Prognostic significance of 5-fluorouracil metabolism-relating enzymes and enhanced chemosensitivity to 5-fluorouracil by 5-chloro 2,4-dihydroxy-pyridine in urothelial carcinoma.

BACKGROUND: Recently, S-1, a novel 5-fluorouracil (5-FU)-based agent containing the strong dihydropyrimidine dehydrogenase (DPD) inhibitor, 5-chloro-2,4-dihydropyrimidine (CDHP) has been clinically used to treat various non-urothelial carcinomas (UC). High levels of thymidylate synthase (TS), the target enzyme of 5-FU and DPD which degrades the majority of 5-FU, are associated with poor prognosis in some cancers. However, only a few reports have dealt with this in UC. The aim of this study was to investigate the clinical significance of TS and DPD in upper tract urothelial carcinoma (UTUC) and evaluate the role of TS and DPD on the sensitivity of 5-FU in UC cell lines and the anti-tumor effect of S-1 in UC xenograft model. METHODS: Firstly, we evaluated the immunohistochemical expression of TS and DPD in 176 patients with UTUC to determine their prognostic significance. Secondly, the levels of TS and DPD in UC cell lines were measured by ELISA and real-time PCR. Furthermore, the association between their levels and the sensitivity to 5-FU was examined using the small interfering RNA (siRNA) specific for TS and DPD. Thirdly, the anti-tumor effect of S-1 was evaluated in UC xenograft model. RESULTS: Immunohistochemical evaluation of TS and DPD in UTUC human samples revealed that TS expression was significantly associated with stage, grade, and lymphovascular invasion and DPD expression was significantly associated with grade. Multivariate analysis revealed that high TS expression was an independent predictor of disease-specific survival in them. In in vitro study using UC cell lines, high levels of TS and DPD were associated with low response to 5-FU and these associations were confirmed with siRNA specific for TS and DPD. In in vivo study using UC xenograft model, S-1 treatment dramatically inhibited tumor growth compared to controls, tegafur, or UFT in UC tumor with a high level of DPD. CONCLUSIONS: TS plays an important role in the prognosis of UTUC and S-1 may be a key agent for UC tumor, especially with a high level of DPD.

[Urinary bladder metastasis of prostate cancer : a case report].

A 62-year-old man was referred to our outpatient clinic because of his elevated serum prostatic specific antigen level. The transrectal ultrasonography guided biopsy of the prostate revealed prostate cancer. Computed tomography, magnetic resonance imaging (MRI) and bone scintigraphy showed multiple metastases to his bones and lymph nodes. The MRI incidentally revealed a solitary tumor at the right lateral wall of the urinary bladder. Transurethral resection of the bladder tumor was performed, and histopathological examination showed the bladder tumor composed of not urothelial carcinoma but metastatic adenocarcinoma from prostate cancer.

[Torsion of a testicular cancer in cryptorchidism prolapsing out of the inguinal canal: a case report].

A 47-year-old man visited our hospital suffering from intensive pain of the swelling mass in his left inguinal region. He had never recognized the left testis in his scrotum, and felt the left inguinal mass growing slowly since a year ago. Computed tomography and Doppler uitrasonography revealed a mass approximately 5 cm in diameter separating from intestines in the abdominal cavity and not supplied sufficient blood flow. We suspected that the mass was a testicular cancer in cryptorchidism with testicular torsion and performed orchiectomy. At the time of the operation, the mass and the spermatic cord were twisted and prolapsed out of the aponeurosis of external abdominal oblique muscle. Histopathologically, malignant degeneration was demonstrated in the undescended testis, and the cell type was seminoma. We definitely diagnosed the mass as torsion of a testicular cancer in cryptorchidism prolapsing out of the inguinal canal.

[Prostatic retention cyst around the bladder neck: a case report].

We report a case of a prostatic retention cyst around the bladder neck causing prostatitis-like symptoms. A 34-year-old man was referred to our hospital for treatment of a cystic lesion in his prostate and prostatitis-like symptoms such as pollakisuria, dysuria and pain on urination. Blood examination and urinalysis showed neither systemic inflammation nor urinary tract infection. Transrectal ultrasonography (TRUS), magnetic resonance imaging (MRI) and cystoscope revealed a projecting prostatic cyst which occupied the bladder outlet and seemed to cause the prostatitis-like symptoms. Transurethral resection of the cyst was performed and the symptoms were markedly improved. Histopathologically, the cyst was retention cyst of the prostate.

[Pheochromocytoma with chronic renal failure: a case report].

Pheochromocytoma is a catecholamine-secreting tumor which provokes various symptoms such as episodic headache, sweating and tachycardia. Meanwhile patients with hemodialysis have similar symptoms. Additionally patients with chronic renal failure often can not take the 24-hour urine collection test. Therefore it is said to be difficult to diagnose pheochromocytoma in patients with end stage renal disease. We present herein a case of a woman with hemodialysis discovered to have a pheochromocytoma. A 48-year-old female was admitted to our hospital due to paroxysmal hypertension during hemodialysis. Plasma dopamine and noradrenaline were slightly elevated. Computerized tomography revealed a 2 cm round mass at left adrenal gland. 131I-MIBG scintiscan detected that tumor at the same lesion. Under the diagnosis of pheochromocytoma, she had taken alpha-adrenergic blocking agent for 4 weeks and left adrenalectomy was successfully performed.

[A case of chronic expanding hematoma in retroperitoneal space].

A 34-year-old female patient visited a nearby hospital with a chief complaint of right flank pain and decreased weight. Computed tomography showed a right retroperitoneal mass 10 cm in diameter on the right kidney, displacing the liver and the right kidney. The patient was referred to Kawasaki Municipal Hospital for further evaluation. The mass was suspected to be chronic expanding hematoma or neurogenic tumor of renal capsule origin. A retroperitoneal tumorectomy was performed with a right subcostal incision. A mass was noted in the smooth capsule. The mass was easily removed from the right renal capsule. However, there was significant adhesion between the mass and the peritoneum as well as the liver capsule. Therefore, a partial hepatectomy was needed for complete resection of the mass including the capsule. A fibrous capsule was noted and most of the mass was blood clot-like tissue. The histopathological diagnosis was chronic expanding hematoma with no malignancy. A retroperitoneal chronic expanding hematoma has very rarely been reported.

[Testicular tumor presenting as acute scrotum with infection caused by gas-producing bacteria].

A 46-year-old male patient visited our hospital with the chief complaint of a right scrotal swelling and pain. The enlarged scrotum was 8 cm in diameter with redness of the skin of the right scrotum. There was a firm mass in the scrotum with marked tenderness. The patient's body temperature was 38.0C, and blood tests showed increased inflammatory markers. The results of computed tomography and magnetic resonance imaging showed that the enlarged scrotum was filled with gas and there was a mass partially composed of fat inside it. The patient was treated with antibiotics, but the fever persisted and the inflammatory markers further increased. The size of the right scrotum gradually increased. A right high inguinal orchiectomy was performed to control the inflammation and makea diagnosis. Thehistopathological diagnosis was necrosis of seminoma, and culture of thene crotic tissuewas positivefor Clostridium. Thepre sent caseappe ars to bethefirst caseof a testicular tumor associated with acute scrotum due to tumor growth, necrosis and infection caused by gas-producing bacteria.

[Gastric metastasis from renal cell carcinoma 20 months after radical nephrectomy: a case report].

Metastatic lesions from renal cell carcinoma (RCC) commonly occur in the lung and bone, gastric metastasis has rarely been reported in the literature. We present herein a case of a man with gastric metastasis from RCC. A 49-year-old male was admitted to our hospital complaining of dyspnea on exercise. He had undergone right radical nephrectomy due to RCC two years ago (T3a NO MI), followed by postoperative immunotherapy with interferon-alpha and interleukin 2. Gastrointestinal endoscopy revealed a solitary polypoid lesion about 20 mm in diameter in the greater curvature of the middle gastric body. Endoscopic needle biopsy revealed poorly differentiated adenocarcinoma. Partial gastrectomy was performed and histologic examination of the resected specimen confirmed diagnosis of clear cell renal carcinoma. Metastasis of any cancer to the stomach is quite uncommon. In particular, gastric metastasis from RCC is extremely rare. To our knowledge, this is the 15th case of gastric metastasis from RCC reported in Japan.

Endocytoscopy: novel endoscopic imaging technology for in-situ observation of bladder cancer cells.

BACKGROUND AND PURPOSE: Recent advances in endoscopy have enabled microscopic imaging of live bladdercancer cells in situ. The newly developed Endocystoscopy system (Olympus Medical Systems Co., Tokyo, Japan) is a flexible digital endoscope that has more than a 450-fold magnifying power on a video monitor. PATIENTS AND METHODS: This supermagnifying endoscope was used to evaluate bladder carcinoma in five patients through the working channel of a rigid cystoscope. RESULTS: The cell structure and nuclear morphology were imaged adequately compared with conventional hematoxylin and eosin staining of a biopsy specimen. The tumors were graded correctly in four of five cases. CONCLUSION: This novel technology appears to be useful for histologic diagnosis during endoscopic examinations, potentially allowing us to avoid a conventional biopsy.

[Localized amyloidosis of the bladder treated effectively by occlusive dressing technique therapy using Dimethyl sulfoxide (DMSO): two case reports].

The first case is a 50-year-old female. She was consulted to our hospital for further examination of right hydronephrosis that was shown by ultrasonography. Cystoscopy revealed tumorous lesion around the right orifice. Bladder tumor was suspected and transurethral biopsy of the bladder was performed. The second case is a 54-year-old man. He was consulted to our hospital because right hydronephrosis was shown by counterized tomography. A tumorous or stenotic lesion in the lower end of ureter was suspected. Cystoscopy revealed yellowish and thickened tissue in the trigonal area. Bladder amyloidosis was suspected and transurethral biopsy of the bladder was performed. The histopathological diagnosis indicated amyloidosis and systemic amyloidosis was excluded. Both cases were treated by occlusive dressing technique therapy using Dimethyl sulfoxide (DMSO) successfully.

Renal damage inhibited in mice lacking angiotensinogen gene subjected to unilateral ureteral obstruction.

OBJECTIVES: To determine how angiotensin II (Ang II) contributes to renal interstitial fibrosis, the inflammatory response, and tubular cell apoptosis and proliferation in unilateral ureteral obstruction using mice genetically deficient in angiotensinogen (Agt(-/-)). METHODS: The left kidney of wild-type mice (WT; C57BL/6) and Agt(-/-) mice was obstructed for 2 weeks, and then both kidneys were harvested. The serum Ang II levels were determined by radioimmunoassay. The expression of transforming growth factor-beta in renal tissue was assessed using enzyme-linked immunosorbent assay. The renal tissue was stained with Masson's trichrome. Renal tubular proliferation and apoptosis was detected by immunostaining for proliferating cell nuclear antigen and single-stranded DNA, respectively. Interstitial leukocyte and macrophage infiltration was investigated by immunostaining for CD45 and F4/80, respectively. RESULTS: The serum Ang II levels in the Agt(-/-) mice were significantly lower than those in the WT mice (P < .01), and tissue transforming growth factor-beta in the obstructed kidney of Agt(-/-) mice was significantly lower than that in WT mice (P < .05). Interstitial collagen deposition was significantly lower in the Agt(-/-) obstructed kidneys than in the WT obstructed kidneys (P < .01). Tubular proliferation was significantly greater and tubular apoptosis was significantly lower in the Agt(-/-) obstructed kidneys than in the WT obstructed kidneys (P < .01 and P < .01, respectively). Interstitial infiltration by leukocytes and macrophages was significantly lower in the Agt(-/-) obstructed kidneys than in the WT obstructed kidneys (P < .01 and P < .01, respectively). CONCLUSIONS: The results of the present study support the targeting of Ang II as a reasonable approach by which to prevent renal tissue damage in unilateral ureteral obstruction.