Hideo Morishita

Immunohistochemical Detection of Intercellular Adhesion Molecule-1 (ICAM-1) and Major Histocompatibility Complex Class I Antigens in Seminoma

Expression of intercellular adhesion molecule-1 (ICAM-1) and major histocompatibility complex (MHC) antigens, and characterization of tumor-infiltrating mononuclear cells (TIM) were examined immunohistologically in 10 specimens of seminoma. ICAM-1 and MHC antigens were not detected on normal spermatogenic cells. ICAM-1 and MHC class I antigens were variably expressed in 7 and 9 seminomas, respectively, whereas class II antigens were not detected. Although the degree of expression of ICAM-1 and MHC antigens was not correlated with any clinical or histopathological factors, neither of the antigens was detected on an anaplastic seminoma. Various numbers of TIM were detected in all of the seminoma, and comprised mainly T cells bearing the lymphocyte function-associated antigen (LFA)-1. No significant correlation was noticed between the degree of lymphocyte infiltration and ICAM-1 or MHC antigen expression. Although ICAM-1 and MHC class I antigens were expressed in seminoma, possibly facilitating an anti-tumor reaction of host, their expression remained low in several cases, despite marked lymphocyte infiltration within the tumor.

Use of the harmonic scalpel for nephron sparing surgery in renal cell carcinoma

PURPOSE The harmonic scalpel is a new tool for excising and coagulating tissue with ultrasound using higher frequencies than an ultrasonic aspirator. We evaluated the usefulness of the harmonic scalpel in nephron sparing surgery. MATERIALS AND METHODS We used the harmonic scalpel to incise the renal parenchyma during nephron sparing surgery in 10 patients with renal cell carcinoma. RESULTS Bleeding from the renal parenchyma was minimal but hemostasis of the larger vessels was not obtained even when the harmonic scalpel was used at maximal coagulation power. The cut surface of the kidneys, especially the vessels, were more clearly recognized than if an ultrasonic aspirator had been used, enabling hemostasis by figure-of-8 suture. CONCLUSIONS The harmonic scalpel is useful for obtaining a clear parenchymal stump and hemostasis during nephron sparing surgery, although complete hemostasis of the arcuate or larger vessels cannot be achieved.

Giant cell tumor of the kidney

A multinucleated giant cell tumor developed in the left renal pelvis of a 60-year-old man. The tumor was morphologically indistinguishable from giant cell tumor of bone and considered to be both primary and benign, with a follow-up period of one year and no evidence of either recurrence or metastasis.

Presence of mucosal change in the urinary bladder in nonhematuric patients with long-term exposure and/or accumulating high-dose cyclophosphamide. Possible significance of follow-up cystoscopy on preventing development of cyclophosphamide-induced hemorrhagic cystitis.

Objective: Cyclophosphamide (CPA)-induced hemorrhagic cystitis is sometimes difficult to manage. We investigated the mucosal changes in patients subjected to CPA therapy in relation to the duration and accumulating dose of CPA. Methods: Fifteen patients, all of whom were receiving CPA, were studied. Investigation of the dose and duration of CPA administration, urinalysis and cystoscopy was performed. Results: The total doses of CPA administered ranged from 2.5 to 237.0 g, and the duration of administration ranged from 4 to 130 months. Four patients with hematuria (micro or macro) showed various degrees of mucosal hyperemia and telangiectasia. Of 11 patients without microhematuria, 6 patients also revealed mucosal changes distinctive of CPA-induced hemorrhagic cystitis. CPA-induced cystitis with no hematuria insidiously progressed in the patients who received CPA orally at a total dose of more than 40 g and/or for longer than 36 months. Conclusion: Early mucosal lesion of the urinary bladder, which will most likely be followed by CPA-induced hemorrhagic cystitis, may develop prior to the appearance of microscopic hematuria. Periodic prophylactic cystoscopy is recommend in patients receiving CPA.

Successful treatment of idiopathic retroperitoneal fibrosis with steroid administration in a patient with a positive gallium scan

A patient with idiopathic retroperitoneal fibrosis with a positive Ga-67 scan was successfully treated with steroids. Administration of methylprednisolone improved the ureteral obstruction and gallium accumulation also disappeared.

Primary gastrointestinal stromal tumor in the retroperitoneum

Abstract  Gastrointestinal stromal tumor (GIST) is the most frequent non‐epithelial neoplasm in the gastrointestinal tract. GIST has received much attention both for its clinical significance and biological nature, while the retroperitoneal condition identical to GIST has been rarely described. Presented herein is a case of GIST arising from the retroperitoneum in a 67‐year‐old man. The solid tumor measuring 4 cm was uncovered in the retroperitoneum, between the abdominal aorta and inferior vena cava, on computed tomography. The patient underwent surgical excision of the tumor. Histological examination showed proliferating spindle cells in the clearly demarcated tumor; immunoreactivity for Kit and CD34 in tumor cells confirmed the diagnosis of GIST. The histological origin of GIST is suggested to be gastrointestinal pacemaker cells, because they share specific immunoreactivity for CD117/Kit, which is also relevant to pathogenesis of GIST. The present case was a rare primary GIST in the retroperitoneum with typical immunopathological features.

Electrical resistance of appliances as a cause of urethral stricture following transurethral resection of prostate.

We performed transurethral resection for prostatic hypertrophy on 128 patients, and encountered 6 causes of postoperative urethral stricture. As they occurred during a short period, we investigated the causes. An electrical check revealed electrical resistance of more than 10,000 omega in the electric cord of a resectoscope. When an unused loop was connected with three used cords (No. 1, 2 and 3) and a new cord, the resistances were 2,000, 5,000, 0.9 and 0.5 omega, respectively. Moreover, the respective resistances were 15,000, 1,150,000, 1.3 and 0.9 omega when a used loop was tested. These findings suggested that the excessive resistance resulted from the use of a worn cord and that the used loop caused the postoperative urethral stricture.