Kiyohito Yamazaki

Clinical analysis of incidentally found renal cell carcinomas

We reviewed 74 patients with incidentally found renal cell carcinomas (20%) out of 366 patients treated in affiliated hospitals over the past 14 years. The annual rate of the incidentally found carcinomas has increased up to 40% of the total. CT scan and/or ultrasonotomography were used in the first diagnosis in 76% of these 74 patients. The prognosis for the incidental group was more favorable than that of the classical symptom group, since the former group consisted of patients with smaller-sized carcinomas which usually tend to be confined to the kidney.

Tumor Size of Renal Cell Carcinoma: Its Clinical Implication

We studied the clinical implication of tumor size in renal cell carcinoma, by revealing its relation with the other histopathological and clinical features. The tumor size was well correlated with histopathological findings and metastatic status of the carcinoma. Smaller carcinomas (usually less than 60 mm) generally had a higher disease-specific survival than those of 60 mm or greater. The results indicated that the size reflected the biological character of the carcinoma. However, 10% of patients with the smaller carcinoma had lymph node metastasis or distant metastasis at the time of diagnosis, each of which contributed to a renal cell carcinoma-related death in the early follow-up period.

Regional Lymph Node Metastasis in Renal Cell Carcinoma: Incidence, Distribution and Its Relation to Other Pathological Findings

Extended ipsilateral lymphadenectomy performed on 102 patients with renal cell carcinoma revealed 21 patients (21%) having regional lymph node metastasis. Of the 21 patients, 6 (6%) had single-node metastasis and 15 (15%) multiple-node metastasis. PT, pV, pM, cell type and grade were all correlated with regional node metastasis. The metastatic lymph node foci were distributed along the pathways of normal lymphatic drainage. The recurrence of the disease was correlated with lymph node metastasis, indicating that metastasis is one of the prognostic factors. The very close correlation of node metastasis with vein invasion suggests that removal at least of the ipsilateral lymph node might be necessary when removal of a thrombus in the renal vein or vena cava is indicated.

Expression of squamous cell carcinoma-associated antigen in grade 3 pT1 transitional cell carcinoma of the bladder and prediction of its progression and intravesical recurrence

Background. Among superficial transitional cell carcinomas (TCC) of the bladder, Grade 3 pT1 disease is associated with a higher risk of progression and intravesical recurrence. The authors determined whether or not squamous cell carcinoma‐associated antigen (SCC antigen) could predict clinical behavior of Grade 3 pT1 disease.

Clinical study of penile cancer

Recent progress in molecular biology suggests a certain relationship between penile cancer and human papilloma virus infection. However, the treatment for penile cancer has not been established since each institute has experienced only a small number of patients. We analyzed the result of our treatment for 14 penile cancer patients during past twenty years. Ten of the 14 patients were initially treated for the primary lesion with a combination of peplomycin (PEP) or bleomycin (BLM) and radiation therapy. Of these, 9 were found not to have residual viable cancer cells in their primary lesions. No local recurrence was found in all 7 patients in whom the penis was preserved. This result suggests that combination of PEP (BLM) and radiation preserves the penis without increasing the risk of local recurrence. Penile cancer-related death did not occur in patients without lymph node metastasis. However, this cancer death did occur in 4 out of 7 patients with lymph node metastasis, suggesting that metastasis is one of the important prognostic factors. PEP (BLM) and radiation therapy with or without regional lymph node dissection did not improve the prognosis of patients with advanced penile carcinoma, such as with pN2, pN3 or distant metastasis. More effective management may be necessary for these patients.