Complete response of lung metastasis to interferon-alpha therapy after radical nephrectomy for sarcomatoid renal cell carcinoma with Stauffer syndrome: a case report

A 75-year-old man was admitted to our hospital with liver dysfunction and elevated C-reactive protein level. He was diagnosed with renal tumor by ultrasonography. Computed tomography revealed a renal cell carcinoma (cT3aN0M0) with Stauffer syndrome. Laparoscopic radical nephrectomy was performed. Histological findings indicated clear cell carcinoma with a sarcomatoid component. After 1 month, lung metastasis was detected on an X-ray film. Interferon-α was administered, and complete response was achieved 2 months later. He has shown no evidence of recurrence in 27 months.     

Pancreatic and duodenal metastases from renal cell carcinoma 13 years after radical nephrectomy: a case report

A 52-year-old male was admitted to our hospital complaining of orthostatic vertigo, fatigue and weight loss, who underwent right total nephrectomy for renal cell carcinoma(RCC) with curative operation 13 years ago (in 1992). Endoscopic examination revealed a submucosal tumor with erosion in the duodenum. The diagnosis made from the biopsy specimens was metastatic RCC in the duodenum. Abdominal CT scan revealed that his metastasis has spread to the pancreas. Five million units of interferon a was administered intramuscularly three times a week for 1 month. He received blood transfusions and palliative care. He died 5 months later because of disease progression. Metastases of RCC have been often reported in the lungs, the liver, and the bones, but rarely in the gastrointestinal tract. This is a very rare case of metastatic RCC in the duodenum, which was diagnosed 13 years after curative right nephrectomy. Since late recurrence is characteristic of renal cell carcinoma, careful long-term follow-up is needed. To our knowledge, this is the 19th case of duodenal metastasis from RCC reported in the literature.     

Appendicitis in an incisional hernia after radical nephrectomy: a case report

Appendicitis is one of the most common surgical emergencies, and is usually diagnosed clinically on point tenderness in the right iliac fossa. The diagnosis can be difficult if there is abnormal anatomy. This case looks into the presentation of appendicitis within an incisional hernia secondary to radical nephrectomy. Appendicitis may present within hernias, and there should be a low threshold for computed tomography assessment of hernias when there is clinical doubt about the symptoms associated with the hernia.     

Late relapse of testicular cancer 21 years after first complete remission: a case report

We report here a case of very late relapse of a nonseminomatous germ cell tumor 21 years after first complete remission. A 42-year-old man, with a clinical history of right testicular cancer, was referred to our hospital with elevated serum alpha-fetoprotein (AFP) level. CT scan demonstrated a 5 x 5 cm retroperitoneal lymph node swelling compressing the inferior vena cava (IVC) extending from the right renal vein down to the bifurcation of the aorta. The patient received a total of four courses of combination chemotherapy consisting of cisplatin, etoposide, paxlitaxel, and ifosfamide. However, the retroperitoneal lymph node metastasis did not respond to chemotherapy, and the serum AFP level increased. Extended bilateral retroperitoneal lymph node dissection with right nephrectomy, partial duodenectomy, and vena cavectomy were performed. The patient has been followed up with no evidence of disease for 48 months after the operation without any further therapy.     

Testicular seminoma after the complete remission of extragonadal yolk sac tumor : a case report

Background

Between 2% and 5% of malignant germ-cell tumors in men arise at extragonadal sites. Of extragonadal germ cell tumors, testicular carcinoma in situ (CIS) are present in 31–42% of cases, and CIS are reported to have low sensitivity to chemotherapy in spite of the various morphology and to have a high likelihood of developing into testicular tumors. A testicular biopsy may thus be highly advisable when evaluating an extragonadal germ cell tumor.

Case presentation

A 36-year-old man was diagnosed as having an extragonadal non-seminomatous germ cell tumor, that was treated by cisplatin-based chemotherapy, leading to a complete remission. In the meantime, testicular tumors were not detected by means of ultrasonography. About 4 years later, a right testicular tumor was found, and orchiectomy was carried out. Microscopically, the tumor was composed of seminoma.

Conclusions

We herein report a case of metachronous occurrence of an extragonadal and gonadal germ cell tumor. In the evaluation of an extragonadal germ cell tumor, a histological examination should be included since ultrasonography is not sufficient to detect CIS or minute lesions of the testis.

     

Successful complete androgen blockade (CAB) therapy for prostatic cancer detected from multiple lung metastases: a case report

Prostatic cancer is rarely diagnosed by detection of lung metastases. We report a case of prostatic cancer in a 73-year-old man detected by abnormalities in chest X-ray and serum prostate specific antigen (PSA) level. He was initially admitted to our hospital due to elevation of PSA level. On the first transperineal prostatic needle biopsy, prostatic cancer was not detected and he was followed. Seven months after the first biopsy, chest X-ray revealed multiple abnormal nodules in the lung fields bilaterally and PSA level was again elevated. A second prostatic biopsy and whole-body examination were performed, and he was diagnosed with moderately differentiated prostatic adenocarcinoma with multiple lung metastases. Complete androgen blockade therapy was performed immediately. Two months after the beginning of treatment, PSA level was normalized and the multiple lung metastases had completely disappeared. There has been no evidence of recurrence or PSA relapse 24 months after detection of the prostatic cancer. This is the 26th case of prostatic cancer diagnosed in Japan following detection of multiple lung metastases.     

Late relapse and urothelial carcinoma of residual ureter 16 years after radical nephrectomy: a case report

A 66-year-old male was referred to our hospital for evaluation of tumors in his left residual ureter and the lung. He had a history of left nephrectomy due to "malignant renal tumor", performed by a general surgeon at another hospital 16 years ago. Since a definitive diagnosis of the kidney was uncertain, we speculated that the original renal disease was a renal pelvic cancer and had metastasized in the residual ureter and the lung. We performed systemic chemotherapy followed by resection of residual ureter with bladder cuff Pathological examination revealed urothelial carcinoma. However, the lung tumors did not respond to salvage chemotherapy and slowly progressed. Bronchoscopic biopsy was performed 2 years later and histological finding showed clear cell type renal cell carcinoma.     

Small intestinal cancer with extensive lymph node metastases showing complete remission by methotrexate/5-fluorouracil sequential therapy: Report of a case

A case of poorly differentiated adenocarcinoma of the small bowel with extensive lymph node metastases is herein presented, which responded to methotrexate/5fluorouracil (MTX/5-FU) sequential therapy. The lymph node metastases disappeared completely after 10 months of treatment. After recurrence, combination therapy with radiation, hyperthermia, and cisplatinum were also effective in reducing the degree of nodal swelling while still allowing the patient to maintain her accustomed lifestyle for a prolonged period of time. Further multiinstitutional studies are still needed, however, to fully assess this new therapeutic regimen for small bowel cancers.     

Retroperitoneoscopic radical nephrectomy with concomitant distal pancreatectomy: case report

Whereas laparoscopic radical nephrectomy has emerged as the standard of care for most low-stage renal tumors, laparoscopic pancreatic surgery remains uncommon. We describe a retroperitoneoscopic radical nephrectomy and concomitant distal pancreatectomy for a large left renal mass with suspected involvement of the adrenal gland and the distal pancreas.     

Prostatic cancer with multiple pulmonary metastases treated successfully with hormonal therapy: a case report

A 66-year-old, man was referred to our hospital for further examination of multiple pulmonary nodules on chest X-ray performed on medical examination. He was referred to our clinic because his chief complaint was poor urinary stream. Prostatic cancer was suspected on digital rectal examination and magnetic resonance imaging. Serum prostatic specific antigen (PSA) level was 134.9 ng/ml. Histological examination of transrectal prostatic sextant biopsy revealed well differentiated adenocarcinoma of prostate. Abdominal computed tomography-scan, gastro-intestinal tract examination and bone scintigraphy demonstrated no other primary lesions or distant metastases. Under the diagnosis of prostatic cancer with multiple pulmonary metastasis, we performed total androgen blockade (TAB) consisting of luteinizing hormone releasing hormone agonist and flutamide following dietylstilbestrol (DES) intravenous injection therapy. After three months, pulmonary nodules disappeared on chest X-ray and PSA level decreased to below 0.1 ng/ml. Pulmonary nodules also disappeared on CT-scan after six months after TAB. He is alive and free from the recurrence for 42 months.     

Urothelial carcinoma in a remnant ureter after a radical nephrectomy for renal cell carcinoma: A case report

Urothelial carcinoma of a ureteral stump after a radical nephrectomy for renal cell carcinoma is rare. We present the case of a 76-year-old man with painless gross hematuria. The patient had undergone a right nephrectomy for renal cell carcinoma 30 months previously. Cystoscopy showed a blood clot in the right ureteral orifice, and ureteroscopy revealed a papillary mass in the right ureter. The patient underwent a right ureterectomy and bladder cuff resection. The pathology examination showed a high-grade urothelial carcinoma. However, a superficial bladder tumor was discovered postoperatively, and a transurethral resection of the bladder tumor was performed. At 8 months postoperatively, the patient was alive with no evidence of recurrence. A ureteral stump evaluation must be performed when painless hematuria is noted in patients after a nephrectomy.     

Late metastases of prostatic adenocarcinoma to urinary bladder after radical prostatectomy: a case report]

We report a case of metastasis of prostatic cancer to urinary bladder. A 67-year-old man was admitted with a complaint of macroscopic hematuria, who had undergone radical prostatectomy and surgical castration for prostatic cancer (pT3N0M0) 53 months before. Computed tomographic (CT) scan revealed an invasive tumor on the right wall of the urinary bladder and swelling of paraaortic and pelvic lymph node metastases. These lesions were diagnosed as bladder tumor with lymph node metastases, and then transurethral biopsy of bladder tumor was performed. Because macroscopic hematuria could not be controlled and severe progressive anemia was found after the biopsy, simple cystectomy and bilateral cutaneoureterostomy were performed on the next day. Histopathological analysis showed that the tumor was adenocarcinoma, which was thought to be a metastatic tumor from the prostatic cancer.     

Splenosis mimicking local recurrence after radical nephrectomy: a report of two cases

Splenosis is autotransplantation of splenic tissue and usually follow traumatic or surgical rupture of the spleen. We report two cases of splenosis which presented as a local recurrence after radical nephrectomy for left renal cell carcinoma (RCC). The patients were a 65- and a 71-year-old male, who had been operated for RCC including splenectomy because of disrupture of the splenic capsule 8 and 9 years earlier respectively. In both cases, follow up computed tomographic scans showed small nodules under the left diaphragm. Although we initially suspected local recurrence, we considered the possibility of splenosis. Both patients underwent technetium-99m Sn colloid scans and were diagnosed with splenosis successfully. Therefore, we could avoid unnecessary surgical explorations.     

Laparoscopic radical nephrectomy in ACDK-associated renal cell carcinoma accompanied by duplicated IVC: a case report

A 59-year-old male patent who had undergone chronic dialysis for 13 years presented with gross hematuria. Radiological examinations showed a cystic renal tumor in the left kidney, multiple renal cysts due to acquired cystic disease of the kidney (ACDK), and a duplicated inferior vena cava (IVC). Although we suspected that the branches of the left IVC might be anormalous with regard to number and location, we could not obtain information about the left renal vein by 3-dimensional computed tomography because of the decreased blood flow in the end-stage kidney. Laparoscopic radical nephrectomy was performed using a transperitoneal approach. We first identified the left IVC and then exposed its surface widely so that we could identify the veins draining into it. We identified and divided two renal veins and also identified an adrenal vein and a gonadal vein draining directly into the left IVC. The enlarged kidney with multiple renal cysts was removed in a purely laparoscopic procedure.     

Complete remission of lung and hepatic metastases from renal cell carcinoma by interferon alpha-2b therapy: a case report]

A right renal tumor was found in a 74-year-old man with multiple metastases to the lungs and liver. Tumor thrombus extending into the inferior vena cava and a right spermatic varicocele were also noted at the first visit. Interferon alpha-2b and interferon gamma were administered for treatment. Partial remission of lung metastases, complete remission of hepatic metastases, and disappearance of the varicocele occurred after 4, 6 and 8 weeks, respectively. Then the primary right renal tumor was resected. Although only interferon alpha-2b was continued twice weekly by self-injection, complete remission of the lung metastases was obtained 13 weeks after the initiation of therapy. No evidence of recurrence or new metastasis has been found after 18 months. These results indicate that even advanced renal cell carcinoma may show a rapid response to interferon alpha. Interferon alpha is worth trying for metastatic renal cell carcinoma and should be continued for at least a few months.     

A case report of multiple bilateral breast metastases after colorectal cancer

Introduction and importanceAlthough primary breast cancer is the most common tumor in women, breast metastases are rare findings. We report the first case in English literature with CRC metastases to the breast and adrenal gland concurrently.Case presentationA 42-year-old Caucasian female complained of abdominal pain over the last 3 days. Her history was remarkable for stage 2 colon cancer and she was free of disease for 2 years before the presentation, due to receiving Surgical-chemotherapy. The radiologic investigation showed a well-defined cystic mass in the left adrenal gland and left breast nodule. After adrenalectomy, the diagnosis of the mass was metastatic mucinous adenocarcinoma. During the surgical preparation, bilateral breast lumps were noticed. Histopathology of breast mass showed mucinous adenocarcinoma. Immunohistochemical staining revealed that the neoplastic gland was positive for CDX2, CK20, and P53 mutation and negative for CK7, PR, ER, and HER2. Overall, the diagnosis was metastatic colorectal adenocarcinoma to the breast.Clinical discussionMetastatic lesions in the adrenal gland tend to be bilateral with irregular shape. Breast metastases are singular unilateral lesions with predominance in the left breast. Biopsy and immunohistochemistry make the final diagnosis.The management plan is complex and depends on many factors like the general condition of the patient and the presence of other metastases. However, breast metastases may be a clinical clue to disseminated disease.ConclusionBreast metastases should be in the differential diagnosis in patients with a history of colorectal adenocarcinoma, in order to provide the appropriate clinical care.     

Complete remission of brain metastases from prostate cancer by gamma knife radiosurgery: a case report]

A 59-year-old male visited us with a chief complaint of dysuria. The serum prostate specific antigen (PSA) level was within normal limits, and intravenous pyelography and urethrocystography showed no abnormal findings. Because of his urinary retention, transurethral resection of prostate was performed under a clinical diagnosis of benign prostatic hyperplasia. The pathological diagnosis was poorly differentiated adenocarcinoma of the prostate. Not only combination hormone therapy with goserelin acetate and flutamide, but also intermittent arterial infusion chemotherapy with cisplatin (CDDP) and pirarubicin (THP) using a reservoir system was administered. Additionally total pelvic irradiation was delivered. Magnetic resonance imaging (MRI) demonstrated that his prostate was reduced to less than 50% in size and he had no difficulty in voiding. He suddenly developed dysarthria and hemiplegia 3 months later. MRI and computed tomography (CT) revealed multiple brain metastases. After the gamma knife radiosurgery, neurological findings disappeared and MRI showed dramatic shrinkage of metastatic brain tumors. Metastasis to the pancreas was recognized on CT and he died of multiple organ failure 30 months after his first visit.