Itsuki Komiyama

HISTOPATHOLOGICAL STUDY OF THE MÜLLERIAN DUCT REMNANT: CLARIFICATION OF DISEASE CATEGORIES AND TERMINOLOGY

PURPOSE We determined by histopathological studies whether there is an etiological difference in 2 distinct categories of müllerian duct remnant diseases. In addition, we clarified the nomenclature of these diseases. MATERIALS AND METHODS We recently performed radical prostatectomy in a patient with prostate cancer associated incidentally with a so-called müllerian duct cyst in the prostatic midline. The specimen was examined by pathological and immunohistochemical testing with special attention to the relationship of the cyst and utricle. We also investigated the histology of so-called enlarged prostatic utricles or vagina masculinus extirpated from patients with severe hypospadias or intersex disorder. RESULTS The round cyst removed with the prostate seemed to arise from the verumontanum and it contained fluid with a high concentration of prostate specific antigen. Histological and immunohistochemical examination of its lining epithelium demonstrated that cyst characteristics were identical to those of the prostatic utricle. On the other hand, pouches extirpated from patients with pediatric problems were lined by squamous epithelium. CONCLUSIONS The so-called müllerian duct cyst appeared to originate from the prostatic utricle, and so should be termed a utricular cyst or cystic utricle. Conversely the so-called enlarged prostatic utricle should be termed a vagina masculinus or male vagina. The term müllerian duct remnant, which would include these 2 abnormalities, may usefully be replaced by the term utricular abnormalities.

EFFECTS OF INTRAVESICAL CAPSAICIN AND RESINIFERATOXIN ON DISTENSION-INDUCED BLADDER CONTRACTION IN CONSCIOUS RATS WITH AND WITHOUT CHRONIC SPINAL CORD INJURY

PURPOSE To compare conscious, normal rats and rats with chronic spinal cord injury (CSI) in terms of the rhythmic bladder contractions (RBCs) induced by intravesical infusion of saline, and to determine how these contractions are influenced by intravesical capsaicin and resiniferatoxin. MATERIALS AND METHODS Female Sprague-Dawley rats, normal or with spinal transection at the level of Th8-Th9, were investigated cystometrically under isovolumetric conditions before and after intravesical administration of capsaicin or resiniferatoxin. RESULTS Spinal transection induced a significant increase in bladder weight. In both control and CSI animals, intravesical saline instillation induced reproducible RBCs that could be blocked by hexamethonium. Four weeks after the transection, the CSI animals had a significantly larger threshold volume than the controls, even after correction for bladder weight. The mean amplitude and duration of the RBCs did not differ between the two groups, but the frequency was significantly lower in CSI animals. Both capsaicin (0.1 and 1 mM) and resiniferatoxin (1 and 10 microM), instilled intravesically, were found to inhibit RBCs in both normal and CSI rats. There were no qualitative differences in the response to the drugs between the two groups. However, resiniferatoxin was approximately 100 times more potent than capsaicin. CONCLUSION Capsaicin and resiniferatoxin inhibited RBCs in both normal and CSI rats, suggesting that activity in sensory fibers (C and Adelta), which are sensitive to the action of these drugs, is initiated by bladder filling in both types of rat.

Squamous cell carcinoma in the renal pelvis of a horseshoe kidney.

Abstract We report a rare case of squamous cell carcinoma in the renal pelvis of a horseshoe kidney. An 80‐year‐old woman was referred to the National Nagano Hospital for the examination of occult blood in her urine. Microscopic hematuria was found, but pyuria was not seen. Computed tomography and magnetic resonance imaging showed a mass in the left renal pelvis of the horseshoe kidney. No renal stone or hydronephrosis was found. Cytopathological examination in the voided urine specimen was positive. Left nephroureterectomy with the splitting of the isthmus of the horseshoe kidney was performed without renal pedicle clamping using a microwave tissue coagulator. No bleeding was encountered after separating the isthmus. A final pathological diagnosis of squamous cell carcinoma with a tumor thrombus was made. Lymph node metastasis had developed and rapidly progressed and the patient died of disseminated malignancy 4 months after the operation.

Continent urinary reservoir formation with transverse colon for patients with pelvic irradiation.

Background: The creation of a continent transverse colon pouch for patients who had previously received radiation therapy for cervical cancer was attempted.

Severe Cyclophosphamide-Induced Hemorrhagic Cystitis Successfully Treated by Total Cystectomy with Ileal Neobladder Substitution: A Case Report

A 45-year-old woman with intractable cyclophosphamide-induced hemorrhagic cystitis was successfully treated with total cystectomy and ileal neobladder substitution. To our knowledge this is the first reported reconstruction of the lower urinary tract in a patient with acute hemorrhagic cystitis using a neobladder. Neobladder substitution is contraindicated if the urethra or bladder neck is involved in the disease, although neither was involved in our patient. Whether these lesions are generally left intact has not been discussed previously. If a neobladder can be used, life threatening hemorrhagic cystitis should be treated with total cystectomy accompanied by immediate neobladder substitution.

Granular cell tumor of the urethra.

Abstract:  A 38‐year‐old woman was referred for urethral tumor treatment. Needle biopsy of the tumor was performed. Histologically, the tumor was composed of large polygonal cells with eosinophilic and periodic acid‐Schiff (PAS)‐positive granular cytoplasm, indistinct cell margins and small round central nuclei. Immunohistochemical staining for S100 protein, vimentin, and neuron‐specific enolase (NSE) was positive, indicating that it was a granular cell tumor. Excision of the tumor including the urethra and appendicovesicostomy using the Mitrofanoff principle were performed. There has been no tumor recurrence in the 8 months after the operation.

A clinical and pathological study of radical prostatectomy for prostate cancer

BACKGROUND Thirty-one patients with prostate cancer underwent radical prostatectomy and simultaneous pelvic lymphadenectomy at Matsumoto National Hospital between 1988 and 1994. Prognostic factors are discussed from their clincopathological findings. METHODS The patients ranged from 54 to 80-year-old, with an average age of 69.9 years. The median follow-up period was 44 months. The diagnosis was confirmed by needle biopsy or transurethral resection of the prostate. All the patients received short-term endocrine therapy preoperatively, and only noncuratively resected patients underwent adjuvant therapy postoperatively. At initial diagnosis, the tumor grades were well, moderately, and poorly differentiated adenocarcinoma in 9, 12, and 10 patients, respectively. The clinical stage was defined as A2, B, C, D1, and D2 in 12, 4, 6, 3, and 6 patients, respectively. RESULTS A difference of tumor grade was found between the initial diagnosis and the final diagnosis based on the resected prostate in 8 patients (26%), with 7 of them (88%) showing an increase in grade in the final diagnosis. Also revealed was that 11 of the 25 patients (44%) in stage A2, B, C, or D1 had been understaged preoperatively. The five-year actuarial survival rates were 100%, 92%, and 51% for patients with well, moderately, and poorly differentiated adenocarcinoma, respectively, with a significant difference noted between well and poorly differentiated adenocarcinoma (p = 0.03). Recurrence only developed in patients with pathological stage D tumors. However, the presence or absence of lymph node metastasis did not affect the crude 5-year survival rate. Several stage D patients were successfully treated by radical prostatectomy and adjuvant therapy, achieving long survival. CONCLUSION These results indicate that patients in clinical stage C have tumors which exhibit differing biological behavior. These patients should be analyzed and classified more precisely so that the most appropriate therapy can be chosen.