Hashimura T

Absence of p53 Overexpression and Favorable Response to Cisplatin-based Neoadjuvant Chemotherapy in Urothelial Carcinomas

It has been controversial whether cancer cells harboring loss or inactivation of the tumor suppressor p53 are resistant or sensitive to DNA‐damaging agents including cisplatin and doxorubicin. Overexpression of mdm2 oncoprotein, a negative regulator of p53, is assumed to be an alternative to p53 dysfunction. Archival urothelial carcinoma specimens obtained from 60 patients prior to cisplatin‐based chemotherapy were immunohistochemically studied for overexpression of p53 and mdm2. Thirty‐two patients (group I) were treated with chemotherapy in the neoadjuvant setting, while 28 patients (group II) underwent chemotherapy for distant metastases or inoperable locoregional tumors. In group I, the responsiveness was correlated with staining status of p53 (P=0.0225) and the combination of p53 and mdm2 (P=0.0497). Negative staining of p53 and negative for both p53 and mdm2 could have predicted favorable response to chemotherapy in 16 of 18 (88.9%) and in 12 of 13 (92.3%) tumors, respectively. On the other hand, p53‐positive and p53 and/or mdm2‐positive staining could have predicted poor response only in 7 of 14 (50.0%) and 8 of 19 (42.1%) tumors, respectively. Disease‐specific survival of the p53‐negative group was significantly superior to that of the p53‐positive group (P=0.0086). Difference in survival did not become more significant when overexpression of mdm2 was taken into consideration (P=0.0456). In contrast, in group II, there was no correlation of responsiveness to chemotherapy or survival with p53‐ or p53/mdm2‐staining status. The patients with urothelial carcinomas negative for overexpression of p53 will benefit from neoadjuvant chemotherapy. From clinical viewpoint, however, p53 status alone or the combination of p53 and mdm2 status is not enough to identify those patients who will not benefit from the treatment.

Primary carcinoid tumor arising in a retroperitoneal mature teratoma in an adult.

Abstract  An extremely rare case of a primary carcinoid tumor arising in a mature retroperitoneal teratoma is reported. A 53‐year‐old woman was admitted for further examination of an incidental retroperitoneal mass with calcification. Computed tomography scans demonstrated a tumor with fat, soft tissue and bone densities on the left renal hilum. Surgical excision of the tumor was performed with a preoperative diagnosis of retroperitoneal teratoma. The pathological diagnosis was mature teratoma, including all three germ layers. A carcinoid tumor was evident among teratoid tissues and it was thought to be a teratoma with malignant transformation. The patient did not have a carcinoid syndrome and had an uneventful recovery. She has been followed for 31 months with no recurrence. Carcinoid tumors rarely occur in teratomas of the ovary and the testis and, to our knowledge, this is the first case of carcinoid arising in a retroperitoneal mature teratoma.

Nuclear morphometry for improved prediction of the prognosis of human bladder carcinoma

Background. Histologic grade and clinical stage generally are used for estimating the prognosis of bladder carcinoma. However, both methods have been reported to have a rather low reproducibility and to be unsatisfactory for predicting the recurrence and progression of superficial bladder carcinoma. Recently, nuclear morphometry was used to quantitate the malignant potential of cancer cells in a more objective and reproducible manner. The authors quantitatively analyzed the malignant potential of bladder carcinoma at initial presentation using a combination of several nuclear morphometric variables.

Anti-promoting effect of nordihydroguaiaretic acid on N-butyl-N-(4-hydroxybutyl)nitrosamine and sodium saccharin-induced rat urinary bladder carcinogenesis.

The effects of oral administration of nordihydroguaiaretic acid (NDGA), an antioxidant and inhibitor of arachidonic acid metabolism, on rat bladder carcinogenesis were examined. Six‐week‐old male Fischer 344 rats were given drinking watar containing 0.05% N‐butyl‐N‐(4‐hydroxybutyl)nitrosamine for 4 weeks. Following this 4‐week period, diet containing 5% sodium saccharin (SS) with or without 0.1% NDGA supplement was given to the rats for 36 weeks. The incidences of papillary or nodular (PN) hyperplasia and of papilloma in the group treated with SS plus NDGA were significantly lower than those in the group treated with SS alone. The number of PN hyperplasic foci per 10 cm of basement membrane in rats treated with SS plus NDGA was also lower than that in the group treated with SS alone. These results suggest that NDGA has an anti‐tumor‐promoting effect on rat bladder carcinogenesis.

Chronic expanding hematoma in the psoas muscle

Abstract  We report an unusual case of chronic expanding hematoma in the psoas muscle. A 53‐year‐old man was admitted for evaluation of a mass shadow in the left lower lung field on chest X‐rays. He had also been suffering from dull left back pain. A computed tomography scan showed a cystic lesion with a rim enhancement in the left retroperitoneal space. Mixed signal intensity in a mosaic pattern was seen on a T2‐weighted magnetic resonance image. We could not rule out a suspicion of a neoplastic intratumoral hemorrhage. Due to increased pain and the definite diagnosis, surgery was performed. Histopathological examination confirmed the diagnosis of chronic expanding hematoma. The expansion process is thought to be due to the irritant effects of blood and its breakdown products, which cause repeated exudation and bleeding from capillaries in the granulation tissues.

Neoadjuvant flutamide monotherapy for locally confined prostate cancer

Background: We compared the clinical effects and impact on quality of life (QOL) of patients who received a 3‐month course of flutamide monotherapy before radical prostatectomy with those who received a 3‐month course of luteinizing hormone‐releasing hormone (LHRH) agonist monotherapy.

SPONTANEOUS REGRESSION OF A RENAL ARTERIOVENOUS MALFORMATION

A renal arteriovenous fistula is an anomalous connection between the arterial and venous systems. An acquired type of arteriovenous malformation, especially after percutaneous renal biopsy, often resolves within a few months. However, most symptomatic congenital arteriovenous malformations require surgical or interventional therapy and their natural history remains unknown. We report a case of spontaneous regression of a congenital type of arteriovenous malformation.

Effects of Retinoids and Inhibitors of Arachidonic Acid Metabolism on Tumor‐promoter‐induced Soft Agar Colony Formation of Mouse Epidermal Cells and Rat Urinary Bladder Cells

Effects of retinoids and inhibitors of arachidonic acid metabolism on tumor‐promoter‐induced soft agar colony formation of mouse epidermal cells and rat bladder cells were evaluated. Topical application of retinoic acid, an anti‐tumor‐promoter, to female SENCAR mouse skin inhibited 12‐O‐tetradecanoylphorbol‐13‐acetate‐induced soft agar colony formation of mouse epidermal cells, an event proposed to be essential for tumor promotion. Effects of dietary retinyl acetate, nordihydroguaiaretic acid (NDGA) and quinacrine hydrochloride on colony formation of rat bladder cells were then examined. Male Fischer 344 rats were given 0.05% N‐butyl‐N‐(4‐hydroxybutyl)nitrosamine for 3 weeks, followed immediately by the administration for 9 weeks of 5% sodium saccharin supplemented with or without 0.05% retinyl acetate, 0.1% NDGA or 0.01% quinacrine hydrochloride. Saccharin‐induced colony growth was significantly inhibited by the administration of retinyl acetate or NDGA, suggesting that these two agents have anti‐tumor‐promoting effects on rat bladder carcinogenesis. Thus, the colony‐forming assay might be useful for early detection of anti‐tumor‐promoters of skin and bladder.

Continent Urinary Reservoir Using Sigmoid Colon and Appendix After Pelvic Exenteration for Bulky Leiomyosarcoma: A Case Report

We report on a man with bulky leiomyosarcoma occupying the entire pelvic cavity that was treated by pelvic exenteration. A urinary reservoir was constructed using a detubularized segment of sigmoid colon. The appendix was tunneled into the taenia to form a continent catheterizable stoma using the Mitrofanoff principle. Descending colostomy was also created. There is no evidence of recurrence 24 months after treatment and the patient has returned to full physical activity. Continence is complete with a capacity of up to 500 ml. and regular bowel movements. Because of the lack of intestinal anastomosis, this procedure may be recommended as an option for urinary diversion after pelvic exenteration.

[Combination therapy of daily intramuscular injection of interferon-alpha and oral administration of fluorouracil for advanced renal cell carcinoma].

BACKGROUND To achieve optimum drug delivery of Interferon-alpha in treatment of renal cell carcinoma, a regimen consisting of its daily intramuscular administration, in combination with oral fluorouracil, was designed and carried out. Its efficacy is examined retrospectively. METHODS In our department 7 patients with disseminated renal cell carcinoma were treated with daily intramuscular injection of interferon-alpha (3 x 10(6) IU) and daily oral administration of fluorouracil. All patient was nehprectomized before initiation of the regimen. RESULTS Two patients achieved complete, and three patients achieved partial response radiographically (Overall response rate 71%). Metastatic sites of responders were lung (4) and pleura (2). The time required until response was 3.9 (median 5.4) months. In two responders, new lesions appeared in other organs despite durable response in initial pulmonary metastatic sites. There were two no-responders, one patient is alive with stable disease and the other patient died for progression of the disease. In all, two patients died of disease, one died for other cause, one surviving without evidence of disease, and three are surviving with disease. No significant side effect was noted in these seven patients. CONCLUSIONS This regimen can be carried out on outpatient basis and considerable response can be expected for pulmonary and pleural lesions.