Cheng-Ping Ma

Spontaneous Retroperitoneal Hemorrhage from Kidney Causes

Spontaneous retroperitoneal hemorrhage is an uncommon entity and even rarer when the underlying cause is from the kidney. Renal tumors comprise the majority of atraumatic kidney rupture. Renal cell carcinoma and angiomyolipoma are the most common diseases in this group. Oral anticoagulant therapy and hemodialysis could be responsible for a few cases. In 3 reported cases no pathological explanation could be found. With the help of modern facilities, diagnosis can be made preoperatively and conservative surgery is indicated in these patients. However, nephrectomy is the treatment of choice for patients presenting with shock as the initial symptom or solid renal mass with perirenal hematoma.

Establishment and characterization of renal cell carcinoma cell lines with multidrug resistance.

Abstract Many of the discoveries of multidrug resistance (MDR) have resulted from studies using drug-resistant cultured tumor cell lines as experimental models. To date, there has been no report on the detailed characterization of such a cell line from renal cell carcinoma (RCC). By long-term exposure of an established RCC (RCC8701) to increasing concentrations of adriamycin, we established a series of subcultures that were considerably more resistant to the cytotoxic effect of this drug. Biological morphology and cell cycles were analyzed by morphometry and flow cytometry. The chemoresistance index of cells were measured by methyl tetrazolium assay. For evaluation of the expression of MDR-related protein (MRP), mdr-1, glutathione transferase (GST-π), and topoisomerase II mRNAs, the reverse transcription-polymerase chain reaction was used. Membranous expression of mdr-1-related p-glycoprotein was analyzed by immunofluorescence cytometry. The intracellular content of both glutathione (GSH) and glucose- 6-phosphate dehydrogenase (G-6-PDH) were measured using a capillary electrophoresis method. Compared with parent cells, the resistant sublines had a slower growth rate and lower confluent density. They were smaller and mixed with giant cells in different sizes and with different numbers of nucleoli. Flow cytometric analyses showed that resistant cells had a greater percentage of cells in the G2/M phase. The resistant cells, RCC8701/ADR800, were 122 times more resistant to adriamycin and 238 times more resistant to epirubicin than the parent cells. The resistant cells also demonstrated cross-resistance to cisplatin and 5-fluorouracil. In addition to MRP, the contents of mRNA coding for mdr-1, GST-π, and topoisomerase II in the MDR sublines were higher than in the native cell line. A higher content of cytoplasmic GSH and G-6-PDH were found in the resistant cells; however, the expression of the MDR-related membranous glycoprotein, p-glycoprotein, was not raised. The adriamycin-induced MDR sublines may be used as an experimental system for the search of a means to overcome drug resistance and elucidate possible mechanisms of acquired MDR involved in human renal cancer.

The Correlation of Membranous Glycoprotein-GP-170, Cytoplasmic Glutathione and Glucose-6-Phosphate Dehydrogenase Levels with Multidrug Resistance in Transitional Cell Carcinoma Cell Lines of the Urinary Tract

The expression of membranous glycoprotein gp-170, cytoplasmic glutathione (GSH) and energy-related glucose-6-phosphate dehydrogenase (G-6-PD) in cultured normal urothelial cells and transitional cell carcinoma (TCC) cell lines was analyzed by flow cytometric and enzymatic methods. The chemosensitivity of these tumor cells to four major types of anticancer drugs, including cisplatin, thiotepa, methotrexate, 5-fluorouracil, adriamycin and vinblastine, was correlated with biological activities in TCC cell lines. The TCC cell lines displayed a general sensitivity to anticancer drugs with a low incidence of highly resistant cell lines (23%). The expression of multidrug resistance was not related to cellular differentiation or invasiveness of cancer cells. Only 24% of TCC cell lines had an elevated expression of gp-170, but their expression was not related to drug resistance. Increased cytoplasmic GSH and G-6-PD was observed in over 90 per cent of TCC cell lines, but no correlation with drug resistance and cellular differentiation was observed. The biological activities of GSH and G-6-PD were not related to the drug resistance of TCC. The low expression rate of gp-170 in TCC cells indicates that other mechanisms should be involved in the development of MDR in TCC cells.

Benign Testicular Tumors

Testicular tumor is considered rare in Oriental people and benign testicular tumor has never been reported from this area. From 1969 to 1985 70 cases of intratesticular tumors were treated at Tri-Service General Hospital. 12 of them were benign in nature including 8 epidermoid cysts, 1 cavernous hemangioma, 1 foreign body granuloma with pseudocyst, 1 Sertoli cell tumor and 1 intratesticular simple cyst. A testis-sparing procedure was performed for 5 epidermoid cysts, the Sertoli cell tumor and the simple intratesticular cyst. The tumors were excised completely and the testes were preserved after careful and thorough frozen section pathological studies. One of the epidermoid cysts and the case of simple testicular cyst were diagnosed correctly before surgery by using scrotal ultrasound.

The Effecxt of Methylene Blue-Sensitized Photodynamic Treatment on Bladder Cancer Cells: A Further Study on Flow Cytometric Basis

The cytotoxic effect mediated by methylene blue-sensitized photoinactivation on bladder cancer cells has been well known for years, but the actual mechanism is still not clear. Specific fluorescence stains were used in a multiparameter approach. The changes in cellular size, granularity, protein content, RNA and DNA were analyzed by flow cytometry. The results showed that, in addition to cell size, all the other parameters, including cellular granularity, protein, RNA and DNA, diminished following photodynamic therapy. The cytotoxic efficacy is closely related to time of stain and illumination. The DNA and cell cycle were affected simultaneously with decreased DNA content and arrest in the G0/G1 phase. These multistage processes occurred synchronously after the phototherapy. Our results suggest that the methylene blue-sensitized photooxidation of bladder cancer cells is carried out by multimedia reactions through which the intracellular proteins (enzymes in mitochondria), RNA (ribosomes) and DNA (chromatin) decrease with loss of cytoplasmic granularity.

Renal Angiosarcoma- A Case Report And Literature Review

PURPOSE In adults renal cell carcinoma (RCC) accounts for over 85% of all diagnosed renal cancers. A much more rare and aggressive malignant tumor of the kidney is angiosarcoma (AS) with less than 25 cases described internationally. Both RCC and AS have similar radiological appearances and thus require histological evaluation for definitive diagnosis. We present a case of renal AS in a 63-year old male who was initially radiologically diagnosed as RCC, and review the current renal AS literature. METHODS The current English literature from 1981 and onwards on renal AS was reviewed and compared to our current case. RESULTS The median age and sex of patients with renal AS at presentation was 63 years old (mean 61 years) and common in males with a left kidney predominance. Symptoms included flank pain, palpable mass, and hematuria with imaging suggestive of RCC. Hematogenous metastatic spread often occurred with median survival time of 3.5 months from time of diagnosis (mean 5.8 months). Histologically, the tumors have classical features of angiosarcoma with numerous blood-filled vascular spaces lined by plump pleomorphic endothelial cells with CD31 and CD34 staining positivity. Overall treatment was radical nephrectomy with radiation therapy for local control and metastases. The use of chemotherapy was not consistent. CONCLUSION Although RCC accounts for the majority of malignant renal tumors, the poor prognosis of AS and its similar radiological appearance to RCC imparts the importance of histological evaluation and the potential radiological mimicry of AS.

Snail-Headed Catheter Retriever: A Simple Way to Remove Catheters from Female Patients

A snail-headed catheter retriever was designed to remove the Double-J* catheter from female patients. The catheter can be removed within a few minutes using topical anesthesia at the outpatient department without endoscopic instrumentation and lithotomy position. No infection or bleeding developed following the procedure and all patients tolerated it well. The cost-effective retriever can be used as a convenient alternative for Double-J catheter removal from female patients.

Antitumor Activity of Doxorubicin-Monoclonal Antibody Conjugate on Human Bladder Cancer

Doxorubicin (adriamycin) was conjugated via the dextran bridge method to a murine IgG3 monoclonal antibody, 1G3.10, directed against human bladder cancer. The drug-antibody conjugate, prepared from using 25% oxidized dextran as the linker, retained essentially the original immunological activity of the antibody using ELISA as tested against an antigen-positive target cell line (TSGH-8301), which has been shown to express an antigen recognized by the monoclonal antibody 1G3.10. Antitumor effect of the conjugate in vitro was evaluated by its inhibition on 3H-uridine incorporation into the established human bladder cancer cells. The conjugate exhibited a significantly higher cytotoxicity on target TSGH-8301 cells than that by a control antibody-doxorubicin conjugate prepared identically from an irrelevant mouse IgG3 monoclonal antibody. No apparently different cytotoxicity was detected on control antigen-negative bladder tumor cells of J82 between these two drug-antibody conjugates. Verapamil, a calcium channel blocker, enhanced the in vitro cytotoxicity of doxorubicin-1G3.10 monoclonal antibody conjugate. Results obtained from in vivo evaluation using xenografted target TSGH-8301 bladder tumor indicated that the 1G3.10 monoclonal antibody conjugate containing doxorubicin injected 4X, i.p., significantly inhibited TSGH-8301 bladder tumor growth in nude mice, whereas free monoclonal antibody, free drug and the mixture of both showed only moderate inhibition of tumor growth as compared to the untreated control. Verapamil also enhanced in vivo antitumor activity of the conjugate. There was no side effect (weight loss) detected on the conjugate-treated mice. Results obtained from in vivo evaluation using xenografted control J82 bladder tumor showed no specific antitumor activity as exhibited by doxorubicin-1G3.10 monoclonal antibody conjugate in comparison with free drug, mixture of drug and antibody without conjugation, or doxorubicin conjugated to the irrelevant antibody. These results suggested that doxorubicin conjugated with bladder tumor associated monoclonal antibody could be useful as a potentially cytotoxic agent in immunochemotherapy of human bladder cancer.

Transitional Cell Carcinoma of the Labia Minor: Evidence of Contact Implantation of Bladder Cancer

A 63-year-old woman underwent transurethral resection of bladder tumors in 1989 and 1991 due to grade 1 to 2, stage pT1 transitional cell carcinoma. Followup outpatient cystourethroscopy and urine cytology every 3 months revealed no disease. In 1993 the patient underwent resection of an anterior urethral tumor on the posterior lip due to mild urethral obstruction and easy contact bleeding. Histology confirmed grade 1 to 2, stage pTa transitional cell carcinoma. Subsequently the patient was closely followed for possible recurrence. In April 1995 during routine cystoscopy 2 tiny nodular lesions on each labia minor were noted in contact with the urethral meatus (fig. 1). Wide excision of the tumors was performed and patholoecal evaluation revealed grade 1, stage pTa transitional cell carcinoma (fig. 2). Convalescence was uneventful and the patient remains disease-free.

Transitional Cell Carcinoma of the Kidney with Extension into the Inferior Vena cava

A case of transitional cell carcinoma of the kidney, invading the inferior vena cava, is presented. Preoperative diagnosis is almost impossible and frozen section is necessary to decide the type of surgery. Radical surgery with removal of thrombi was performed in our patient but was obviously not helpful. The value of aggressive surgery is not clear. This may be the 6th case in the literature.