CD169+ Macrophages Residing in the Draining Lymph Nodes and Infiltrating the Tumor Play Opposite Roles in the Pathogenesis of Bladder Cancer.

Purpose: CD169+ macrophages are considered to enhance anti-tumor immunity by capturing lymph-borne dead tumor cells. The number of CD169+ macrophages in regional lymph nodes (RLNs) is positively correlated with prolonged cancer-free survival in various human cancers. However, a recent study argued against this dogma; that is, CD169+ macrophages infiltrating into the tumor were associated with poor prognosis in patients with breast cancer. To explain this discrepancy, we quantified the number of CD169+ macrophages located in the bladder tumor and RLNs of the same patients and examined their relationship with the 5-year survival rate. Patients and Methods: Tumor and RLN specimens resected from 40 invasive bladder cancer patients (29 males and 11 females; median age, 70.7 years; range, 49-81 years) who underwent radical cystectomy were evaluated using immunostaining. Results: The number of CD169+ macrophages in RLNs was associated with a good cancer prognosis, while CD169+ macrophages infiltrating the tumor strongly correlated with a higher incidence of lymphovascular invasion. Conclusion: CD169+ macrophages play opposing roles in the induction of anti-tumor immunity based on their location in RLNs or tumors.

[Usefulness of Ascitic Fluid Analysis for Diagnosis of Intraperitoneal Bladder Rupture : A Case Report].

An inebriated 58-year-old woman with a history of hysterectomy presented to the emergency department with abdominal pain. The patient received hydration and acetaminophen, which led to symptom resolution. The patient returned with severe abdominal pain, 12 hours later. Computed tomography (CT) revealed a large volume of ascites and bladder wall disruption. Ascitic fluid analysis showed an elevated creatinine (Cre) level of 7.56 mg/dl, and the ascites to serum Cre ratio was 2.96, which indicated urinary ascites secondary to bladder rupture. The patient was diagnosed with intraperitoneal bladder rupture and underwent successful conservative treatment using an indwelling urinary catheter.

Spontaneous bladder rupture due to bladder carcinoma: A case report required emergency radical cystectomy.

We report a case of spontaneous bladder rupture due to bladder carcinoma. A 52-year-old female presented in septic shock, and computed tomography revealed free air in the subphrenic space and a mass in the middle of the pelvis. The exploratory laparotomy helped to confirm a definitive diagnosis: bladder rupture due to bladder carcinoma. She underwent a radical cystectomy and survived. Surgical intervention is recommended to manage carcinomatous bladder rupture. Timely and accurate diagnosis is essential to optimize the patient's outcomes. The possibility of spontaneous bladder rupture should not be overlooked as a differential diagnosis in cases of the acute abdomen.

CD169-positive sinus macrophages in the lymph nodes determine bladder cancer prognosis.

CD169+ macrophages are suggested to play a pivotal role in establishing anti-tumor immunity. They capture dead tumor cell-associated antigens and transfer their information to lymphocsytes, including CD8+ T cells, which is important for successful tumor suppression. This study aimed to determine the prognostic significance of CD169+ macrophages residing in the tumor-draining lymph nodes from cases of bladder cancer. In this retrospective study, 44 bladder cancer patients who received radical cystectomy were examined. The abundance of CD169+ macrophages in the regional lymph nodes and the number of CD8+ T cells in the primary tumor were investigated by immunohistochemistry. A CD169 score was calculated based on the intensity of CD169 staining and the proportion of CD169+ macrophages, and the scores were compared to the patients' clinicopathological parameters. A high CD169 score was significantly associated with low T stage and with a high number of CD8+ T cells infiltrating into the tumor. The group with high CD169 expression had significantly longer cancer-specific survival than the group with low CD169 expression (5-year cancer-specific survival rate: 83.3% vs 31.3%). In a multivariate analysis, the CD169 score was identified as a strong and independent favorable prognostic factor for cancer-specific survival. Our findings suggest that CD169+ macrophages in the lymph nodes enhance anti-tumor immunity by expanding CD8+ T cells in bladder cancer. The CD169 score may serve as a novel marker for the evaluation of bladder cancer prognosis.

Safety of transperineal 14-core systematic prostate biopsy in diabetic men.

OBJECTIVES: To examine whether the transrectal ultrasound-guided transperineal 14-core prostate biopsy can be carried out safely in diabetic men and to determine adequate antimicrobial prophylaxis protocol in this setting. METHODS: The present study included 539 men, 135 with concurrent diabetes mellitus (DM) and 404 without DM, who underwent transperineal extended 14-core biopsy due to elevated prostate-specific antigen > or = 2.5 ng/mL and/or abnormal digital rectal examination. Any complication requiring prolonged hospitalization or rehospitalization during the 4-week post-biopsy period was considered major. All other complications were considered minor. Intensity of antimicrobial prophylaxis was prospectively reduced in a stepwise manner down to single dose of oral levofloxacin. RESULTS: Except for DM, there was no significant difference in clinical background between the diabetic and non-diabetic men. The procedure was completed in all revealing prostate cancer in 42% of the diabetic men and 36% of the non-diabetic men (P = 0.23). Incidence of minor or major complications was not significantly different between the two groups. Minor complications were observed in 15.6% and 16.6% of each group, respectively, with voiding disturbance being the most common. No infectious major complication was observed regardless of the presence of DM. In the diabetic men, there was no statistical difference in incidence of biopsy-related complications according to modality of DM treatment, HbA1c level or antimicrobial prophylaxis protocol. CONCLUSIONS: Transperineal 14-core biopsy can be carried out without major infectious complications in diabetic men. Oral levofloxacin 300 mg once before the procedure seems to represent an effective antimicrobial prophylaxis in diabetic men without other risk of infection.

Transplantation of an autologous mesothelial cell sheet prepared from tunica vaginalis prevents post-operative adhesions in a canine model.

Post-operative adhesions often cause severe complications such as bowel obstruction and abdominopelvic pain. Previously, we reported that transplantation of a mesothelial cell sheet is effective for preventing adhesion in rat model. We also proposed a new technique for harvesting autologous mesothelial cells from tunica vaginalis without intra-abdominal maneuvers. In this study, we examined whether an autologous mesothelial cell sheet can prevent post-operative peritoneal adhesions in a canine adhesion model. Mesothelial cells were isolated from the tunica vaginalis of male beagles. Isolated cells were cultured on fibrin gel. We named this construct the "mesothelial cell sheet." Animals underwent surgery to induce peritoneal adhesion formation and were then transplanted with the mesothelial cell sheets (sheet group, n = 4), fibrin gel (fibrin group, n = 4), or no materials (sham group, n = 4). Four weeks after the transplantation, we evaluated adhesion formation and scored adhesion levels. The abdominal wall transplanted with the mesothelial cell sheet was covered with mesothelium. The total adhesion score of the sheet group was significantly lower than that of the fibrin group and the sham group. These results indicated that transplantation of an autologous mesothelial cell sheet is effective for preventing post-operative adhesion formation in the canine adhesion model. Our mesothelial cell sheet has the potential to be a powerful adhesion prophylactic material in surgery.

The efficiency of Sairei-to for retroperitoneal fibrosis: two case reports.

The conventional approach for management of retroperitoneal fibrosis (RF), an inflammatory process of retroperitoneal fibro-adipose tissue, leading to the compression and obstruction of the ureters and other adjacent organs is ureterolysis with omental wrapping, and an effective alternative to surgery is immunosupressive medication such as oral corticosteroids. Sairei-to (TJ-114) is a traditional herbal medicine used for the treatment of RF in Japan. It has both anti-inflammatory and anti-allergic effects. Here we report two cases of RF successfully treated with Sairei-to. One case was idiopathic and the other was caused by artificial graft-induced vasculitis. Both cases were treated with Sairei-to following the decompression of uremia by precutaneous nephrostomy or indwelling ureteral stents. There was hardly any ureteral obstruction three months after the administration of Sairei-to. They have been doing well for 12 and 26 months. Sairei-to rarely causes side effects such as immunodeficiency, gastro-duodenal ulcer and osteoporosis that often accompany long-term administration of corticosteroids. Sairei-to is a safe and effective medicine for the treatment of RF. We therefore recommend Sairei-to as an alternative for corticosteroid therapy.

Novel and simple method for isolating autologous mesothelial cells from the tunica vaginalis.

OBJECTIVE: To report the development of a new method of isolating autologous mesothelial cells from the tunica vaginalis that are easily obtained and generally free from the effects of abdominal cancer, and to investigate whether transplanting these mesothelial cells is effective in preventing postoperative adhesions. MATERIALS AND METHODS: The tunica vaginalis was resected from male Lewis rats, and mesothelial cells were collected by enzymatic disaggregation. To investigate the efficacy of mesothelial cells in preventing adhesion, harvested cells were transplanted into a rat intestinal hernia adhesion model. RESULTS: Cells isolated from the tunica vaginalis were homogenous, polygonal when confluent, expressed cytokeratin and vimentin, and the cell surface was covered with microvilli, which is the characteristic appearance of endogenous mesothelial cells. The transplantation of autologous mesothelial cell sheets reduced peritoneal adhesion. CONCLUSION: We developed a new method of obtaining autologous mesothelial cells from the tunica vaginalis. These cells may provide a valuable option for treating patients at risk of postoperative adhesions.

Lymphadenopathy of sinus histiocytosis mimicking metastatic bladder cancer: a case report.

A case of invasive bladder cancer accompanied with enlarged pelvic lymph nodes, which were interpreted as metastasis, is reported. The lymphadenopathy eventually regressed spontaneously while the bladder cancer increased in size. Total cystectomy and pelvic lymph node dissection were performed. Histopathological examination of the lymph nodes revealed dilation of the sinuses and marked increase in the number of histiocytes, which suggested sinus histiocytosis. Sinus histiocytosis is often associated with malignant tumor. It is considered as a sign of the host's immune activation with favorable prognostic significance. Nevertheless, such lymphadenopathy mimics a metastatic lymph node, making proper staging difficult.

[Bladder cancer producing granulocyte colony-stimulating factor (G-CSF): a case report].

A case of bladder cancer producing granulocyte colony-stimulating factor (G-CSF) is reported. A 76-year-old male was admitted to our hospital with gross hematuria and leukocytosis. He was diagnosed with advanced bladder cancer. His white blood cell (WBC) count and serum granulocyte colony-stimulating factor (G-CSF) level were elevated (peak WBC 22,010/microliter, peak G-CSF 351 pg/ml), which immediately normalized after cystectomy. The histopathological diagnosis was transitional cell carcinoma, grade 3, pT4, pN1. Immunohistochemical examination was positive for G-CSF and G-CSF receptor. There has been no recurrence of cancer for more than 23 months since the operation without any additional therapy.