Masao Osafune

Late recurrence of renal cell carcinoma after nephrectomy.

Late recurrence of renal cell carcinoma is unusual. Of 43 patients who underwent curative nephrectomy more than 10 years before, 2 cases (4.7%) had late recurrence. The 2 cases, both female patients, had late recurrence 12 and 19 years from the date of nephrectomy. The clinical aspects of late recurrence are discussed briefly.

Heparan sulfate in the stone matrix and its inhibitory effect on calcium oxalate crystallization

SummaryThe nature of the soluble stone matrix and its possible role in urinary stone formation was studied. For this purpose we performed two-dimensional cellulose acetate membrane electrophoresis of the glycosaminoglycans (GAGs) which were contained in the soluble stone matrix, substances adsorbed onto calcium oxalate crystals in vitro (crystal surface binding substances, CSBS) and urinary macromolecules (UMMs). The main GAG in the soluble stone matrix and CSBS was found to be heparan sulfate, whereas the UMMs contained various GAGs usually seen in urine. An inhibition assay showed the soluble stone matrix to have the strongest inhibitory activity among these macromolecular substances when inhibitory activity was expressed in terms of uronic acid concentration. It is suggested that the main GAG in the soluble stone matrix consists of heparan sulfate, which has a strong inhibitory activity on calcium oxalate crystal growth and aggregation and constitutes part of the CSBS.

Hormone Receptor in Renal Cell Carcinoma and Correlation With Clinical Response to Endocrine Therapy

Analyses of hormone receptors in cytosols from 41 renal cell carcinoma specimens were performed by the dextran-coated charcoal technique, using estradiol, synthetic progestin R5020 and synthetic androgen R1881. Binding data were calculated according to the method of Scatchard. Of 41 renal cell carcinomas estradiol receptor was detected in 11, R5020 receptor in 11 and R1881 receptor in 13. No significant correlation between histopathological findings and hormone receptors was observed. Patients were classified into those positive and negative for receptors. The clinical response of endocrine therapy for 17 with advanced residual or metastatic lesions after nephrectomy was studied in regard to the survival rates. Although there was no complete or partial regression in tumor size, the survival rate of patients with 1 or more receptors was significantly higher than that of patients negative for receptors (p less than 0.01). In conclusion, hormonal manipulation in patients with renal cell carcinoma cannot induce an antitumor effect but seems to increase survival in patients with receptors.

Extramedullary plasmacytoma (EMP) of urinary bladder.

An extramedullary plasmacytoma (EMP) is presented with an isolated lesion in the urinary bladder accompanying an IgG-K paraproteinemia. After a short-term oral melphalan administration, the tumor soon regressed together with the paraprotein, and has never recurred during the two-year follow-up. This is the fourth case of primary EMP of the urinary bladder reported in the literature.

Spontaneous regression of pulmonary metastases after nephrectomy for renal cell carcinoma

A case of spontaneous regression of pulmonary metastases from renal cell carcinoma after nephrectomy is presented. In a 57-year-old Japanese male who had already had pulmonary metastases at the time of nephrectomy, the metastatic lesions disappeared without adjuvant therapy 8 years after nephrectomy. He is still surviving without recurrence or any signs indicative of new metastasis at the present. The clinical aspects of this interesting phenomenon are discussed briefly.

Combination chemotherapy including Adriamycin for advanced transitional cell carcinoma of the urinary tract

SummaryThirty-three patients with advanced transitional cell carcinoma of the urinary tract (23 bladder cases, 8 ureter cases, and 2 renal pelvis cases) were treated by three-drug combination chemotherapy using two protocols (protocol I: Adriamycin 50 mg/m2, cyclophosphamide 500 mg/m2, and 5-fluorouracil 500 mg/m2, protocol II: Adriamycin 50 mg/m2, cyclophosphamide 500 mg/m2, and cis-platinum 50 mg/m2). Protocol I induced responses in three of 19 patients (16%), (1 complete response, 2 partial responses), and protocol II (1 complete response, 4 partial responses) in five of 14 patients (36%). The overall response rate was 24%. The duration of response was relatively short (median duration 5.1 months). The combination therapy was relatively well tolerated except in three patients, including two mortalities. In our study, three-drug combination chemotherapy with Adriamycin, especially that including cis-platinum, was effective against transitional cell carcinoma of the urinary tract, but the results were not completely satisfactory.

Transitional cell carcinoma arising from bladder left behind.

A case of transitional cell carcinoma arising from a bladder which was left behind for more than 24 years without pyocystis syndrome is described. A search in the literature revealed 10 cases of defunctionalized bladder that developed tumors over a rather short latent period ranging from 3 months to 7 years, and mostly with evidence of severe bladder infection.

Autologous Mixed Lymphocyte Tumer Cell Culture in Patients With Renal Cell Carcinoma

Cell-mediated immunity was studied by measurement of lymphocyte response to autologous tumor cells in 19 surgically treated patients with histologically proved (mixed lymphocyte tumor cell culture) renal cell carcinoma. Tumor stage was low in 9 patients and high in 10, while grade was low in 11 and high in 8. Of 8 patients in whom a positive lymphocyte response was detected 6 had high and 2 had low stage tumors (p less than 0.05), while the grade of disease was low in 7 and high in 1 (p less than 0.05). Furthermore, the more advanced and undifferentiated the tumor the more significant the decrease in lymphocyte response (p less than 0.05). Lymphocyte response was positive in 5 of 8 patients with low stage and low grade tumors but negative in 7 with high stage and high grade disease. However, no correlation between the lymphocyte response and the degree of microscopic lymphocytic infiltration in and around the tumor was found. This study confirms that the specific immunological defense mechanism of patients with renal cell carcinoma against the tumors remains well at an earlier stage of tumor development, especially in cases with well differentiated malignancy, and showed attenuation in parallel with pathological spread or in poorly differentiated tumors.

Renal cell carcinoma having heterogeneous histological appearance and homogeneous enzymatic property

A case of renal cell carcinoma (RCC) presenting various histologic growth patterns, including papillary, tubular and solid arrangements, and an area resembling sarcoma are described. In order to identify RCC of high versatility or renal carcinosarcoma, electrophoretic studies of tissue alkaline phosphatase (Al‐P) and γ‐glutamyl transpeptidase (γ‐GTP), as well as histochemical studies of these enzymes, were conducted. The Al‐P was proved to be bond type alone and the γ‐GTP corresponded with the novel isozyme associated with RCC tissue. Moreover, these two enzymes were found to be distributed in every part of different histologic appearance. It was concluded from these results that the histologic pleomorphism of the case herein reported was due to morphologic transformation of the neoplastic cells sharing essentially identical enzymatic nature.

Benign non-parenchymal renal tumors: Radiologic appearances

Two non-parenchymal renal tumors, capsular leiomyoblastoma and schwannoma in renal sinus, are reported with respect to radiographic appearance, reviewing the literature. Computerized tomography (CT) scan and pyelography define the localization of the renal tumor substantiated by angiography identifying the feeding arteries. Precise investigation of neovascularity is necessary to exclude malignant potency. A tumor in the renal sinus without destruction of pelvo-calyceal system should include schwannoma in the differential diagnosis.