Yoshiharu Hiratsuka

Renal Primitive Neuroectodermal Tumor: A Morphologic, Cytogenetic, and Molecular Analysis with the Establishment of Two Cultured Cell Lines

We report two patients with renal primitive neuroectodermal tumor (PNET) in whom the diagnosis was established by both a cytogenetic and a molecular analysis. Histologically, both renal tumors were composed of uniform immature round cells with a positive immunoreactivity for 013 (p30/32 MIC2). The cytogenetic analysis with in situ hybridization (chromosome painting) demonstrated reciprocal translocation t(11;22)(q24;q12) specific to PNET in the cultured cells derived from each tumor. The reverse transcriptase-polymerase chain reaction (RT-PCR) in both tumors demonstrated EWS/ FLI-1 fusion transcripts, representing the molecular equivalent of t(11; 22). A Southern blot analysis also confirmed EWS gene rearrangement in both renal tumors. In addition, the authors also established two new cell lines (designated as FU-RPNT-1 and FU-RPNT-2) from renal PNETs. When transplanted into athymic mice, FU-RPNT-1 and FU-RPNT-2 reproduced and maintained the morphologic and molecular characteristics of the original tumors. In conclusion, the detection of t(11; 22) and EWS/FLI-1 fusion transcripts is considered to provide a novel adjunctive method for diagnosing renal PNET. These newly established cell lines thus may be used to investigate the biologic behavior related to renal PNETs.

Solitary psoas muscle metastasis after radical nephrectomy for renal cell carcinoma

Abstract Skeletal muscle is a very rare location for the metastasis of renal cell carcinoma (RCC) and only one case of solitary metastasis to the psoas muscle has been reported. We present a 63‐year‐old male patient with late recurrence (14 years) after left side radical nephrectomy for RCC. He first visited Chikushi Hospital, Fukuoka University, Japan in January 2000 for a postoperative follow‐up because he had shifted residence to the area. Follow‐up was by abdominal computed tomography (CT) and chest X‐ray. In December 2001, a CT scan showed a 1.5 cm enhanced mass in the right psoas muscle without any other metastasis. The mass was resected that month and histological study showed RCC metastasis.

Renal Angiosarcoma: A Case Report

We report the first case of angiosarcoma in the kidney occurring in a woman; the tumor was initially believed to be renal cell carcinoma. This malignant tumor was discovered in a patient with macrohematuria. The final diagnosis was confirmed by histologic and immunohistochemical findings. A review of the literature on this tumor is also included in the discussion.

Postoperative UFT Adjuvant and the Risk Factors for Recurrence in Renal Cell Carcinoma: A Long-Term Follow-Up Study

Background Radical nephrectomy is the standard therapy for low‐stage renal cell carcinoma. However, recurrence sometimes develops even in patients who are considered to have undergone a curative resection of the primary tumor. The purpose of this study was to evaluate the usefulness of UFT (a 1: 4 mixture of tegafur and uracil) adjuvant and the risk factors for recurrence in renal cell carcinoma.

The influence of oxygen free radical scavengers on the reduction of membrane-bound Na+-K+-ATPase activity induced by Ischemia/reperfusion injury in the canine kidney

The present study was designed to determine whether the administration of free radical scavengers, superoxide dismutase (SOD), catalase or dimethylsulfoxide (DMSO) is able to ameliorate ischemia/reperfusion injury in the canine kidney and also ascertain whether or not a relationship exists between oxygen free radicals and membrane-bound Na(+)-K(+)-ATPase activity. In 23 dogs, the vascular pedicle of the left kidney was clamped for 75 min at room temperature. The experimental animals received free radical scavengers for 30 min starting at 2 min prior to reperfusion. Renal tissue specimens were enzyme-histochemically examined regarding the activity of membrane-bound Na(+)-K(+)-ATPase, and a marked reduction just before reperfusion was revealed. The SOD- and the DMSO-treated groups showed a marked recovery of the membrane-bound Na(+)-K(+)-ATPase activity; however, the untreated and the catalase-treated groups still demonstrated a marked reduction 1 day after reperfusion. At the same time, widespread acute tubular necrosis in the cortex was observed in the untreated and catalase groups in comparison with the SOD and the DMSO groups. In addition, the SOD and the DMSO groups significantly preserved better renal function. Based on these findings, it was thus concluded that free radical scavengers ameliorate the recovery of depressed membrane-bound Na(+)-K(+)-ATPase activity and ischemia/reperfusion injury in the canine kidney.

Catheterless Cutaneous Ureterostomy

New procedures for tubeless cutaneous ureterostomy are described. The fundamental principles of the methods are 1) an everted ureteral nipple formation combined with a triangular skin flap as a permanent stoma and 2) a 2-stage operation to obtain a viable ureteral nipple against slough and retraction.

URINARY LEVELS OF NUCLEAR MATRIX PROTEIN 22 IN PATIENTS WITH URINARY DIVERSION

OBJECTIVES To evaluate the influence of various types of urinary diversion on urinary nuclear matrix protein 22 (U-NMP22) levels. METHODS U-NMP22 values were determined for 38 urinary diversion patients without upper urinary tract cancer. The patients were divided into three groups: tubeless cutaneous ureterostomy (n = 12), ileal conduit (n = 15), and continent urinary reservoir (n = 11). The mean values and false-positive rates of U-NMP22 (cutoff value 12 U/mL) were compared among the three groups. RESULTS The mean +/- standard error U-NMP22 value for the ureterostomy, ileal conduit, and reservoir groups was 20.1 +/- 5.8 U/mL, 335.6 +/- 63.5 U/mL, and 671.8 +/- 220.4 U/mL, respectively (P = 0.0030). The false-positive rate of U-NMP22 for the ureterostomy, ileal conduit, and reservoir groups was 41.7%, 100%, and 100%, respectively. In the ureterostomy group, the exclusion of patients with pyuria improved the false-positive rate of U-NMP22 from 41.7% to 12.5%. CONCLUSIONS U-NMP22 levels may be useful in the diagnosis of upper urinary tract cancer in patients with a tubeless cutaneous ureterostomy. However, in patients with urinary diversion using a bowel segment, U-NMP22 has no diagnostic value because of the high U-NMP22 levels.

Chronic Incomplete Obstruction of the Ureter: A New Experimental Model

To produce a chronic moderate hydronephrosis in dog, a method of partial ureteral occlusion using a specially designed polypropylene obturator was developed. In 11 of 14 dogs undergoing this procedure, excretory urography constantly revealed a moderate degree of hydronephrosis persisting for 7 weeks. Combination of this method in one ureter with the vaginal-cuff cutaneous ureterostomy, previously reported, in the contralateral ureter is a useful model for split renal function study of unilateral chronic hydronephrosis or obstructive nephropathy analogous to that of clinical case.

Subcutaneous penectomy and phalloplasty using a testicle for invasive urethral carcinoma.

Invasive bulbomembranous urethral carcinoma appears highly aggressive and requires radical local excision to cure. The standard surgical therapy for this tumor includes en bloc resection of the penis, urethra, scrotum and pubic bone with radical cystoprostatectomy.1 However, recently it has become increasingly important to also consider quality of life.2,3 We report on a patient with invasive bulbous urethral carcinoma, who has been satisfied 5 years after surgery with the surgical and cosmetic results of the methods used for penis and bladder preservation.

Anticoagulant induced submucosal hemorrhage mimicking a renal pelvic tumor

A 73-year-old woman presented with gross hematuria and slight lumbago in June 1998. She had been on oral warfarin potassium for 4 years because of a permanent pacemaker implantation for the sick sinus syndrome. IVP revealed irregular right caliceal and pelvic defects, and narrowing of the infundibula. The left kidney was slightly hydronephrotic due to ureteropelvic junction stenosis. Abdominal computerized tomography (CT) showed thickening of the bilateral renal pelvic wall and the vestibule in the stomach with a slight homogeneous enhancement, which was considered suspiciously similar to bilateral renal pelvic and gastric tumors, or a malignant lymphoma (part A of figure). However, photogastroscopy did not reveal a stomach tumor. Repeat abdominal CT failed to show bilateral renal pelvic or gastric tumor. However, a hematoma was evident between the left gluteus medius and gluteus minimus (part B of figure). A thrombotest revealed less than 10% of normal value (normal during therapy 10% to 20%). We concluded that bilateral renal pelvic wall thickening was allowing hemorrhaging into the submucosa.