In the present study, the authors tried to establish transplantable urogenital carcinomas onto nude mice and evaluate anticancer drugs using these experimental models.
The results were as follows:
Urogenital carcinomas, which were obtained from sixty-one patients during the surgical treatments, were aseptically xenotransplanted onto nude mice. The primary take developed in thirteen cases (21.3%). These included three cases of renal call caricinoma (21.4%), three of renal pelvis or bladder carcinoma (30.0%) and seven of testicular tumor (43.8%). The primary take did not developed in to prostatic carcinoma.
Of these thirteen cases with primary take, eight were established as the transplantable tumors (13.1%). They were two cases of renal cell carcinoma (14.2%), two of renal pelvis or bladder carcinoma (20.0%) and four of testicular tumor (25.0%). The transplantable tumors preserved all histological characteristics observed in their original tumors.
To transplantable tumors of renal cell carcinoma passed before four weeks, CDDP (5.0mg/kg) was administrated by intraperitoneal injection once in every two weeks. No difference, however, was shown in the estimated tumor weight between the CDDP group and the control (p>0.1).
In transplantable tumors of embryonal carcinoma of testis passed before two weeks of experiment, an intraperitoneal injection of CDDP (3.0mg/kg) once a week for four weeks revealed a significant difference in the estimated tumor weight as compared to that of the control group (p<0.01). No significant reduction in the estimated tumor weight was shown in the groups with BLM (5.0, 10, 20mg/kg) and with VBL (0.5, 1.0, 2.0mg/kg) (p>0.1). Intraperitoneal injection with a combination of BLM (10mg/kg) and VBL (1.0mg/kg) also showed the same results (p>0.05).
EMP (100, 150mg/kg), which was administrated by intraperitoneal injection twice a week for three weeks, did not cause reduction in the estimated tumor weight in transplantable tumors of prostatic carcinoma passed before six weeks. Intraperitoneal injection with a combination of CPM (20mg/kg), 5FU (30mg/kg) and MMC (0.1mg/kg) showed the same result as those for EMP.
The results in the experiments described above are parallel to those in experiences with clinical patients with renal cell carcinoma, testicular tumor and prostatic carcinoma. Therefore, transplantable urogenital carcinoma on nude mice is recommended as an experimental model for the screening of anticancer drugs.

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Adjuvant immunization of rabbits was performed by the routine methods using γ-Sm and β-MSP separated and purified from seminal plasma by the previously reported method to prepare anti γ-Sm and anti β-MSP serum.
Localization of γ-Sm and β-MSP was examined using these anti-sera by the enzyme antibody method (PAP method: Peroxidase-Antiperoxidase method) in normal tissue and primary prostatic cancer.
Prostatic glandular epithelial cells, reserve cells and prostatic glandular secretions were stained specifically by the enzyme antibody method in normal and hypertrophic prostatic glands, but no specific staining was noted in the seminal vesicle spermatic duct and testis.
Specific staining was noted in primary prostatic cancer and metastatic prostatic cancer.
By the enzyme antibody method, we recognized that γ-Sm and β-MSP were prostatic specific antigens.

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Serum prostatic antigens (γ-Seminoprotein: γ-Sm and β-Microseminoprotein: β-MSP) were measured by radioimmunoassay in 167 patients: 17 with histologically verified untreated prostatic cancer, 81 treated cancer, 39 prostatic hypertrophy and 29 other disease with malignancy.
The average γ-Sm levels of 23 normal men was 0.27ng/ml (range 0ng/ml to 3.7ng/ml), and we determined that normal γ-Sm levels is 1.93ng/ml.
The average β-MSP level was 29.6ng/ml (range 0ng/ml to 97.6ng/ml). The γ-Sm level from all patients with prostatic carcinoma gave positive results.
Both prostatic antigens, especially γ-Seminoprotein, may show alimitation of detection in early prostatic cancer groups.
There was a significant relationship between γ-Sm levels and β-MSP levels (for all 48, r=0.828), but the γ-Sm levels did not correlate with serum prostatic acid phosphatase (PAP).

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ABH isoantigen of 154 superficial urothelial tumor including 11 carcinoma in situ of the bladder was investigated by the avidin-biothin-peroxidase complex (ABC) method, and the results were compared with those obtained by the specific red cell adherence test (SRCA).
Antigenicity as detected by ABC method seemed to be correlated to tumor grade and recurrence rate, while that by SRCA method did not. 62 percent of the low grade papillary bladder tumor of blood group other than O was positive by ABC method, while only 25 percent was positive by SRCA method. As for the recurrence rate of low grade tumor, 11 of 33 cases (33%) with positive ABH showed recurrence during the minimum 3 years' followup period, while 13 of 21 cases (62%) without ABH isoantigens did so in blood group other than O. In carcinoma in situ of the bladder, it was found that ABH antigen was deleted in 82 percent of the patients using ABC method. Even among the patients who were initially positive by both methods, antigenicity tended to be deleted as clinical course progressed.
The advantages of ABC method are: 1) it is more sensitive and more specific than SRCA and peroxidase anti peroxidase (PAP) method, 2) in blood group O, the sensitivity was increased, 3) the technique is simple, and 4) many slides can be processed at one time. In view of the fact, however that the urothelial tissues processed in alcohol show variable reduction of their reactivity, it was suggested that the current method needs to be reappraised for accurate interpretation of tissue ABH reactivity.

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Intermittent functional electrical stimulation (FES) was used in the management of pollakisuria, urgency and/or urge incontinence without either urinary tract infection or bladder outlet obstruction. A success rate of 71 per cent (10 of 14 cases) was achieved.
Three to 100Hz rectangular electric pulses, 30 to 500 volts in amplitude and 0.2msec in duration, were employed. One FES lasted for thirty minutes. It was repeated at intervals of 3 days to 1 month via an anal plug electrode. A series of treatment consisted of 2 to 10 times of FES. There were 10 males and 4 females evaluated and one case of neurogenic bladder (lower motor neuron lesion) complaining of stress incontinence was also treated.
The maximum urethral closure pressure did not elevate during or after FES, and was not responsible for the effect of FES. FES seemed to indirectly inhibit a contraction of the detrusor by supressing its hyperexitability without weakening its contractile force, and the effect continued after FES. FES might activate cerebral regulatory or inhibitory function to the detrusor. This procedure has no adverse effect except for a slight pain in the anus and should be tried in the control of overactive (hyperreflexic or irritable) bladder.

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Uroflowmetry in combination with sphincter electromyography (UFM-EMG) was performed following cystometry simultaneously with electromyography (CMG-EMG) on 149 patients with various lower urinary tract disorders. UFM-EMG was compared to CMG-EMG as a means of diagnosing detrusor-sphincter-dyssynergia. Of 85 patients etimated to be with synergia in CMG-EMG, 82 were also diagnosed as synergia in UFM-EMG. However, among 16 patients estimated to be with dyssynergia in CMG-CMG, 8 were diagnosed as dyssynergia and another 8 as synergia in UFM-EMG.
Furthermore, among 48 patients equivocal by CMG-EMG, 35 were finally diagnosed as synergia and 7 as dyssynergia in UFM-EMG. Only 6 patients remained without final diagnosis by UFM-EMG. We consider that, those who were etimated to be with synergia by CMG-EMG may not need further examination, byt those estimated to be with dyssynergia or equivocal by CMG-EMG require another check up using UFM-EMG. Eighteen patients (12.1%) were finally diagnosed as dyssynergia using UFM-EMG.
All patients examined were classified into four groups according to cystometrogram patterns namely upper moter neuron lesion (UMNL), complete lower moter neuron lesion (LMNL), incomplete LMNL, and normal. The highest incidence of dyssynergia was observed in complete LMNL (35.7%) followed by UMNL (15.8%), incomplete LMNL (12.3%), and normal (3.9%).

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The purpose of the present study is to examine the hypothesis that human urothlial carcinoma produces hyaluronate, which is thought to be one of migration factors of malignant cells in the event of invasion into the connective tissue. In order to clarify whether hyaluronate is produced in a significant amount by urothelial carcinoma in vitro, the hyaluronate concentration was measured in incubation medium of cell lines derived from human bladder carcinomas (NBT-2, MGH-U1, T-24, KU-1 and KU-7) and these results were compared with those of cell lines derived from human fibroblast, uterus carcinoma (Hela) and human renal cell carcinoma (KU-2). Furthermore, histological study was performed to evaluated the distribution of acidic glycosaminoglycans (GAG) in the cytoplasm of these cells.
The original tumors of NBT-2, MGH-U1 and T-24 were high grade, non-papillary and invasive bladder urothelial tumors, while KU-1 and KU-7 were derived from papillary, non-invasive urothelial carcinoma.
For the determination of GAG as a total amount, the incubation medium was collected for 10 days from culture bottles and passed through 8.0μ-pore filter to exclude cell debris. Aliquats were used for the measurement of hyaluronate by a hyaluronate-specific radioassay. The amount of total GAG was measured by the carbazole reaction reported by Bitter & Muir in the incubation medium which had been digested in pronase-E solution, and the results were expressed as the amount of uronic acid per mg protein of cells used for the assay.
The amount of total GAG in the incubation medium was highest in fibroblast (181±15μg/mg protein; mean±S.E.M.) and this was followed, in a decreasing order, by T-24, MGH-U1, KU-7, NBT-2 and KU-1. The hyaluronate production in the medium was also highest in fibroblast. In the 5 cell lines originated from human bladder carcinomas, those from high grade, invasive tumors (MGH-U1, T-24) seemed to have higher hyaluronate production rates than those from non-invasive tumors. Moreover, the histochemical study with colloidal iron stain revealed the presence of abundant ferrisol particles in the perinuclear region (perinuclear granules) predominantly in those cell lines with higher HA production. The amount of uronic acid as well as hyaluronate in the incubation medium of Hela and KU-2 was not measurable, as these data were subtracted with blank values in control medium.
The distribution of abundant GAG in the cytoplasm and significant hyaluronate production in the cell lines from highly malignant bladder carcinomas suggest that hyaluronate and other related GAG might be involved in the characterization of the aggressiveness of the original tumors.

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It has been known for years that normal urothelial cells display a surface mutinous coat which is rich in acidic glycosaminoglycans such as hyaluronate. Normally hyaluronate occurs in trace levels in human urine, but it might be elevated in urine of patients with urothelial carcinomas of the bladder. A hyaluronate-specific radioassay is now in use for the determination of hyaluronate in body fluids. This assay system allows one to measure the hyaluronate concentration in the urine without any pretreatment of samples.
To test the role and usefullness of urinary hyaluranate determination in the diagnosis of bladder carcinoma, a retrospective study was performed. Twenty-four-hour urine was collected under the presence of thymol from 19 healthy subjects, 23 patients with newly-diagnosed bladder carcinoma, 11 patients with urolithiasis and 6 patients with renal cell carcinoma. Urinary excretion of total acidic glycosaminoglycans (GAG) was measured in cetylpiridinium chloride-precipitates by the carbazole reaction reported by Bitter & Muir and experssed as the amount of uronic acid. In normal subjects, total daily GAG excreted in the urine averaged 9.2±0.8mg (mean±S. E. M.) and the amount of hyaluronate excretion was 460±60μg/day (mean±S. E. M.). The upper limit for hyaluronate excretion was 900μg/day (mean+2S. D.) and those who excreted hyaluronate more than this normal limit were determined to have significant “hyaluronuria”.
In patients with urolithiasis, the mean value for total GAG excretion was significantly higher than that of normal subjects (p<0.05), but there was none who presented significant “hyaluronuria”. The mean levels of total urinary GAG and hyaluronate in patients with renal cell carcinoma did not differ significantly from those in healthy subjects. In those with bladder carcinoma, both the levels of total GAG and hyaluronate in the urine (13.3±1.2mg/day and 880±120μg/day, respectively) were significantly higher than in healthy subjects (p<0.05).
Out of 23 patients with bladder carcinoma, 16 had grade II or III high grade carcinomas. In these patients with high grade tumors, the hyaluronate excretion was higher as compared to those with low grade bladder lesions. In these 16 patients, 11 presented significant “hyaluronuria” (68.8%). Even in patients with low stage bladder lesions, those who had significant “hyaluronuria” seemed to have higher recurrence rate than those without it.
The significant hyaluronate in the urine of these patients seemed specific for bladder carcinoma, because this special GAG fraction decreased to normal range after successful resection of the bladder lesions. From these observations, it is concluded that the measurement of hyaluronate in the urine is valuable aids not only to diagnose but also to monitor the progression of bladder carcinoma.

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A new examination (bolusmetry) to evaluate the urine transport function of th pelvioureteric system was performed in 7 adult patients with congenital unilateral hydronephrosis.
Whistle-tipped Fr. 5 catheters were introduced to each ureter about 5cm proximal from the ureteral orifice by transuretheral endoscopic technique.
Bolus voulme and frequency, and changes in them caused by furosemide injection, were estimated by using a drop counter which was connected to the terminal end of the ureteral catheter.
Bolusmetry was performed comparing the hydronephrotic side and the healthy side, pre-and postoperatively, and these results were then compared with a conventional examination.
We obtained the following results: 1) Bolus volume of the hydronephrotic side was 0.05±0.02 (mean±S. D.)ml in oliguric state, and it was significantly lower than the value of the healthy side which was 0.19±0.7ml.
Injection of diuretics increased the bolus volume of the healthy side ten times or more. On the other hand, the bolus volume of the hydronephrotic side was increased slightly by the injection of furosemide and it was approximately one-fourth of the value of the healthy side. 2) The value of bolus frequency was similar to the peristaltic-frequency which was measured by the electromyogram. A decreasing tendency was noticed in bolus frequency of the hydronephrotic side but it was not significant. 3) In patients with severe hydronephrosis, the bolus volume of the hydronephrotic side was decreased and the response to the diuretics was not so significant. By bolusmetry, functional or organic obstruction of the ureteropelvic junction was detected. 4) In 3 patients who had nephrectomy or nephrostomy, the kidney function had deteriorated severely. The bolus volume was lower than 0.25ml at the diuretic state. 5) Bolus volume was increased postoperatively in 3 of 4 patients who had received pelvioplasty.
One patient did not show the formation of bolus by the injection of diuretics, and the cause of the hydronephrosis was functional obstruction of the pelvioureteric junction.
We concluded that volusmetry is a valuable method for evaluating the function of urine transport in the ureteropelvic system. Especially in hydronephrosis, bolusmetry is useful on the occasion of the choice of operative procedure, or for the evaluation of the result after operation.

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Sixteen testicular tumor patients with non-seminomatous germ cell tumors (NSGT) or hCG positive seminomas of stage I or II were treated by orchiectomy, retroperitoneal lymphadenectomy and adjuvant chemotherapy. Patients with bulky lymph node metastases were excluded. Serum AFP and hCG were useful as the tumor markers for their clinical courses. The average period of follow-up was 37.5 months. Staging was done by physical examination, serum markers and radiologic examinations. Combination chemotherapy (VBL, BLM etc.) was administered to clinical stage II patients before and after lymphadenectomy. Actinomycin D (ACT-D) was administered immediately after lymphadenectomy for five days to all patients.
Maintenance regimen of ACT-D was administered to all patients (ACT-D doses: 0.5mg/day×5days, every 2 months in the 1st year and every 3 months in the 2nd year). The patients with continuously high level serum markers and with the lesions of recurrence received cytoreductive chemotherapy as stage III testicular tumor (CDDP etc.).
Of six stage I patients all remained free of desease. While, often stage II patients four had recurrence signs. All of these four patients had abnormal radiologic findings after elevation of serum markers. Complete remission was obtained in two patients. One died of cancer, who was resistant to chemotherapy. The other is now on treatment.
During prophylactic ACT-D administration for out patients, no severe side effect was observed.
Our therapeutic system of stage I or II testicular tumor based on tumor markers was demonstrated in this report.

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Permanent urinary diversion procedures were performed on 224 patients. The types of procedures performed were ileal conduit in 110 cases, ureterocutaneostomy in 72 cases and nephrostomy in 42 cases. These procedures were accomplished during the period from 1971 through 1981 at the Department of Urology, School of Medicine, Iwate Medical University and its affiliated hospitals. The renal functions were observed for postoperative changes.
The renal functions were observed through the use of pyelography, BUN, creatinine, serum electrolytes (Na, K, Cl, Ca), the PSP test, the Fishberg test and urinalysis. These observations were made preoperatively and on the 1st to the 7th postoperative day, the 8th to the 14th day, the 1st to the 3rd month, the 6th month, the 1st year and once every year thereafter.
The renal function was disturbed preoperatively in the renal fistula group, the uretero-cutaneostomy and ileal conduit groups in this order, and every subject of the nephrostomy group was afflicted with hydronephrosis.
A transient hydronephrosis was noted in the ileal conduit group in the first three month postoperatively, but returned to the normal after 6 months. The creatinine exhibited a change ranging from 1.0 to 1.2mg/dl.
The urinary tract remained without infection in 42.1% of the postoperative patients and in 60% of those whose urinary tract infection had disappeared within one year. The renal function was maintained favorably as a whole. Pyelography revealed an improvement by the 6th month in the ureterocutaneostomy group and in the nephrostomy group. The BUN and creatinine that had shown a decrease by the 6th month, were normalized. However, it re-elevated thereafter and the creatinine level remained at approximately 2.0mg/dl. Urinary tract infections were observed in 100% of the patients in both groups. In the absence of appropriate treatment, one can assume that renal function would tend to gradually decrease in both groups.

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In our clinic carcinoma in situ of the bladder diagnosed histopathologically had been followed up in 28 cases. The 14 cases out of them underwent total cystectomy and ileal conduit formation. Total urethrectomy was also performed in 4 of them. Although carcinoma in situ is usually difficult to diagnose cystoscopically, velvet-like abnormal mucosa can be found in the oblique visual field by careful observation during cystoscopy. We have been doing biopsy of these portions by TUR with furgulation as treatment instead of cold punch biopsy. We proposed seven points of biopsy area including prostatic urethra, because 4 cases of prostatic involvement have been experienced in our cases. Based on the biopsy results of 7 points, we proposed our criteria whether carcinoma in situ diagnosed by biopsy should be followed up conservatively or removed totaly.

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In 28 cases of carcinoma in situ diagnosed histopathologically by TUR biopsy, 10 cases were followed up and treated by bladder instillation method of Bleomycin, Mitomycin and Adriamycin. Two cases of them had to undergo total cystectomy and 4 cases were performed 2nd TUR biopsy and furgulation which showed carcinoma in situ in 3 cases and atypia in one case even after instillation therapy. The urine cytology showed 6 cases returned to positive within 3 months and 3 cases returned to positive in 6 to 12 months. Only one case continued to be negative after 12 months. These results indicate that bladder instillation therapy can not cure carcinoma in situ. Electron microscopic examination of carcinoma in situ showed findings resembling Grade III in the invasive papillary transitional cell carcinoma. Therefore carcinoma in situ will have the same aggresive characteristics as Grade III transitional cell carcinoma even in the state of in situ.

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Based upon our experience, we have studied the problem of urolithiasis in a geriatric hospital during the period of 1972 to 1978. We experienced 76 clinical (48 male, 28 female) and 29 autopsied cases (13 male, 16 female) with urinary calculi, aged over 60 years of age.
The population of urolithiasis of the total number of outpatients and the autopsied cases were 3.7% and 2% respectively. Male patients with vesical calculi and female patients with renal pelvic calculi were frequently found in the clinical cases.
In autopsy, vesical calculi and renal pelvic calculi were found almost equally frequently in male. On the other hand, in female, renal pelvic calculi were more frequently observed than vesical calculi.
Ureteral stones were scarcely seen both in the clinic and in autopsy. Most of the calculi were composed of the phosphate including magnesium ammonium phosphate. Predisposing diseases to the calculi were mainly prostatic hypertrophy in male and cerebrovascular accidents in female.
These results indicate that urolithiasis in geriatric patients is significantly related with the stasis of urinary stream and urinary infection.

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Independent of the conventional way of discriminating between organic and functional impotence through checking whether nocturnal penile tumescence (NPT) really takes place coincident with the REM sleeping time, Barry et al. (1980) tried a simple method of using postage stamp sheets to identify presence or absence of NPT:
A sheet of postage stamps is twisted around the penis at night. Positive NPT is confirmed by the break of a stamp-sheetlong perforation. We tested this method in 38 patients of impotence, comparing the results with those of penothermocurves after visual sexual stimulation (VSS) and of penile tumescence monitoring. Test stamp-sheet were broken in 32 cases (84.2%) and not broken in the other 6 (15.6%).
VSS-loading tests carried out in the 6 unbroken cases yielded results showing that their impotence was organic in one and functional in the other 5 (13%), disclosing that the results were inconsistent with each other.
In view of Barry's method being performed by the patients themselves, such inconsistency in the result is considered inevitable. Anyhow, the method is simple in handling, so that it may be appreciated as useful for the screening test of impotence.

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Staghorn calculi were removed by nephrolithotomy with the one-layer interrupted parenchymal suture method designed by Taguchi and renal parenchymal disturbance following the operation were evaluated by computerized tomography. Twenty kidneys in 17 cases were examined pre and postoperatively for changes in the incised and sutured part of the renal parenchyma. (4 kidneys were not examined preoperatively.) No serious complications were found in any cases except for one in which transient renovascular hypertension was developed. The average length of the parenchymal incision was 8.4cm, the average clamping time of the renal pedicle was 27 minutes and 11 seconds, and the interval between operation and CT scanning ranged from 3 weeks to 2 years and 5 months. The postoperative CT scanning demonstrated the low density areas following enhancement and depression of the parenchyma. These changes were classified into the following 3 patterns: Type I-no changes were observed in the parenchyma, or a linear low density area was found (5 kidneys, 25.0%); type II-a long, narrow strip of low density area was found in accord with the excised and sutured part (5 kidneys, 25.0%); and type III-a wedge-shaped low density area or depression of the parenchyma was found (10 kidneys, 50.0%). The length of the parenchymal incision was analysed with reference to these patterns. The length of type I was significantly shorter than that of type II or III (p<0.05).
The clamping time of the renal pedicle in type I was also shorter than that in type II and III, but the differences did not reach a statistically significant level. Type II pattern frequently was found shortly after the operation. It is, however, undeniable that type II may transform to type III. Recently, Plasma Renin Activity (PRA) was determined before and after the operation in 7 cases. None of them showed significant elevation of PRA postoperatively. Althought the one-layer interrupted parenchymal suture method is not anatrophic in a strict sense, it had little influence on the renal parenchyma and dit not complicate renal hypertension, routinly.

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Thirty-four male patients with invasive bladder cancer had total cystectomy at our hospital between 1977 and 1982. Of the 28 patients who had not undergone simultaneous urethrectomy, 3 (10.7%) required a subsequent therapeutic urethrectomy for clinically observed urethral carcinoma. The interval between the dates of total cystectomy and delayed urethrectomy in the 3 patients ranged from 12 to 39 months. Two of the 3 patients died of cancer 4 and 28 months after the therapeutic urethrectomy, respectively. The remaining patient had irradiation of 5, 000rads on the small pelvic area as an ajuvant therapy to the urethrectomy. After 45 months of the urethrectomy, he was still alive without any evidence of cancer.
Once the basement membrane is infiltrated, the urethral tumor has access to the vascular corpora and hematogenous dissemination. This may be the major reason why the urethral tumor should be treated multidiciplinarily. In conclusion, a total cystectomy should be accompanied by a prophylactic urethrectomy, because after cystectomy the urethra is functionless and easily neglected area which can give origin to lethal transitional cell carcinoma.

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Experience of one stage repair for severe penoscrotal hypospadias is presented. With the several innovative modifications such as (a) fibrous plaque contributing to chordee deformity distal to the meatus was excised by mobilizing the urethra from corpora without detaching it from the glans, (b) a neourethra to the tip of glans was formed by either ipsilateral double or criss-cross flipping of the “wing” like skin flap attached to the urethra, and (c) meticulous meato- and glanoplasty, the method is thought to be an original one to repair distal hypospadias with consistently successful outcome.

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Clear cell adenocarcinoma, so-called mesonephric adenocarcinoma, is a rare primary tumor of the bladder, resembling clear cell adenocarcinomas arising in various sites within the female genital tract. Histologically, it is composed of large cells with clear cytoplasm and hobnail-shaped cells arranged in mixtures of papillary, tubular, and solid patterns.
A case of clear cell adenocarcinoma of the bladder in 68-year-old woman is reported. It was a gooseegg-sized papillary tumor and located in the left lateral and posterior wall of the bladder. The patient is now apparently free of disease 3 years after a partial cystectomy. The behavior and location of the tumor suggest the possibility of the müllerian origin.

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A 29-year-old patient with malignant interstitial cell tumor of the testis was reported. The case showed lung and lymph node metastases of the cancer and gynecomastia. Although plasma testosterone decreased below the lowest value of normal adult male, urinary estrogen was markedly increased, especially urinary estradiol was found 77 times as high as normal level. The metastatic lymph node was examined for steroidgenesis in vitro. From the results of the studies, progesterone, 17α-hydroxyprogesterone and 4-androstenedione were metabolized to testosterone, indication the presence of 17α-phydroxylase, C17-20 lyase and 17β-hydroxysteroid dehydrogenase in the metastatic tumor. The patient died 2 years and three months after admission, despite irradiation and chemotherapy. There was a significant correlation between the plasma alkaline phosphatase level and the degree of tumor growth.
Interstitial cell carcinoma of the testis is extremely rare. To our knowledge, 31 cases have been reported. It may be concluded from the clinical reviews of the cases previously reported as follows.
1. Evaluation of Malignancy: Since there have been some reports that only the tumor associated with metastasis can be regarded as malignant, the malignancy should be evaluated based on histological findings of the primary tumor, namely, mitosis, invasion of the tumor into vessels and the adjacent tissues.
2. Age: The age of the patients averaged 55 year-old, ranged 20 to 82. The malignant tumor has not been recognized in the period of prepuberty.
3. Metastasis Pattern: The tumor usually shows lymph node metastasis, although hematogenic pathways might be secondary to lymphatic pathways. It is noteworthy that bone metastasis has occasionally been reported.
4. Treatment: Lymph node dissection should be performed for patinets without hematogenic metastasis. For the inoperable case, o, p'-DDD is uniquely effective in the treatment for the tumor.
Consequently, it is suggested that interstitial cell carcinoma of the testis is an estrogen producing tumor, and that plasma or urinary estrogens may become a marker of the presence of the tumor.

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