Ikuo Shinoda

Malakoplakia of urinary bladder following cadaveric renal transplantation.

Malakoplakia of the urinary bladder following cadaveric renal transplantation in a twenty-two-year-old woman is reported. Urinary tract infection with Escherichia coli persisted postoperatively. Three years later, gross hematuria and fever occurred. Yellow-tan mucosal plaques or nodules were observed cystoscopically, and histologic examination revealed malakoplakia of the urinary bladder with characteristic foamy histiocytes containing Michaelis-Gutmann bodies.

Nucleolar Organizer Regions in Prostate Cancer

A silver colloid technique for the staining of nucleolar organizer regions (NORs) was applied to paraffin sections of 52 clinical prostate cancers, 5 incidental carcinomas of the prostate, 12 benign prostatic hypertrophy (BPH) specimens and 7 normal prostates. The mean numbers of silver-stained NORs (AgNORs) in these lesions were 3.12 +/- 0.52 in clinical cancer, 2.65 +/- 0.64 in incidental cancer, 1.66 +/- 0.16 in BPH, and 1.76 +/- 0.22 in normal prostate. There was a statistically significant difference in agNORs numbers between cancer and benign prostatic tissues (p < 0.001). However, no significant difference was observed in AgNORs numbers between incidental and clinical carcinoma of the prostate. In clinical cancer, only poorly differentiated adenocarcinoma showed a statistically larger number of AgNORs than the well or moderately differentiated group (p < 0.02). Correlation between AgNORs numbers and clinical stage was not obvious. There was no relationship between the number of AgNORs and serum values of tumor markers such as PAP, PSA and gamma-Sm. Moreover, the AgNORs numbers did not show a relation to decreasing rates of serum marker levels during successful anti-androgen therapy. If the patients with prostate cancer were divided into two groups by 2.9 of AgNORs number, the group with the smaller number of AgNORs (n = 14) was found to have a tendency towards a longer disease-stabilizing period than the larger group (n = 17).

Adjuvant chemotherapy for uroepithelial transitional cell carcinoma

SummaryThe effectiveness of adjuvant chemotherapy in transitional cell carcinoma of the bladder (T1/G3 and >=T2) and the upper urinary tract were evaluated. Among a group of 136 patients (male 107, female 29) with such tumors, complete tumor resection was possible in 108, in whom durationof survival and disease-free interval with or without chemotherapy were compared. The combination of antineoplastic agents used was changed from 5-fluorouracil (5-FU)+vincristine (VCR)+bleomycin (BLM) or pepolomycin (PEP)+mitomycin C (MMC) or 5-FU+VCR+PEP+cyclophosphamide (CPM)+adriamycin (ADM) to CPM+ADM+cis-platinum (DDP) or methotrexate (MTX)+vinblastine (VBL)+ADM+DDP. Of the 59 patients in the chemotherapy group, 23 (39%) had side effects due to the treatment; however, fever and gastrointestinal symptoms were the chief adverse effects and were well tolerated. The 5-year survival rate and mean disease-free interval in the chemotherapy group were 76.3% and 24.6+ months, respectively, in bladder cancer patients, and 78.2% and 25.8+ months in those with upper urinary tract tumors. However, in the nonchemotherapy group (n=49) the corresponding values were 62.7% and 21.1+ months in patients with bladder cancer and 67.3% and 42.0+ months in those with upper urinary tract tumor. There was a statistically significant difference (P<0.05) in the disease-free intervals of the two treatment groups for bladder cancer patients. Recurrence, regardless of time, was observed in 25% of chemotherapy cases and in 65% of non-chemotherapy cases, and this difference was also statistically significant (P<0.001). These results suggest that adjuvant chemotherapy for uroepithelial transitional cell carcinoma may be effective in extending survival and significant by protracting the disease-free period, especially in cases of advanced bladder cancer.

Intra-arterial chemotherapy using a reservoir for endocrine-refractory prostate cancer

For local control in patients with endocrinerefractory prostate cancer, an intra-arterial chemotherapy regimen comprising methotrexate (MTX), Adriamycin (ADM), and cisplatin (CDDP) was evaluated. A total of 19 patients having a mean age of 66.4±8.8 years and a mean performance status (PS) of 1.3±1.0 were enrolled. Of these patients, 3 had proved to be resistant to initial endocrine therapy and the remaining 16 had relapsed from disease stabilization after endocrine therapy. The catheter tip was placed in the internal iliac artery in 16 cases, in the common iliac artery in 2 cases, and in the aorta in 1 case after occlusion of the contralateral feeding artery. The intra-arterial chemotherapy was performed mainly using MTX (30 mg/m2), ADM (30 mg/m2), and CDDP (50 mg/m2) as one course and was repeated for a mean of 2.9±2.3 courses. Then, in an outpatient clinic, 5-fluorouracil (5-FU), ADM, or MTX was given intra-arterially as maintenance chemotherapy until re-relapse. As based on the criteria for evaluation of nonsurgical therapy in prostate cancer proposed by the Japanese Urological Association, the prostatic lesion showed a partial response (PR) in 9 cases and no change (NC) in 10 cases. As judged from the response of prostate-specific antigen (PSA), a complete response (CR) was obtained in 6 cases, a PR, in 3 cases; and NC and progressive disease (PD), in 2 cases each. Therefore, the overall response rate was 63%. Improvement in the symptoms was observed in 83% of patients. The duration of the response was 15.1±10.5 months for the PR cases and 7.4±5.7 months for the NC cases. Furthermore, the mean survival time observed in the PR group was 38.9 months, which was better than that seen in the NC (16.4 months) and PD (10.5 months) groups. These results suggest that intra-arterial chemotherapy may become and option for the treatment of locally advanced and endocrine-refractory prostate cancers. Using a reservoir, this chemotherapy can be easily given in an outpatient clinic.

Intra-arterial administration of methotrexate, Adriamycin, and cisplatin as neoadjuvant chemotherapy for bladder cancer

SummaryAs neoadjuvant chemotherapy for advanced bladder cancer, the intra-arterial administration of methotrexate (MTX), Adriamycin (ADM), and cisplatin (CDDP; IA-MAC) was evaluated. A total of 48 patients with bladder cancer (≧T2 or CIS) were selected and received 30.1 mg MTX, 34.5 mg ADM, and 89.1 mg CDDP as an average course. The mean tumor-regression rate after 2 or 3 weeks was 52.3%, and patients with grade 3 transitional-cell carcinoma showed the best results, achieving a 69.6% regression rate. In 30 cases (63%), downstaging was observed. Among the 46 patients who underwent subsequent surgical therapy, the bladder could be preserved in 26 cases by transurethral resection or segmental resection. According to the criteria of the Japanese Association of Cancer Therapy, a histological effect of GIII or better was obtained in 15 cases (29%). The histological effect correlated well with the tumor-regression rate. As compared with intravenous therapy with MTX, vinblastine, ADM, and CDDP (M-VAC), IA-MAC treatment was well tolerated due to its lower degree of bone marrow suppression, and it resulted in a longer disease-free interval and better survival. In addition, the period prior to surgical therapy was shortened in this study. These results suggest that IA-MAC chemotherapy can be useful as an arm of multidisciplinary treatment of advanced bladder tumors.

Immunological comparison between prostate-specific antigen and γ-seminoprotein

SummaryProstate-specific antigen (PA) and γ-seminoprotein (γ-Sm) were compared by immunocytochemical, immunodiffusion and immunoblotting methods using rabbit anti-PA antibody and rabbit anti-γ-Sm antibody. Enzyme immunoassys (EIAs) were developed for measurements of PA and γ-Sm to determine a correlation between serum PA and γ-Sm levels in patients with prostate cancer. The patterns of localization and distribution of PA and γ-Sm were identical in prostate tissue sections, including benign and cancerous human prostacs. The immunodiffusion study showed that the antigens with which anti-PA antibody and anti-γ-Sm antibody reacted in seminal plasma and prostate tissue homogenates were identical to each other. In the immunoblotting study, anti-PA antibody and anti-γ-Sm antibody recognized a single antigen corresponding to a molecular weight of approximately 33,000 both in seminal plasma and prostate tissue homogenates. The EIAs developed in this study were sensitive, specific, and reproducible, and the correlation between serum PA and γ-Sm values determined by these EIAs was highly significant (r=0.99, P(0.001). These results indicated that PA and γ-Sm were immunologically identical and that serum PA and γ-Sm determined by immunoassays using anti-PA antibody and anti-γ-Sm antibody should be evaluated as identical tumor markers for serodiagnosis of prostate cancer.

Clinical assay of serum SCC-Ag in urothelial cancers.

Serum squamous cell carcinoma related antigen (SCC-Ag) values were determined in 86 patients with urothelial cancers. Mean + standard deviation for serum SCC-Ag. was 3.4 ± 0.98 ng/ml and positive values (> 2.0 ng/ml) were found in 27%. Neither pathological stage nor cell grade of the urothelial cancer showed any relation to serum SCC-Ag. Serum SCC-Ag. changed parallel to the clinical course. These results suggest that, as there is no specific tumor marker in urothelial cancer, serum SCC-Ag. may be a useful aid in diagnosing cancer and monitoring these patients. Used together with another non-specific marker, an increase in the accuracy of diagnosis of these malignancies can be expected.