(Background) In order to examine the difference in histological findings during acute rejection between ABO-incompatible renal transplantation and compatible, we studied biopsy specimens from renal allografts histopathologically.
(Methods) Twenty one ABO-incompatible cases (ICBG) and fifteen compatible cases (CBG) who were transplanted at Tokyo Women's Medical College and considered to have acute rejection clinically were selected. Lightmicroscopic findings classified Banff schema, deposition of globulins and complements, expression of HLA class II antigen (DR) and adhesion molecules (ICAM-1, VCAM-1), subset of infiltrating cells, blood type antigen and specific antigen for endothelium (Thrombomoduline: TM, Factor VIII) were compared between CBG and ICBG on biopsy specimens.
(Results) Tubulitis was observed in 71.4% of ICBG and all cases of CBG. Severe interstitial infiltration of CD8 positive cells and polymorphonuclear leucocyte (PMN) glomerular infiltration was showed in 52%, 85.7% of ICBG and 100%, 0% of CBG. The incidence of fibrinogen deposits was 47.6% in ICBG and 26.7% in CBG. Tubular expression of DR, ICAM-1 and VCAM-1 were positive in 25%, 40%, 45% of ICBG and 91.7%, 100%, 100% of CBG. Monoclonal antibody for TM was demonstrated more strongly positive in CBG (73.3%) than in ICBG (28.6%). These findings had significant differences in ICBG from CBG.
(Conclusions) Acute rejection of ABO-compatible renal transplantation was characterized by tubulitis accompanied by high expression of DR, ICAM-1 and VCAM-1, which subsequently injure tubulo-interstitium. On the other hand, ABO-incompatible acute rejection showed endothelial injury characterized by fibrinogen deposition and severe PMN infiltration in glomeruli (glomerulitis).

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(Background) The objective of this study is to evaluate the frequency of regional lymph node metastasis, clinical outcomes and histopathological findigns of renal pelvic or ureteral cancer with regional lymph node metastasis.
(Patients and Methods) One hundred and sixty three patients with renal pelvic or ureteral cancer were treated in our hospital between 1961 and 1995. Eighty nine in 155 patients underwent lymph node dissection. Frequency of regional lymph node metastasis, clinical outcomes and histopathological findings of these 89 patients were investigated. Patient survival rates were determined by actuarial calculation using Kaplan-Meier method with log-rank test.
(Results) The status of lymph node involvement was pN0 in 61 (68.5%), pN1 in 5 (5.6%), pN2 in 15 (16.9%) and pN3 in 8 patients (9.0%). The 5-year survival rate was 78.8%, 12.5%, 20.0% and 0% for pN0 pN (+), pN1, pN2 and pN3 respectively.
In 28 patients with regional lymph node metastasis, patients with distant metastasis were all dead within 1.2 years and the 3- or 5-yer survival rates of patients without distant metastasis were 31.4% and 15.7%. The difference between two groups were obvious (p<0.01). The 3-year survival rate was 100%, 66.7%, 33.3% and 0% for pT1, pT2, pT3 and pT4 patients with M0 and pN (+) respectively.
(Conclusion) Our data suggested that conventional treatments were not effective for almost patients with regional lymph node metastasis. However in the patients with low grade, under pT3 and M0, pN1-2, the possibility of long time survival was shown.

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(Purpose) We evaluated expression of angiogenic factors, tumor vessel density and recurrence in superficial bladder cancer by immunohistochemistry.
(Methods) Fourty tumor specimens from bladder preserving operation and 11 normal epithelia were stained for factor VIII-related antigen, vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and acidic fibroblast growth factor (aFGF). Maximum vessel density (MVD) was counted in a 200× field in the highest vascularized area stained for factor VIII. Superimposing a 4×4 square ocular grid on the boundary between epithelium and interstitium, average vessel density (AVD) and vascular surface density (VSD) were calculated by dividing the vessel number in the grid and the intersection number of vessel walls on the lattice lines by the area of interstitium calculated from the number of the gird cross points, respectively.
(Results) Positive rates of VEGF, bFGF and aFGF by immunohistochemistry were 50%, 23% and 43% in the superficial bladder cancer, respectively. The positive rate of VEGF staining was higher in G2-3 tumors than in G1 tumors. All normal epithelia, except one which was positive for aFGF, was negative for those three factors. T1 tumors had a higher MVD than that of Ta. AVD and VSD of the tumor were higher than those of normal epithelium, but negative correlation between the number of positive angiogenic factors and the vessel density was revealed. The recurrence group had a lower vessel density and a higher ratio of VSD/AVD than those of the non-recurrence group.
(Conclusion) These findings suggest that the expression of VEGF, bFGF and aFGF was not reflected by the tumor angiogenesis, the angiogenesis is required topically at the invasive front of the superficial bladder cancer, and the tumor which had fewer and broader tumor vessels has a high tendency to recur.

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(Purpose) Uroithiasis seems to be the dominant disease for male. In the recent Japanese epidemiological report, the sexual ratio was reported 2.3:1. This sexual ratio is almost stable from 1960. We studied epidemiologically based on age and stone components the differences between the sexes.
(Patients and Method) From 1977 to 1996 the upper urinary tract stones which spontaneous excretion or surgical removal in our hospital were the subjects of study, Stone analysis was carried out infrared spectrometer. The statistical analyses were performed by the chi-square test and Mann-Whitney's U test. Significance was declared for a probability value of less than 0.05.
(Results) In the epidemiology of our treated patiens sexual ratio was 1.83:1. We studied sexual ration in age and stone components. The sexual ratio of the patients, 60 years and over was decreased compared with that of the patients under 60 years of age. We found the tendency that the sexual ratio was decreased at 60 years old and over. In the female urolithiasis patients less than 60 years old the frequency of calcium oxalate contained stone patients was predominantly smaller than male. In the female urolithiasis patiens of 60 years and over the stone component ratio was similar to male urolithiasis patients.
(Conclusion) In point of frequency sexual ratio was decreased at 60 years old and over. In the female patients less than 60 years old the frequency of calcium oxalate contained stone was predominantly small. This low frequency of calcium oxalate contained stone in the female less than 60 years old seemed to be a factor of the sex differences of frequency.

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(Background) It is well recognized that tumor volume correlates with pathological stage, histological grade and progression in prostate cancer. We analyzed the tumor volume and the percent of gland involvement with tumor (%TV/PV) to determine if either or both of these morphometric factors would be good predictors of pathological stage.
(Methods) The pathological reviews were retrospectively performed on the basis of the 22 step sectioned prostate specimens removed by radical retropublic prostatectomy for clinical T1c-T2-T3 prostate cancer. The percent of gland involvement with tumor was calculated using the following formula {100×(tumr volume cc/prostate volume cc)}. When the patients had organ confined disease (OCD) or specimen confined disease (SCD) they were defined as surgically cured patients, whereas the patients with positive surgical margin, seminal vesicle involvement or positive lymphnode were defined as not surgically cured patients.
(Results) The likelihood of OCD was 25% in patients with clinical T1c-T2 disease. No patients with clinical T3 had OCD. Patients with SCD was not observed.
The mean tumor volume was 1.3cc in the surgically cured patients and 6.2cc in the not surgically cured patients. The tumor volume correlated with pathological stage (r=0.607, p=0.0054). The mean %TV/PV was 3.23% in the surgically cured patients and 18.2% in the not surgically cured patients. The %TV/PV also correlated with pathological stage (r=0.543, p=0.0129).
Both the tumor volume and the %TV/PV in surgically cured patients were less than those in the not surgically cured patients. A correlation between tumor grade and both the tumor volume and the %TV/PV were not observed.
(Conclusion) The tumor volume and the %TV/PV correlated well with the final pathological stage. Multiple regression analysis showed that the tumor volume was the best predictor of pthological stage.

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(Background) Radiation therapy has widely been used for cancers in the pelvis. Radiation cystitis, one of the late complications, presents often as hemorrhagic cystitis, which is refractory to the conventional therapy and may threaten the patient's life. We used hyperbaric oxygen therapy on patients with radiation cystitis to test its potential benifit.
(Methods) Ten patients aged from 46 to 81 years with a mean of 62 years underwent one or more courses of hyperbaric oxygen therapy according to their symptoms, consisting of 20 sessions (3 to 5 sessions a week) at the Department of Hyperbaric Medicine, the University of the Ryukyus Hospital in the 9-year period from 1985 to 1994. They included 8 patients having a history of cervical cancer, one with external genital cancer and one with vaginal cancer. During the 75min hyperbaric oxygen therapy patients received 100% oxygen at 2 absolute atmosphere pressure in the Multiplace Hyperbaric Chamber.
(Results) Hematuria subsided and subjective symptoms including urinary frequency improved in seven patients. Cystoscopic findings including mucosal edema, redness, and capillary dilation were partially improved. The procedure subjectively and objectively palliated the 10 patients in a favorable manner.
(Conclusions) To date we have not armed any active procedure to control radiation-induced refractory hemorrhagic cystitis in terms of efficacy, invasiveness, and adverse effects. Therefore, in consideration of our clinical results, hyperbaric oxygen therapy appears to be useful for radiation cystitis.

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A case of renal malignant lymphoma is reported. A 74-year-old man was admitted to our hospital on September 8, 1995, complainning of right flank pain, abdominal mass, and anorexia for two months.
Physical examination revealed an enlarged right axillary lymph node and abdominal mass of child's head size. Computerized tomography showed a tumor (11×7cm) encompassing the right kidney parenchym, and enlarged paraaprtoc lymph nodes with invasion of the left iliac creat. Transcutaneous echo-guided needle biopsy revealed that the tumor was non-Hodgkin's malignant lymphoma, diffuse large cell type, positive for B cell marker.
The patient was treated with full dose of CHOP regimen. However, adriamycin was replaced with pirarubicin and the dose of the other drugs were reduced for the subsequent 4 courses because of severe leukocytopenia, thrombocytopenia, hepatotoxicity, snd alopecia after the first course of the treatment. The patient showed complete remission and discharged on March 12, 1996. He, after 17 months, has no signs of recurrence.
We reviewed 43 Japanese cases previously reported as renal malignant lymphoma. It is increasing in Japan especially in elderly. The 2-year survival is 26.6%.

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A case of metastasis to the seminal vesicle of renal cell carcinoma is reported. A 60-year-old man was referred to our department for evaluation of intermittent hematospermia and asymptomatic macrohematuria for about 2 years. He had a left radical nephrectomy for localized renal cell carcinoma 5 years ago. Panendscopy showed a little bleeding of posterior urethra, but there were no abnormal images of upper urinary tracts. Two years later he had asymptomatic macrohematuria again and panendscopy showed swelling and bleeding of verumontanum. Transurethral resection of verumontanum revealed clear cell carcinoma histopathologically and CT revealed seminal vesicle or prostate tumor, then total cystectomy was performed. Pathological examination indicated metastasis to seminal vesicle of renal cell ccarcinoma. There has been no report of metastasis to seminal vesicle of renal cell carcinoma in literature. This is the first case in the world.

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We report a rare case of retroperitoneal schwannoma arising from left adrenal gland. A 45-year-old man with upper abdominal discomfort was found to have a tumor in the left adrenal gland by abdominal ultrasonographic scan. The laboratory findings were all normal but angiogram indicated slightly hypervascular adrenal tumor. Eventually, he was underwent left adrenalectomy. The removed mass was measured 6.5×5.7×5.0cm and weighed 75.5g. Pathological study revealed benign schwannoma arising from the adrenal gland, consisting mainly of the Antoni A type. A review of the literature on adrenal schwannoma is included.

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