The possible existence of androgen receptors (ARs) in human Leydig cells was examined by means of a biochemical AR assay, Western blot analysis, Northern blot analysis and immunohistochemistry.
Percoll gradients were utilized to isolate highly purified Leydig cells from human testicular tissue. After these cells were confirmed to retain their morphological and biochemical integrity, they were used for the AR assay, Western blot analysis and Northern blot analysis. ARs in the purified Leydig cells were measured using ³H-methyltrienolone as the labeled ligand. A high affinity AR was detected in total cell extracts of both purified Leydig cells and whole testicular tissues, but the Bmax was less in the former than the latter.
In Western blot analysis with anti-human AR (hAR) monoclonal antibody, two bands, different in molecular weight, were positively stained. These two 97kDa and 80kDa proteins were thought to be the specific AR proteins which were translated from the first and second initiation site of hAR cDNA, respectively.
Northern blot analysis of RNA from purified Leydig cells as well as RNAs from prostatic and total testicular tissues proved the presence of AR using the hAR cDNA probe, and showed that the molecular size of AR mRNA is about 9.5kb.
Immunoreactive ARs in the human testicular tissue with anti-hAR monoclonal antibody were found predominantly in the nuclei of Leydig cells, suggesting that ARs, like other steroid receptors, exist mainly in nuclei of them.
These findings provided the evidence that ARs are present in human Leydig cells and suggested that some local autoregulations may exist in the human testis.

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Urological tumors were examined for the presence of human papillomavirus (HPV) DNA by using Southern blot hybridization.
In 20 male patients with condyloma acuminatum, HPV type 6 was found at 85% (17/20), HPV type 11 at 95% (19/20), HPV type 16 at 5% (1/20) and HPV type 18 at 0% (0/20). In 2 female patients with condyloma acuminatum, HPV types 6, 11, 16 and 18 were found at 100% (2/2), 100% (2/2), 50% (1/2) and 0% (0/2), respectively. All 6 of the patients who were positive for HPV type 6, were also positive for HPV type 11. Two patients were positive for HPV types 6, 11 and 16, the last of which was frequently found in penile cancer and uterine cervical cancer.
In 6 patients with penile cancer, two patients were positive for HPV type 16 and negative for HPV types 6, 11 and 18. The remaining 4 patients were negative for all these HPV types. One patient who was positive for HPV type 16 had penile cancer after three previous episodes of penile condyloma acuminatum. From this information, a malignant change in the condyloma acuminatum was assumed to indicate the possible association of HPV type 16 with the process of malignant degeneration.
HPV types, 6, 11, 16 and 18 were not detected in a female patient with vulvar cancer.
Although HPV was thought to participate in the development of urological tumors except for external genital tumors, all patients examined, consisting of 3 with benign prostatic hypertrophy, 5 with prostatic cancer and 24 with bladder cancer, were negative for HPV types 6, 11, 16 and 18. Eight patients with bladder cancer were negative for HPV type 33.

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To evaluate the factors contributing to the decline in erectile function with age, we performed measurement of nocturnal penile tumescence (NPT) and penile vascular examinations in 407 men. The following results were obtained.
1) The penile circumferential increment during NPT measured by an erectometer was gradually dereased with age, especially markedly after 60 years of age. The percentage of subjects in whom the NPT was less than 10mm increased with age: 2.7% in the 5th decade, 7.1% in the 6th decade, 16.7% in the 7th decade and 29.1% in the 8th decade. These findings indicate that the incidence of organic erectile dysfunction increased with age.
2) To evaluate the penile vascular status, measurement of penile blood pressure index (PBPI) and papaverine test were performed. The mean PBPI values were significantly decreased in the subjects over 70 years of age. The percentage of subjects having good response to papaverine injection obviously decreased with age: 66.7% between 50 to 59 years, 48.6% between 60 to 69 years, and 15.8% of over 70 years. All subjects in whom the NPT was less than 10mm showed either a low PBPI level of less than 0.6 or an incompleter esponse to papverine injection. These results suggest that penile vascular impairment plays a major role in the age-associated decline in erectile function.
3) We investigated the relationship between cigarette smoking and penile vascular impairment. Smokers showed not only lower PBPI values but higher incidence of the incomplete response to papaverine injection than nonsmokers. Therefore, it is considered that cigarette smoking is a significant risk factor in the erectile dysfunction that occurred in the aged.

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In the present investigation, serial measurements of bone mineral content before and after successful renal transplantation were evaluated by single photon absorptiometry, using a Bone Mineral Analyser (Norland Corp., USA).
Twenty-four renal transplant recipients, whose grafts were well functioning for more than 6 months, were the subjects of this study; they were divided into two groups: one was AZP group which includes 12 patients receiving azathioprine and high dose of steroid and another was CYA group which includes 12 patients receiving cyclosporin A and low dose steroid as immunosuppressants. In both groups patients were similar in regard to age, source of donor, duration on dialysis prior to transplant. Variation rate of bone mineral content was calculated as follow s: b-a/a×100 (a; value before transplantation, b; value after transplantation). Nonpaired t-test was used when comparing the values of both groups.
The results were as follows:
1) AZP group showed no improvement of BMC after 24 months, but only one patient showed improvement of BMC after 36 months.
2) In CYA group, improvement of BMC was found in 5 out of 11 patients after 12 months, in 7 out of 10 patients after 24 months and in 4 out of 4 patients after 36 months.
3) The cumulative dose of methyl-prednisolone was significantly lower in CYA group than in AZP group both one and three months after transplantation (p<0.001).
It is concluded that the cumulative dose of methyl-prednisolone may have an important factor in the recovery of bone.

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The focus of my study was the immunohistological expressions of bladder tumour cells when stained by several antigens, those being; Carcinoembryonic antigen (CEA), Ferritin, Beta 2 Microglobulin (β2-MG), Keratin and Glycogen. There were 59 cases of bladder cancer studied using the Peroxidase-antiperoxidase technique (PAP) of staining. Specimens were formalin-fixed, parrafin embedded, and then sectioned.
Some correlation was found between histological grade, stage and CEA incidence but was not found in the Ferritin or β2-MG. Keratin and Glycogen were detected in all cases. These staining patterns were mosaic according to higher grade and stage. It is believed this demonstrates that immunohistochemical expressions of staining with CEA, Keratin, and Glycogen may be a sensitive indicator of histological grade, stage.

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The focus of my study was the immunohistochemical studies of tumour cells induced by ADM intravesical instillation therapy when stained by several antigens, those being; Carcinoembryonic antigen (CEA), Ferritin, Beta 2 Microglobulin (β2-MG), Keratin and Glycogen befre oand after the therapy. Then I discussed as to their value in indicating therapeutic efficacy. There were 18 cases of bladder cancer studied using the Peroxidase-antiperoxidase technique (PAP) of staining.
Data indicated a 44.4% response rate following therapy with intravesical ADM. Immunohistochemical evaluation showed improvement as indicated by not staining with CEA. Also observed was no change and slightly diffuse staining with Keratin: and a decrease in all layers of Glycogen expression: However this could not be observed with the Ferritin or β2-MG. It is believed this demonstrates that immunohistochemical expressions of staining with CEA, Keratin, and Glycogen may be a sensitive indicator of a therapeutic response to intravesical ADM.

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In animal experiments, in assessing the vesicourethral function, it is desirable to keep the micturition reflex in a physiologic state. Most anesthetics used to immobilize the animals tend to suppress the micturition reflex. An alternative means is decerebration. However, a decerebrate animal is not easily prepared. Instead of anesthesia or decerebration, we applied animal hypnosis to rabbits for immobilization. The urodynamic characteristics during animal hypnosis were compared with those under anesthesia.
Twenty male rabbits weighting 2.5 to 3.0kg were used. Animal hypnosis was produced by placing the rabbit on its back and restraining it in a V-shape trough and maintaining it there until it relaxed. Under hypnosis, cystometry was performed by the suprapubic route. The external sphincter EMG was recorded simultaneously with bladder pressure using a needle electrode. The urethral pressure profile was also measured during hypnosis. These measurements were repeated under anesthesia induced by intravenous pentobarbital injection (30mg/kg). Furthermore, the hypnotic degree was assessed from respiratory rate and pupil size during these urodynamic measurements.
In the rabbit, hypnosis began within 1min and lasted for 30 to 60min. During hypnosis, insertion of a catheter, pricking with a needle electrode and suprapubic puncture did not interrupt the immobility. Urodynamic study under animal hypnosis showed that, as bladder volume increased, the sphincter EMG activity increased and that the EMG activity ceased with bladder contraction. Bladder contraction coincided with the expulsion of saline from the urethral meatus. The maximal bladder pressure during micturition was 23.5±8.0mmHg. The maximal bladder capacity at which the micturition reflex occurred was 41.4±22.3ml. EMG amplitude was 110±49μV.
Pentobarbital reduced the amplitude of sphincter EMG to the value of 11.0±8.OμV. Furthermore, saline was infused into bladder passively from the urethral meatus. Thus, the micturition reflex did not occur under pentobarbital anesthesia. The urethral pressure profile could be measured during animal hypnosis. The maximal closure pressures were 87.6±8.2mmHg under hypnosis and 58.3±2.36mmHg under anesthesia. Thus, pentobarbital significantly depressed the pressure profile. Hypnosis was characterized by immobility, myosis and diminution of respiratory rate. These states were not changed during UDS.
Compared with bladder and sphincter activity under pentobarbital, animal hypnosis was demonstrated to afford a more physiologic state. Therefore, this method seems to be useful for urodynamic studies in animal experiments.

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Disintegration of urinary stones by electrohydraulic lithotripsy (EHL) under transurethral flexible nephroureteroscopy was performed for 39 renal and ureteral stones in 38 patients. The use of a ureteral guide tube facilitated the endoscopic manipulation and allowed the endoscope to access the stones in all cases except for two with a severe ureteral stricture.
Thirty-seven of the 39 stones (94.9%) were successfully disintegrated and 35 stones (89.7%) were destructed. And 33 stones were completely excreted within 6 months (average, 27.9 days). Complications including ureteral perforation in 3 cases, one of whom required open ureterolithotomy, urinary extravasation in one, failure of removing the ureteral stent in one and perirenal abscess in one who underwent surgical incision.
The transurethral flexible endoscope provides a clear vision in the whole urinary tract up to the renal calyx with a minimal complication. This technique could be used as a non-invsivea treatment of urolithiasis adjunct to extracorporeal shock wave lithotripsy (ESWL), and also it could be an effective measure for other urological diseases such as the upper urinary tract tumors.

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γ-Sm, the specific antigen of the prostate, is useful for the diagnosis and following-up of prostatic cancer. It is recognized as the tumor marker. The serum γ-Sm is increased in some cases of acute prostatitis. We evaluated the serum γ-Sm in patients with acute prostatitis. Serum γ-Sm, PAP, CRP and WBC count were measured before treatment with antibiotics and 3 to 5 days and 1 week thereafter. In the acute phase of inflammation (before treatment) serum γ-Sm increased in 62.5% of the cases. Then it decreased quickly and was within the normal range 3 to 5 days later. This change of serum γ-Sm is similar to that of WBC count, fever and urinalysis. But the decrease of serum γ-Sm is earlier than that of CRP. PAP does not increase in any phase of inflammation. It suggests that the serum γ-Sm reflects cell damages of the prostatic gland or increased permeability due to prostatitis.

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Both D-dimer and E fragments in urinary FDP were determined in renal transplantation patients. Urinary D-dimer fragments increased in 14 out of 20 acute rejections (70.0%) and in 6 out of 18 chronic rejections (33.3%). Urinary E fragments increased in 8 out of 9 acute rejections (88.9%) and in 4 out of 5 chronic rejections (80.0%). It is suggested that urinary FDP-E fragment is a better indicator to detect or predict rejection than the whole Urinary FDP.
The appearance of D-dimer in the urine indicates intravascular coagulation in glomeruli followed by a secondary fibrinolysis in the course of the rejection reaction. The urinary D-dimer/FDP ratio which was used as the indicator of fibrinolytic activity in glomeruli was obtained in various conditions of renal transplants. The ratios were relatively high in the urines from well functioning grafts. This ratio deteriorated at the onset of rejection crisis and tended to go upward during the course of the recovery when the rejection was reversible. In the cases of irreversible acute rejection and chronic rejection, these ratios remained at a low level. D-dimer/FDP ratio might be useful indicator to predict the reversibility of rejection and the prognosis of renal allograft. Furthermore, these findings suggest that fibrinolytic and thrombolytic therapy by the tissue-type plasminogen activator (t-PA) along with immunosuppressive drugs might be more effective for the treatment of these rejections.

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In order to investigate the presence of androgen insensitivity in patients with male infertility, intratubular androgen receptor (AR) was measured in patients with idiopathic oligozoospermia and azoospermia.
The specimens were obtained by testicular biopsy or orchiectomy from 56 patients with oligozoospermia and 5 with azoospermia for clinical study, and 17 with varicocele, 22 with vas disorders and prostatic cancer, which had a mean germinal epithelium score count of 8.5 or greater by the method of Johnsen (JSC) for deciding the cut-off levels, as the control group.
Intratubular AR was measured by a 5-point micro-receptor assay, an exchange assay with the DCC method, using 40μl of each sample extract and ³H-methyltrienolone as the ligand.
The genital skin AR assay was also conducted simultaneously in 34 patients.
The results were as follows:
1) No significant correlation was noted between intratubular ARs and genital skin ARs.
2) The maximum binding (Bmax) of AR in the total intratubular extract was intermediate between that of the cytosol fraction and the nuclear extract.
3) Significant corellation was noted between the Bmax of ARs by the micro-receptor assay and those by the conventional assay.
4) The Bmax of AR in the control group (n=22) was 30.38±9.89fmol/mg protein (mean±S. D.) and was over 11fmol/mg protein in all cases. Therefore, 11fmol/mg protein was decided as the cut-offlevel for androgen insensitivity.
5) Comparative studies were undertaken between two groups, i.e., low AR group and normal AR group, with AR as a parameter for male infertility.
The plasma LH and T×LH products in the low AR group were significantly higher than in the normal AR group. However, no significant differences in JSC, plasma T and FSH levels were noted between the two groups. In addition, there were no significant differences in intratubular T or 5α-dihydrotestosterone (DHT) levels between the two groups.
These results suggest that some failures of ARs in the hypothalamus may exist in patients with low ARs, but only 7 of the 61 patients had low ARs. Thus androgen insensitivity in infertile men may be rare.

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One hundred and forty-four patients primarily receiving kidneys from cadaver donors between Jan., 1978 and Oct., 1989, were reviewed. The patients' ages ranged 14-53 with a mean±S. D. of 34.7±8.0 years old. There were 100 males and 44 females. Twenty kidneys were harvested from heart-beating donors and 124 from non-heart-beating donors. In harvest from non-heart-beating donors, we perfomed in situ cooling through a double balloon catheter placed in the aorta to minimize prolonged warm ischemia. The number of matched HLA A, B antigens was (mean±S. D.) 1.7±0.8 antigens and for HLA DR antigens, it was 1.2±0.5. One hundred and nineteen of the 144 recipients have had a history of blood transfusion preoeratively. The patients were treated with four different immunosuppressive protocols; regimen I consisting of horse antilymphocyte globulin (ALG), regimen II of large-dose (14mg/kg/day) of cyclosporin (CsA) and steroid, regimen IIIa of low-dose (4mg/kg/day) of CsA, steroid and a short course of ALG (500mg/day) and regimen IIIb of low-dose (6mg/kg/day) of CsA, steroid and a short course of ALG (1000mg/day). Fifteen patients received regimen I therapy from Jan., 1978 to Nov., 1982, 49 received regimen II from Nov., 1982 to Dec., 1986, 23 received regimen IIIa from Jan, 1987 to Dec., 1987 and 57 received regimen IIIb from Jan., 1988 to Oct., 1989.
Graft survival was 40% at 1 year, 33% at 2 years, 26% at 3 years and 19% at 5 years in regimen I group, 78% at 1 year, 74% at 2 years, 71% at 3 years and 64% at 5 years in regimen II, 64% at 1 year and 55% at 2 years in regimen IIIa, and 89% at 1 year in regimen IIIb. Patient survival was 86% at 1 year, 84% at 2 years and 79% at 3 through 5 years in regimen I group, 98% at 1 year and 96% at 2 throug 5 years in regimen II, 92% at 1 through 2 years in regimen IIIa and 100% at 1 year in regimen IIIb.
Present problems in cadaver kidney transplantation are also discussed.

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We reviewed 115 incontinent women undergoing conservative treatment. Urinary incontinence was caused by pelvic floor weakness (genuine stress incontinence) in 54 patients, by involuntary detrusor contraction (detrusor instability) in 38 and by both (mixed type) in 23. Tricyclic antidepressants or alpha-adrenergic stimulators were given to 30 ptiaents with pelvic floor weakness; Incontinence disappeared in 4 patients (13%) and was improved in other 3 patients (10%). Twenty-two patients with pelvic floor weakness underwent pelvic floor exercise with or without medication; Incontinence disappeared in 8 patients (36%) and was improved in other 11 patients (50%); The presence or absence of medication did not affect the results. Twenty-eight patients with involuntary detrusor contraction underwent bladder training combined with medication of detrusor relaxants; Incontinence disappeared in 4 patients (14%) and was improved in other 13 patients (46%); There was no significant difference in the results between smooth muscle relaxants and tricyclic antidepressants. Of the 23 patients with mixed type, 11 underwent bladder training with medication; Incontinence disappeared in 2 patients (18%) and was improved in 3 patients (27%); The remaining 11 patients received medication, pelvic floor exercise or urethral dilatation, and only 2 patients were cured or improved of incontinence. Follow-up of the patients with involuntary detrusor contraction or mixed type showed that urinary incontinence tended to recur after discontinuation of medication. These results indicate that incontinent women with pelvic floor weakness should be treated first with pelvic floor exercise, and then with bladder training with medication. Although it has only a limited effect, it is an acceptable treatment of urinary incontinence caused by involuntary detrusor contraction.

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The histochemical detection of human papillomavirus (HPV) was performed using the tequnique of in situ hybridization from the formalin fixed paraffin embedded specimens of penile carcinoma and condyroma aquminatum. One of 19 penile cancer cases (5.3%) revealed the positive staining on the nuclei of the tumors for HPV type 16/18. However, the positive nuclei were scattered and localized in small part of the tumor which showed no koilocytosis. On the contrary, 11 of 12 condyloma aquminata cases (91.7%) showed positive staining on the nuclei of the tumors for HPV type 6/11, also 5 of the 11 cases (45.5%) revealed cross reaction for other type of HPV. The HPV types 6/11, 16/18 and 31/33/35 may be unrelated to the pathogenesis of the Japanese penile carcinoma. However, further study is necessary to evaluate that the number of HPV-DNA copy in our cases is too small, or the other type of HPV is responsibility.

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Quantification of the argyrophilic nucleolar organizer regions (AgNORs), using a one-step silver colloid method, was made in proliferative urothelial lesions including neoplasm of the rat urinary bladder induced by 0.05% N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) and of the human urinary bladder. The mean numbers of AgNORs in various experimental lesions in rats given BBN for 5-30 weeks in drinking water were: nontreated urothelium (n=6), 1.26±0.09; urothelium outside focal lesions (n=10), 1.75±0.10; simple hyperplasia (n=10), 2.01±0.15; papillary or nodular (PN) hyperplasia (n=10), 2.15±0.19; papilloma (n=5), 2.37±0.12; and transitional cell carcinoma (TCC) (n=5), 3.52±0.23. There was a significnat difference in the mean number of AgNORs between any two groups (p<O.05), except for simple hyperplasia vs PN hyperplasia (p=0.085). In various proliferative lesions of human biopsy and resected samples, the mean numbers of AgNORs were: normal urothelium (n=8), 1.71±0.08; proliferative cystitis (n=14), 1.79±0.18; hyperplasia (n=8), 1.76±0.23; mild dysplasia (n=5), 2.15±0.36; moderate dysplasia (n=13), 2.61±0.27; severe dysplasia (n=6), 3.46±0.57; G0 of TCC (n=9), 1.95±0.17; G1 of TCC (n=16), 2.39±0.20; G2 of TCC (n=21), 3.33±0.31; G3 of TCC (n=15), 4.68±0.51; and carcinoma in situ of TCC (n=10), 3.61±0.52. These results indicate that there is a stepwise increase in number of AgNORs from normal urothelium through various grades of preneoplastic lesions to carcinoma, and that the number of AgNORs reflects a proliferative activity of the experimental and human urinary bladder lesions, which is related to the grade of cancerous tissue. Moreover, cancer chemotherapy induced changes of AgNORs number in bladder cancer and such changes were remarkable in the tissue of patients with a good response for chemotheray. Thus, quantification of AgNORs could be a new method for the histopathological assessment of urothelial proliferation in both human and rat urinary bladder.

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On 24 reno-ureteral units of 21 patients with a silicon ureteral stent, urodynamic study of the upper urinary tract was performed by diuresis radionuclide urography (DRU). We obtained the following conclusions.
1. A silicon stent was useful to maintain urinary stream in ureteral operation.
2. In extrinsic ureteral stricture due to pelvic malignant tumor, pattern of DRU was still poor after indwelling stent.
3. When a stent of the 5.8F's outer diameter was used for an adult, a too thick stent for the ureteral size might rather interrupt the urinary stream.
4. Patterns of DRU and GFR measured by Gates' method in the state of ureterl stenting could warns that hydronephrotic kidney may develop.

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Renal function of eighteen children with solitary kidney (14 congenital and 4 aquired) was assessed using DMSA renal uptake rate and urinary excretion of α₁-MG, α₂-MG, NAG and microalbumin. Seven of the cases were associated with vesicoureteral reflux (VUR) and two with congenital hydronephrosis. These anomalies have been already treated surgically before entering this study.
DMSA renal uptake rate of 8 children was the same as that of the controls (51.8±3.7%; mean±SD). However, the uptake rate of 10 cases were more than 2SD below the mean of the controls. In five of them, including two children with no other urinary tract anomaly, the uptake rate was less than 70% of the mean of the controls.
Half of 14 children evaluated with α₁-MG showed high values. In 6 of these 7 cases, DMSA renal uptake rate was more than 2SD below the mean of the controls.
Urinary microalbumin was not correlated with urinary α₁-MG or DMSA renal uptale rate. Three of 4 children with high values of urinary microalbumin were more than 10 years old.
Nine of 12 children evaluated with all the indices mentioned above showed high values of urinary α₁-MG and/or microalbumin. Low DMSA renal uptale rate was revealed in 7 out of these 9 children including two cases without urinary tract anomaly.
These results indicate that, in the cases with solitary kidney even though no other urinary tract amomaly is recognized, renal overload may have already developed in early life.

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A syndrome of detrusor-sphincter dyssynergia (DSD) is occasionally found in patients with brain bladder. To evaluate the brain stem function in cases of brain bladder, urodynamic study, dynamic CT scan of the brain stem (DCT) and auditory brainstem response (ABR) were performed. The region of interest of DCT aimed at the posterolateral portion of the pons. The results were analysed in contrast with the presense of DSD in urodynamic study.
DCT studies were performed in 13 cases with various brain diseases and 5 control cases without neurological diseases. Abnormal patterns of the time-density curve consisted of low peak value, prolongation of filling time and low rapid washout ratio (low clearance ratio) of the contrast medium. Four of 6 cases with DSD showed at least one of the abnormal patterns of the time-density curve bilaterally. In 7 cases without DSD none showed bilateral abnormality of the curve and in 2 of 7 cases only unilateral abnormality was found.
ABR was performed in 8 patients with brain diseases. The interpeak latency of the wave I-V (I-V IPL) was considered to be prolonged in 2 cases with DSD compared to that of 4 without DSD. In 2 cases with DSD who had normal DCT findings, measurement of the I-V IPL was impossible due to abnormal pattern of the ABR wave.
Above mentioned results suggests the presence of functional disturbance at the posterolateral portion of the pons in cases of brain bladder with DSD.

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The first case of carcinosarcoma originating from the renal pelvis in Japan is reported.
A fifty-five year old woman was admitted to the hospital on July 13, 1987, complaining of a one-year history of lumbago. On physical examination, a mass of child's head size was palpable in the right loin. There were other palpable masses in the posterior head (8×8cm), left anterior chest (3×3cm) and sacral region (3×3cm). A chest X-ray showed multiple pulmonary metastases and an excretory urogram revealed a non-visualizing right kidney. Computed tomogram and renal angiogram suggested right renal tumor. Right renal arterial embolization with ethanol scleosing was performed. She had previously undergone biopsy of the sacral lesion at another hospital, histological examinations of which pointed to suspected carcinosarcoma. She was treated by a combination chemotherapy with vincristine, adriamycin and cyclophosphamide. Despite one course of chemotherapy, her general condition deteriorated with progression of metastatic lesions in the regions other than the lungs. She died of the disease on december 9, 1987. Autopsy was performed. Sections of the right kidney showed a transitional cell carcinoma in-situ with squamous and glandular differentiation in addition to the chondrosarcoma. The metastases were found in the liver, lung and bone, all of which consisted of chondrosarcoma. On the other hand skin metastases consisted of both carcinomatous and sarcoma-tous elements. The pathological specimens were reviewed at the Armed Forces Institute of Pathology, Washington, D. C.

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