Yoshiaki Kinebuchi

Autologous bone‐marrow‐derived mesenchymal stem cell transplantation into injured rat urethral sphincter

Objectives:  To evaluate the functional and histological recovery by autologous bone‐marrow‐derived mesenchymal stem cell (BMSC) transplantation into injured rat urethral sphincters.

Implanted mouse bone marrow-derived cells reconstruct layered smooth muscle structures in injured urinary bladders.

This study is a preliminary investigation to determine if bone marrow-derived cells, when implanted into freeze-injured urinary bladders, differentiate into smooth muscle cells and reconstruct smooth muscle layers. Bone marrow cells were harvested from femurs of male ICR mice and cultured in collagen-coated dishes for 7 days. After 5 days of culture, the cells were transfected with green fluorescent protein (GFP) genes for identification in recipient tissues. Three days prior to implantation, the posterior urinary bladder walls of female nude mice were injured with an iron bar refrigerated by dry ice. Seven days after the culture and 3 days after the injury, adherent, proliferating GFP-labeled bone marrow-derived cells (1.0 × 105 cells) were implanted into the injured regions. For controls, a cell-free solution was injected. At 14 days after implantation, the experimental urinary bladders were analyzed by histological, gene expression, and cystometric investigations. Just prior to implantation, the injured regions did not have any smooth muscle layers. After 14 days, the implanted cells surviving in the recipient tissues were detected with GFP antibody. The implanted regions had distinct smooth muscle layers composed of regenerated smooth muscle marker-positive cells. The implanted GFP-labeled cells differentiated into smooth muscle cells that formed into layers. The differentiated cells contacted each other within the implanted region as well as smooth muscle cells of the host. As a result, the reconstructed smooth muscle layers were integrated into the host tissues. Control mice injected with cell-free solution developed only few smooth muscle cells and no layers. Cystometric investigations showed that mice with implanted the cells developed bladder contractions similar to normal mice, whereas control mice did not. In summary, mouse bone marrow-derived cells can reconstruct layered smooth muscle structures in injured bladders to remediate urinary dysfunction.

Prostate-specific antigen, Gleason sum and clinical T stage for predicting the need for radionuclide bone scan for prostate cancer patients in Japan.

Abstract

Recurrent retroperitoneal malignant nerve sheath tumor associated with neurofibromatosis type 1 responding to carboplatin and etoposide combined chemotherapy

A 25-year-old man was referred to our hospital with left flank pain, and computed tomography (CT) and magnetic resonance imaging (MRI) revealed large retroperitoneal masses. Physical examination revealed many café-au-lait spots and superficial neurofibromas, and a diagnosis of neurofibromatosis type 1 (von Recklinghausens disease) was made. The tumor was resected, and the pathological diagnosis was malignant peripheral nerve sheath tumor (MPNST). Six months after the operation, lung metastases were detected. Surgical resection was incomplete, as there were too many lesions. He received four courses of chemotherapy with carboplatin and etoposide, and the metastatic lung lesions were markedly decreased. After chemotherapy, complete resection of the remaining lung lesions was performed, and there has been no recurrence to date.

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.

Relapsed prostate cancer with neuroendocrine differentiation and high serum levels of carcinoembryonic antigen without elevation of prostrate-specific antigen : A case report

Abstract:  A 62‐year‐old man had been treated with combined androgen blockade due to cT2bN1M0 prostate cancer, and his serum prostate‐specific antigen (PSA) levels decreased and remained under the level of 0.5 ng/mL during therapy. Approximately 40 months after the initial therapy, difficulty on urination and constipation developed gradually, and serum carcinoembryonic antigen (CEA) and pro‐gastrin‐releasing peptide (ProGRP) levels were high at this point. He underwent transrectal and transurethral biopsy of the prostate, which revealed adenocarcinoma positive for CEA and chromogranin A. He received palliative pelvic irradiation, and oral estramustine phosphate and etoposide combined therapy. Tumor markers decreased and clinical symptoms improved for several months. The patient died of encephalopathy of unknown etiology approximately 11 months after the relapse.

Testicular cancer with tumor thrombus extending to the inferior vena cava successfully removed using veno-venous bypass : A case report

Abstract:  A 33‐year‐old man with a left testicular tumor was referred to Shinshu University Hospital for advanced therapy. Radiographic imaging revealed multiple metastases in the retroperitoneal lymph nodes (RPLN) and bilateral lungs, as well as tumor thrombus that extended from the left renal vein to the inferior vena cava (IVC) adjacent to the right atrium. After orchidectomy, a diagnosis of embryonal carcinoma was made with a clinical stage of T1N2M1bS3, which has a poor prognosis, based on the International Germ Cell Cancer Collaborative Group consensus. After eight courses of chemotherapy, the patients tumor markers normalized and the lung metastases disappeared, but the RPLN and tumor thrombus remained. Retroperitoneal lymph node dissection and thrombectomy were performed using a veno‐venous bypass (VVB). The pathological examination of the thrombus revealed a mature teratoma. The patient has been disease‐free since surgery.

Rat Bladders Augmented with a Novel Bovine Pericardium-Derived Biomaterial Reconstruct Functional Tissue Structures

Objectives: To determine if rat bladders augmented with an acellular Japanese bovine pericardium‐derived biomaterial (CardioDISC [CD]) could support bladder reconstruction, and increase bladder volume and compliance.

Resection of local recurrence of renal cell carcinoma in a hemodialysis patient 6 years after radical nephrectomy

Abstract  Left radical nephrectomy was performed on a 39‐year‐old‐man because of renal cell carcinoma (grade 1, clear cell and granular cell carcinoma: pT3b pN0 pM0), 6 years after the beginning of hemodialysis. The second surgical intervention for local recurrence was performed 6 years after the first operation (grade 2 > 3, clear cell and granular cell carcinoma).

Adrenal cavernous hemangioma associated with myelolipomatous metaplasia

cancer tissues play important roles in cancer cell survival and tumor growth though supply of oxygen and nutrition. In addition, such neovasculature can also enable cancer cell dissemination from the primary tumor to distant organs. Therefore, it is possible that evaluation of angiogenesis in the primary tumor mass is a useful marker for diagnosis of disease stage, metastasis and outcome in patients with solid tumors. However, it is still unclear whether existing evaluation methods for cancer tissues can exactly reflect the status and pathological roles of angiogenesis. In a previous review, we emphasized that the pathological significance and prognostic value of MVD in patients with prostate cancer is unclear because of differences in methodology, including antibodies used, counting method and selection of area. Conversely, Taverna et al. showed the influence of the structural diversity of the cancer-related vasculature on the evaluation of the significance and role of angiogenesis in cancer tissues. Briefly, neovasculatures in cancer tissues show diversity in vessel sizes, shapes and connecting patterns, because they have complex forms of branched anatomical structure. Additionally, the process of angiogenesis comprises various steps, such as proliferation, migration and tube formation. Therefore, they suggested surface fractal dimension, as a numerical index of the 2-D geometrical complexity of tumor vascular networks, to enable evaluation in the quantitative method. This parameter depends on the number of vessels and pattern of distribution. In recent years, they have reported that 2-D geometrical complexity in non-tumoral prostate tissues is significantly higher than that in low-risk prostate cancer. This finding is worthy of attention to discuss the appropriate method in evaluation of angiogenic status in tissues. However, although they established the quantitative evaluation by using anti-CD31 antibody in 2005, the relationships between vascular surface fractal dimension and clinicopathological features in prostate cancer tissues were analyzed by using anti-CD34 antibody. We previously reported that anti-CD31 and anti-CD34 have different characteristics to reflect the angiogenic status in human tissues of cancers, including prostate cancer. Thus, even if new evaluation tools are developed, the uniformity of methods to detect cancer-related neovascularity is a problem that we still have to face. We agree with the opinion that it is still unclear which method most accurately reflects the pathological roles and clinical significance of angiogenesis in patients with prostate cancer. In addition, another open question is regarding the standardization of measuring method. Regardless of the numerous investigators who have reported on the relationships between MVD and clinicopathological features, tumor progression, and survival cancers, there is no study wherein MVD is used as a criterion for selection of enrolled patients, and strategies of observation and treatment in clinical trials. As we pointed out in the previous review, it is difficult to decide on a single antibody for detection of “cancer-specific” endothelial cells, because they have marked diversity depending on the malignant potential of cancer cells, stage and surrounding conditions. Furthermore, newer molecules and factors are being developed even now. We believe that constant investigations and more detailed analyses by using new technology are essential to obtain unbiased and versatile results on the pathological significance and prognostic role of angiogenic status in cancer patients.