosporine (14.3 vs. 18.7 microg/ml, P = 0.01), while, that level in patients treated with angiotensin receptor blockers (ARB) was significantly higher than that in patients without treatment of ARB (17.9 vs. 14.7 microg/ml, P = 0.01). Our results indicate that post-transplant serum adiponectin levels are decreased after transplantation in association with insulin resistance in the development of NODAT, and that TAC and ARB influence the level of adiponectin in serum.
Transplant International 03/2009; 22(7):694-701. · 2.92 Impact Factor
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ABSTRACT: We report a case of spontaneous rupture of the common iliac artery associated with fibromuscular dysplasia (FMD). A 21-year-old previously healthy male presented with acute onset of colic pain, suspected to be caused by a ureteral stone. Abdominal computed tomography and angiography revealed a retroperitoneal hematoma caused by rupture of the common iliac artery. In spite of an emergency operation initiated quickly, the patient died. A pathological examination demonstrated FMD of the common iliac artery. Although very rare, it is important to bear in mind that the possibility of retroperitoneal hemorrhage exists in patient with sudden lumbago.
Hinyokika kiyo. Acta urologica Japonica 11/2007; 53(10):721-4.
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ABSTRACT: We analyzed clinical effects of flutamide as a second-line agent for maximum androgen blockade (MAB) in patients with relapsing prostate cancer who received bicalutamide as the first-line MAB agent. This study included 13 patients with progressive prostate cancer who had relapsed after first-line MAB, with bicalutamide at 80 mg/day. After checking for antiandrogen withdrawal syndrome, they were given flutamide at 375 mg/day as second-line MAB. The effectiveness of that therapy was evaluated by changes in prostatic specific antigen (PSA) levels, with response defined as a decrease of greater than 50% from the start of therapy. We also compared several factors between responders and non-responders. Nine (69.2%) of the 13 patients showed a decrease in PSA levels, of whom five (38.5%) had a greater than 50% decrease and were defined as responders. The median duration of PSA response was 11.0 months (range 5-20 months). Patients who had a longer duration of response to first-line MAB had a significantly greater response to second-line MAB. For advanced prostate cancer patients who progressed on first-line MAB with bicalutamide, flutamide administration as a second-line antiandrogen was found to be relatively effective, especially for those who showed a longer duration of response to the first-line MAB. Our results confirm previous findings that MAB using flutamide is an effective second-line hormonal therapy.
International Journal of Urology 04/2007; 14(3):264-7. · 1.75 Impact Factor
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ABSTRACT: Here we report a rare case of inflammatory myofibroblastic tumor of the bladder. The patient was a 72-year-old man. We diagnosed this case preoperatively as urachal tumor from urine cytology, cystoscopy, and magnetic resonance imaging. We performed partial cystectomy. Histopathological examination revealed that the tumor was an inflammatory myofibroblastic tumor. To our knowledge, this is the 51st reported case of inflammatory myofibroblastic tumor of the bladder in Japan. He has been followed up for 13 months without any evidence of local recurrence.
Hinyokika kiyo. Acta urologica Japonica 01/2007; 52(12):955-7.
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ABSTRACT: Two cases of synchronous ipsilateral renal cell carcinoma and renal pelvic transitional cell carcinoma are presented, one in a 70-year-old man and another in a 54-year-old man. These two cases were diagnosed preoperatively as synchronous ipsilateral renal tumor and pelvic tumor from urine cytology, retrograde pyelography, computed tomography and magnetic resonance imaging, and in both two cases, nephroureterectomy was performed. Pathological diagnosis was renal cell carcinoma and renal pelvic transitional cell carcinoma, which existed incidentally in the same kidney. To our knowledge, these cases are the 34th and 35th reported cases of synchronous ipsilateral renal cell carcinoma and renal pelvic transitional cell carcinoma in Japan.
Hinyokika kiyo. Acta urologica Japonica 02/2006; 52(1):23-6.
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ABSTRACT: A 60-year-old male, who had been maintained on hemodialysis for 4 years, visited our hospital to receive living renal transplantation. He complained of macrohematuria, and preoperative examination showed elevation of psostate specific antigen (PSA). Cystoscopy revealed papillary tumors on the right lateral bladder wall. Transurethral resection of bladder tumor (TUR-Bt) was performed and histopathological examination showed transitional cell carcinoma, G2, pTa. The histologic diagnosis of the transrectal needle prostate biopsy specimen was moderately differentiated adenocarcinoma. Combined androgen blockade as a neoadjuvant therapy and radical prostatectomy were performed. A case of synchronous double primary cancers, comprised of adenocarcinoma of the prostate and transitional cell carcinoma of the urinary blader in a hemodialysis patient has never been previously reported in the Japanese literature.
Hinyokika kiyo. Acta urologica Japonica 11/2005; 51(10):689-93.
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ABSTRACT: A 57-year-old male was referred to our hospital with a complaint of dizziness. Abdominal computed tomography and retrograde pyelography revealed a left renal tumor associated with hydronephrosis due to pelviureteric junction (PUJ) obstruction. A radical nephrectomy was performed and histological diagnosis was renal cell carcinoma. Only five cases of renal cell carcinoma with hydronephrosis due to PUJ obstruction have been previously reported in the Japanese literature.
Hinyokika kiyo. Acta urologica Japonica 03/2005; 51(2):109-12.
