Masafumi Suzuki

RENAL CELL CARCINOMA OF LOWER NEPHRON ORIGIN

Thirty‐four renal cell carcinomas, including 4 small tumors localized in the medulla were studied by means of histochemical and immunohistochemical methods using the markers for the lower nephron. Seven tumors had binding sites for soybean and peanut agglutinins and showed positive reactions to monoclonal antibodies to epithelial membrane antigen and cytokeratin. All these markers normally exist in the epithelial cells of distal and collecting tubules. There was no tumor from the thick ascending limb in our materials because of negative reaction to the monoclonal antibody against Tamm‐Horsfall protein. Also negative was to CEA, which means there was no adenocarcinoma of colonic metaplastic origin from the renal pelvic mucosa. There were two histologically different types of cancers derived from the lower nephron, papillotubular adenocarcinoma with partial transitional differentiation, and papillary adenocarcinoma. All seven patients were males, aged between 30 and 84 years. The prognosis was quite poor since all six patients with known follow‐up died of tumor.

Breast-conserving surgery after chemotherapy: value of MDCT for determining tumor distribution and shrinkage pattern.

OBJECTIVE For this study, we investigated the usefulness of MDCT in assessing the extent of residual breast cancer after neoadjuvant chemotherapy. To ensure the success of breast-conserving surgery, we evaluated the usefulness of determining the tumor distribution before neoadjuvant chemotherapy and the shrinkage pattern after neoadjuvant chemotherapy. SUBJECTS AND METHODS MDCT before and after neoadjuvant chemotherapy was performed in 46 consecutive patients with 47 locally advanced breast cancers. The distribution pattern of contrast enhancement on MDCT before neoadjuvant chemotherapy was classified into five categories: solitary lesion, grouped lesion (localized lesion with linear, spotty, or linear and spotty enhancement), separated lesion (multiple foci of contrast enhancement), mixed lesion (grouped lesion with multiple foci), and replaced lesion (diffuse contrast enhancement in whole quadrants). RESULTS There was agreement between the MDCT assessment and pathologic findings in 44 (94%) of the 47 tumors. In the partial response group with nonreplaced lesions, MDCT revealed three shrinkage patterns: pattern 1a, concentric shrinkage without surrounding lesions; pattern 1b, concentric shrinkage with surrounding lesions; and pattern 2, shrinkage with residual multinodular lesions. Breast-conserving surgery was performed successfully in 14 patients including complete response cases that were detected on the basis of MDCT findings and partial response cases that were detected on the basis of observation of pattern 1 shrinkage. In all five patients with pattern 2 shrinkage, CT underestimated the residual tumor extent by more than 2 cm. CONCLUSION MDCT classification of tumor distribution before neoadjuvant chemotherapy and of shrinkage patterns after neoadjuvant chemotherapy is important in the preoperative evaluation of patients undergoing breast-conserving surgery.

A pathological study on eosinophilic lymphfolliculoid granuloma (Kimura's disease).

The present study Included 46 cases of eosinophilic lymphfolliculoid granuloma(Kimuras disease), which occurred mainly in males between the ages of 11 to 52 years. The common sites were the soft tissue of the head and neck region. Although recurrence was not infrequent, the clinical course was benign. Laboratory findings revealed eosinophilia and frequent elevation of serum IgE. The histological characteristics consisted of proliferation of lymphoid follicles and granulation tissue with infiltration of eosinophils, mast cells, plasma cells, lymphocytes, and histiocytes, some degree of vascular proliferation, and fibrosis. With the appliance of unlabeled peroxidase‐antiperoxidase method, a marked reticular reaction of IgE was confirmed in the germinal center of the folliculoid structure, and there were quite a number of IgE producing plasma cells. Many mast cells with IgE bound to their cell surface were seen in the granulation tissue. Toluidine blue staining and electron microscopy revealed fairly well preserved granules in mast cells, being quite different from the changes seen in type I allergy.

Renal metastasis of thyroid carcinoma

We report here the sixth known case of metastatic renal tumor of thyroid carcinoma. In 1999, a 37‐year‐old man was referred to us with a left renal mass found incidentally by ultrasound during an annual check‐up. Computed tomography (CT) revealed a well‐defined, hyperdense mass 3 cm in diameter in the middle of the left kidney. Left radical nephrectomy was performed under the preoperative diagnosis of renal cell carcinoma. Histologically, the tumor was metastatic of typical papillary thyroid carcinoma.

Anaplastic carcinoma of the esophagus.

The present report includes the histological, electron microscopical and immunohistochemical findings observed in two cases of anaplastic carcinoma of the esophagus. Anaplastic carcinoma of the eosphagus revealed histological features similar to oat‐cell carcinoma and carcinoid. Positive argyrophil reaction, neurosecretory granules, and hormonal activity suggest that both cases come under the category of neuroendocrine cell tumors. Anaplastic carcinoma of the esophagus may be considered as a pluripotential tumor. The biological behavior of this tumor is quite different from that of carcinoid and is a highly malignant tumor.

Malignant mesothelioma of testicular tunica vaginalis

We report here a case with malignant mesothelioma of testicular tunica vaginalis. An 81‐year‐old Japanese man with left hydrocele was referred for operation. When hydrocelectomy was performed, a thick wall of tunica vaginalis without malignancy was observed. Seven months after hydrocelectomy, a hard irregular mass was noticed in the left scrotum, therefore inguinal orchiectomy was performed. Pathologically, the mass showed severe atypia and mitosis. The diagnosis of malignant mesothelioma was made. He refused any adjuvant treatment and died 1 year later from multiple metastases to the paraaortic lymph nodes and lumbar supine.

Polymerase chain reaction-single strand conformation polymorphism analysis of the p53 gene in paraffin-embedded surgical material from human renal cell carcinomas

Abstractp53 tumour suppressor gene mutations were studied in 118 renal cell carcinomas using paraffin-embedded surgical material. Optimal results were obtained with analysis of exon lengths between 150 and 200 base pairs for polymerase chain reaction. Single strand conformation polymorphism and sequencing analysis revealed only two point mutations (2/118, 2%): one involving codon 135; TGC→TTC (cysteine→phenylalanine) and the other codon 175; CGC→CAC (arginine→histidine). Both of these cases were classified as granular cell subtype on microscopic observation. The data suggest that the p53 tumour suppressor gene is not related to tumour initiation, promotion, or progression of renal cell carcinomas. However, there is the possibility that granular cell type carcinomas may have a different genetic background from clear cell type renal neoplasms.

Clinicopathological study of pheochromocytoma of the urinary bladder: Immunohistochemical, flow cytometric and ultrastructural findings with review of the literature

Pheochromocytomas usually arise from the adrenal medulla but may also arise from the carotid body, the retroperitoneum, the urinary bladder, and other locations. We report three cases of pheochromocytoma of the urinary bladder with clinicopathological, immunohistochemical, flow cytometric, and ultrastructural findings. Case 1, a 13‐year‐old boy presented with hematuria. He underwent partial cystectomy, 31 years later he presented with a tumor in the thoracic vertebra. Case 2, a 35‐year‐old woman presented with headache, nausea, vomiting, palpitations, and diaphoresis on evacuation. She underwent total cystectomy and regional lymph adenectomy. She survived for 10 years without recurrence or metastasis; however, she died from another disease. Case 3, a 31‐year‐old man presented with dysuria. He underwent total cystectomy and regional lymph adenectomy. The tumor metastasized to the lymph nodes, and the patient died after 4 years. The urinary bladder tumors in these three cases protruded into the lumen and invaded deeper than the middle of the muscle layer. The tumor of the urinary bladder, metastatic lymph nodes, and thoracic vertebra showed alveolar and trabecular patterns, and tumor cells were surrounded by capillaries. The tumor cells were moderate in size with ovoid nuclei and abundant eosinophilic cytoplasm that contained acidophilic granules reactive to Grimelius stain. Vascular invasion was observed in cases 1 and 2. Immunohistochemically, tumor cells showed reactivity for chromogranin, Leu 7, and S‐100 protein. In each of the three cases, the DNA ploidy pattern on flow cytometry was aneuploid. Ultrastructural examination revealed several neurosecretory granules, rough endoplasmic reticulum, and a few mitochondria within the cytoplasm. It is difficult to determine whether pheochromocytoma of the urinary bladder is malignant on the basis of histological, immunohistochemical, and flow cytometric findings. Long‐term follow up is necessary.

Metanephric Adenoma of the Kidney with Massive Hemorrhage and Necrosis: Immunohistochemical, Ultrastructural, and Flow Cytometric Studies

Metanephric adenoma of the kidney is rare. We report 2 cases of metanephric adenoma with massive hemorrhage and necrosis. Case 1, a 42-year-old Japanese woman, complained of abdominal pain. Case 2, a 41-year-old Japanese woman, complained of fever and lumbago. They underwent nephrectomy. The cut surface was solid and yellow with massive hemorrhage and necrosis. These tumors showed packed tubular and glomeruloid patterns. The tumor cells were uniform and small, with uniform, oval, and hyperchromatic nuclei and scant cytoplasm, and showed reactivity for cytokeratin, vimentin, and CD 57. The MIB-1 indexes were up to 0.63%. The DNA ploidy pattern was diploid. The tumor cells formed small tubular structures with lumina and microvilli. These features suggested that metanephric adenoma is a benign tumor of an immature epithelial nature.

CLINICOPATHOLOGICAL STUDY ON SMALL RENAL CELL CARCINOMAS WITH METASTASES

Seven metastasizing small renal cell carcinomas smaller than 30 mm in the greatest diameter were clinicopathologically studied for a better understanding of their characteristic features as compared to those of small tumors without metastases. Grayish‐white infiltrating tumors in gross appearance and alveolar or solid microscopic structure consisting of granular or spindle cells and of atypical nuclei were suggestive of having metastases. Two tumors which had positive reactions to the lower nephron markers such as SB A, PNA, and/or DBA were considered to be of lower nephron origin and displayed poor prognosis. ACTA PATHOL. JPN. 37: 947–954, 1987.