Tatsuro Murase

Transitional cell carcinoma of the bladder in patients with renal pelvic and ureteral cancer.

We reviewed 41 cases of transitional cell carcinoma of the renal pelvis and ureter with special reference to the coexistence or subsequent development of bladder cancer. Bladder cancer was associated with an upper urinary tract neoplasm in 20 of the 41 cases (48 per cent). Most of these patients (15 of 20) were treated by radical total cystectomy of 1-stage nephroureterocystectomy. The incidence of ureteral stump cancer after nephrectomy alone or incomplete nephroureterectomy was 64 per cent (7 of 11 patients). Twelve surgically removed specimens of the renal pelvis, ureter and/or bladder were examined extensively for the histological association of pre-neoplastic disease, such as atypical hyperplasia and carcinoma in situ. Every specimen had these changes of the urothelium adjacent to and remote from obvious tumors.

Carcinoma of the Bladder: A Clinical and Pathological Analysis of 87 Autopsy Cases

A clinical and pathological analysis was done on 87 autopsy cases of carcinoma of the bladder. Of the 87 cases 68 were men and 19 were women, with a mean age of 64 years. The average survival time was 39 months from the onset of symptoms to death. The patients with multiple tumors had a longer average survival time than the patients with single tumors (51 compared to 40 months), and the average survival times were definitely more favorable for men than for women (43 compared to 23 months). Histological examination revealed transitional cell carcinoma in 77 patients, squamous cell carcinoma in 4, vesical adenocarcinoma in 3 and urachal adenocarcinoma in 3. Squamous cell carcinoma and vesical adenocarcinoma seemed to be more malignant neoplasms. Metastasis was noted in 58 of 87 cases (66.7 per cent) and occurred most frequently in lymph nodes (37.9 per cent), liver (29.9 per cent), lungs (29.9 per cent) and bones (24.1 per cent). Of the 87 cases of bladder carcinoma 11 had primary carcinoma in organs other than the bladder.

Multivariate Evaluation of Prognostic Determinants in Bladder Cancer Patients

To clarify the relative importance of factors affecting the survival of patients with bladder cancer, a multivariate analysis by Coxs proportional hazards model was performed on 264 patients initially treated from 1973 to 1984 at Nagoya University Hospital. Clinicopathological data included in the analysis were sex, age, symptoms, interval from onset of symptoms to first consultation, smoking history and tumor characteristics (location, size, number, shape, histological grade and stage). The analysis revealed that stage is the most statistically significant determinant for survival, followed by size, irritative symptoms, age and grade in this order. The model composed of the above five determinants yielded hazard ratios of: 4.6 for stage (pT2-pT4 vs. pTa-pT1); 3.1 for size (greater than 3 vs. less than or equal to 3 cm); 2.5 for irritative bladder symptoms (present vs. absent); 2.7 for age (70 years or more vs. younger), and 2.1 for grade (high grade vs. low grade tumors). We conclude that these findings quantitatively confirm previous clinical impressions that accurate staging of the tumors is most important for improving the prognosis of bladder cancer patients, and that each of the above five determinants should be considered when planning an effective initial treatment regimen.

Zosteriform inflammatory metastatic carcinoma from transitional cell carcinoma of the renal pelvis.

improvement. The possibility of cutaneous metastatic carcinoma was also considered. A biopsy specimen revealed extensive invasion of dilated dermal lymphatic vessels by groups of malignant cells, which had a hyperchromatic pleomorphic nucleus with infrequent atypical mitotic figures (Fig. 2). This cutaneous malignancy resembled the primary transitional cell carcinoma of the renal pelvis. A biopsy specimen of a left axillary lymph node confirmed the diagnosis of metastatic transitional cell carcinoma. Chest x-ray and computed tomography of the chest and abdomen showed no evidence of metastatic lesions. Two courses of combination chemotherapy were administered together with radiation therapy (total of 15 Ko-ichi Ando, MD,a Yoshinori Goto, MD,a Kumiko Kato, MD,b Tatsuro Murase, MD,b Yoshinari Matsumoto, MD,c and Masaru Ohashi, MDC Nagoya, Japan

An immunochemical and immunohistochemical study of S100 protein in renal cell carcinoma

The authors localized S100 protein in renal tubules and renal cell carcinoma by immunohistochemical study and quantitative analysis by enzyme immunoassay. The α subunit of S100 protein (S100‐α) was localized in epithelial cells of proximal tubules, thin limbs of loops of Henle, collecting tubules, and a few of Bowmans capsules. The β subunit (S100‐β) was immunostained in the distal tubules, thick and thin loops of Henle, collecting tubules, and a few proximal tubules. In renal cell carcinoma, S100‐α was immunohistochemically demonstrated in 82% (41/50) of patients including sarcomatoid variants, whereas S100‐β was detected in 46% (23/50). Both the number of positively stained tumor cells and the staining intensity were greater in S100‐α than in S100‐β. Concentrations of S100‐α in the cortex were 80.3 ± 22.5 ng/mg protein (n = 7), whereas those of renal cell carcinoma were 387 ± 533 ng/mg protein (n = 19), i.e., about five times higher. Concentrations of S100‐β in both normal kidney (1.96 ± 0.74 ng/mg protein) and renal cell carcinoma (2.05 ± 2.16 ng/mg protein) were much lower than those of S100‐α. The authors also localized S100‐α and S100‐β in tissues of other renal tumors and tumors arising from other organs. S100ao appears to be a useful immunohistochemical marker for renal cell carcinoma.

Evaluation of Gamma-Enolase as a Tumor Marker for Renal Cell Carcinoma

To evaluate whether serum gamma-enolase is a useful marker for renal cell carcinoma alpha and gamma-enolases in tissues of 36 renal cell carcinomas and 13 normal kidneys, and in sera of 103 renal cell carcinoma patients were determined with an enzyme immunoassay system. Tissue gamma and alpha-enolase levels were 34 and 2.3 times higher, respectively, in renal cell carcinoma than in normal renal cortex. The tissue gamma enolase-to-total enolase value of renal cell carcinoma (5.3 per cent) was significantly higher than that of normal cortex (0.29 per cent) and medulla (0.51 per cent). Over-all serum gamma-enolase levels were elevated (more than 6.0 ng. per ml.) in 53 of 103 patients (51 per cent) with renal cell carcinoma. In regard to stage the positive rates were 34 per cent (12 of 35) of patients with stage I, 22 per cent (2 of 9) with stage II, 80 per cent (12 of 15) with stage III, 61 per cent (22 of 36) with stage IV and 61 per cent (5 of 8) with recurrent disease. The mean value of serum gamma-enolase in renal cell carcinoma (8.0 +/- 5.7 ng. per ml.) was significantly higher than that of normal subjects (3.1 +/- 0.9 ng. per ml., p less than 0.001). The mean value of serum gamma-enolase in patients with high stage tumors (III and IV, 9.9 +/- 6.8 ng. per nl.) was significantly higher than that of low stage tumors (I and II, 5.8 +/- 3.0 ng. per ml., p less than 0.001). In 39 patients treated by complete surgical excision serum gamma-enolase was significantly reduced postoperatively (p less than 0.01). Furthermore, 7 of 8 patients whose serum gamma-enolase levels were determined serially had levels within the normal range postoperatively that increased when distant metastases appeared. These results indicate that serum gamma-enolase could be a useful tumor marker to stage disease and monitor treatment in patients with renal cell carcinoma.

Clinical pathway for tension-free vaginal mesh procedure: Evaluation in 300 patients with pelvic organ prolapse

Objectives:  To evaluate a clinical pathway of discharge on postoperative day 3 for the tension‐free vaginal mesh (TVM) procedure in patients with pelvic organ prolapse (POP).

Malignant Fibrous Histiocytoma Arising from the Renal Capsule: Report of a Case

We report a case of malignant fibrous histiocytoma arising from the renal capsule. The tumor was found during screening ultrasonography. Surgical excision and adjuvant chemotherapy consisting of cyclophosphamide, vincristine, adriamycin and actinomycin D were performed. There has been no recurrence as of 2 years and 4 months after the operation. We reviewed the 5 other cases of malignant fibrous histiocytoma arising from the renal capsule.

Evaluation of Intravesical Alum Irrigation for Massive Bladder Hemorrhage

The efficacy of intravesical alum irrigation was analyzed after application to 9 patients with continuous and severe bladder hemorrhage. Causes of bleeding were radiation cystitis in 4 patients, vesical invasion by cervical cancer in 3, bladder cancer in 1 and cyclophosphamide-induced cystitis in 1. Though alum treatment was initially effective for control of massive bladder hemorrhage in all patients, it eventually failed to suppress a subsequent hemorrhage in 2 patients (78% success rate). No significant side effects directly related to this therapy were observed. In conclusion, alum irrigation is effective for controlling massive bladder hemorrhage for a rather short time. Therefore, additional treatment modalities should also be considered for primary diseases.

Overactive bladder and glaucoma: A survey at outpatient clinics in Japan

Objective:  To determine the prevalence of a history of glaucoma and the relative safety of prescribing anticholinergics to patients with overactive bladder (OAB).