Expression level of integrin alpha 5 on tumour cells affects the rate of metastasis to the kidney.

Tumour metastasis is known clinically to have organ specificity. We hypothesised that integrins might be involved in determining the organ specificity of tumour metastasis. Here, we report the results of spontaneous metastasis tested in nude mice that were inoculated with Chinese hamster ovary (CHO) cells expressing integrin alpha 5 beta 1 at various levels. The growth of the primary tumour inversely correlated with the alpha 5 expression level on CHO cells, which is consistent with a previous report (Schreiner et al, 1991). The rates of pulmonary, lymph node, and adrenal metastases that developed in nude mice were not related to changes of the alpha 5 expression level on CHO cells. Kidney metastasis developed in 40% of nude mice inoculated with alpha 5B2 cells (CHO cells overexpressing alpha 5) and in 20% of mice with CHO-K1 cells (CHO cells expressing native alpha 5), whereas inoculation with CHO-B2 cells (alpha 5-defective mutants) and alpha 5CHO cells with the highest expression of alpha 5 did not lead to development of kidney metastasis. Furthermore, alpha 5CHO, which shows the slowest growth of these cell types, did not lead to primary tumours in nude mice. These findings suggest that there is an appropriate level of alpha 5 expression on tumour cells that leads to metastasis. Microscopic observations revealed that micrometastasis in the kidney was formed in glomeruli. An adhesion assay using frozen sections of the kidney demonstrated that alpha 5B2 cells, but not CHO-B2 cells, effectively adhered to glomeruli. Kidney metastasis in vivo and the adhesion of alpha 5B2 to glomeruli shown ex vivo were significantly suppressed by the administration of GRGDS peptide. Finally, we conclude that the interaction of alpha 5 beta 1 on tumour cells with fibronectin in kidney glomeruli is involved in kidney metastasis and that the tumour has appropriate levels of integrins crucial for metastasis.

Retroperitoneoscopic ureterolithotomy for impacted ureteral stone.

Retroperitoneoscopic ureterolithotomy was successfully performed in two patients with impacted upper ureteral stone. The retroperitoneal space was extended using a balloon dissector and four ports were established into the retroperitoneal space according to Gaur's procedure (1993). The impacted ureteral stone was removed after the ureter was incised using a hook electrode. An indwelling splint or stent was placed in the ureter. The incised ureter was not sutured and an indwelling drain was placed in the retroperitoneal space. Urine leakage ceased within 3 days postoperatively. With regard to complications, the first patient developed wound infection caused by methicillin-resistant Staphylococcus aureus and the second patient had abscess formation in the psoas muscle. Retroperitoneoscopic ureterolithotomy should be useful as an alternative treatment for impacted ureteral stones because it involves minimal postoperative pain.

Squamous cell carcinoma of the renal pelvis with inferior vena caval extension.

BACKGROUND: We report here on a third case of squamous cell carcinoma (SCC) of the renal pelvis extending to the inferior vena cava. METHODS/RESULTS: A 48-year-old man was diagnosed with an advanced left renal pelvic tumor on computed tomography. He had undergone extracorporeal shock wave lithotripsy for left staghorn calculi 10 years ago. An inferior vena cavagram showed tumor thrombus extending to the inferior vena cava. Percutaneous left renal biopsy revealed SCC. The patient received three courses of combination chemotherapy with cisplatin, bleomycin and etoposide. However, 1 month after the last course of chemotherapy, he died of cancer progress. CONCLUSION: This is the third case of SCC of the renal pelvis extending to the inferior vena cava in the world.

[A case of patent urachus in an adult male].

A 31-year-old man was referred to our hospital for evaluation of urachal rest. The history of his present illness dated back to birth, when the umbilicus was projected and urinary discharge was noted. At that time, the symptom of discharge had spontaneously subsided. At the age of 22, however, the patient again experienced discharge from the umbilicus. Although he did not seek treatment, after six years this symptom disappeared. Around this time, however, pyuria was revealed during medical examination, and abdominal ultrasonography (US) suggested the presence of urachal rest. At the time of hospitalization, physical examination revealed that the patient's right testis was not palpable. He was diagnosed with patent urachus with hemilateral aplasia and monorchism by US, computed tomography, magnetic resonance imaging and cystoscopy. The patient subsequently underwent radical operation. Patent urachus in adults is very rare, and only a few cases have been reported. To our knowledge, only one previously reported case involved a recurrence after spontaneous healing. Further, this is the first report of a patient with patent urachus with hemilateral aplasia and monorchism. Radical operation is generally recommended, based on the fact that very few cases heal conservatively.

[Screening of urogenital malignancies by transabdominal ultrasonography in "human dry dock"].

BACKGROUND: Transabdominal ultrasonography (US) has been widely accepted as a diagnostic method with which to examine multiple organs simultaneously. This study was designed to evaluate the efficacy of trans-abdominal US to screen for urogenital malignancies. METHODS: From 1993 through 1997 109,077 men and 28,023 women underwent abdominal US to screen for abdominal and pelvic diseases as part of a regular health check-up program at the Tokyu Medical Health Center. RESULTS: Twelve renal cell cancers (RCCs), 7 bladder tumors (BTs), 4 prostatic cancers (PCs), and 1 testicular tumor (TT) were detected. All cancers were diagnosed pathologically and treated surgically except for one PC. Surgical pathological examination and conventional imaging revealed that all 12 RCCa and 6 of the 7 BTs were of less advanced stage than pT1N0M0. However, all 3 PCs and the TT were pT3N0-1M0 and pT1N3M0, respectively. The stage and grade of these 12 RCCs were significantly lower than those of 29 symptomatic RCCs. All 12 patients with RCC patients and 6 of the 7 patients with BT had no urological symptom, whereas 3 of the 4 patients with PC and the patient with TT had urogenital symptoms. Microscopic examination of the urine revealed both red blood cells and tumors cells in two of the seven patients with BT. All four patients with PC had serum levels of prostatic-specific antigen greater than 4 ng/ml. CONCLUSION: These results indicate that screening by transabdominal US as part of regular health check-ups can detect many types of urogenital malignancy. In particular, US is useful for detecting low-grade and low-stage RCCs and superficial BTs but is less sensitive for early-stage PCs and TTs.

[High-dose chemotherapy with autologous peripheral blood stem cell transfusion in the treatment of advanced testis cancer].

Four patients with advanced testis cancer were treated by high-dose chemotherapy supporting by autologous peripheral blood stem cell transplantation. High-dose chemotherapy (carboplatin 250 mg/m2 or nedaplatin 200 mg/m2, etoposide 1,500 mg/m2, ifosphamide 7.5 g/m2 was given and peripheral blood stem cell transfusion was performed 72 hours after the last dose of chemotherapy. High-dose chemotherapy. was given followed by 1 or 2 cycles of pre high-dose therapy consisting of cisplatin 100 mg/m2 or carboplatin 500 mg/m2, etoposide 450 mg/m2, ifosphamide 6 g/m2. All 4 patients were evaluable. Three patients obtained a complete response and one showed a partial response. The partial responder was given RPLND. The RPLND specimen showed necrotic tissue.

[Study on the relationship between vascular invasion and prognosis in patients with locally confined renal cell carcinoma].

BACKGROUND: There exists controversy concerning the relationship between the vascular invasion and the prognosis in the locally confined renal cell carcinoma (RCC). We have tried to study on the relationship between the vascular invasion and the prognosis in these patients. METHODS: Of the five hundred and forty-eight patients with RCC who did not have lymph node and distant metastasis, the 464 patients without having the micro- and/or macro-vascular invasion (tumour thrombus) were analysed as the control, and the remaining 85 with micro- and/or macro-vascular invasion were subject to this study. RESULTS: There observed a significantly favourable prognosis in the patients with RCC who did not have the vascular invasion (pV0) compared with the patients who had the vascular invasion (pV1a: n = 43, P = 0.00068, pV1b: n = 34, 0 < P < 0.00006, pV2: n = 8, P = 0.012). Furthermore, the patients with pV1a showed a significantly favourable prognosis compared with the patients with pV1b (p = 0.00032), and the patients with pV2 (0 < P < 0.00006), and the patients with pV1b (P = 0.00032), and the patients with pV2 (0 < P < 0.00006), and the patients with pV1b also showed a significantly favourable prognosis compared with the patients with pV2 (0 < P < 0.0006). As to the relationship between the tumour size and vascular invasion (V-stage) the tumour size got larger along with the elevation of the V-stage, and there also observed a significant difference of the tumour size between the patients with pV10 and pV1a (P = 0.00578), with pV0 and pV1b (0 < P < 0.000061) and pV0 and pV2 (P = 0.0002). The same result was obtained in the relationship between the localization of the tumour and prognosis, i.e., the patients with pV2 showed a higher frequency of larger occupation of the tumour within the kidney compared with other V-stage patients. Regarding the recurrence rate, there observed a tendency toward high frequency of recurrence along with the elevation of V-stage. Furthermore, there observed an untoward relationship between the elevation of the V-stage and the periods of recurrence after nephrectomy. In an effort to analyse the disease-free survival, there observed a significant difference among the patients with pV0, pV1a, pV1b and pV2. CONCLUSION: We conclude that the vascular invasion is a very important prognostic factor in the patients with locally confined RCC. Furthermore, along with the elevation of the V-stage, it directly reflects the poorer prognosis.