Koji Urasaki

Intratumoral heterogeneity of MIB-1 labelling index in gastric gastrointestinal stromal tumor (GIST)

BackgroundThe MIB-1 labelling index (LI) is used as a prognostic indicator for gastrointestinal stromal tumors (GISTs). However, whether a biopsy-based LI represents the entire tumor is uncertain, because the LI is not always homogeneous. In this study, we examined the extent and characteristics of LI heterogeneity in gastric GISTs.MethodsWe analyzed ten c-kit-positive gastric GISTs with diameters exceeding 3 cm, of which six were multilobular and four were unilobular. For MIB-1-immunostained sections, continuous digital images were obtained through the maximum diameter of the lobules. We obtained LIs for images by carrying out computer-assisted image analysis, and calculated the means and standard deviations (SDs) of the LIs for the lobules. For each lobule, intralobular heterogeneity was evaluated on the basis of the SD. For multilobular tumors, interlobular heterogeneity was assessed on the basis of the mean LI difference between lobules.ResultsThe SDs, which ranged from 0.8% to 9.8%, indicated intralobular heterogeneity. Moreover, considerable interlobular heterogeneity was noted in five (83%) of the six multilobular GISTs, in which the maximum interlobular mean LI difference ranged from 9.6% to 27.2%. Notably, although the high maximum mean LI (14.1%–32.3%) showed that these five GISTs were high-grade tumors, they also contained at least one lobule showing a low-grade mean LI value (2.7%–5.1%).ConclusionGastric GISTs often show intralobular or interlobular MIB-1 LI heterogeneity. In multilobular GISTs, multiple biopsy samples may be required for the accurate evaluation of tumor grade.

Ten-year protocol biopsy findings of renal allografts in the calcineurin inhibitor era

Abstract:  Ten‐year protocol biopsies were performed in 16 patients treated with calcineurin inhibitor (CNI) continuously. All kidney grafts were functioning well at the time of biopsy with the mean serum creatinine level of 1.6 ± 0.8 mg/dL. The specimen of biopsy showed various degrees of tissue injury. According to the Banff grading, allograft glomerulopathy (cg) was observed in one case. Interstitial fibrosis (ci) and tubular atrophy (ct) were observed more frequently in 13 (81%) and 15 (93%) cases, respectively. Fibrous intimal thickening (cv) was seen in one (7%) case. Arteriolar hyaline thickening (ah) was seen in 14 (87%) cases. These findings were associated with chronic rejection in one case, recurrence of original disease in four (25%) cases, toxicity of CNI in 14 (87%) cases. Longer follow‐up studies are needed to confirm whether CNI should be continued or not in the long‐term period following kidney transplantation for better graft survival.

Histopathologic evaluation of living kidney donor candidates by pre-operative kidney biopsy

Abstract:  A lack of deceased kidney donors in Japan has led to dependence on living donors in as many as 80% of cases. At the same time, indications for living‐donor kidney donation have been expanding in terms of donor medical status as well as HLA matching and ABO compatibility, thus emphasizing the donor shortage. To facilitate final medical decision‐making for living kidney donation, we attempted kidney biopsy in six donor candidates who had problems such as mild diabetes and slight proteinuria. The biopsy specimens showed various degrees of tissue injury ranging from partial glomerular sclerosis to arteriole hyalinization. On the basis of the biopsy findings, kidney donation was subsequently performed in three of the six cases with full informed consent, and not done in the remaining three cases. Longer‐term studies will be needed to clarify the outcome in both the donors and recipients in these cases.

Overlapped glomerular lesions of chronic rejection and recurrent lupus nephritis in transplanted kidney: a case report

Masuzawa N, Urasaki K, Okamoto M, Nobori S, Ushigome H, Yoshimura N, Yanagisawa A. Overlapped glomerular lesions of chronic rejection and recurrent lupus nephritis in transplanted kidney: a case report.
Clin Transplant 2011: 25 (Suppl. 23): 49–52.
© 2011 John Wiley & Sons A/S.

A case of living-related renal transplant from the donor with membranous nephropathy.

Abstract:  Introduction:  When a patient who had renal replacement therapy becomes older, an elder donor candidate may be considered as a potential donor for living‐related transplantation. Elder donor candidate might have pre‐existing disease including mild renal dysfunction, such as proteinuria. Marginally appropriate donors might be considered for renal graft because of the shortage of donors. A successful outcome after kidney transplantation from a living‐related donor diagnosed as membranous nephropathy is reported.

A rare case of vascular rejection in a renal transplant recipient with nephrotic range proteinuria

Abstract:  In the post‐cyclosporine A era, it has been reported that acute rejection after kidney transplantation is commonly revealed as an asymptomatic increase in the serum creatinine level. Nephrotic range proteinuria is observed in patients with recurrent or de novo glomerulonephritis, or with chronic transplant nephropathy and glomerulopathy in the late phase. Acute rejection occurring with nephrotic range proteinuria without a rise of serum creatinine has been rarely reported. Here, we report a rare case of vascular rejection in a renal transplant recipient with nephrotic range proteinuria. A 34‐yr‐old male renal transplant recipient presented with acute vascular rejection and early‐onset nephrotic syndrome. Severe nephrotic range proteinuria was detected with a minimally elevated level of serum creatinine. Biopsy showed severe glomerulitis and vasculitis, which was relieved by conversion of the immunosupressant regimen. Severe proteinuria was a sign of acute vascular rejection with severe glomerulitis and vasculitis. Careful observation to ensure maintenance of immunosuppression is necessary in such cases.

Analysis of preexisting baseline kidney lesions revealed by biopsy in living kidney donors: relationship with clinical parameters at the time of donation

Okamoto M, Koshino K, Nobori S, Ushigome H, Okajima H, Urasaki K, Yoshimura N. Analysis of preexisting baseline kidney lesions revealed by biopsy in living kidney donors: relationship with clinical parameters at the time of donation.
Clin Transplant 2010: 24 (Suppl. 22): 27–30.