We report a rare case of a metastatic tumor of the tunica vaginalis and epididymis with hydrocele from occult gastric cancer. A 72-year-old patient showed a painless scrotal swelling. Scrotal ultrasound showed a right hydrocele and a follow-up hydrocelectomy showed a mass on the epididymis. The operation was thus converted to radical orchiectomy. The tumor was revealed as an adenocarcinoma in the tunica vaginalis and epididymis. Abdominal computed tomography found gastric cancer, which was confirmed by a gastric fibroscopy biopsy. The patient was referred to the hemato-oncology department for chemotherapy but died after 3 months.
Adenocarcinoma ; Aged ; Biopsy ; Epididymis ; Follow-Up Studies ; Humans ; Male ; Orchiectomy ; Stomach ; Stomach Neoplasms ; Testicular Hydrocele

PURPOSE: The aim of this study was to investigate the changes in and implications of preoperative and postoperative serum uric acid levels in patients with living donor nephrectomy. MATERIALS AND METHODS: We studied 207 patients between 1998 and 2007 at our hospital undergoing living-donor nephrectomy for kidney transplantation. The serum uric acid level and estimated glomerular filtration rate (eGFR) were measured preoperatively and at 1 year postoperatively. We also analyzed multiple independent variables such as age, sex, blood pressure, body mass index (BMI), serum total cholesterol, hemoglobin, hematocrit, total protein, albumin, calcium, and phosphorus. RESULTS: The mean age of the study patients was 38.3+/-10.8 years. The mean serum uric acid concentration at 1 year after kidney donation was higher than preoperatively (5.05+/-1.39 mg/dl preoperatively vs. 5.85+/-1.14 mg/dl postoperatively) and was significantly greater in patients with hyperuricemia (uric acid> or =6.8 mg/dl) than in patients without hyperuricemia (uric acid < 6.8 mg/dl): 1.63+/-0.75 mg/dl vs. 0.69+/-0.66 mg/dl, respectively. The multivariate analysis showed that preoperative serum uric acid was the primary predictive factor of postoperative serum uric acid (r=1.136, p=0.001), and preoperative GFR was an independent secondary predictive factor (r=-0.004, p=0.047). The receiver operator characteristics (ROC) curves for the preoperative serum uric acid cutoff of 5.7 mg/dl showed the highest sensitivity and specificity of 96% and 86%, respectively. CONCLUSIONS: These results suggest that preoperative serum uric acid and GFR were important predictive factors of postoperative serum uric acid after living-donor nephrectomy. Therefore, in the selection and management of kidney donors, not only patients with a low GFR but also those with high uric acid (serum uric acid > or =5.7 mg/dl) require careful observation before and after living-donor nephrectomy.
Blood Pressure ; Body Mass Index ; Calcium ; Cholesterol ; Glomerular Filtration Rate ; Hematocrit ; Hemoglobins ; Humans ; Hyperuricemia ; Kidney ; Kidney Transplantation ; Living Donors ; Multivariate Analysis ; Nephrectomy ; Sensitivity and Specificity ; Tissue Donors ; Uric Acid

A multilocular cyst of kidney is a rare pathological entity, which has been reported in the literature under several names. These various names reflect the controversy surrounding their nature. This tumor is traditionally regarded as benign in nature and a nephrectomy has to be performed because of the difficulty in its accurate diagnosis. Malignant recurrence of a multilocular cyst of kidney has an even rarer incidence, with only a few cases having been reported. We report a case of 50-year-old male, with an incidentally detected right renal cystic mass. This mass was pathologically confirmed as a multilocular cyst of kidney after a radical nephrectomy, which locally recurred as a malignant mesoblastic nephroma.
Diagnosis ; Humans ; Incidence ; Kidney Diseases, Cystic ; Kidney* ; Male ; Middle Aged ; Nephrectomy ; Nephroma, Mesoblastic ; Recurrence*

A primary genitourinary melanoma is rare, accounting for less than 1% of all cases of melanoma. They have been presented in case reports, with a subsequent paucity of insight into the natural history of the disease and appropriate management of patients. The prognosis of patients with a genitourinary melanoma is poor. Delay in seeking medical attention for symptoms, and misdiagnosis at presentation, contribute to a more advanced stage at diagnosis. Our case involved a 71 year old woman, who came to our hospital due to vaginal spotting. On local excision, mass was found on the vestibule and forward to the urethra. The pathological diagnosis, by special immunohistochemical staining, such as S-100 protein and HMB-45, was that of a malignant melanoma.
Aged ; Diagnosis ; Diagnostic Errors ; Female ; Humans ; Melanoma* ; Metrorrhagia ; Natural History ; Prognosis ; S100 Proteins ; Urethra ; Vagina

A lipoleiomyosarcoma (L-LMS) is an extremely rare tumor, which is a well-differentiated liposarcoma, with leiomyosarcomatous differentiation. Leiomyosarcomatous differentiation may consist of either a well-differentiated liposarcoma, with an intrinsic smooth muscle component, or a dedifferentiated liposarcoma (DL), having smooth muscle differentiation in the dedifferentiated zones. We report an L-LMS appertaining to the latter type, affecting the spermatic cord.
Leiomyosarcoma ; Liposarcoma ; Muscle, Smooth ; Spermatic Cord*

Metastatic cancers in the spermatic cord are extremely rare. A 79-year-old man, who had undergone palliative chemotherapy and radiotherapy one year previously, due to inoperable esophageal cancer, visited our hospital suffering from right inguinal swelling. Ultrasonography showed echogenic lesions superior to the right testis, suspicious of a swollen bowel loop. An emergency exploration revealed no bowel content or mesentery, but with thickened of the spermatic cord and epididymis four times that of the contralateral side. Pathology confirmed a metastatic carcinoma, likely to have originated from the esophagus.
Aged ; Drug Therapy ; Emergencies ; Epididymis ; Esophageal Neoplasms* ; Esophagus ; Hernia* ; Humans ; Male ; Mesentery ; Neoplasm Metastasis* ; Pathology ; Radiotherapy ; Spermatic Cord* ; Testis ; Ultrasonography

The condition of pseudo-epitheliomatous keratotic and micaceous balanitis (PKMB) has been described as a rare, scaling, raised lesion of the glans penis, which on histological examination showed acanthosis, hyperkeratosis and pseudo-epitheliomatous hyperplasia. It was originally thought to be a benign condition. However, recent case reports suggest that PKMB has a high propensity for malignant change. Treatment by biopsy has shown that pseudo-epitheliomatous keratotic and micaceous balanitis should be determined by the severity of the disease. We report a case of PKMB in a 38-year-old man, who presented with a one year history of an eruption on the glans penis.
Adult ; Balanitis* ; Biopsy ; Humans ; Hyperplasia ; Male ; Penile Neoplasms ; Penis

A retroperitoneal lymphangioma is a rare tumor, most commonly affecting the neck or axillary area. We report a case of a 60-year-old man, with left flank pain, who had a retroperitoneal cavernous lymphangioma, with hemorrhagic complication. The diagnosis was made after complete excision of the tumor, followed by pathologic documentation.
Diagnosis ; Flank Pain ; Humans ; Lymphangioma* ; Middle Aged ; Neck ; Retroperitoneal Space*

PURPOSE: The events of cell stress and cell death are linked, with the heat shock proteins (Hsps) induced in response to stress appearing to function at key regulatory points in the control of apoptosis. The purpose of this study was to investigate the effect of arisostatins A on the Hsp70 expression and signal mechanism of its transcription. MATERIALS AND METHODS: We used natural arisostatins A produced by Actinomycete, in Caki cells. We measured the growth rate of cell using trypan blue staining, and the induction of the transcriptional levels of Hsp70 with arisostatins, which was quantified by reverse transcript-polymerase chain reaction (RT-PCR) and transiently transfecting cells with a Hsp70. The induction of the transcriptional levels of Hsp70 with arisostatins A was quantified by RT-PCR and transiently transfecting cells with a Hsp70 promoter-luciferase reporter plasmid. RESULTS: Arisostatins A-induced Hsp70 up-regulation was not prevented by the overexpression of peroxiredoxinI (PrxI), PrxII or treatment of superoxide dismutase and catalase. However, the arisostatins A-mediated expression of Hsp70 was reduced significantly in Caki cells treated by the antioxidant, N-acetylcystein. Inhibition of the Janus tyrosine kinase (JAK) activity with AG490 did not inhibit the arisostatins A-induced Hsp70 up-regulation, suggesting that JAK is not associated with the arisostatins A-mediated Hsp70 expression. The mechanism of Hsp70 induction depends on the activation of heat shock factor-1. However, arisostatins A did not effect the change in the expression levels of heat shock factor-1. CONCLUSIONS: These findings suggested that Hsp directly regulates specific stress-responsive signaling pathways, which may antagonize the signaling cascades that result in apoptosis.
Apoptosis ; Carcinoma, Renal Cell* ; Catalase ; Cell Death ; Cell Line* ; Heat-Shock Proteins* ; Hot Temperature* ; HSP70 Heat-Shock Proteins* ; Plasmids ; Protein-Tyrosine Kinases ; Shock ; Superoxide Dismutase ; Trypan Blue ; Up-Regulation

PURPOSE: To investigate whether the up-regulation of Bcl-2 gene expression may be associated with chemotherapy resistance and malignant progression in human renal cell carcinomas (HRCC). MATERIALS AND METHODS: The HRCC cell line, SN12C, was cultured in MEM medium, supplemented with 10% FBS. Full length of Bcl-2 cDNA was obtained using the sense primer (5'-ATGGCGCACGCTGGGAGAACGG-3') and the antisense primer (5'-TCACTTGTGGCTCAGATAGG-3') and inserted into SN12C cells to establish stable cells expressing the Bcl-2 gene (SN12C/smcb2). To investigate the response to doxorubicin in orthotropic organs, SN12C/smcb2 and parental cells were implanted into the subcapsular renal tissue of nude mice (n=5). The mice were treated with doxorubicin (8mg/kg) on days 8 and 15 following tumor cell implantation. Tumor tissues, obtained from the kidneys and lungs, were ex vivo cultured (SN12C/smcb2-kidney and SN12C/smcb2-lung, respectively). To compare the metastatic potential in these cell lines, the gelatinolytic activity was measured by zymogram and the expression of type IV collagenase (MMP-9) examined by western blot. RESULTS: In the in vitro study, the SN12C/smcb2 was more resistant to doxorubicin than the parental cells, and treatment and those cells produced a higher rate of tumor formation and metastasis. The SN12C/ smcb2-kidney showed higher gelatinolytic activity than the parental cells. Higher expression levels of type IV collagenase were detected in the SN12C/smcb2-lung and SN12C/smcb2-kidney, but barely detected in SN12C. CONCLUSIONS: The up-regulation of Bcl-2 gene expression in HRCC cells induces drug resistance to doxorubicin and increases the metastatic potential. Although the drug resistance induced by Bcl-2 over-expression enhances distant metastasis (lung), the up-regulation of Bcl-2 may enhance the malignant potential of tumor cells and produce distant metastasis.
Animals ; Blotting, Western ; Carcinoma, Renal Cell* ; Cell Line ; Collagenases ; DNA, Complementary ; Doxorubicin ; Drug Resistance* ; Drug Therapy ; Genes, bcl-2* ; Humans* ; Kidney ; Lung ; Mice ; Mice, Nude ; Neoplasm Metastasis ; Parents ; Up-Regulation