Kiyozo Kishi

Transitional cell carcinoma of the bladder in patients with renal pelvic and ureteral cancer.

We reviewed 41 cases of transitional cell carcinoma of the renal pelvis and ureter with special reference to the coexistence or subsequent development of bladder cancer. Bladder cancer was associated with an upper urinary tract neoplasm in 20 of the 41 cases (48 per cent). Most of these patients (15 of 20) were treated by radical total cystectomy of 1-stage nephroureterocystectomy. The incidence of ureteral stump cancer after nephrectomy alone or incomplete nephroureterectomy was 64 per cent (7 of 11 patients). Twelve surgically removed specimens of the renal pelvis, ureter and/or bladder were examined extensively for the histological association of pre-neoplastic disease, such as atypical hyperplasia and carcinoma in situ. Every specimen had these changes of the urothelium adjacent to and remote from obvious tumors.

Adenocarcinoma of urachus report of 7 cases and review of literature

Seven cases of adenocarcinoma of the urachus treated at the National Cancer Center Hospital, Tokyo, over a nineteen-year period are reported. One hundred fifty-five cases reported in English literature and 140 cases in Japanese literature were analyzed with respect to the modalities of treatment, mean remission times, and sites of recurrence or metastases. From this review and experience on the 7 cases reported here, extended radical total cystectomy with well-designed radio- and chemotherapy was proposed for the treatment of this disease.

Carcinoma of the Bladder: A Clinical and Pathological Analysis of 87 Autopsy Cases

A clinical and pathological analysis was done on 87 autopsy cases of carcinoma of the bladder. Of the 87 cases 68 were men and 19 were women, with a mean age of 64 years. The average survival time was 39 months from the onset of symptoms to death. The patients with multiple tumors had a longer average survival time than the patients with single tumors (51 compared to 40 months), and the average survival times were definitely more favorable for men than for women (43 compared to 23 months). Histological examination revealed transitional cell carcinoma in 77 patients, squamous cell carcinoma in 4, vesical adenocarcinoma in 3 and urachal adenocarcinoma in 3. Squamous cell carcinoma and vesical adenocarcinoma seemed to be more malignant neoplasms. Metastasis was noted in 58 of 87 cases (66.7 per cent) and occurred most frequently in lymph nodes (37.9 per cent), liver (29.9 per cent), lungs (29.9 per cent) and bones (24.1 per cent). Of the 87 cases of bladder carcinoma 11 had primary carcinoma in organs other than the bladder.

Significance of carcinoma in situ and dysplasia in association with bladder cancer

Cystectomy specimens of 118 transitional cell carcinomas of the bladder were analyzed by step-sectioning. The carcinoma in situ and dysplasia adjacent to and remote from the visible bladder cancer were correlated with the tumor configuration on cystoscopy, and grade and stage of the disease. Results showed that a combination of papillary and nodular carcinomas in a single bladder was associated with a high incidence of mucosal involvement. Moreover, more than 50 per cent of all grade 3 carcinomas were associated with carcinoma in situ and dysplasia adjacent to and remote from the visible tumors. Carcinoma in situ and dysplasia were not related to the stage of disease. For management of bladder cancer, it appears important to assess the gross configuration of tumors by cystophotography and to determine the grade of tumors by biopsy, because mucosal involvement was found to be correlated closely with the tumor configuration and grade 3 disease.

Analysis of 90 Step-Sectioned Cystectomised Specimens of Bladder Cancer

For systematic understanding of papillary superficial carcinoma and nonpapillary invasive carcinoma of the bladder 90 cystectomized specimens of transitional cell carcinoma of the bladder were analyzed by step-section. From gross and microscopic observations bladder cancer was classified into 3 types: type 1--multiple papillary superficial carcinomas with or without small areas of dysplasia or carcinoma in situ, type 2--multiple coexistent papillary and nonpapillary carcinomas with widespread dysplasia and carcinoma in situ, and type 3--solitary nonpapillary invasive carcinoma without dysplasia and carcinoma in situ. Actuarial 5-year survival rates for types 1 to 3 were 97, 50 and 17 per cent, respectively. Although this classification is somewhat overlapping and there is a bias that basic data are obtained from the cystectomized specimens, we believe that such an analysis is necessary for considering the histogenesis and progression of human bladder cancer.

Sequential changes in the prostate of rats treated with chlormadinone acetate, testosterone and N-nitroso-N-methylurea.

An attempt was made to induce prostatic adenocarcinoma in rats. Temporary chemical castration of F344 rats was achieved by administration of diet containing 0.05% chlormadinone acetate (CMA) for three weeks. The prostate was then stimulated by three consecutive daily intramuscular injections of testosterone propionate (100 mg./kg.). On the day after the last testosterone injection, N-nitroso-N-methylurea (NMU) (50 mg./kg.) was injected intravenously. Animals were sacrificed 10 days and 4, 20, 40 and 60 weeks after NMU treatment. Well-differentiated adenocarcinomas were obtained in three of fifty-four animals (5.6%) by this treatment and a high incidence of simple hyperplasia (88%) and atypical hyperplasia (19%) was also observed at 60 weeks. More studies are necessary to develop a protocol resulting in more rapid induction of prostatic adenocarcinomas at higher incidence.

Treatment of carcinoma in situ by total cystectomy: Histopathological analysis

SummarySeventeen specimens of primary or secondary carcinoma in situ (CIS) obtained by cystectomy were examined by step-sectioning. The posterior and lateral walls were mainly affected and 53% of the specimens showed invasion. Cases with a past history of superficial bladder cancer showed a particularly high incidence of invasion. Varieties of biological behavior of CIS are discussed.

Relationship Between Papillary and Nodular Transitional Cell Carcinoma in the Human Urinary Bladder

A total of 186 cystectomized specimens were examined by step-sectioning to determine the relation between papillary and nodular transitional cell carcinomas of the urinary bladder. Tumors were classified as papillary (PC), nodular (NC), and carcinoma in situ (CIS) according to their gross and microscopic configurations. These cases, grouped as simple combinations of PC, NC, and CIS, namely, PC, PC + CIS, PC + NC, PC + NC + CIS, NC, NC + CIS, and CIS, were analyzed with respect to (a) the time from the initial symptom to cystectomy, (b) the treatment before cystectomy, (c) the grade, (d) the stage of tumors, (e) the multiplicity of tumors, (f) the presence of papillary structures inside or on the surface of nodular carcinoma, and (g) data on survival after cystectomy. Of the tumors, 17 were classified as CIS and 80 as PC and PC + CIS. Studies on 57 cases suggested an early change from PC to a mixture of PC and NC through papillonodular carcinoma during development, whereas 6 showed late development of NC during repeated recurrence of PC. These courses indicate that some cases of NC developed from PC. On the other hand, 26 cases exhibited direct progression from CIS to NC. Thus nodular invasive carcinomas may develop in two ways: by emergence of a more anaplastic cell population within a preexisting low grade papillary carcinoma; and by de novo development of an invasive nodular carcinoma directly from CIS.