The effectiveness of interferon-alpha subtypes alternation for metastasis from renal cell carcinoma.

Interferon-alpha (IFN-α) has been used in systemic treatment for metastatic renal cell carcinoma (mRCC). IFN-α has at least 14 subtypes, each of which has different biological activity. There have been reports that mRCC resistant to an IFN-α treatment responded to another IFN-α subtype. This study was performed to evaluate the effectiveness of alternation of different IFN-α subtypes for mRCC that did not respond to initial IFN-α treatment. In our department and associated institutions, alternating therapy of IFN-α was provided for 15 initial IFN-α refractory mRCC cases from June 2005 to September 2008. Among the 15 patients, the effects of alternating IFN-α therapy were as follows: complete response (CR), 0 cases; partial response (PR), 1 case; stable disease (SD), 3 cases; progressive disease (PD), 11 cases. The response rate (CR+PR) was 7% and disease control rate (CR+PR+SD) was 27%. No severe side effects were observed in any of these cases. The PR case is still in PR 21 months after alternating IFN-α therapy. Among the three SD cases, one has continued SD for 14 months and the other for 12 months. Alternating IFN-α therapy for mRCC can be attempted even if other cytokines are not effective.

Antibiotics therapy was effective in preventing bilateral staghorn renal matrix stones.

Herein we report a case for which antibiotic therapy was effective in preventing bilateral staghorn renal matrix stones. A 34-year-old man was referred to our hospital for right lower abdominal pain and fever. Blood data and urinary analysis indicated a urinary tract infection and renal failure. The diagnosis was bilateral pyelonephritis for staghorn renal matrix stones. He had undergone percutaneous neprolithotripsy (PNL) for bilateral staghorn renal matrix stones. Almost all fragments were removed by the grasper. However, 3 months after the operation, bilateral staghorn renal matrix stones rapidly developed, so he underwent PNL again. After the operation, low-dose antibiotic therapy was continued to prevent pyelonephritis. As a result renal matrix stones did not reoccur. Until now, 1 year after the start of antibiotic therapy, no further sign of relapse has been noted.

Adrenal androgen levels as predictors of outcome in castration-resistant prostate cancer patients treated with combined androgen blockade using flutamide as a second-line anti-androgen.

OBJECTIVES: To analyze the clinical effects of flutamide as a second-line anti-androgen for combined androgen blockade in patients with castration-resistant prostate cancer (CRPC) initially treated with bicalutamide as a first-line anti-androgen. METHODS: Our study population consisted of 16 patients with CRPC who were treated with flutamide (375 mg daily) as second-line hormonal therapy. Dehydroepiandrosterone (DHEA), androstenedione, androstenediol, testosterone and dihydrotestosterone were measured to investigate the relationship between plasma androgens and outcome following treatment. Furthermore, adrenal androgen levels in a medium of adrenal cancer cell line were also measured. RESULTS: Second-line hormonal therapy using flutamide resulted in a reduction of the prostate-specific antigen (PSA) level in 14 (87.5%) of 16 patients. A PSA decline greater than 50% was observed in 8 (50%) of the 16 patients. The duration of median responsiveness was 6.25 months. PSA elevation of baseline androstenediol level was a predictive factor of PSA responsiveness. The lower DHEA group improved the duration of responsiveness to flutamide. In vitro, 3 micromol/L flutamide suppressed DHEA, androstenedione and androstenediol synthesis compared with bicalutamide in a medium of adrenal cancer cell line. CONCLUSIONS: Our data show that flutamide suppresses the adrenal androgens in comparison with bicalutamide. The responsiveness and response duration of flutamide can be predicted in patients with a higher baseline androstenediol level and a lower DHEA level. Metabolites from adrenal androgens contribute to the progression of prostate cancer.

[Asymptomatic pheochromocytoma of the urinary bladder : a case for which preoperative diagnosis was possible].

A 62-year-old man who was diagnosed as having a bladder tumor by computerized tomography in another hospital. On August 4,2006 he visited our hospital. Cystoscopic examination revealed a submucosal tumor posterior to the right orifice. Computer tomography and magnetic resonance imaging showed the same findings. Therefore, we considered the possibility of asymptomatic pheochromocytoma of the urinary bladder. 131I-metaiodoberzyl guanidine scanography showed an abnormal accumulation in the bladder. Endocrinologic examination disclosed an increased level of serum and urinary noradrenalin. Pheochromocytoma of the bladder was diagnosed, and on October 25, 2006 a partial cystectomy and right ureteroneostomy were performed. Histologically, the tumor was pheochromocytoma of the urinary bladder. He has been receiving follow-up clinical observation for 30 months following the operation, and there has not been any evidence of recurrence.

Successful treatment for metastases from renal cell carcinoma with alternation of interferon-alpha subtypes.

Here we present a case in which alternation of interferon-alpha (IFN-alpha) treatments was effective in treating pulmonary metastases and lymph node metastases from renal cell carcinoma (RCC). A 56-year-old man underwent left radical nephrectomy under the diagnosis of left RCC. The histological diagnosis was clear cell carcinoma G2, IFN-alpha, pT1b. He subsequently underwent two operations for right pulmonary metastasis and right hilar lymph node metastasis. Postoperatively he was treated with intramuscular administration of natural IFN-alpha (Sumiferon) which prevented definite recurrence for 1 year. However, multiple pulmonary metastases and left hilar lymph node metastasis occurred 11 months after discontinuation of Sumiferon. Therefore, treatment with another natural IFN-alpha (OIF) was started. Although OIF was continued for 7 months, pulmonary metastases and left hilar lymph node metastasis continued to progress. Therefore, treatment was changed to Sumiferon, after which the pulmonary metastases and left hilar lymph node metastasis decreased in size. The metastases showed no progression for 16 months after switching from OIF to Sumiferon.

[A case of inflammatory myofibroblastic tumor recognized in the retroperitoneum and the kidney].

A 61-year-old man consulted his local physician because of abdominal pain and was referred to our hospital after bilateral renal tumors were suspected on CT. CT and MRI showed a tumor, approximately 3 cm in diameter in the right renal pelvis and a cyst in the left kidney. There were no malignant cells detected on cytological studies of two urine specimens that were voided commonly and obtained from the right renal pelvis, respectively. Under a diagnosis of right renal pelvic tumor, the patient underwent laparoscopic right nephroureterectomy. Pathological examination demonstrated two inflammatory myofibroblastic tumors; one was located in the upper portion of the right kidney and the other was in the fatty tissue of the right renal hilus. There has not been any evidence of recurrence detected on follow-up for three months postoperatively.

Evolution of acute focal bacterial nephritis into a renal abscess.

Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney presenting as an inflammatory mass without frank abscess formation, which may represent a relatively early stage of renal abscess. The pathogenesis of AFBN is thought to be hematogenous infection or ascending infection from the lower urinary tract. For the majority of children, the pathogenesis may be related to ascending infection, because pre-existing malformative uropathy, especially vesicoureteral reflux (VUR), is common in pediatric patients. Few clinical reports have demonstrated the evolution of this condition into renal abscess in children. We report a girl with AFBN associated with VUR that evolved into a renal abscess despite appropriate intravenous antibiotic therapy. We undertook serial radiological observation of its evolution. It is important to differentiate AFBN from renal abscess because the management of the two entities may be different, and follow-up studies are indispensable to determine appropriate therapy.