Isao Kuroda

Ectopic thyroid in an adrenal mass: a case report

BackgroundIt is difficult to explain ectopic thyroid beneath the diaphragm because during the development the thyroid descends from the tongue to the anterior of the trachea. A few cases of ectopic lesions have been reported in the literature for abdominal organs including the adrenal glands, but the mechanism by which the thyroid components migrate into the abdomen has been poorly understood.Case presentationA 54-year-old woman was diagnosed as having an adrenal mass. Laparoscopic adrenalectomy was carried out. Microscopically, the mass was composed of normal adrenal and ectopic thyroid tissues.ConclusionWe herein describe the fourth case reported of ectopic thyroid in the adrenal gland.

Effective use of strontium-89 in osseous metastases

Bone is one of the organs to which cancer metastasizes most frequently. However, it is not a vital organ, therefore, survival after the occurrence of osseous metastasis is relatively favorable. Improvements of medical treatment bring prolonged survival to patients with osseous metastases. But this makes us to recognize the importance of quality of life (QOL) due to several factors, including pain. It is important for oncologists to know how to deal with such painful osseous metastases, as pain relief may enable patients to live their remaining lives to the fullest. Strontium-89 (89Sr) has been used worldwide as in Japan, while being reported to have positive effects on pain relief and QOL improvement in patients with osseous metastases. This review paper is aimed to present not only the history, roles, and medical characters of 89Sr, but also new aspects, such as how to use bone turnover markers, which location of osseous metastases is suitable for effective use of 89Sr.

Nephrotic syndrome as a result of membranous nephropathy caused by renal cell carcinoma

A 77‐year‐old woman was admitted for a renal biopsy to evaluate a case of nephrotic syndrome. In the course of the examination, a right renal tumor was incidentally found. We performed a right radical nephrectomy in advance of the renal biopsy. Histologically, the tumor was diagnosed as a renal cell carcinoma (clear cell carcinoma) and the non‐neoplastic renal cell tissue showed membranous nephropathy (MN). After surgery, the nephrotic syndrome remitted without any further medical treatment and the MN was considered to be a malignancy associated syndrome. There have been few case reports in the literature regarding this association and we wish to describe another case.

Testicular seminoma after the complete remission of extragonadal yolk sac tumor : a case report

BackgroundBetween 2% and 5% of malignant germ-cell tumors in men arise at extragonadal sites. Of extragonadal germ cell tumors, testicular carcinoma in situ (CIS) are present in 31–42% of cases, and CIS are reported to have low sensitivity to chemotherapy in spite of the various morphology and to have a high likelihood of developing into testicular tumors. A testicular biopsy may thus be highly advisable when evaluating an extragonadal germ cell tumor.Case presentationA 36-year-old man was diagnosed as having an extragonadal non-seminomatous germ cell tumor, that was treated by cisplatin-based chemotherapy, leading to a complete remission. In the meantime, testicular tumors were not detected by means of ultrasonography. About 4 years later, a right testicular tumor was found, and orchiectomy was carried out. Microscopically, the tumor was composed of seminoma.ConclusionsWe herein report a case of metachronous occurrence of an extragonadal and gonadal germ cell tumor. In the evaluation of an extragonadal germ cell tumor, a histological examination should be included since ultrasonography is not sufficient to detect CIS or minute lesions of the testis.

Hypercalcemia upon recurrence of renal cell carcinoma producing parathyroid hormone-related protein

We established a new renal carcinoma cell line that produces parathyroid hormone-related protein (PTHrP) and interleukin-6 in culture. The cellular production of PTHrP was confirmed by Northern blot analysis and immunofluorescence examination. Bone and lung metastases occurred simultaneously 3.5 years after surgery. The patient did not show hypercalcemia at this time, despite the presence of multiple osteolytic metastases. About 7 months after bone metastasis was first shown, serum PTHrP was detected by means of an immunoradiometric assay and the calcium level was found to be elevated to 3.29 mmol/l. The hypercalcemia was successfully controlled by i.v. administration of bisphosphonates.

Langerhans cell histiocytosis on the penis: a case report

BackgroundLangerhans cell histiocytosis affects mainly young children and features an accumulation of CD1a+ dendritic Langerhans cells in the bone, skin, and other organs. A few cases of Langerhans cell histiocytosis on the penis have been reported in the literature. We present a case of Langerhans cell histiocytosis on the penis and review the similar cases in the literature.Case presentationThe patient was a 13-year-old boy who had a history of lymph node, femur bone, and pituitary-thalmic axis lesions from Langerhans cell histiocytosis who noticed a painful nodule on the prepuce of his penis. The histological and immunohistochemical examination fulfilled the criteria of Langerhans cell histiocytosis.ConclusionWe herein describe the case reported of Langerhans cell histiocytosis on the penis.

Source strength assay of iodine-125 seeds sealed within sterile packaging.

Early‐stage prostate cancer is widely treated by iodine‐125 (I‐125) seed implantation. While quality assurance methods are in place to assure consistency in I‐125 seed source strength, current methods involve the breaking of the sterilization package, raising issues concerning sterility and time limitations. The purpose of this study was to develop a method of characterizing the total source strength of I‐125 seeds within a cartridge that has been sealed within a sterilization package and to evaluate the probability of detecting an out‐of‐calibration seed (aberrant seed). We defined a protocol to determine the ability of a well‐type ionization chamber to detect aberrant I‐125 seeds within a cartridge sealed in the sterilization package. A novel jig for a well‐type ionization chamber was designed to accommodate the sterilization package. One seed was chosen randomly from two cartridges containing five or 15 seeds (0.544 U source strength) and was exchanged with aberrant seeds of six different source strengths. The source strength was measured at each position within the cartridge. The results indicated that the response of the well chamber was sensitive to changes in the aberrant seed position within the cartridge and the source strength of the aberrant seed. The correlation coefficient between single seed and batch assay results was high (0.998). A novel jig and a measurement method using a well ionization chamber were developed, which allowed for a batch assay characterization of the total source strength of I‐125 seeds within a cartridge sealed within sterilization package. This method is simple, time‐saving, and offers greater practical application. PACS number: D6.20.Dk

Granulomatosis with Polyangiitis (Wegener’s Granulomatosis) Accompanied by Dysuria

A 65-year-old male visited us with complaints of retarded urination, dysuria, gross hematuria, and fever. Urinalysis showed pyuria. Prostatic tumor with lung metastasis was suspected from computed tomography and magnetic resonance imaging. Transurethral prostatic biopsy and bronchoscopic biopsy only revealed fibrinoid necrosis and inflammatory infiltration. Right lateral maxillary sinusitis was also found by MRI. ANCA testing was positive with specificity for anti-PR3 (PR3-ANCA). On the basis of these results, Granulomatosis with polyangiitis (GPA) was diagnosed. GPA involving the prostate gland is unusual, and only a few cases have previously been reported.

Basal Cell Proliferation Induced by Chlormadinone Acetate Suggests Stem Cell Transformation of Prostatic Cells

Introduction and Objective: Epithelial to Mesenchymal transition (EMT) at the first hormonal therapy is thought to play an essential role in obtaining castrate resistance for hormone naive prostate cancer. So we studied EMT of prostatic cells after exposing various hormonal agents using transurethral resection (TUR) specimens. Patients and Methods: TUR specimens without hormonal use (4 cases), specimens after three weeks of chlormadinone acetate (CMA) (9 cases), specimens after average six months of dutasteride (3 cases), and specimens two weeks after initial use of degarelix (3 cases) were studied using HE and immunohistochemical staining with prostate specific antigen (PSA), prostatic stem cell markers such as CD44, CD117, CD133 and Vimentin. Results: Specimens treated with CMA showed acinar dilatation and atrophy of glandular cells. Specimens treated with dutasteride showed marked decrease of gland and specimens treated with degarelix showed decrease of glandular cells. PSA was stained all of the prostatic glandular cells in all specimens. CD44 was stained at basal cells in normal prostatic tissue without hormones, however in hormone treated specimens, basal cells elongate and some glandular cells were also stained by CD44, especially in CMA treated specimens. Only small numbers of infiltrating cells in interstitial tissue positively stained with CD 117 and CD 133 in all specimens. Vimentin was stained in all mesenchymal interstitial cells. Conclusion: Elongation of basal cells and increased sensitivity to CD44 in glandular cells, especially treated with CMA, were thought to the result of EMT of prostatic glandular cells.