Mayumi Kushima

Fournier’s gangrene caused by candida species as the primary organism

Fourniers gangrene is a rare entity caused by polymicrobial aerobic and anaerobic bacteria. We report a case of Fourniers gangrene caused by Candida as the primary organism. A 65-year-old man presented with perineal soft-tissue infections. He underwent surgical debridement and suprapubic cystostomy with both antifungal and antimicrobial therapy. The histopathologic examination revealed necrotizing fasciitis with Candida species as the sole initial pathogen. The case suggests that primary fungal pathogens should be considered as a causative organism of Fourniers gangrene.

Primary Heterologous Carcinosarcoma of the Ureter with Necrotic Malignant Polyps

Carcinosarcoma is a rare and aggressive disease characterized by biphasic neoplasms with distinct mesenchymal and epithelial components. We report a case of ureteral carcinosarcoma with malignant necrotic polyps. The patient was a 58-year-old woman with painless hematuria, who was later diagnosed as having ureteral carcinosarcoma. Three long pendulous polypoid-shape tumors consisting of high-grade transitional cell carcinoma with chondrosarcomatous and osteosarcomatous elements were found. Two months after nephroureterectomy, the tumor relapsed in the bladder. Despite anterior exenteration, the patient died of local recurrence 6 months after her initial visit. To our knowledge, only 10 cases of this disease have been reported in the literature.

Heterogeneity and progression of renal cell carcinomas as revealed by DNA cytofluorometry and the significance of the presence of polyploid cells

With special attention to the presence of polyploid cells, we examined heterogeneity and progression of renal cell carcinomas. We separated 116 blocks from 51 tumors into several specimens according to the histologic findings, and analyzed their DNA ploidy patterns. Thirty-one tumors (61%) were aneuploid, 29 of which showed intratumoral DNA ploidy heterogeneity. Diploid cell lines were observed in 47 tumors (92%). Polyploid cells in the diploid component were more frequently found in tumors with mixed diploid and aneuploid patterns than in the purely diploid tumors. Of the diploid cases, higher stage cases tended to have a higher incidence of polyploid cells than the lower stage cases. The incidence of aneuploid cases and DNA heterogeneity became greater as the tumors progressed. Aneuploid cases had a poorer outcome than did the diploid cases. If diploid cases with polyploid cells were classified as aneuploid cases, the difference in the survival rate between the diploid and aneuploid cases became more significant. Diploid renal cell carcinomas with polyploid cells may be an intermediate stage between diploidy and aneuploidy. Analyzing renal cell carcinomas for the presence of polyploid cells is useful for differentiating diploidy, which is actually aneuploid, from pure diploidy.