Hideo Otsuki

Bilateral adrenal leiomyosarcoma treated with multiple local therapies

A 62-year-old woman presented with right flank pain, and computed tomography (CT) showed bilateral adrenal tumors (right, 8 cm; left, 4 cm). There were no abnormal findings on physical examination, and adrenal hormone levels in serum and urine were within normal limits. Radiological studies showed a right adrenal tumor with intratumoral hemorrhage, a cystic tumor in the left adrenal gland, and no sign of distant metastasis. Because laboratory tests showed normal levels of adrenal hormones, we considered the tumors to be nonfunctioning adrenal tumors. The right adrenal tumor was surgically removed because it was thought to be malignant, and histological examination revealed that it was a leiomyosarcoma. Postoperative CT showed a pleural metastasis in the right chest wall. The patient received combination chemotherapy with cyclophosphamide, vincristine, adriamycin, and dacarbazine. The metastasis was also treated with radiofrequency ablation (RFA). Because the left adrenal tumor grew rapidly despite two courses of the chemotherapy, it too was surgically removed. After the operation, metastasis in the right iliac bone was treated with RFA and radiotherapy. Positron emission tomography detected bilateral femoral metastases, and these were treated with radiotherapy in combination with a low dose of cisplatin. A liver metastasis and a small metastasis in the left kidney were treated with RFA and a metastasis in the pancreatic tail was removed surgically. Sixteen months after the right adrenalectomy, the patient died due to systemic spread of the disease. Multiple local treatments including RFA, radiotherapy, and resection were effective for the local control of metastatic lesions of adrenal leiomyosarcoma.

Prostate Cancer Cells in Different Androgen Receptor Status Employ Different Leucine Transporters

Leucine stimulates cancer cell proliferation through the mTOR pathway, therefore, inhibiting leucine transporters may be a novel therapeutic target for cancer. L‐type amino acid transporter (LAT) 1, a Na+‐independent amino acid transporter, is highly expressed in many tumor cells. However, leucine transporter(s) in different stages of prostate cancer, particularly in the stages of castration resistance with androgen receptor (AR) expression, is unclear.

Transurethral Resection in Saline Vaporization: Evaluation of Clinical Efficacy and Prostate Volume

OBJECTIVE To assess the efficacy and safety of transurethral resection in saline vaporization for symptomatic bladder outlet obstruction and the change in prostate volume. METHODS A total of 106 patients with symptomatic bladder outlet obstruction underwent transurethral resection in saline vaporization. The effectiveness of the treatment was evaluated using the International Prostate Symptom Score (IPSS), quality of life score, urinary peak flow, and prostate volume preoperatively and at 1, 3, 6, and 12 months postoperatively. To assess the treatment effect, the patients were divided into 3 groups according to the preoperative prostate volume: group 1 (<45 cm(3), n = 40), group 2 (≥ 45 but <65 cm(3), n = 34), and group 3 (≥ 65 cm(3), n = 32). RESULTS The mean perioperative hemoglobin loss was 1.2 g/dL. The mean IPSS, quality of life score, and prostate volume decreased significantly from 24.3, 5.2, and 52.8 cm(3) to 11.1, 2.7, and 29.9 cm(3), respectively (P < .01) and the mean urinary peak flow had increased significantly from 7.3 to 15.1 (P < .01) at 1 month. Moreover, the IPSS, quality of life score, and prostate volume had significantly decreased to 8.8, 2.3, and 26.1 cm(3) at 3 months (P < .05). The investigation of groups classified by prostate size demonstrated that the IPSS in group 3 continued at a significantly lower level than that in groups 1 and 2. The prostate volume decreased gradually and resulted in 52.8% volume reduction for ≤ 12 months. No significant complications were seen; however, irritative symptoms occurred frequently (11.3%). CONCLUSION Transurethral resection in saline vaporization was a safe and effective treatment option and was more efficacious for patients with a larger prostate. The bother scores and prostate volume gradually decreased for ≤ 12 months.

Malignant lymphoma of mucosa-associated lymphoid tissue involving the renal pelvis and the entire ureter: A case report

Mucosa-associated lymphoid tissue (MALT) lymphoma occurs in various sites, but rarely in the urinary tract. Imaging studies of a 69-year-old male revealed a left hydronephrosis and diffuse thickening of the renal pelvic and upper ureteral wall. Retrograde pyelography revealed a narrowing in this region, and brush cytology specimens contained atypical cells. As the lesion was considered to be malignant, surgical excision was performed. Histological analysis revealed an intense lymphoid infiltrate mainly consisting of B cells. The immunohistochemistry results demonstrated that the lesion was positive for CD20 and CD79a and negative for CD5 and cyclin D1. These findings led to a diagnosis of MALT lymphoma. Pathological exploration disclosed a focally dense invasion of lymphoma cells into not only the renal pelvis, but the whole ureteral wall and surrounding tissue; therefore, the patient underwent eight courses of rituximab treatment. Diffuse invasion of lymphoma cells into the whole ureter was rarely observed. Since the surgery, the patient has survived for 78 months without evidence of a recurrence of lymphoma.

Sufficient Volume Ablation with Photoselective Vaporization of the Prostate Delivers 5-Year Durability and Improves Symptom Relief for Larger Prostates

OBJECTIVES To assess the long-term durability of photoselective vaporization of the prostate (PVP) for symptomatic benign prostatic enlargement (BPE) or benign prostatic obstruction (BPO) and treatment efficacy for large BPE. METHODS Four hundred fifty-seven patients with symptomatic BPE underwent PVP between January 2006 and April 2009. Efficacy was evaluated with the International Prostate Symptoms Score (IPSS), Quality of Life (QOL) score, urinary peak flow (Qmax), postvoid residual volume (PVR), and prostate volume. Parameters were checked preoperatively, and at 1, 3, and 5 years postoperatively. One hundred fifty-three patients completed 5-year follow-up. To assess treatment effects, patients were divided into two groups according to the preoperative prostate volume: group A (<60 mL, n=104) and group B (>60 mL, n=49). RESULTS Mean IPSS, QOL score, Qmax, and PVR improved significantly and were maintained for 5 years with no significant differences; at year 1, prostate volume had decreased significantly from 54.0 mL to 30.6 mL (43% of volume ablation) and remained at that level until year 5. Investigations according to prostate size demonstrate that IPSS and QOL scores in group B remained at significantly lower levels, and Qmax in group B improved more than in group A. 1.1% of patients needed transurethral resection of the prostate due to BPO recurrence. CONCLUSIONS PVP is effective and provides durable results for 5 years, with sustained symptom relief and improved urinary flow rate, as well as a 43% volume reduction of prostate volume. Our data indicate PVP is more efficacious for larger prostates under sufficient volume ablation.

Photoselective vaporization of the prostate: pursuing good indications based on the results of 400 Japanese patients

Study Type – Therapy (individual cohort)

A case report of retroaortic left renal vein with tumor thrombus of renal cell carcinoma

A 75-year-old woman was referred to our department for evaluation of a left renal tumor. Computed tomography and other imaging studies demonstrated a left renal mass and tumor extension into the left renal vein passing caudally behind the aorta. We clinically diagnosed the tumor as renal cell carcinoma (RCC) associated with a retroaortic left renal vein thrombus, and performed a radical nephrectomy. Pathological examination of the surgical specimen showed a grade 2, clear cell carcinoma with a renal vein thrombus and negative surgical margin. Retroaortic left renal vein is a rare anomaly with a prevalence of 1.8–2.4%. RCC associated with a retroaortic left renal vein thrombus is rarer still. To our knowledge, this is only the third case report to describe an RCC associated with a tumor thrombus in the retroaortic left renal vein.

MP83-11 Y+LAT2 (SLC7A6) EXPRESSION IN CASTRATION RESISTANT PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: Leucine stimulates cancer cell proliferation through the mTOR pathway, therefore, inhibiting leucine transporters can be a novel therapeutic strategy. One of leucine transporters, L-type amino acid transporter (LAT) 1 (SLC7A5), a Na-independent amino acid transporter, has been reported to be selectively expressed in many cancer cells. Recently it has been shown that primary prostate cancer expresses LAT3 (SLC43A1), while castration resistant or highly aggressive prostate cancer expresses LAT1 as a main leucine transporter. In this study, we examine leucine transporters during acquisition of hormone independence. METHODS: A new 00LN-abl00 cell line was established after culturing LNCaP cells for 6 months under androgen-free conditions, which is a model of castration resistant prostate cancer (CRPC) with androgen receptor expression. Uptake of C leucine was examined in the presence or absence of LAT inhibitors or Na. Expression of a major leucine transporter was inhibited by siRNA in LN-abl cells. In silico analysis of leucine transporter expression was examined using Oncomine for different progression status of prostate cancers in clinical data sets. RESULTS: Cell viability was decreased to 10% in the absence of leucine. LNCaP cells principally expressed LAT3, and their leucine uptake was more than 90% Na-independent. In LN-abl cells, Nadependent uptake of leucine was 3.8 pmol/mgprotein/min, while, Naindependent uptake was only 0.52, therefore, leucine uptake of LN-abl was largely (~85%) Na-dependent. yLAT2 (SLC7A6) expression was confirmed in LN-abl, however, expression of LAT1, LAT3, yLAT1 (SLC7A7), ATB0 (SLC6A14), B0AT1 (SLC6A19), B0AT2 (SLC6A15) or b0AT (SLC7A9) were not observed. Knockdown of yLAT2 lead to significant leucine uptake inhibition (40%) and cell growth inhibition (20%) in LN-abl cells. In silico analysis revealed that more frequent upregulation of SLC7A6 (yLAT2) was observed in hormone resistant or metastatic samples in 2 data sets. In addition, some advanced prostate cancer appeared to express high levels of LAT3, suggesting heterogeneity in leucine transporter expression among different prostate cancers. CONCLUSIONS: New CRPC cell line with increased expression of yLAT2 was established in vitro. This is consistent with the fact that at least some advanced stage prostate cancers express yLAT2 in Oncomine data. Considering the diversity of leucine transporter expression, target of anti-leucine transporter therapy should be individualized.

PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE FOR THE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA: INITIAL EXPERIENCE IN 250 JAPANESE PATIENTS

RESULTS: : In all 250 patients, PVP was performed successfully. Mean operation time was 70 minutes (range 17 to 218). No major complication occurred intraoperatively and no blood transfusions were necessary. Immediate postoperative serum sodium values were normal. At 1, 3 and 6 months after surgery mean IPSS decreased from 20.9 preoperatively to 9.6, 8.9 and 8.3, the mean QOL score improved from 5.2 to 2.4, 2.2 and 2.0, the mean Qmax (ml/s) increased from 8.4 to 16.9, 16.4 and 16.8, and the mean Vres (ml) decreased from 137 to 31, 24.5 and 31.4, respectively. Mean PSA value (ng/ml) decreased