Tomohiro Kuwahara

Primitive neuroectodermal tumour of the kidney with spontaneous regression of pulmonary metastases after nephrectomy

A 23-year-old women was admitted complaining of a 7-month history of general fatigue, slight fever, right flank pain and gross haematuria. CT showed a a 13 ¥ 10 cm right renal mass (Fig. la) and several nodules in both lungs, suggesting multiple pulmonary metastases. CT and cavography revealed a filling defect in the right renal vein and the inferior vena cava (IVC), suggesting a tumour thrombus in both (Fig. la). Aortography showed the mass to be hypervascular (Fig. lb). She underwent radical nephrectomy with cavotomy under a diagnosis of metastatic RCC with IVC tumour thrombus. The pulmonary metastatic lesions decreased in size and number 14 days after surgery (Fig. 1c) and subsequently increasingly regressed with time. At 2 months after surgery they had completely regressed (Fig. 1d) . Before surgery her urinary excretion of homovanillic acid (HVA) and vanillylmandelic acid (VMA) were 3.3 and 3.3 mg/day (within the normal ranges; HVA 1.5–6.6 mg/day; VMA 1.3–5.1 mg/day). The histological findings of the resected tumour showed the typical small round to ovoid tumour cells and several neuroblastic Homer Wright rosettes, suggesting the tumour to be a primitive neuroectodermal tumour (PNET) or neuroblastoma (Fig. 2a). Positive reactions were obtained with the antibodies against synaptophysin, neurone-specific enolase, S100 protein and CD99 (MIC2) [1] (Fig. 2b) but not to chromogranin and neurofilament. Taken together, the histological findings and laboratory results suggested a diagnosis of PNET of the kidney. The resection of the primary lesion was probably responsible for the complete regression of the pulmonary metastases. The patient remains well 1 year after surgery.

Neurologic toxicity associated with interferon α therapy for renal cell carcinoma

Abstract  A 67‐year‐old man received interferon α (IFN α) therapy for lung metastases of renal cell carcinoma (RCC). Multiple pulmonary metastases disappeared completely. However, neurological toxicity was detected by magnetic resonance imaging (MRI) as abnormal brain lesions. After discontinuation of IFN α therapy, his neurological symptoms and abnormal lesions on MRI disappeared completely. Complete remission of RCC has continued, and results of neurological study have remained normal for 5 years after discontinuation of IFN α therapy.

Isolated Renal Tuberculosis following Intravesical Bacillus Calmette-Guérin Therapy for Bladder Cancer

We present a case of isolated renal tuberculosis following bacillus Calmette-Guérin (BCG) therapy for bladder cancer. In the presurgical radiographic examination, we suspected an atypical renal cell carcinoma. According to the diagnosis of renal cell carcinoma, we performed a radical nephrectomy. The histological findings were tuberculosis-specific inflammatory changes and the patient received an antituberculous multiple drug therapy for a year. It is concluded that we should pay attention to the possibility of a renal tuberculosis granuloma in any patient who presented with subacute formed renal masses following BCG treatment before deciding on the strategy of the treatment of the renal masses, especially in patients who had received such a treatment which induced an immunocompromised state.

Effects of castration on nitric oxide-mediated relaxations in male rat corpus cavernosum smooth muscle.

Background: The effects of castration on nitric oxide- mediated relaxations and nitric oxide synthase activity in male rat corpus cavernosum smooth muscles. Methods: Eight-week-old male rats were assigned to two groups: control (sham operated) and castrated animals. After 8 weeks, corpus cavernosum smooth muscle strips were mounted in an organ bath for isometric tension recordings. Electrical field stimulation (EFS) was applied to the strips precontracted with 30 µM phenylephrine. The microdialysis probe was inserted into the strip, and Krebs-Henseleit solution was perfused into the probe. The dialysate during EFS and cholinergic stimulation was collected, and the amount of NO–2/NO–3 (NOx) released in the dialysate was measured by the Greiss method. Sodium nitroprusside and carbachol were cumulatively added to the strips precontracted with 30 µM phenylephrine. Results: EFS caused frequency-dependent relaxations and NOx releases in the strips. Pretreatment with Nω-nitro-L-arginine (100 µM) and tetrodotoxin (1 µM) completely inhibited relaxations and NOx releases. The maximum relaxation in the castration group was significantly greater than that in the control group. The release of NOx was significantly greater in the castration group than in the control group. Sodium nitroprusside relaxed the tissues in both groups similarly. Carbachol failed either to relax the tissue or to increase the amount of NOx production in the tissue. Conclusion: The present data suggest that castration enhances nitric oxide synthase activity and nitric oxide-mediated relaxations in the male rat corpus cavernosum.