Hiroji Ohoka

CA125-PRODUCING ADENOCARCINOMA OF THE SEMINAL VESICLE

A case of primary seminal vesicle carcinoma is reported. The tumor was a CA125‐producing adenocarcinoma consisting of fine papillary‐tubular, intricate branching or anastomosing glandular structures and was composed of small cuboidal, but occasionally hobnailed, cells with mostly clear, but occasionally granular, cytoplasm. Some tumor cells showed evidence of secretion of seromucinous materials into the interpapillary and cystic space. lmmunohistochemically, almost half of the tumor cells expressed a positive reaction with anti‐CAl25, a common serological marker for ovarian epithelial carcinomas; however, no tumor cells expressed any other serological tumor markers such as carcinoem‐bryonic antigen, α‐fetoprotein, human chorionic gonadotropin, prostatic specific acid phosphatase, or prostatic specific antigen. The patient showed a high level of serological CA125, which fluctuated parallel with the growth, removal and recurrence of the tumor. The morphological and immunohistochemical findings suggested a close relationship between the present tumor and clear cell carcinoma of the ovary, which is thought to be of a Müllerian‐Wolfian duct origin.

Mycotic aneurysm of the renal transplant artery.

Abstract  A case of mycotic aneurysm secondary to septicemia is reported. A 59‐year‐old man with end‐stage renal failure underwent renal transplantation from a living donor. On the fifteenth postoperative day, he was febrile and his arm around an entry wound of the drip infusion had infectious signs. Cultures of the blood and pus discharge grew Methicillin‐resistant Staphylococcus aureus. Vancomycin was administered intravenously for 30 days. Then the existence of a mycotic aneurysm on the transplant artery was not suspected by computed tomography. After his infectious signs disappeared, examinations revealed a pseudoaneurysm measuring 4 cm in diameter at the site of anastomosis between the renal transplant and external iliac arteries by computed tomography. He has been carefully followed up with a conservative management. This is the first case of a mycotic aneurysm treated conservatively and displaying an uneventful course without rupture.

Extramedullary plasmacytoma arising from an adrenal gland

Extramedullary plasmacytoma is a rare malignant neoplasm typically arising outside the bone marrow of patients who show no clinical evidence of multiple myeloma. We report a rare case of extramedullary plasmacytoma that was primarily found in a right adrenal lesion. Surgical excision and radiotherapy were performed for treatment of the primary lesion. Although laboratory examinations demonstrated the presence of M-protein and elevation of monoclonal IgG-lambda, a surgically excised mass revealed monoclonality of IgG-kappa. We therefore diagnosed extramedullary plasmacytoma independent of simultaneous benign M proteinemia, because the types of M-protein were quite different. One year after radiotherapy, no local recurrence was observed.

Cavernous hemangioma of the urinary bladder in an 8-year-old child.

An 8‐year‐old boy was admitted to Ehime University Hospital, Ehime, Japan, for the further investigation of a 5‐month episode of gross hematuria accompanied by lower abdominal pain. Magnetic resonance imaging revealed a solid tumor measuring 3 cm in diameter of the bladder wall. Cystoscopy demonstrated a red, wide‐based, nodular tumor situated on the dome of the bladder. Histological examination of tissue taken at hot biopsy showed fibrolipoma. In consideration of potential malignancy, a partial cystectomy was carried out after informed consent was given. Histological examination of the resected specimen showed it to be cavernous hemangioma.

Thomsen-Friedenreich antigen in bladder tumors as detected by specific antibody: A possible marker of recurrence

SummaryTUR specimens of non-invasive transitional-cell carcinomas were examined for their expression of Thomsen-Friedenreich (T) antigen by indirect immunofluorescence staining using rabbit IgG antibody which was raised with desialated glycophorin. Nine (45%) out of 20 tumors of low grade (Grade I and II), and 5 (56%) of 9 tumors of high grade (III) were diffusely stained with anti-T (T-positive), whereas T-antigen in normal tissue was cryptic and stained only after neuraminidase treatment (cryptic T-positive). Of the T-negative tumors, 9 (45%) of the low grade but only one of the high grade tumors, were stained positively for the cryptic T-antigen. The rest of the tumors were devoid of the cryptic T-antigen. Eighty percent of both Tumors expressing T-antigen and those lacking the cryptic T-antigen recurred within two years. Recurrence was not influenced by initial histological grade.

Histopathology of a human allografted kidney with clinically sufficient function

To clarify the clinico‐pathological significance of protocol biopsy and clinically silent rejection in the management of renal graft recipients, we selected a total of 139 (23%) from 604 biopsy specimens according to the following criteria: 1) less than 1.4 mg/dL of serum creatinine and 2) more than 1 500 mL/d of urine volume at time of biopsy. Clinical indications for the biopsy were classified into five categories: i) protocol biopsy (73 specimens), including 69 cases at discharge post‐transplantation; ii) slight increase in serum creatinine (32); iii) proteinuria (20); iv) evaluation of pulse‐therapy (13); and v) fever elevation (1). Except for the last category, the specimens were histopathologically diagnosed as being normal in 50 (68%), 6 (17%), 1 (5%), and 5 (38%) specimens, respectively. Even borderline changes, and mild acute rejection, as well as drug‐induced nephropathy were included, implying the existence of clinically silent rejection or drug‐induced nephropathy. Obvious diversity in the histopathological diagnosis was noted in category iii) showing proteinuria, which was mainly caused by chronic rejection, drug‐induced nephropathy and glomerulonephritis. The graft survival rate was no different among the four categories, except for category v). These results indicate that biopsies obtained from functionally sufficient renal grafts could provide useful information in the management of the recipients. The clinical significance of protocol biopsy awaits further clarification by the analysis of a large number of cases.

Flow cytometric evaluation of Thomsen-Friedenreich antigen on transitional cell cancer using monoclonal antibody

SummaryIn 31 transitional cell cancer (TCC) tissues and 5 normal bladder muscosae (NBM), we compared the results of flow cytometry (FCM) and immunohistochemical examination in evaluating the expression of Thomsen-Friedenreich antigen (T-Ag) using a monoclonal antibody. On immunohistochemical examination, 14 (45%) cancer tissues showed T-Ag, while 7 (23%) cancer tissues and all NBM showed only cryptic T-Ag, which was detected only after neurminidase treatment. Ten (32%) high grade cancer tissues showed neither T-Ag nor cryptic T-Ag. On FCM the T-Ag positive cells (TPC) and the T-Ag positive cells after neuraminidase treatment (nTPC) were counted in fresh cell suspensions. FCM was more sensitive than immunohistochemical study in detecting T-Ag. Additionally, FCM revealed that some tumors had both T-Ag and cryptic T-Ag at the same time. The ratio of nTPC to TPC was well correlated with the stage or grade of the tumor and may be a more reliable marker of TCC than the expression of T-Ag assessed by immunohistochemical techniques.

ADRENAL MEDULLARY HYPERPLASIA : HYPERPLASIA-PHEOCHROMOCYTOMA SEQUENCE

We present a case of unilateral adrenal medullary hyperplasia in a 63‐year‐old woman with‐clinical signs and symptoms of pheochromocytoma unassociated with multiple endocrine neoplasia. The surgically removed adrenal gland revealed diffuse medullary hyperplasia with multiple micronodules measuring up to 2 mm. The micronodules were composed of enlarged chromaffin cells with atypia, histologically similar to those of pheochromocytoma, forming small solid alveolar patterns separated by a fibrovascular stroma. Removal of the hyperplastic adrenal gland resulted in disappearance of paroxysmal nocturnal hypertension and palpitation. These results suggest that diffuse and nodular medullary hyperplasia is the precursor of pheochromocytoma.

TT virus infection among renal transplant recipients

To clarify the prevalence of TT virus (TTV) infection in renal transplant recipients and to estimate the role of TTV in patients with post-transplant liver function abnormalities, TTV-DNA of 47 renal transplant recipients was screened by polymerase chain reaction (PCR) according to a method described by Okamoto et al. before and after the renal transplantation. One of them was positive for hepatitis B surface antigen (HBsAg), one was positive for anti-hepatitis C virus (HCV) and other 45 were negative for both HBsAg and anti-HCV. TTV-DNA was detected in 22 of 47 patients before renal transplantation, and nine became positive after transplantation. All 47 patients showed a normal level of ALT before transplantation. Three of nine (33%) who became positive for TTV-DNA after transplantation and three of 16 (19%) who were negative for TTV-DNA before and after transplantation showed transient elevation of ALT. These results indicate that TTV was highly prevalent among renal transplant recipients, but a clear association between TTV and post-transplant liver function abnormality was not found.

Histological study of urinary bladder transplantation in rats.

Patients who require cystectomy are usually treated with an ileal conduit or intestinal neobladder for urinary control. In some of them, however, the bowel segment cannot be used because of previous abdominal surgery or radiation treatment. Bladder transplantation from cadavers may be beneficial to these patients, if possible. To obtain basic knowledge about bladder transplantation, we developed an animal model of whole bladder transplantation in rats. Male Lewis rats weighing 270-320 g were used as both donors and recipients. Of the 23 recipients, 12 (52.2%) survived 7 days or longer after surgery. At 1 week after transplantation, the bladder showed loss of transitional epithelium and remarkable cellular infiltration. In the bladder at 5 weeks after transplantation, the transitional epithelium regenerated markedly and submucosal cellular infiltration was much improved. Regeneration of some smooth muscle cells was also noted. At 6 months after transplantation, the nerve fibers were recognized in the bladder and the volume of the transplanted bladder was well preserved (1.0-1.3 ml). This article describes an animal model of whole bladder transplantation in the rat which we produced and the results of our study. Because a large number of pure-bred animals can easily be used, we believe our rat model is very useful for basic studies of bladder transplantation.