Yasushi Umezaki

Risk factors associated with abnormal glucose tolerance in the early postpartum period among Japanese women with gestational diabetes

To identify the risk factors associated with abnormal glucose tolerance (AGT) on the first postpartum oral glucose tolerance test (OGTT) among Japanese women with gestational diabetes (GDM).

De novo papillary renal cell carcinoma in an allograft kidney: Evidence of donor origin

To the Editor: An increased incidence of primary malignancies has been recognized in transplant recipients. Renal cell carcinomas (RCC) represent 4.6% of all malignancies in renal transplant recipients, whereas RCC constitutes 2% of all cancers in the general population. According to the Cincinnati Transplant Tumor Registry, there are fewer instances of RCC that develop in the allograft kidneys (up to 10%), while nearly 90% of RCC in renal transplant recipients have been found in native kidneys. De novo RCC has been described as the opposite of pre-existing tumors before transplantation. Pathological characteristics of de novo RCC occurring in the allograft kidney have not been well described. Furthermore, genetic studies to determine the tumor origin, whether from the donor or the recipient, have been performed in only a few reported RCC cases, although it is clinically important considering the association of tumor transmission. We report a case of de novo papillary RCC developing in an allograft kidney diagnosed 13 years after renal transplantation, and which was genetically confirmed to be of donor origin. A 49-year-old Japanese male presented with end-stage renal disease secondary to chronic glomerulonephritis of unknown etiology when he was at the age of 25. The patient had no family history of renal disease. After 5 years of hemodialysis, he underwent renal transplantation at the age of 29 from a deceased donor. The donor was a 37-year-old Japanese male who died of cerebral hemorrhage. The donor had no significant medical illness in his family history or past history according to medical records. Immunosuppressive therapy was maintained with methylprednisolone, cyclosporine and mizoribine. The patient presented with an episode of chronic rejection that successfully treated by steroids 7 years after transplantation. At that point, ultrasonography showed no evidence of a solid or cystic lesion in the allograft kidney. Graft function had been stable with serum creatine level of 1.1 to 1.3 mg/dL, although the patient exhibited 30 mg/dL of proteinuria on rare occasions. However, 13 years after transplantation, ultrasonography revealed a 2.3 cm solitary cystic lesion in the lower pole of the allograft kidney. During the following 7 years, the cyst had increased in size to 4.0 cm with slight blood flow inside, which led to suspicion of malignancy. There was no other cystic lesion in the allograft kidney or native kidneys. An extensive workup ruled out any primary or metastatic lesion. The patient underwent a partial nephrectomy of the allograft kidney in 2010, 20 years after transplantation. No recurrence has been found on most recent evaluation. Graft function has resumed and the patient has maintained dialysis-free status. The contralateral kidney of this particular donor, which had been transplanted to a Japanese female and resected 12 years after transplantation due to chronic rejection, presented no solid or cystic lesion. In the resected specimen, a well-circumscribed tumor was located in the renal cortex. The tumor measured 4.0 ¥ 3.5 ¥ 3.5 cm in size. The cut surface was solid and yellowish-white with tiny hemorrhages. No necrosis was noted. Histologically, a unilocular cyst was densely filled with small cuboidal cells with scanty basophilic cytoplasm. The cuboidal cells also lined the cyst wall (Fig. 1a). The tumor cells formed papillae and tubules, arranged in a single layer on the basement membrane. The nuclei were small, uniform and had hyperchromatic chromatin with a finely granular pattern. The papillary cores frequently contained aggregates of foamy macrophages and hemosiderin laden macrophages. Kidney parenchyma around the tumor showed mild interstitial fibrosis and slight tubular atrophy. Formalin-fixed paraffinembedded tissue sections were immunohistochemically stained. The antibodies used were vimentin (DAKO, Glostrup, Denmark, monoclonal, clone V9, dilution 1:100), high molecular weight cytokeratin (DAKO, monoclonal, clone 34bE12, dilution 1:100), cytokeratin 7 (DAKO, monoclonal, clone OV-TL12/30, dilution 1:100), CD10 (DAKO, monoclonal, clone SS2/36, dilution 1:100), and alpha-methylacylcoenzyme A racemase (AMACR) (DAKO, monoclonal, clone 13H4, dilution 1:100). Prostate tissue and the allograft kidney parenchyma around the tumor were used as positive control. The tumor cells were positive for vimentin, cytokeratin 7 (Fig. 1b), CD10 and AMACR, but negative for high molecular weight cytokeratin (Fig. 1c). Pathological diagnosis was papillary RCC type 1, Fuhrman’s nuclear grade 2, and stage pT1aN0M0. Comparative microsatellite analysis was performed to detect tumor origin according to a previously described method. Recipient peripheral blood and paraffinembedded tissue from the tumor and the allograft kidney parenchyma (donor tissue) were used. In total, 15 short tandem repeat (STR) markers were compared for microsatellite analysis. All of the analyzed STR markers were detected and the predominant DNA patterns of the tumor matched those of the donor, confirming that the tumor was of donor origin (Fig. 1d). The present case provides some insights into the nature of de novo RCC developing in an allograft kidney. First, the present case of RCC was confirmed to be of donor origin by microsatellite analysis on genomic DNA. It is of clinical Pathology International 2011; 61: 694–696 doi:10.1111/j.1440-1827.2011.02714.x

Influence of the interval between antenatal corticosteroid therapy and delivery on respiratory distress syndrome

In spite of the recommendation for rescue antenatal corticosteroids (ACS), the optimal time interval between primary and rescue courses has not been clearly demonstrated. The aim of this study was to determine the effects of the interval between a single ACS course and delivery on the incidence of respiratory distress syndrome (RDS).

Factors associated with patients with gestational diabetes in Japan being at increased risk of requiring intensive care

To investigate factors associated with high‐risk gestational diabetes (GDM) among patients with GDM.

Low Expression of S100P Is Associated With Poor Prognosis in Patients With Clear Cell Adenocarcinoma of the Ovary.

Objective The S100P protein stimulates cell proliferation and survival, thereby contributing to cancer progression. The purposes of this study were to evaluate S100P expression in ovarian clear cell adenocarcinoma and to determine whether S100P expression was correlated with the clinicopathological features or prognoses of patients with clear cell adenocarcinoma. Methods We examined S100P expression in 30 ovarian clear cell adenocarcinoma specimens using immunohistochemistry analysis. The Kaplan-Meier method was used for analysis of overall survival, and comparisons were made based on the log-rank test. Results Negative staining for nuclear S100P was associated with a poor prognosis as compared with that of positive staining for nuclear S100P in specimens from patients with clear cell adenocarcinoma. Conclusions These data suggested that S100P may serve as an independent prognostic factor and marker for acquired resistance to chemotherapeutic drugs in clear cell adenocarcinoma.