[Burned-out tumor and carcinoma-in-situ of the testis mimicking an extragonadal germ cell tumor: a case report].

Multiple tumors of mediastinum, retroperitoneum and lung were detected in a 40-year-old man presented with lumbago and lower abdominal pain. As biopsy specimen taken from the cervical lymph node suggested germ-cell tumor and his testes were normally palpable, the initial diagnosis was an extragonadal germ-cell tumor. However, since ultrasonography of his left testis showed a small high echoic lesion (5 mm) assumed to be a burned-out tumor, orchiectomy was performed. Histological findings confirmed scar tissue as burned-out tumor and also revealed some malignant cells lining the seminiferous tubules that were thought to be the carcinoma-in-situ of the testis. After chemotherapy of etoposide and cisplatinum he achieved a partial response which has been maintained for 7 months. Examinations for burned-out tumor or carcinoma-in-situ of the testis should be made for the patients with an extragonadal germ cell tumor who have normally palpable testes.

[Histological effects of short term endocrine therapy on prostatic cancer].

BACKGROUND: The objective of this study is to investigate the pathological changes which occurred in prostatic cancer shortly after the commencement of endocrine therapy. METHODS: Fourty-three patients underwent radical prostatectomy immediately after the short term endocrine therapy (treatment period was within one month) and the histological pictures of operative specimens were compared to those obtained from the pretreatment biopsy specimens. RESULTS: Degenerative changes of cancer cells, such as nuclear and cytoplasmic vacuole, collapse of the cytoplasm and the appearance of naked hyperchromatic nucleus were noticed after the short term endocrine therapy. Especially in the cases which were histologically evaluated to be poorly differentiated in the biopsy specimens, not only degenerative changes but also destruction of cancer nests caused by cell death were observed. The histological effects affected by short term endocrine treatment had no relation to the prognosis, but in the cases of stage D2, the pathological grade judged by post-therapeutic specimens were found to be useful for the prediction of prognosis. CONCLUSION: Endocrine therapy induces remarkable pathological changes in prostatic cancer within a very short time after beginning treatment.

[Efficacy of the chemosensitivity test using collagen gel matrix-supported culture system for urogenital tumors].

BACKGROUND: We evaluated the usefulness of in vitro tumor culture system using a specialized collagen gel matrix (CGM assay) as a chemosensitivity test. PATIENTS AND METHODS: Chemosensitivity results of CGM assay were compared with other in vivo and in vitro assays on an implantable murine bladder tumor cell line (MBT-2). In addition we investigated the possibility of the clinical use of CGM assay using clinical specimens obtained from urogenital malignant tumor patients by comparing the result with that of the other chemosensitivity test, SDI testing using single cells (conventional SDI test). Methods of CGM assay were as follows. Tumor tissues on the collagen gel matrices were incubated under the existence of anticancer drugs following 4 days preculture. Drug sensitivities were evaluated by counting the number of viable cells adjusted to the tumor weight. RESULTS: Inhibition rates in MBT-2 were high in the order of mitomycin C, cisdiamminedichloroplatinum (II), (2"R)-4'-0-tetrahydropyranyl adriamycin. Four of 6 anticancer drugs were decided as chemosensitive drugs. These results corresponded to the results of the antitumor effects on subcutaneously transplanted MBT-2 in vivo, moreover was correlated well with those of the conventional SDI test. Twenty of 22 cases, including 11 of 13 bladder cancer cases, 1 of 3 renal cancer cases, 2 of 3 testicular cancer cases and 1 of 1 adrenal cortical cancer cases, were evaluable in the clinical study of the CGM assay. Corresponding rates between the results of the CGM assay and those of the conventional SDI test performed simultaneously in 12 cases were excellent for each anticancer drug. CONCLUSION: This CGM assay can serve as an effective tool for chemosensitivity testing because of its convenience and high evaluable rate.

Potentiation of antitumor effect of bleomycin by local electric pulses in mouse bladder tumor.

C3H mice bearing subcutaneously transplanted mouse bladder carcinoma (MBT-2) were treated with intramuscular injection of bleomycin followed by local delivery of electric pulses at the tumor site. The tumors markedly reduced and even disappeared for several days after this treatment. Neither electric pulses nor bleomycin administration alone showed a significant inhibitory effect on the tumor growth. Thus, it is demonstrated that in mouse bladder tumor the antitumor effect of bleomycin can be considerably potentiated by local electric pulses.

[Two cases of primary sclerosing lipogranuloma in scrotum--review of 63 cases reported in Japan].

We reported two cases of primary sclerosing lipogranuloma in the scrotum. We performed tumor resection in both cases, but in one of the two cases tumor recurrence was observed 7 days after the removal. Sixty-three cases have been reported in our country, and we discuss the diagnosis and treatment with reference to previous reports.

Transferrin concentration in seminal plasma with special reference to serum hormone levels in infertile men.

The concentration of transferrin in seminal plasma and serum levels of LH, FSH, testosterone, and prolactin were measured in 94 male patients attending our infertility clinic. The concentration of transferrin in patients with azoospermia was lowest among azoospermia, oligozoospermia, and normozoospermia groups. There was significant positive correlation between the concentration of transferrin in seminal plasma and sperm density. However, seminal plasma transferrin was inversely correlated with serum levels of LH, FSH, and prolactin, respectively. It is suggested that transferrin in seminal plasma contributes to the activation of seminiferous tubules and can be used as a reliable index of Sertoli cell function.

Calcium control of actin-myosin-based contraction in Triton-treated murine bladder tumor cells.

Using mouse bladder tumor cells (MBT-2 cells) and epithelial cells, the present study evaluated the functional characteristics of the actomyosin system in bladder cancer cells. An immunofluorescence study demonstrated the presence of contractile proteins (actin and myosin) in MBT-2 cells as well as bladder epithelial cells. Triton-treated MBT-2 cells and epithelial cells showed a Ca(2+)-dependent contraction. This was inhibited by N-ethylmaleimide-modified myosin subfragment 1 (NEM-S1), demonstrating that the interaction between actin and myosin is responsible for the contraction of Triton-treated cells. The extent of Ca(2+)-dependent contraction was much greater in MBT-2 cells than in epithelial cells. These results suggest that MBT-2 cells possess a locomotive apparatus consisting of actin and myosin, and that Ca2+ can activate this actomyosin system, leading to the contraction or active locomotory movement of tumor cells.

[Clinical results of prophylactic intravesical chemotherapy on superficial bladder cancer using the dye exclusion assay].

A chemosensitivity test was carried out on superficial bladder cancer using the dye exclusion assay for the purpose of screening chemosensitive drugs for prophylactic intravesical chemotherapy. Bladder cancer cells of each patients were incubated, in vitro, in the presence of adriamycin, (2"R)-4'-0-tetrahydropyranyladriamycin, mitomycin C, pepleomycin and 4'-epi-adriamycin (500 micrograms/ml) at 5%, CO2, 37 degrees C for 2 hours. The cytotoxic effect of the drugs was evaluated by the ratio of stained cells by trypan-blue. The most effective drug was instilled postoperatively into the bladder 3 times for the first week, and every 2 weeks during the following 14 weeks. In 18 patients followed more than 4 months the prophylactic effect was evaluated. Fifteen of the 18 patients completed the protocol, but the remaining 3 patients failed to complete to the instillation because of severe irritability of the bladder. Tumor recurrence was demonstrated in two patients. Non-recurrence rates of tumors at 12 and 24 months were 93.8% and 82.0%, respectively. These results suggested that this rapid and handy assay was useful for the purpose of screening chemosensitive drugs for the intravesical chemotherapy.

Prototype of a reflux-preventing ureteral stent and its clinical use.

We have experimentally produced a ureteral stent which prevents vesicorenal reflux. This stent has a thin silicon sleeve at its distal end (intravesical portion). In a model experiment the sleeve demonstrated an excellent capability to prevent reflux. The sleeve allowed flow of fluid with minimal pressure rise. A patient with bilateral ureteral obstruction was managed with endoscopic insertion of a sleeved stent in the right ureter and a usual pigtail stent in left ureter. During cystography vesicorenal reflux was not observed on the right side while reflux occurred on the left side. Excretory urography forty days after stent placement demonstrated recovery of renal function and maintenance of drainage in both renal units. Thus, the drainage characteristic of this stent appears to be approximately the same as that of usual stent.

[Visualization of the intravesical urine stream].

Although many urodynamic techniques have been used to evaluate the function of the lower urinary tract, the principles of these measurements are only based on a relationship between flow rate and pressure. In addition to these measurements, the intravesical urine stream would provide useful information on urodynamics. We have experimentally attempted to visualize the urine stream in a bladder using transrectal ultrasound examination. Since an air-particle is a good target for ultrasound visualization, we instillated a 10% glycerine solution into the bladder for the maintenance of air-particles. Before instillation, this glycerine solution was strongly shaken so that air-particles were kept in the solution. The urine stream was successfully observed throughout the whole process of voiding. In video-recording analysis, the velocity of urine stream was measured by tracing some air-particles. The velocity of urine stream was approximately 28.4 cm/sec in the body and increased to 116.6 cm/sec at the bladder neck. Thus, the urine stream was accelerated toward the urethra during voiding. Therefore, it seems that visualization of the urine stream offers a new parameter for evaluation of urodynamic studies.

[Postoperative intravesical instillation of THP for superficial bladder tumor: clinical results of prophylactic effects on the recurrence. Fukushima THP Research Group].

Intravesical instillation of pirarubicin (THP) was performed on 66 patients with superficial bladder cancer after transurethral resection to evaluate the prophylactic effect against tumor recurrence. Intravesical chemotherapy was carried out at the concentration of 20mg/40ml. THP was initially instilled three times for one week, following instillation of every two weeks for ten times, and then every one month for seven times. Bladder irritability was demonstrated 21 of 66 cases (31.8%). Although there was a case of contracted bladder, generalized side effect was no case. Eligible cases for evaluation of efficacy were 43 out of 66 patients. The non-recurrence rate (by Kaplan-Meier's method) at one and two years were 90.4% and 77.8%, respectively. Intravesical THP instillation seems to be effective for the purpose of prophylaxis against the recurrence of superficial bladder tumor.

[A case of idiopathic calcinosis of the scrotum].

We report a case of idiopathic calcinosis of the scrotum. The patient was a 33-year-old male with a complaint of multiple scrotal nodules, from which white chalky materials occasionally broke out. The nodules were first noticed 17 years ago, and since then gradually increased in size and number. Sometimes he had felt itching on the scrotum, but otherwise he had been in good health. Blood analysis and biochemical analysis revealed normal findings. In addition, there were no abnormal findings in serum electrolyte analysis including calcium and phosphate concentrations. Analysis of the intra-nodular content by infrared spectrophotometry showed that it consisted of calcium phosphate (52%) and magnesium ammonium phosphate (48%). We reviewed the literature and discuss the etiology of this disease.

[A case of a foreign body in the urinary bladder--a surgical suture needle was found in urinary bladder].

We report a case of an unusual foreign body in the urinary bladder. A 66-year-old male had undergone an operation of rectal cancer 6 years previously. He visited our hospital with irritative urinary symptoms. Urinalysis showed hematopyuria, and X-ray examination revealed a curved fine shadow (about 2 cm in length and 3 mm in width) at the vesical region. In cystoscopic examination, a calcified surgical suture needle was identified on the trigonal region. The needle was removed transurethrally by a stone crushing forceps. Thus, it was assumed that the needle had been left in the abdominal cavity at the operation 6 years ago and it had migrated into the bladder during these 6 years. Many cases of foreign bodies in the urinary bladder have been reported. However, to our knowledge, this is the first report of a surgical suture needle, in the bladder.

[A case of adrenal black adenoma associated with Cushing's syndrome].

The patient was a 24-year-old female, who had clinical and laboratory findings of Cushing's syndrome with slight virilizative changes. CT scan, ultrasound sonography and scintigraphy demonstrated that there was a functioning tumor at the right adrenal region. Thus we performed right adrenalectomy. The tumor was a characteristic black adenoma of adrenal gland, and it microscopically consisted of compact cells with remarkable intracellular pigmented granules. Thirty-two cases of functioning adrenal black adenoma have been reported in our country and all of them were associated with Cushing's syndrome.

[Prostatic cancer with cystic degeneration: a case report].

A 73-year-old man with prostatic cancer with cystic degeneration is reported. He visited our clinic for postoperative examination of left metastatic lung cancer and treatment of prostatic hypertrophy. When the prostatic biopsy was performed, bloody fluid was aspirated and prostate size on digital examination was reduced. The obtained specimen consisted of scar tissue. Urethrography showed an elongation of prostatic urethra in addition to the compression of urinary bladder from the rear. CT scan demonstrated a prostatic cyst approximately 8 cm in diameter with an irregular margin. Following the transurethral resection of the prostate, the prostatic cyst was opened and papillary tumor observed. Histological examination revealed a well differentiated medullary cancer which coincided with the pathological finding of left metastatic lung cancer. He died from dyspnea caused by pleuritis carcinomatosa 6 years later. Nine cases of prostatic cancer with cystic degeneration in the Japanese literature are reviewed.

[Ureteral endometriosis: a case report].

A 32-year-old female visited our clinic with the chief complaints of macroscopic hematuria and pollakisuria in February 18, 1987. Cystoscopic examination revealed findings of cystitis but bleeding from the ureteral orifice was not observed. IVP showed right non visualized kidney and retrograde pyelography demonstrated right ureteral stenosis on the lower ureter and right hydronephrosis. Total hysterectomy, right oophorectomy and right ureterolysis were carried out in March 5. Right lower ureter was buried in the fibrous tissue approximately over 2 cm above the crossing with iliac vessels. Dark reddish colored small tumor was noticed in the stenosed ureter and resected. The histological diagnosis confirmed endometriosis. A total of 37 cases of ureteral endometriosis in the Japanese literature was reviewed.

[Silicate urolithiasis: a case report].

A 62-year-old male visited our department complaining of left flank pain and urinary retention on November 6, 1989. Intravenous pyelography showed small stone shadows in bilateral ureters and lower calyx of kidney and the left kidney was not visualized. Endoscopically, calculi were seen in bilateral ureteral orifice. An ureteral catheter could not be passed up from there bilaterally. On November 13, 1989, January 24 and 26, 1990, calculi were passed out spontaneously. Analysis of the stones revealed silica calculus. The patient had a past history of duodenal ulcers. He was administered magnesium silicate and magnesium alminometasilicate as an anti-acid drug for ten years. Sixteen cases of silica calculus in Japan are reviewed.

[Cytologic atypical grade of exfoliative cytology versus histologic differentiation degree in prostatic carcinoma].

Our method of exfoliative cytology using a prostatic fluid collecting catheter is effective in detecting prostatic carcinoma. To presume histological diagnosis by means of the cytology we analyzed cytological findings of 62 cases of prostatic carcinoma in relation with their biopsy findings, clinical stages and clinical courses. In cases in which cellular atypism was low in the cytology the carcinoma was mostly well or moderately differentiated. Conversely, in cases in which the carcinoma was well differentiated atypism was mostly low in the cytology. In cases in which the cellular atypism was high the carcinoma was poorly differentiated, and vice versa. The poorer histological differentiation and the higher cytological atypism, the more advanced carcinoma and the higher death rate from the carcinoma. The tendency seemed to be more related with the cellular atypism than with the histological differentiation. Thus the cytological findings reflect the histology well and the degree of the histological differentiation can be presumed by the cytological atypism. The cellular atypism is not a less important factor than the histologic differentiation degree for determining the clinical stage and the prognosis.

[Chemosensitivity test on superficial urinary bladder cancer using the dye exclusion assay--model of intravesical chemotherapy].

A chemosensitivity test was carried out on superficial bladder cancers using the trypan blue dye exclusion assay for the purpose of screening chemosensitive drugs for intravesical chemotherapy. Transplantable murine bladder tumor cells (MBT-2) were incubated, in vitro, in the presence of adriamycin (4, 40, 400, 1000 micrograms/ml) as well as verapamil (3, 30, 100, 500 micrograms/ml) at 5% CO2, 37 degrees C for two hours. After cellular viabilities were calculated, MBT-2 cells were inoculated into the hind limbs of mice. The cellular viability was correlated well with the ratio of tumor appearance, tumor growth inhibition and prolongation of survival, and was dose dependent in the adriamycin treated groups. On the other hand, a reduction of cellular viability, tumor growth inhibition and prolongation of survival were seen in the high dose verapamil (100, 500 micrograms/ml) treated groups. Human superficial bladder cancer cells were incubated in the presence of adriamycin, 4'-0-tetrahydropyranyladriamycin, mitomycin C and pepleomycin (1000 micrograms/ml) and/or verapamil (500 micrograms/ml). The reduction rates of cellular viability markedly varied with the kind of anticancer drugs. A reduction of cellular viability of human tumor cells as well as MBT-2 cells was seen in the verapamil treated groups. This rapid and handy assay seems to be useful for the purpose of screening chemosensitive drugs for intravesical chemotherapy.