Motoi Tobiume

Lactate dehydrogenase, Gleason score and HER-2 overexpression are significant prognostic factors for M1b prostate cancer

It has not been elucidated whether certain types of M1b prostate cancer (M1b PC) are associated with a poor outcome. The present study retrospectively identified predictive factors related to the outcome of M1b PC. The subjects were 104 patients who attended our hospital and received a diagnosis of M1b PC. The observation period ranged from 4 to 122 months (median, 43 months). The parameters investigated were: T classification, N classification, Gleason score (GS), pretreatment prostate-specific antigen (PSA) level, extent of disease (EOD) grade, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), calcium, and hemoglobin (Hb) levels, platelet count, and the status of HER-2 overexpression as determined with a Hercep Test(TM) Kit using initial needle biopsy specimens for diagnosis. Log-rank test and Cox univariate analysis identified the following factors with statistically significant differences: pretreatment PSA ≥ 192, N1, GS ≥ 8, EOD grade 3+4, high LDH, high ALP, low Hb, and HER-2 overexpression. Multivariate Cox proportional hazard analysis identified the factors GS ≥ 8, high LDH, and HER-2 overexpression with significant differences. The hazard ratio was 5.962, 2.465, and 2.907, respectively, and the probability value was P=0.0218, P=0.0207 and P=0.0090, respectively. When the subjects with GS ≥ 8, high LDH, and HER-2 over-expression were classified as the high-risk group, the 5-year cause-specific survival rate was 51.2, 29.6, and 20.0%, respectively. The present study showed that M1b PC patients with GS ≥ 8, high LDH, and HER-2 overexpression have a very poor outcome and thus, should be treated as a high-risk group requiring close follow-up.

An immunohistochemical study of chromogranin A and human epidermal growth factor-2 expression using initial prostate biopsy specimens from patients with bone metastatic prostate cancer

To investigate, using prostate needle‐biopsy specimens at diagnosis from patients with bone metastatic prostate cancer, whether the relationship between neuroendocrine (NE) cell differentiation and human epidermal growth factor‐2 (HER‐2) expression is a prognostic factor for outcome.

Retrospective study comparing six - and twelve-core prostate biopsy in detection of prostate cancer

OBJECTIVE We compared the safety and efficacy of the 12-core biopsy with those of the conventional systematic 6-core biopsy with PSA levels between 4.1 and 20.0 ng/mL. MATERIALS AND METHODS This study included 428 patients who underwent a 6-core biopsy and 128 patients who underwent a 12-core biopsy. Biopsies were performed transrectally under ultrasound guidance. The 12-core biopsy scheme involved obtaining 6 far lateral cores. RESULTS For patients with PSA level between 4.1 and 10.1 ng/mL, 47 of the 265 patients who underwent 6-core biopsy and 32 of the 91 patients who underwent a12-core biopsy were diagnosed with prostate cancer (p = 0.0006). Among the patients with a PSA level between 10.1 and 20.0 ng/mL, 48 of 163 patients who underwent the 6-core biopsy and 16 of 37 patients who underwent the 12-core biopsy were diagnosed with prostate cancer (p = 0.0606). Three of the 95 patients who were diagnosed with prostate cancer through the 6-core biopsy and 12 of the 48 patients who were diagnosed through the 12-core biopsy had cancer located in the anterior apex. The 12-core biopsy increased the diagnostic rate in the apex (p = 0.001). No statistically significant differences were found in incidence of complications. CONCLUSION We concluded that the 12-core biopsy is a safe and more effective procedure for increasing the diagnostic rate of prostate cancer than the 6-core biopsy in patients with PSA level between 4.1 and 10.0 ng/mL, and the most useful anatomical area to be added was found to be cores from the anterior apex.

Association between gefitinib and hemorrhagic cystitis and severely contracted bladder: a case report

BackgroundGefitinib remains an excellent treatment option for patients with a variety of cancers, including non small cell lung cancer (NSCLC). However, clinicians must be aware of the potential of gefitinib to cause an inflammatory reaction in the skin, lungs and bladder.Case PresentationWe present a case on hemorrhagic cystitis and severaly contracted bladder in a patient with NSCLC on gefitinib.ConclusionsFurther studies are needed to substantiate the association of gefitinib therapy with hemorrhagic cystitis and contracted bladder.

Clinical features of renal cell carcinoma less than 25 millimeters in diameter

Background: We retrospectively investigated the clinicopathological features and prognosis of patients who underwent surgical treatment at our department for renal cell carcinoma (RCC) less than 25 mm in diameter.

Inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease: a case report

IntroductionIt has been reported that immunoglobulin G4-related systemic disease can spread to nearly every organ, and often presents as an inflammatory mass or masses at those sites. In the kidney, this disease is often diagnosed after a radical or partial nephrectomy following the discovery of an inflammatory mass which is often suspected to be a malignant tumor. Here, we present a rare case of inflammatory pseudotumors of the kidney and the lung presenting as immunoglobulin G4-related disease, which were diagnosed by computed tomography-guided biopsies.Case presentationA 54-year-old Japanese man was referred to our hospital with suspected bilateral renal cancer, multiple lung metastases and autoimmune pancreatitis. His serum immunoglobulin G4 level was high. We used computed tomography-guided biopsies and histopathological examinations of the biopsied specimens to diagnose the tumors as immunoglobulin G4-related bilateral renal and lung inflammatory pseudotumors. Our patient was treated with oral prednisolone, and after one month of treatment, contrast-enhanced computed tomography demonstrated a general improvement, as noted by a reduction in size of the masses.ConclusionRenal masses that are formed due to immunoglobulin G4-related disease require comprehensive diagnosis to prevent unnecessary surgical resections from being performed. Further consideration should be paid to immunoglobulin G4-related diseases in the future.

A rare case of metastatic renal carcinoid

BackgroundCarcinoid is an endocrine cell tumor with low-grade atypia, which is generally a low-grade malignant cancer with a good prognosis. Metastatic renal carcinoid is even rarer than primary carcinoids.Case presentationWe present our experience of a patient with metastatic renal carcinoid from the gastrointestinal tract.ConclusionsThe carcinoid tumor of the kidney in our patient, who had a history of liver metastasis from rectal carcinoid, was considered metastatic based on the pathological findings.

Endoscope-assisted minilaparotomic radical retropubic prostatectomy

Objective:  To assess the clinical efficacy of endoscope‐assisted minilaparotomic radical retropubic prostatectomy (EAM‐RRP) compared with conventional radical retropubic prostatectomy (cRRP).

Significant prognostic factor of immunohistochemical HER-2 expression using initial prostate biopsy specimens with M1b prostate cancer.

We examined whether human epidermal growth factor‐2(HER‐2) overexpression could be a useful marker of outcome after hormone therapy in patients with M1b prostate cancer (PC).

Treatment of upper urinary tract stones with extracorporeal shock wave lithotripsy (ESWL) Sonolith vision

BackgroundThe aim was to retrospectively assess the results of treatment of upper urinary tract stones with the Sonolith vision manufactured by EDAP, and purchased in 2004.MethodsThe subjects were 226 Japanese patients who underwent extracorporeal shock wave lithotripsy (ESWL) alone as an initial treatment and could be followed up for at least 3 months, selected from 277 candidate patients who underwent this therapy between 2004 and 2006. Treatment effect was evaluated by kidney, ureter, and bladder X-ray or renal ultrasonography at 1 and 3 months after treatment. A stone-free status or status of stone fragmentation to 4 mm or smaller was considered to indicate effective treatment.ResultsAt 3 months after treatment, the stone-free rate was 69.4% and the efficacy rate was 77.4% for renal stones, while these rates were 91.5 and 93.3%, respectively for ureteral stones. Assessment of treatment effect classified by the location of stones revealed a stone-free rate of 94.6% and an efficacy rate of 94.6% for lower ureteral stones (4.0 mm or smaller, 1 subject; 4.1-10.0 mm, 31 subjects; 10.1-20.0 mm, 5 subjects: number of treatment sessions, 1 or 2 sessions [mean: 1.03 sessions]). Complications of this therapy included renal subcapsular hematoma and pyelonephritis in 1 case each.ConclusionsESWL with the Sonolith vision manufactured by EDAP produced a treatment effect equivalent to those achieved with other models of ESWL equipment. ESWL seems to be an effective first-line treatment also in patients who have lower ureteral stones 10 mm or larger but do not wish to undergo TUL, if measures such as suitable positioning of the patient during treatment are taken.