(Purpose) In this study, we investigated the ultrastructure of the microvasculature in human renal cell carcinoma (RCC) specimens. (Materials and Methods) RCC specimens from 30 patients were studied by light microscopy after hematoxylin and eosin staining and α-smooth muscle actin staining, and by electron microscopy after uranyl acetate lead nitrate staining or periodic acid thiosemicarbazide gelatin methenamine silver staining. (Results) In the light microscopy, the capillaries located adjacent to the renal medullary tubules in normal renal tissue specimen were in an orderly manner, while capillaries in the RCC specimens were found to be densely or sparsely distributed unconventionally. The pericytes encircling the capillary endothelial cells were positive for α-smooth muscle actin and formed aggregates in many of the RCC specimens, but did not form aggregates in the normal tissue specimens. In the electron microscopy, capillary endothelial cells in the normal renal tissue specimens were found to form well-developed membranous structure such as characterized by fenestrations and tight junctions. However, few pericytes were detected. On the other hand, the capillary endothelial cells in RCC specimens were found to be immature with poorly developed junctional complexes. Capillary pericytes with numerous cytoplasmic processes were found in many of the RCC specimens. In addition, the basement membranes of the capillary walls were structurally abnormal in that it was being multilayered. Based on the results of analysis of a total of 324 capillaries observed in all RCC specimens, capillaries could be classified as type I capillaries, associated with well-developed pericytes with numerous processes, or type II capillaries, associated with few pericytes with few processes. Type I capillaries predominated in cases which an angiographically hypervascularity was detected. Whereas, type II capillaries predominated in cases in which angiographically hypovascular pattern were detected. (Conclusion) The fine structure of the pericytes seems to reflect the qualitative difference in capillary structure between normal renal tissue and RCC specimens. Therefore, the present findings may contribute to the recognition of intratumoral hemodynamics.
(Background) In our investigations to develop microexplosion lithotripsy (MEL), the detonation theory, which was proposed in industrial blasting, was proved to be tenable also in MEL with tiny explosives of a few mg. According to the theory, the peak pressure of shock wave generated by blasting was analyzed relating to the volume of calculi. (Methods) 472 cases of renal urinary calculi to be disintegrated by ESWL were examined. (Results) For the successful disintegration, the maximum length of calculi, which was employed conventionally, was a good predictor as for those less than 15mm (disintegrated in 95%) and those more than 25mm (disintegrated in 8%). However, the maximum length could not predict the successful result in calculi with intermediate maximum length between 15 and 25mm. For this intermediate range of the maximum length, the volume of calculi was a very good indicator to show whether the integration was possible or not, because the large majority (90%) of calculi less than 6cm3 was treated successfully, while none of calculi more than 6cm3 was disintegrated. According to the theory, the peak pressure of shock wave generated by blasting, which was required to disintegrate a calculated of 6cm3, was calculated as 80MPa. (Conclusion) Since it is believed that the peak pressure generated by usual ESWL machines is between 80 and 120 MPa at the focussing point, the conclusion in this report that the maximum volume of calculi disintegrated by ESWL might be 6cm3 was thought to be fairly reasonable.
(Background) The objective of this study is to evalute the prognosis of carcinoma of the prostate presenting as non-regional superficial lymphnode metastasis. (Methods) From 1986 to 1996 at the Chiba University Hospital, 205 cases of prostatic cancer with distant metastasis were experienced. (Results) In nine of them, non-regional lymphnode metastasis was observed at the diagnosis. In all of them, serum prostate specific antigen and/or prostate acid phosphatase levels were elevated. In eight of nine cases, cancer nodule was detected by digital rectal examination. Anti-androgen therapy was effective in eight cases and five year survival rate was 56%. (Conclusion) From these observations, prostate cancer should be considered when superficial lymphnode was enlarged.
(Introduction and Objectives) It is reported that cytokeratin 19 (CK-19) mRNA is not expressed in the peripheral blood cells of the healthy subjects (Am. J. Pathol. 142: 1111. 1993). Detection of DNA fragments of CK-19 in the peripheral blood suggests the existence of epithelial malignant tumor cells. In this study, we detected CK-19 genes in peripheral blood of patients with urogenital malignancy, and thus clarified the possibility of understanding tumor expansion. (Methods) Mononuclear cells were separated from the peripheral blood of 39 patients with urogenital tumor and 9 controls. Total cellular RNA was extracted according to the method described clsewhere. The CK-19 gene expression was investigated using nested reverse transcription polymerase chain reaction (nested RT-PCR) and confirmed by Southern Blotting. These results were compared to the clinical stages. (Results) CK-19mRNA was not detected in any of 9 controls. CK-19mRNA was detected in 3 out of the 10 bladder cancer cases. Two had metastases and 1 had muscle invasion without metastasis. One of 6 urothelial cancer case of the upper urinary tract showed positive amplification, and had liver, bone and lymphnode metastases. After one course of chemotherapy, mRNA became negative. In prostate cancer cases, three among 7 were positive and all 3 cases had distant metastases. In renal, testicular and penile cancer cases, the positive ratio were 3/6, 1/8 and 2/2, respectively. All positive cases of renal and testicular cancer had distant metastases, but one case of penile cancer had no metastasis. (Conclusion) The detection of CK-19mRNA in the circulating blood by nested RT-PCR makes it possible to detect micrometastasis. to evaluate therapeutic effects and to predict the prognosis.
(Background) Vesicoureteral reflux and urinary incontinence are frequently observed among myelodysplastic patients. Since the conservative therapy is not always effective to improve these pathologies, surgical intervention is necessary for some of the patients. (Methods) Thirty-eight myelodysplastic patients were divided into 2 groups: Group A comprised 17 patients who had been operated by anti-reflux surgery (crossover method) alone and Group B 21 patients who had undergone anti-reflux surgery (Orikasa's method) and augmentation enterocystoplasty with or without sling operation. Cessation rate of reflux, bladder capacity, bladder compliance and operative complications were analyzed in the 2 groups. A questionnaire was sent to the patient asking to answer frequency of clean intermittent catheterization (CIC), severity of urinary incontinence, satisfaction rate for operation and so on. Mean followed-up periods were 11.7 (5.3-13.6) years for Group A and 3.7 (0.6-6.9) years for Group B, respectively. (Results) Reflux was successfully eradicated in 19 of 24 ureters (79%) of Group A and in 25 of 29 ureters (86%) of Group B, which was not significantly different. In Group A, bladder capacity and compliance slightly improved. The latter, however, remained less than 10ml/cmH2 O. Bladder capacity and compliance of Group B increased more than twice the original value with statistical significance. Operative complication in Group A was ureteral obstruction in 1 patient, which eventually necessitated peritoneal dialysis. In Group B revision of ventriculoperitoneal shunt was necessary in 4 patients, incomplete ileus was conservatively treated in 3, and a bladder stone was formed in 1. The patients assessed that frequency of pyelonephritis was less in Group B compared to Group A. Other subjective parameters, however, such as frequency of CIC, severity of urinary incontinence, postoperative changes in the amount of urinary incontinence, and satisfaction rate for operation, were not different between the 2 groups. (Comments) Though operation-related complications occurred more frequently in those of Group B, these patients enjoyed significant improvement in bladder capacity and bladder compliance. We conclude when the conservative therapy fails to cure and improve vesicoureteral reflux and urinary incontinence, surgical interventions including anti-reflux surgery and augmentation cystoplasty with or witout sling operation are recommended as a treatment option.
A 34-year-old house wife presented with a right renal mass detected by work-up for epigastralgia. The mass located in the right renal sinus was round and approximately 3cm in diameter. Although the tumor was well enhanced with contrast medium on CT scan, it was hypovascular on the early arterial phase of renal angiography. Translumbar radical nephrectomy was performed on suspicion of the right renal cell carcinoma. The tumor was solid and hard and, the cut surface of the tumor was homogenously colored pale pink. Microscopically it was hemangiopericytoma arising in the renal sinus, composed of well-developed pericytes and capillaries with so-colled staghorn configuration, with invasion of hilar renal vein. Immunohistochemically, the hemangiopericytes were strongly positive for CD34, but negative for factor VIII associated antibodies. To our knowledge, the present patient is the 6th case in the Japanese literature and the first case with incidentally detected renal hemangiopericytoma.
We report a case of adenocarcinoma of the augmented bladder 19 years after ileocystolasty. The patient was a 53-year-old man who underwent right nephrectomy and ileocystoplasty (Pyrah's method) for contracted bladder due to tuberculosis in 1965. In another hospital, transurethral resection (TUR) was performed against a tumor in the anastomotic site between the bladder and the ileal segment in 1996. Histopathological examination of the specimen obtained by TUR revealed poorly-differentiated mucinous adenocarcinoma. In our hospital, partial cystectomy with total resection of ileal segment and ileocystoplasty were performed. The tumors located in the anastomotic site between the bladder and ileal segment as well as in the ileal segment. Histopathological examination revealed poorly-differentiated mucinous adenocarcinoma. The patient has survived 12 months without any evidence of tumor recurrence. To our knowledge, this is the eighth case report in Japan.
A 57-year-old male was admitted because of the right flank pain. The image examinations, retrogradeurography, abdominal CT and MRI, showed a mass located at the upper right ureter. Although the tumor was not typical as ureteral cancer, we could not make a diagnosis of a benign tumor by image examinations. Therefore nephroureterectomy that was surgical method for ureteral cancer was performed. The tumor was diagnosed as inflammatory pseudotumor of the ureter by histological findings. Inflammatory pseudotumor is extremery rare for ulogeital organs. And this lesion is difficult to distiguish from malignancy only by image examinations. Therefore, the surgical resection and pathological studies are necessary.
This is a report on a surgery performed in Feburuary, 1995 describing the donation of a living donor's horseshoe kidney used for renal transplantation. The recipient was a 31 years-old male on hemodialysis since 1994. The donor was the healthy 55 years-old father of the recipient who had an uncomplicated horseshoe kidney. The isthmus was perfused by an accessory artery. Via transperitoneal approach, the horseshoe kidney was mobilized for in situ perfusion. A microwave coagulator was used to divide the isthmus, and the cut surfaces were closed by mattress sutures and fibrin glue. The left kidney was transplanted into the recipient's right iliacfossa. While his post-transplant course was complicated by urinary leakage, the graft remained free of rejection until and beyond the 6 months post-transplant period when he was discharged at s-Cr 1.7mg/dl. The donor's convalescence was uneventful. During the 20 months post-transplant period both the donor and recipient are doing well.