Hideaki Sekine

Dendritic Cell-Based Immunotherapy of Renal Cell Carcinoma

Dendritic cells potently stimulate antigen-specific immune responses and recent data indicate that they are also capable of eliciting antitumor immune responses. We are performing a pilot study which tests the safety and efficacy of antigen-loaded, cultured blood dendritic cells in patients with metastatic renal cell carcinoma. Dendritic cells are simultaneously pulsed with lysate from autologous tumor cells and with the immunogenic protein keyhole limpet hemocyanin. During the pulse, the cells are activated with a combination of tumor necrosis factor-alpha and prostaglandin E2. Patients receive 5-10 X 10(6) dendritic cells per intravenous infusion and up to six infusions at monthly intervals. The first results demonstrate that this treatment modality is very well tolerated and can be associated with strong immunological and clinical responses. The present article discusses the importance of dendritic cell maturation and the role of helper antigens in dendritic cell-based immunotherapy.

Outpatient basis extracorporeal shock wave lithotripsy for ureter stones: Efficacy of the third generation lithotripter as the first line treatment

Aim:  We assessed the efficacy of a third generation extracorporeal shock wave lithotripsy (ESWL) machine for ureter stones using the Dornier Lithotriptor Compact Delta.

Solitary fibrous tumor of the prostate.

Abstract An extremely rare case of solitary fibrous tumor of the prostate is presented. The patient underwent a radical retropubic prostatectomy and has remained well with no evidence of recurrence during the last 18 months. This is the fifth reported case of such a lesion arising in the prostate.

Equivalent efficacy of mitomycin C plus doxorubicin instillation to bacillus Calmette-Guerin therapy for carcinoma in situ of the bladder

Abstract Background: To elucidate the most efficient topical therapy for carcinoma in situ of the bladder, the efficacy of intravesical mitomycin C plus doxorubicin therapy was compared with bacillus Calmette‐Guerin (BCG) therapy. The clinical behavior of the tumor was analysed according to the histological grade.

Extragonadal germ cell tumor followed by metachronous testicular tumor : A case report

We here present a patient with an extragonadal germ cell tumor followed by a metachronous testicular tumor 7 years later. The histological findings of the extragonadal tumor and the subsequent testicular tumor were quite different; the former was of a mixed type with teratoma, embryonal carcinoma and yolk sac tumor, and the latter a pure seminoma. Such a long clinical time lag as 7 years and the histological differences between the two tumors suggest that they occurred independently. To our knowledge, this may be the first case report in the literature, in which a testicular tumor occurred metachronously after extragonadal tumor extirpation.

DERMATOMYOSITIS ASSOCIATED WITH URACHAL ADENOCARCINOMA

Dermatomyositis affects children and adults, females more often than males, and is traditionally closely associated with internal malignancy. Approximately 30% of patients with dermatomyositis have a malignancy, most commonly of the lung, ovary, breast or stomach.1 Urogenital malignancies associated with dermatomyositis are relatively rare although several cases associated with transitional cell carcinoma of the bladder have been documented.2 To our knowledge we report the first case of dermatomyositis associated with urachal adenocarcinoma. CASE REPORT A 47-year-old female presented with a 4-month history of gross hematuria and edema of the upper body. The patient also reported a 10 kg. weight loss. Physical examination revealed erythema affecting the face, shoulders, chest and back. The face was especially swollen with edema and erythema. Cystoscopy and computerized tomography (CT) demonstrated a solid mass in the dome of the bladder (fig. 1). Biopsy of the skin and deltoid muscle showed epidermal atrophy with a thickened basement membrane, and perivascular and interstitial inflammatory infiltrates. The muscle revealed myofiber degeneration and atrophy, increased interstitial collagen and endomysial inflammatory infiltrates (fig. 2, A). These findings were consistent with dermatomyositis. Laboratory tests demonstrated increased creatine phosphokinase (937 units per l., normal 35 to 165), increased lactic dehydrogenase (1,027 units per l., normal 203 to 450) and increased carcinoembryogenic antigen (46.3 ng./ml., normal less than 5.0). Transurethral resection of the bladder tumor showed moderately differentiated adenocarcinoma invading the bladder wall (fig. 2, B). Consequently, the clinical diagnosis was dermatomyositis associated with urachal adenocarcinoma. For the treatment of dermatomyositis 1 mg./kg. prednisolone per day was administered, and an immediate effect was observed with regard to the skin and muscle symptoms. Total cystectomy was not recommended because of a lung metastasis detected on CT, and the patient instead underwent pelvic irradiation (total 50 Gy.) and 2 courses of systemic chemotherapy with methotrexate, vinblastine, doxorubicin and cisplatin. The response to these therapies was minimal. One year after diagnosis, the patient died of multiple metastases to the liver and lung. However, the characteristic symptoms of dermatomyositis were well controlled by prednisolone until the end of her life.

Brain Metastasis as a Sole Recurrence of Prostate Cancer after Total Prostatectomy

Brain metastasis from prostate cancer is a rare clinical event. We present a case of prostate cancer with a solitary brain metastasis as a sole site of recurrence after total prostatectomy. To our knowledge, this is the third reported case of an isolated brain metastasis from prostate cancer.

Eight case reports on sex‐hormone profiles in sexually mature male Down syndrome

Down syndrome (DS) is a congenital disorder usually caused by an extra copy of chromosome 21. Although the number of postpubertal patients with DS is increasing, only limited information is available on their gonadal and sexual development. The aim of this case report was to examine sex‐hormone profiles in sexually mature male patients with DS. Eight postpubertal male patients with trisomy 21 (mean age 28 years, range 15–54 years) participated in this study. The serum level of luteinizing hormone and follicle‐stimulating hormone was significantly elevated and testosterone was slightly decreased. The testicular volume was smaller in all eight cases than that observed in healthy male subjects. The elevated luteinizing hormone and follicle‐stimulating hormone levels, the lower testosterone levels and a smaller testicular volume observed in all eight cases suggest a significant degree of germinal cell hypoplasia in mature male patients with DS.

Burch bladder neck suspension for cystocele repair: The necessity of combined vaginal procedures for severe cases

Background: Burch operation is an accepted form of bladder neck suspension for small cystoceles. The purpose of the present study was to evaluate the efficacy of Burch repair for severe cystoceles compared with Burch repair along with vaginal procedures.

Eosinophilic cystitis masquerading as invasive bladder cancer.

We report the case of a 33-year-old woman with eosinophilic cystitis, which masqueraded as invasive bladder cancer. The patient remained well with no recurrence or progression after vigorous transurethral resection of the lesion.