Recurrent rhabdomyosarcoma after adjuvant chemotherapy for stage I non-seminomatous germ cell tumor with malignant transformation.

We report a rare case of stage I non-seminomatous testicular germ cell tumor with malignant transformation. The patient received two cycles of chemotherapy (cisplatin, bleomycin and etoposide) tailored to testicular germ cell tumors as an adjuvant therapy after orchiectomy. However, 22 months later, the patient developed a metastasis in the occipital region that consisted of solely rhabdomyosarcoma through malignant transformation of a teratoma component. This case highlights an issue related to adjuvant chemotherapy for testicular germ cell tumors with components of malignant transformation.

[Ureteral cancer occurred in megaureter].

A 58-year-old man visited our hospital with a complaint of asymptomatic gross hematuria for three weeks. The urine cytology at another clinic had indicated Papanicolaou class V. A physical examination revealed soft abdominal distention in lower abdomen. Ultrasonography demonstrated an extremely dilated left pelvis, calyx and ureter in which a round mass was detected. Enhancement CT showed a mass 2 cm in diameter in the middle part of the dilated left ureter. These findings suggested the diagnosis of left ureteral cancer having developed in the megaureter. Neither VUR nor UVJ stenosis were identified by VCG and RP. MR-urography showed a severely dilated left pelvis and tortuous megaureter. On the diagnosis of left ureteral cancer left nephroureterectomy with cuff of bladder was performed. Gross findings showed a 2 cm sized papillary tumor in the extremely dilated ureter, and pathological findings showed grade 2, papillary transitional cell carcinoma and non-specific ureteritis in the dilated ureter. Postoperative course was non-eventful. Postoperative 3 months later multiple bladder tumors were detected all over the bladder, and so TUR-Bt and intravesical instillation therapy with pirarubisin was performed. However multiple bladder tumors had been relapsed and so finally radical cystectomy and right cutaneous ureterostomy were undergone postoperative 6 months later. He has been well 48 months postoperatively.

[Gliotransmitter ATP-mediated cell-to-cell communication].

Much attention has focused on glial cells especially astrocytes because they are not simply supportive but are integrative, being able to receive inputs, assimilate information and send instructive chemical signals to other neighboring cells including neurons and vascular walls. So-called "gliotransmitter" has a central role for these events. Although at first, the excitatory neurotransmitter glutamate was found to be a major extracellular messenger, extracellular ATP has come into the limelight as an important extracellular messenger for these communications. Astrocytes express various neurotransmitter receptors including P2 receptors, release ATP in response to various stimuli and respond to extracellular ATP to cause various physiological responses. The intercellular communication "Ca2+ wave" in astrocytes was found to be mainly mediated by the release of ATP and the activation of P2 receptors, suggesting that ATP is a dominant "gliotransmitter" between astrocytes. Because neurons also express various P2 receptors and synapses are surrounded by astrocytes, astrocytic ATP could affect neuronal activities and even dynamically regulate synaptic transmission in adjacent neurons as if forming a "tripartite synapse". In addition, astrocytes also enwrap blood vessels by their endfeet. Pericytes are cells that are located at the abluminal side of capillaries with patchy structure, and face to astrocytic endfeet. They also express various P2 receptors and communicate with astrocytes by gliotransmitter ATP. In this review, we summarize the role of gliotrasnmitter ATP, as compared with glutamate, in regulation of adjacent cells such as astrocytes, neurons and capillaries. Dynamic communication between neurons, astrocytes and blood vessels mediated by ATP would be a key event in the processing or integration of information in the CNS.

[A prostatic duct carcinoma difficult to distinguish from transitional cell carcinoma: a case report].

A 77-year-old male with a complaint of dysuria and gross hematuria for 3 months visited our hospital. Abdominal ultrasonography, computed tomographic scan and magnetic resonance imaging revealed a prominent tumor from the bladder neck. Serum prostate specific antigen (PSA) level was high (1,130 ng/ml) suggesting prostate cancer, but transitional cell carcinoma (TCC) was detected by transurethral biopsy. Bone scintigraphy revealed multiple bone metastasis. Since gross hematuria requiring bladder tamponade continued, simple cystoprostatectomy and cutaneous ureterostomy were performed. Pathological findings showed prostatic acinar carcinoma and prostatic duct carcinoma mimicking TCC, and PSA immunohistochemically weak positive. The final diagnosis was prostate cancer consisting of acinar and ductal component. Adjuvant hormonal therapy was performed, but was ineffective. The patient died 2.5 months after operation. We reviewed and discussed 66 cases of prostatic duct carcinoma, including our case, in the Japanese literature.

Multipoint methylation analysis indicates a distinctive epigenetic phenotype among testicular germ cell tumors and testicular malignant lymphomas.

Hypermethylation of tumor-suppressor genes has been implicated in the pathogenesis of human cancers. Although a growing number of genes showing hypermethylation is being reported in human cancer, methylation profiles of tumor-related genes in testicular neoplasms have not been well elucidated. This study was designed to show the methylation profiles of multiple CpG islands in testicular germ cell tumors (TGCTs) in comparison with those in testicular malignant lymphomas. We studied the methylation status of E-cadherin, CDKN2B, CDKN2A, BRCA1, RB1, VHL, RASSF1A, RARB, and GSTP1 by use of TGCT tissues and testicular malignant lymphoma tissues (25 primary TGCT tissues and three primary testicular lymphoma tissues). Methylation was not observed in E-cadherin, CDKN2B, CDKN2A, BRCA1, RB1, VHL, RASSF1A, RARB, and GSTP1 in any of the TGCT tissues. In contrast, all three (100%) of the testicular lymphoma tissues demonstrated hypermethylation of E-cadherin, RASSF1A, and RARB, but not CDKN2B, CDKN2A, BRCA1, RB1, VHL, and GSTP1. These data demonstrate that a distinctive epigenetic phenotype underlies the TGCTs and testicular lymphomas at the CpG sites of E-cadherin, RASSF1A, and RARB; a distinctive epigenetic phenotype was not observed among seminomatous TGCTs and non-seminomatous TGCTs at the CpG sites examined.

Primary heterologous carcinosarcoma of the ureter with necrotic malignant polyps. Report of a case and review of the literature.

Carcinosarcoma is a rare and aggressive disease characterized by biphasic neoplasms with distinct mesenchymal and epithelial components. We report a case of ureteral carcinosarcoma with malignant necrotic polyps. The patient was a 58-year-old woman with painless hematuria, who was later diagnosed as having ureteral carcinosarcoma. Three long pendulous polypoid-shape tumors consisting of high-grade transitional cell carcinoma with chondrosarcomatous and osteosarcomatous elements were found. Two months after nephroureterectomy, the tumor relapsed in the bladder. Despite anterior exenteration, the patient died of local recurrence 6 months after her initial visit. To our knowledge, only 10 cases of this disease have been reported in the literature.