Tochigi H

Leiomyosarcoma of the bladder eighteen years after cyclophosphamide therapy for retinoblastoma

We report a case of leiomyosarcoma in the bladder which occurred in an 18-year-old boy who had been treated with cyclophosphamide over a period of 6 years for retinoblastoma diagnosed 50 days postpartum. Total cystectomy and formation of an ileal conduit were performed. Three years after the operation, he was tumor-free.

A male subject with 3 Y chromosomes (48, XYYY): a case report

We describe a male subject with 3 Y chromosomes who presented with complaints of lack of sexual desire and failure to achieve rigid erection. The patient was tall and had markedly incurved little fingers on both hands as well as small testes. Karyotype was 48, XYYY. The patients parents had normal karyotypes. Endocrinological profile suggested a primary functional disturbance of the gonads. Testicular biopsy demonstrated atrophic seminiferous tubules without spermatogenesis. To our knowledge this case represents the third instance of a man with an 48, XYYY karyotype without mosaicism.

Normal bladder wall morphology in Gd-DTPA-enhanced clinical MR imaging using an endorectal surface coil and histological assessment of submucosal linear enhancement using [14C]Gd-DOTA autoradiography in an animal model.

OBJECTIVE The purpose of this study was to investigate normal bladder wall morphology in gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA)-enhanced magnetic resonance (MR) imaging using an endorectal surface coil and to perform histological assessment of submucosal linear enhancement with experimental [14C]-gadolinium-tetraazacyclododecane-tetraacetic acid (Gd-DOTA) autoradiography. METHODS AND MATERIAL MR imaging of the bladder was performed using an endorectal coil in 13 consecutive patients with bladder carcinoma and T1-, T2-, and Gd-DTPA-enhanced spin-echo images of the bladder wall were compared. After injection of [14C]Gd-DOTA into a hamster, autoradiograms of the bladder wall were obtained and compared with serial histological sections. RESULTS The normal bladder wall appeared as a homogeneous layer of intermediate intensity on T1-weighted images. After administration of Gd-DTPA, the bladder wall was visualized as three layers: an inner thin layer of low intensity, a middle layer of marked enhancement, and a thick outer layer of intermediate intensity. The autoradiograms demonstrated dense accumulation of [14C]Gd-DOTA in the submucosal layer. Thus, the inner, middle, and outer layers corresponded to the mucosa, submucosa, and muscularis propria, respectively. The thickness of the bladder wall demonstrated on T2-weighted images was almost equal to that of the outer layer on enhanced T1-weighted images. Thus, T2-weighted images revealed only the muscle layer as an intermediate-intensity band. In the preliminary clinical study, MR imaging invariably showed accurate stages of the bladder carcinoma in 13 patients. CONCLUSION In MR imaging of the normal bladder wall, the submucosa was strikingly enhanced after Gd-DTPA administration, separating the bladder wall into three layers. This may have a potential role in the staging of bladder tumors.

Prognostic Factors of Peripheral Blood Lymphocyte Subsets in Patients with Renal Cell Carcinoma

In 76 patients with renal cell carcinoma (RCC) we assessed the therapeutic effects of interferon-alpha (IFN-alpha) and the outcome of curative resection by analyzing changes in peripheral blood lymphocyte subsets to try to find prognostic indices. The percentage of activated CD8-positive cells present in blood samples before IFN-alpha therapy was significantly higher in progressive disease (PD) patients who died within 8 months than in PD patients who survived for more than 18 months. The high percentage of activated CD8-positive cells present in postoperative blood samples was the most remarkable characteristic in patients in which RCC recurred. Multivariate analysis showed that the percentage of activated CD8-positive cells in postoperative blood samples was the only predictor of recurrence (hazard ratio 1.29, p value 0.02). Thus, the high percentage of activated CD8-positive cells in postoperative blood samples is, therefore, a useful indicator of poor prognosis.

DIABETES INSIPIDUS DUE TO PITUITARY METASTASIS FROM BLADDER CANCER

We report a 41-year-old man with bladder cancer who developed polyuria following successful treatment of hypercalcemia and who was found to have a transitional cell carcinoma within the pituitary gland at autopsy. He also had widespread bone metastases. Although primary urogenital cancers rarely metastasize to the pituitary, the patients clinical course led us to suspect metastatic disease from the bladder cancer. Metastasis to the pituitary gland is more common than generally thought and should be considered in patients with advanced cancer who develop polyuria and polydipsia.

Huge Pelvic Fibromatosis Encroaching on the Urinary Bladder

A patient with a huge pelvic fibromatosis, a form of intra-abdominal desmoid, encroaching on the urinary bladder is described. Because of its rarity, there is frequently a lack of diagnostic awareness of this tumor, particularly in the gynecological or urological patient. Although this tumor is a locally invasive benign tumor which dose not metastasize, management by radical tumor excision without the sacrifice of the major pelvic nerves and vessels is mandatory, since this tumor has generally a high postsurgical recurrence rate.

Prediction of residual total renal function before nephron-sparing surgery using99mTc-DMSA renal scintigraphy

BackgroundAlthough radical nephrectomy is the standard treatment for renal cell carcinoma, nephron-sparing surgery is the preferred treatment in patients with a single functioning kidney. It is important before surgery to evaluate the level of residual renal function likely after the operation. In this study, we investigated the prediction of residual renal function, using technetium Tc 99m dimercaptosuccinic acid (99mTc-DMSA) renal scintigraphy, before nephron-sparing surgery for renal tumors.MethodsPreoperative and postoperative evaluation of renal function was done in 11 patients with renal cell carcinoma or renal angiomyolipoma, using99mTc-DMSA scintigraphy. Nine patients had renal cell carcinoma and 2 had renal angiomyolipoma. Partial nephrectomy was performed in 4 patients and surgical enucleation in 7 patients. Both the predicted total DMSA renal uptake rate prior to surgery and the actual postoperative total99mTc-DMSA renal uptake rate were obtained. Endogenous creatinine clearance and serum creatinine levels were also obtained.ResultsThere was a good relationship between the predicted and postoperative total99mTc-DMSA renal uptake rates. The ratio of the postoperative total DMSA renal uptake rate to the predicted total99mTc-DMSA renal uptake rate was 85% after partial nephrectomy, and 101% after surgical enucleation. There was also a significant correlation between the postoperative total99mTc-DMSA renal uptake rate and creatinine clearance, and postoperative total99mTc-DMSA renal uptake rate levels above 11.4% coincided with serum creatinine levels below 2.0 mg/dL.ConclusionPreoperative assessment with99mTc-DMSA renal scintigraphy is clinically useful for predicting residual renal function after nephron-sparing surgery.

Multimodality therapy for advanced clear cell sarcoma of the kidney in a young adult.

We report a clear cell sarcoma of the kidney (CCSK) in a young adult with multiple liver and bone metastases who was treated with surgery, chemotherapy and radiation. Combination chemotherapy consisting of vinblastine, actinomycin D, cyclophosphamide, pepleomycin, cisplatin (modified VAB-6 regimen) and arterial infusion of mitomycin C and doxorubicin into the hepatic artery resulted in the complete disappearance of the liver metastasis. Although systemic and localized combination chemotherapies were very effective against the liver metastasis, the clinical course was that of high-grade malignancy, resulting in death with brain metastasis 32 months after tumor resection. Differing from typical Wilms tumor in children, the treatment of CCSK has been a subject of controversy, particularly in the advanced and adult type. Nevertheless, we consider that the multimodal treatment has an important role in the stabilization of metastatic lesions even at an advanced stage in the adult type of CCSK.

Mean nuclear volume of bladder cancer : stereological estimation and its clinical value

Mean nuclear volumes (MNVs) of bladder cancer cells from the specimens of 100 patients were estimated by stereological procedure. The value of MNVs of bladder cancer were ranged widely, from 114.6 to 1,041.9 microns3. However, strong correlation was observed between MNV and histopathological grade and stage. Furthermore, the MNV predicts the biological behavior including the malignant potential and prognosis of the patient. Patients with MNV below 315 microns3 had significantly better prognosis than those with MNV above this value (p < 0.01). The 5- and 10-year survival rates for patients with MNV below 315 micron3 were both 97%, while those for patients with MNV above 315 microns3 were 65 and 58%, respectively. MNVs of the recurrent tumors were significantly increased, compared with those of the initial tumors (p < 0.01). MNV of extirpated tumor specimens following chemotherapy consisting of cisplatin and Adriamycin through balloon-occluded arterial infusion (BOAI) was significantly decreased, compared with that before BOAI (p < 0.01). We conclude that the MNV is an excellent predictor for the prognosis of the patient and the tumor recurrence. Furthermore, the stereological estimation of nuclear volume is a simple, quick, inexpensive, and reliable method to assess quantitative analysis of the histological and biological character of bladder cancer.