Efficacy of combination therapy with pembrolizumab and axitinib for metastatic renal collecting duct cell carcinoma: A report on two cases.

Introduction: Immunotherapy-based combinations have become the standard first-line therapy for metastatic renal cell carcinoma. However, combined immunotherapy for renal collecting duct carcinoma had been reported, but its therapeutic efficacy had been unclear. Case presentation: The first case was a 62-year-old man treated with pembrolizumab and axitinib for renal collecting duct carcinoma with multiple bone metastases. After 7 months, the primary and metastatic lesions shrunk and were evaluated as a partial response. The second case was a 71-year-old man treated with pembrolizumab and axitinib for renal collecting duct carcinoma with lymph node and lung metastases. After 9 months, the primary and metastatic lesions shrunk and were evaluated as a partial response. In both cases, the tumor cell expression of programmed death ligand-1 was negative, and CD4+ and CD8+ cells were observed in the tumor. Conclusion: Combined immunotherapy with pembrolizumab and axitinib may be effective for metastatic renal collecting duct carcinoma.

Eight year experience with Studer ileal neobladder.

BACKGROUND: We reviewed our experience with orthotopic continent urinary reconstruction after radical cystectomy to assess the feasibility of Studer ileal neobladder for patients who are relatively advanced in age. METHODS: Between June 1997 and January 2005, 31 consecutive male patients (mean age: 64 years) underwent lower urinary tract reconstruction after radical cystoprostatectomy. Perioperative and late complications, functional outcome of the neobladder, urinary continence, upper urinary tract status and renal function with the metabolic balance were evaluated in all patients. RESULTS: There was no perioperative death, and perioperative and late complication rates were 22.8% and 3.3%, respectively. All 31 patients were able to void urine. Although the mean maximal functional capacity of the neobladder was 122 ml at 1 month after surgery, the mean capacities were increased to 247 ml at 6 months and 321 ml at 1 year after the operation. Urodynamic results at 3 years showed unchanged characteristics as to micturition pattern and volume of residual urine and neobladder pressure remained low. Of 31 patients, 29 (93.5%) showed excellent or good continent status during the daytime and 9 (29%) were completely dry at night in 6 months after surgery. Even at 3 years after the operation, only 1 patient out of 21 evaluated required single pad during nighttime. In a subgroup of five patients (24%) older than 70 years, the status of continence was satisfactory at 3 years after the reconstruction, and only one patient required a pad during the night at that point. Renal function levels and metabolic status were comparable before surgery and 3 years after surgery. Moreover, pyelography revealed normal condition of the upper urinary tract 1 month postoperatively in almost all cases. CONCLUSIONS: These data provide evidence that Studer ileal neobladder is a satisfactory surgical technique for selected patients at our institute. Even for patients older than 70 years, this urinary diversion procedure is safe in terms of morbidity and efficacious as indicated by functional outcome.

Perinephric angiomyolipoma: a unique development pattern surrounding the kidney.

We report a case of a 31-year-old man with extrarenal angiomyolipoma of the perinephric space. He presented with asymptomatic macrohematuria. Computed tomography of the abdomen revealed a large perinephric mass which was separated from the right kidney and its unique growth appeared to have surrounded the kidney. Extrarenal angiomyolipomas of the perinephric fat are rare and they should be considered in the differential diagnosis of a retroperitoneal mass where asymptomatic macrohematuria was presented at the onset.

Detection of the presence of catalytic subunit mRNA associated with telomerase gene in exfoliated urothelial cells from patients with bladder cancer.

PURPOSE: Telomerase has an important role in the immortalization and oncogenesis of human cancer cells, and it appears to be a promising new marker for carcinogenesis. We investigated whether expression of the catalytic subunit of telomerase using reverse transcriptase-polymerase chain reaction (RT-PCR) can be detected in exfoliated cells in bladder washing from patients with bladder cancer. MATERIALS AND METHODS: Exfoliated cells in bladder washing and voided urine samples from patients with and without bladder cancer were analyzed. To determine the number of cells required for successful detection of the subunit using RT-PCR bladder tumor cell lines were used. RESULTS: At least 1 x 10(4) cells were needed in the cell line study for RT-PCR of the subunit. The number of cells in bladder washing fluid and voided urine specimens was more than 5 x 10(4). Human telomerase RT (hTERT) mRNA was expressed in 62 of the 82 bladder washing fluid specimens from patients with bladder cancer but in only 2 of the 86 with benign urological disorders. Overall sensitivity for hTERT was 75.6%, that is 52.4%, 80% and 93.8% for grades 1 to 3 tumors, respectively. In contrast, human telomerase associated protein 1 mRNA was expressed in 17 of the 18 patients with and in 12 of the 23 without cancer. Overall sensitivity for human telomerase associated protein 1 was 94.4%. In 4 (57.1%) of 7 spontaneously voided urine specimens from patients with bladder cancer hTERT mRNA expression was detected. CONCLUSIONS: Detecting hTERT mRNA expression in exfoliated cells in bladder washing samples is more useful for the diagnosis, screening and followup of patients with bladder cancer.

[Characteristics of various electrodes for transurethral surgery].

The characteristics of four electrodes for transurethral surgery were examined by resection experiments using porcine muscles. The electrodes were a loop type (uroloop, ENDO care), a roller type (STORZ), VAPOR CUT (STORZ) and WEDGE (Microvasive Co). With the stroke rate fixed at 1.2 cm/second and the electrical output changed to 200, 220, 240 W, the electrode was moved manually by 1 stroke for resection. Sections were weighed, histological changes on the cut surface were observed under a microscope and the excised + vaporized layer and desiccated layer were measured. A similar study was also made with the electrical output fixed at 200 W and the stroke rate changed to 0.6, 1.2, 2.4 cm/second. When the output was increased, the excised + vaporized layer and desiccated layer became deep with the roller-type. The excised + vaporized layer became deep and the desiccated layer tended to become deep with the UROLOOP and VAPOR CUT. No change in either layer was found with WEDGE. When the stroke rate was increased, both excised + vaporized layer and desiccated layer became shallow with VAPOR CUT, but only the desiccated layer became shallow with WEDGE. In conclusion, the proper output and stroke rate were considered to be 240 W and not more than 0.6 cm/second with the roller-type, 220-240 W and 0.6 cm/second with VAPOR CUT and 200 W and 1.2 cm/second with WEDGE.