Toshikazu Okaneya

Solitary Urethral Recurrence of Sigmoid Colon Carcinoma

We report a rare case of a solitary urethral recurrence of sigmoid colon cancer. The recurrence developed 2 years after a radical resection of sigmoid colon cancer invading the bladder. The involved portion of the urethra was resected and an end-to-end anastomosis was made. The patient has been able to urinate per urethram and has remained free of recurrence for 7 years after the urethral resection.

Thrombolytic therapy for traumatic unilateral renal artery thrombosis.

Abstract  We report a case of traumatic unilateral renal artery thrombosis that was successfully treated by thrombolytic therapy. The patient was a 17‐year‐old woman, who had put her left upper abdomen between a wall and the handle of a ground roller when using it. A computed tomography scan with intravenous contrast showed a lack of contrast in the left kidney. Angiography showed complete occlusion of the left renal artery, and the diagnosis was traumatic left renal artery thrombosis. Following angiography, thrombolytic therapy was performed. Urokinase was administered into the left renal artery, and 360 000 units per 1.5 h was required. Thrombus disappeared and flow of left renal artery was observed. Recovery of left renal function was seen on renoscintigraphy. Surgical maneuvers for traumatic renal artery thrombosis are autotransplantation or thrombectomy generally, but we think that thrombolytic therapy following angiography is a less invasive method and saves warm ischemic time.

Permanent prostate brachytherapy for Japanese men: Results from initial 100 patients with prostate cancer

Objective:  To evaluate the initial results of brachytherapy for prostate cancer with permanent iodine‐125 implant in Japan.

Tuberculous rectourethral fistula

A rare case of tuberculous rectourethral fistula is reported. The fistula developed as a sequel of prostatic tuberculosis and was successfully repaired by the method of omental interposition.

Loss of BAP1 protein expression in the first metastatic site predicts prognosis in patients with clear cell renal cell carcinoma

OBJECTIVES To investigate the intratumoral heterogeneity of BAP1 and PBRM1 expression at the primary site and metastatic sites and to evaluate whether BAP1 and PBRM1 expression in metastatic sites of clear cell renal cell carcinoma (ccRCC) has prognostic value. METHODS AND MATERIALS We collected paired samples from the primary site and the first metastatic site in 41 patients with ccRCC. Immunohistochemistry analyses were performed for the expression of BAP1 and PBRM1 proteins. We retrospectively analyzed the associations between the expression of BAP1 and PBRM1 and overall survival (OS). RESULTS The most common first metastatic sites were lung (68.3%) and lymph node (12.2%). BAP1 protein expression was negative in 8 (19.5%) primary sites and in 11 (26.8%) metastatic sites. PBRM1 protein expression was negative in 9 (22.0%) primary sites and in 11 (26.8%) metastatic sites. The incidences of intratumoral heterogeneity for BAP1 and PBRM1 protein expression in primary/metastatic sites were 9.8%/2.4% and 24.4%/7.3%, respectively. The concordance rates between primary and metastatic sites for BAP1 and PBRM1 protein expression were 82.9% and 63.4%, respectively. Median OS from the first occurrence of metastasis in patients with BAP1-positive and BAP1-negative metastatic sites were 97 months (95% CI: 58-136) and 51 months (95% CI: 13-82), respectively (P = 0.0077). Median OS in patients with PBRM1-positive and PBRM1-negative metastatic sites were 82 (95% CI: 42-97) and 120 (95% CI: 52-120) months, respectively (P = 0.25). CONCLUSION Intratumoral heterogeneity of BAP1 protein expression is more frequent in primary tumor than in metastatic sites. The loss of BAP1 protein expression in metastatic sites predicts poor prognosis in patients with ccRCC.

Induction of cytotoxicity of the renal hilar lymph nodes by pedal subcutaneous administration of interleukin-2 in patients with renal cancer

The authors attempted to increase the cytotoxicity of the renal hilar lymph nodes in ten patients with renal cell carcinoma by administration of recombinant interleukin‐2 (IL‐2) into the subcutaneous tissue of the instep. A total of 5000 to 21,000 units was given over 3 to 12 preoperative days. Mononuclear cells separated from the lymph nodes excised from the renal hilum at surgery served as the effector cells. Fresh autologous tumor cells and three cultured cell lines, K562, Raji, and ACHN, served as the target cells. Cytotoxicity was measured by a chromium‐releasing assay. The results showed that the mononuclear cells from the lymph nodes of the patients given IL‐2 became cytotoxic to all target cells. Surface markers of lymphocytes in the lymph nodes were unchanged. Peripheral blood lymphocytes showed increased cytotoxicity only against Raji cells. Adverse effects were mild or moderate and included local redness, high fever, liver dysfunction, and toxic erythema.

Phenotypical change of tumor-associated macrophages in metastatic lesions of clear cell renal cell carcinoma

Macrophages are the main immune cells of the tumor microenvironment in clear cell renal cell carcinoma (ccRCC). A high density of CD163+ or CD204+ tumor-associated macrophages (TAMs), rather than the density of total TAMs, is known to be linked to poor clinical outcome. In the present study, we investigated the phenotypical differences between the paired primary and metastatic lesions in ccRCC cases. Using immunostaining, the densities of CD163+ and CD204+ TAMs in metastatic lesions were found to be significantly lower compared to primary lesions, although the total number of TAMs was increased in metastatic lesions. Since CD163 and CD204 are considered to be the markers of an M2/protumor phenotype in macrophages, TAMs in metastatic lesions are suggested to have a greater M1/inflammatory function compared with those from primary lesions. These findings give new insights in regard to the immunological status of metastatic lesions of ccRCC.

Effect of Lymphadenectomy During Radical Nephroureterectomy in Locally Advanced Upper Tract Urothelial Carcinoma

Micro‐Abstract The role of lymph node dissection (LND) for upper tract urothelial carcinoma (UTUC) patients remains controversial. We investigated the effect of LND on clinical outcomes during radical nephroureterectomy. In the ≥pT3 subgroup, disease‐free survival and cancer‐specific survival times were significantly prolonged in the pN0 group. LND for patients with locally advanced UTUC might improve disease prognosis. Background: The role of lymph node dissection (LND) for upper tract urothelial carcinoma (UTUC) patients remains controversial. The aim of this study was to evaluate the effect of LND on clinical outcomes during radical nephroureterectomy (RNU) and to determine prognostic factors of survival. Patients and Methods: From 1985 to 2013, 404 patients with UTUC underwent RNU; 5 patients who received neoadjuvant chemotherapy were excluded. Among them, 182 (46%) were pathologically negative for lymph node metastasis (pN0), 177 (44%) were non‐LND (pNx), and 40 (10%) were positive for lymph nodes metastasis (pN1/2). Results: The 5‐year disease‐free survival (DFS) and cancer‐specific survival (CSS) rate were higher in pN0 patients than in pNx patients and in pN1/2 patients. According to multivariate analysis, non‐LND was an independent predictive factor of DFS (hazard ratio [HR], 1.91; P = .004) and CSS (HR, 2.28; P = .003). In the subgroup with muscle‐invasive UTUC, the 5‐year DFS and CSS rates were higher in pN0 patients than in pNx patients. However, there was no statistical difference between pN0 and pNx groups in terms of DFS and CSS in the pT2 cases. DFS and CSS times were significantly prolonged in the pN0 group in the locally advanced UTUC patients (≥pT3). Conclusion: In the ≥pT3 subgroup, the 5‐year DFS and CSS were significantly prolonged in the pN0 group, but there were no statistical differences between pN0 and pNx groups in terms of DFS and CSS in the pT2 subgroup. LND for patients with locally advanced UTUC might improve disease prognosis.

The loss of BAP1 protein expression predicts poor prognosis in patients with nonmetastatic clear cell renal cell carcinoma with inferior vena cava tumor thrombosis

OBJECTIVES Renal cell carcinoma (RCC) is characterized by a propensity for extension into the renal vein and inferior vena cava (IVC) and is associated with poor prognosis. BAP1 mutation, which occurs in about 15% of patients with clear cell RCC (ccRCC), also predicts poor prognosis. The aim of this study was to elucidate the association between BAP1 protein expression and clinicopathological outcomes in patients with nonmetastatic ccRCC with an IVC tumor thrombus (IVCTT). MATERIAL AND METHODS Thirty-five patients with nonmetastatic ccRCC with an IVCTT who underwent radical nephrectomy and tumor thrombectomy at our institution from 1999 to 2010 were retrospectively evaluated. Immunohistochemical (IHC) analyses were performed for the expression of BAP1 protein, and the associations between the expression of BAP1 and clinical outcomes were assessed. Survival analyses were performed using the Kaplan-Meier method and log-rank test. Multivariate analyses of the associations between disease-free survival (DFS) and clinical variables including BAP1 protein expression, tumor size, Karnofsky performance status (KPS) score, and the extension level of the tumor thrombus were performed using a Cox proportional hazard model. RESULTS The median follow-up time was 58.8 months (range: 2-130 months). The median age was 68 years (range: 37-80 years). The median size of the primary tumor was 9.6cm (range: 3.0-15.0cm). The IVCTT extended above and below the diaphragm in 10 (28.6%) and 25 (71.4%) patients, respectively. The KPS score was>80 in 23 patients (65.7%). BAP1 protein expression on IHC was positive in 24 cases (68.8%) and negative in 11 cases (31.2%). The median overall survival in cases with BAP1-negative and -positive tumor on IHC staining were 44.7 and 81.5 months, respectively (P = 0.052). BAP1-negative tumor on IHC staining was associated with a significantly shorter DFS than BAP1-positive tumor (median DFS = 10.0 vs. 26.0 months, respectively; P = 0.011). Multivariate analysis showed that only BAP1-negative tumor on IHC staining was significantly associated with shorter DFS (P = 0.004). CONCLUSIONS Patients whose tumors had loss of BAP1 protein expression were significantly associated with poor prognosis in patients with ccRCC with an IVCTT who underwent radical nephrectomy and tumor thrombectomy.

Effect of tadalafil add-on therapy in patients with persistant storage symptoms refractory to α1-adrenoceptor antagonist monotherapy for benign prostatic hyperplasia: A randomized pilot trial comparing tadalafil and solifenacin

The aim of this study was to investigate the efficacy and safety of tadalafil add‐on therapy with α1‐adrenoceptor antagonists.