Robot-assisted partial nephrectomy in younger versus older adults with renal cell carcinoma: a propensity score-matched analysis.

PURPOSE: Our study aimed to compare the surgical outcomes of robot-assisted partial nephrectomy (RAPN) between younger and older patients after adjusting for their background differences. We particularly assessed RAPN outcomes and safety in older patients. METHODS: We retrospectively evaluated 559 patients clinically diagnosed with T1 renal cell carcinoma (RCC) and treated with RAPN between 2013 and 2022 at five institutions in Japan. The patients were classified into two groups according to their age during surgery (younger group: < 75 years, older group: ≥ 75 years). Propensity score matching (PSM) was performed to adjust for the differences in the backgrounds between younger and older patients, and surgical outcomes were compared. RESULTS: Among the 559 patients, 422 (75.5%) and 137 (24.5%) were classified into the younger and older groups, respectively; 204 and 102 patients from the younger and older groups were matched according to PSM, respectively. Subsequently, patient characteristics other than age were not significantly different between the two groups. In the matched cohort, the older group had more patients with major complications (younger, 3.0%; older, 8.8%; P = 0.045). CONCLUSION: Surgical outcomes of RAPN in older patients with RCC were comparable with those in younger patients, although older patients experiencedsignificantly more complications than younger patients. These results suggest the need for further detailed preoperative evaluation and appropriate postoperative management in older patients receiving RAPN.

Fibroepithelial urethral polyp with minor prostatic glands in an older man.

We describe a man in his 60s with an incidentally detected urethral polyp located in the middle section of his penile shaft. The patient had been suffering from urinary retention for 9 years due to benign prostatic hyperplasia. He was initiated on clean intermittent catheterisation to drain urine 1 year before the detection of the urethral polyp. Holmium laser nucleation of the prostate was performed, and an anterior urethral polyp (5 mm in diameter) was resected. Pathology indicated that the urethral polyp was a fibroepithelial polyp with prostate-specific antigen-immunoreactive heterotopic prostatic glands. There were no problems with urination 6 months after surgery. Fibroepithelial urethral polyps are usually congenital and are rarely described in adults. The clinicopathological features of this polyp, with its uniquely associated minor prostatic glands, are presented.

Adrenal Schwannoma in an Elderly Man: A Case Report and Literature Review.

Schwannoma is a common mesenchymal neoplasm; however, adrenal schwannoma is rare, and it is frequently misdiagnosed as adrenal cortical adenoma. We herein report a 91-year-old Japanese man with right adrenal schwannoma that was pathologically diagnosed after adrenalectomy. To our knowledge, this is the first case of adrenal schwannoma in the oldest patient and with the longest follow-up period reported, including radiological images from 10 years earlier.

Penile warty mucoepidermoid carcinoma with features of stratified mucin-producing intra-epithelial lesion and invasive stratified mucin-producing carcinoma.

AIMS: Stratified mucin-producing intra-epithelial lesion (SMILE) and invasive stratified mucin-producing carcinoma (ISMC) are recently described cervical and penile lesions. We report an unusual case of mixed variant of penile squamous cell carcinomas with warty, usual and mucoepidermoid SMILE/ISMC features. METHODS AND RESULTS: A 62-year-old Japanese man had a glans penis lesion of one-and-a-half years' duration, suggesting malignancy. Partial penectomy and left inguinal lymphadenectomy were performed. Pathological evaluation revealed a mixed squamous cell carcinoma with warty, mucinous and usual features. The mucinous component resembled mucoepidermoid carcinoma (MEC) and SMILE/ISMC. Glandular differentiation was absent. All the diverse tumour components were negative for p16, which was confirmed by negative human papillomavirus (HPV) genotyping. The mucinous component was diffusely positive for cytokeratin 7 and largely negative for cytokeratin 5 and p63. Fluorescence in-situ hybridisation did not detect rearrangement in the MAML2 or EWSR1 genes. The tumour was pathological stage pT2, pN1 (AJCC prognostic stage group IIIA) and was disease-free 26 months after surgery. CONCLUSIONS: The lack of glands in the mucinous areas suggested that MEC should be separated from adenosquamous carcinoma (ASC). Penile SMILE/ISMC may occur without dependence upon HPV status. Further studies will be necessary to determine the pathogenesis and definition of penile SMILE/ISMC, the presence of true MEC arising from the glans penis and the clinicopathological differences of penile ASC, MEC and SMILE/ISMC. Herein, we refer to the SMILE-like penile lesion as 'mucinous penile intra-epithelial neoplasia'.

Acquired cystic disease-associated renal cell carcinoma: a clinicopathological study of seven cases.

The disease entity of acquired cystic disease (ACD)-associated renal cell carcinoma (RCC) has been recently incorporated into the international renal tumor classification. However, there are a few descriptions on clinicopathologic features. We performed a clinicopathologic study of seven cases with ACD-RCC. All tumors were incidentally found. Histologically, the tumor consisted of microcystic or cribriform pattern of neoplastic cells with deeply eosinophilic to oncocytic cytoplasm in the stroma of oxalate crystal deposition. Three cases contained the area of sarcomatoid transformation, of which one case also demonstrated rhabdoid phenotype foci. Six among seven patients had a hemodialysis history of more than 10 years and two patients showing the dedifferentiation had a hemodialysis history of more than 20 years. The follow-up duration ranged from 18 to 107 months with a mean of 59.1 months. Regarding the outcome, four patients were alive without disease. One patient was alive with metastasis 10 months after the operation. No patient died of disease. Finally, ACD-RCC generally pursues a favorable clinical course, but tumors with a hemodialysis history of more than 20 years may cause the dedifferentiation such as sarcomatoid change or rhabdoid features and this phenomenon may lead to worse clinical outcome.

High-grade urothelial carcinoma, plasmacytoid variant, of the renal pelvis with osteoclast-like giant cells and focal rhabdoid features.

In this article, we present a rare case of renal pelvic carcinoma. The imaging examination of a 75-year-old Japanese man disclosed the left renal pelvic tumor. The histological examination showed the finding of predominant undifferentiated discohesive mononuclear cells with abundant osteoclast-like giant cells and a minor component of papillary urothelial carcinoma. Rhabdoid morphology was focally seen. Immunohistochemically, mononuclear cells were focally positive for thrombomodulin and showed a high MIB-1 index, whereas osteoclast-like giant cells were positive for CD68. Urologists should bear in mind that a rare association of high-grade urothelial carcinoma, plasmacytoid variant, with osteoclast-like giant cells and focal rhabdoid features may occur in the renal pelvis.

High-grade mucinous tubular and spindle cell carcinoma: comparative genomic hybridization study.

Mucinous tubular and spindle cell carcinoma (MTSCC) has recently been integrated into the World Health Organization classification. Although MTSCC is generally a low-grade carcinoma, MTSCC with high-grade morphology has been recently reported. We present the first case of high-grade MTSCC with comparative genomic hybridization findings. A 60-year-old Japanese man presented with weight loss and general fatigue. He underwent radical nephrectomy because of the clinical diagnosis of renal cancer. Histologic examination of renal tumor showed findings of high-grade MTSCC. Comparative genomic hybridization analysis showed gain of chromosomes 1q, 7, 16, 19q, and Y and loss of chromosomes 1p, 6p, 8p, 11q (del(11)(q23)), and 13. G-band karyotype showed gain of chromosomes 2, 3, 5, 7, 12, 16, and 20 and loss of chromosome 15. Results of our molecular genetic analysis support the idea that high-grade MTSCC is a real counterpart of low-grade MTSCC. There is no evidence to designate such tumors as unclassified renal cell carcinoma.

Lack of association between the incidence of testicular germ cell tumors and Y-chromosome haplogroups in the Japanese population.

BACKGROUND: Despite being relatively uncommon, testicular germ cell tumors (TGCT) are the most common malignant disease in young men. Epidemiological studies concerning patients with testicular cancer indicate that the most of them have poor semen quality or testicular dysgenesis. However, many studies have shown that the Y chromosome harbors many candidate genes responsible for spermatogenesis process and development and maintenance of the germ cells. The Y chromosome is thought to have a relationship with the formation and progression of TGCT. MATERIALS AND METHODS: To verify this relationship, we investigated if there is any correlation between the Y chromosome structural variations presented as different haplogroups and the occurrence of TGCT in the Japanese population. Using combined haplogroups based on typing of three Y chromosome polymorphic binary markers, we analyzed 68 TGCT derived from Japanese patients together with randomly selected 104 unrelated healthy Japanese matched male controls who were confirmed as residents of the same geographic area. RESULTS: Our findings showed a lack of association between the incidence of TGCT and the different Y- chromosome haplogroups in Japanese population. CONCLUSION: We concluded that there are no significant variations in males from different Y chromosome lineages regarding their susceptibility or resistance for developing TGCT. The previously hypothesized role of the Y chromosome in the development of TGCT is still uncertain and needs further verification.

Molecular characterization of heat shock-like factor encoded on the human Y chromosome, and implications for male infertility.

Azoospermia and oligospermia are major causes of male infertility. Some genes located on the Y chromosome are suggested as candidates. Recently, HSFY, which is similar to the HSF (heat shock transcription factor) family, has been mapped on the human Y chromosome as multicopies. However, newly available sequence data deposited at NCBI shows that only the HSFY gene located on Yq has a long open reading frame containing a HSF-type DNA-binding domain. HSFY is similar to LW-1 on the human X chromosome and a murine HSFY-like sequence (mHSFYL), 4933413G11Rik, on the mouse chromosome 1. LW-1 and mHSFYL have 53% and 70% homology to HSFY for amino acid sequences of their presumed DNA-binding domains, respectively. Comparison of the presumed DNA-binding domains unveiled that the three HSF-like factors, HSFY, LW-1, and mHSFYL, belong to a different class than conventional HSFs. When we screened for deletions on the Yq of males suffering from infertility, we found that HSFY was involved in interstitial deletions on the Y chromosomes for two azoospermic males who had DBY, USP9Y, and DAZ but did not have RBMY located on the AZFb. Expression analysis of HSFY, LW-1, and mHSFYL unveiled that they are expressed predominantly in testis. Furthermore, immunhistochemistry of HSFY in testis showed that its expression is restricted to both Sertoli cells and spermatogenic cells and that it exhibits a stage-dependent translocation from the cytoplasm to the nucleus in spermatogenetic cells during spermatogenesis. These results may suggest that deletion of HSFY is involved in azoospermia or oligospermia.

Prognostic significance of matrix metalloproteinases-2 activation ratio in renal cell carcinoma.

BACKGROUND: Matrix metalloproteinases (MMPs) are a family of zinc-dependent endopeptidases. MMP-2 and MMP-9 have been reported to be closely associated with tumor invasion and metastasis in various human carcinomas. METHODS: Tissue samples were obtained from 57 patients with renal cell carcinoma (RCC) who underwent radical nephrectomy in our hospital. We examined the expression of MMPs by gelatin zymography and assessed correlations with clinico-pathological parameters and clinical outcomes. RESULTS: We detected bands corresponding to MMP-9, proMMP-2 and active MMP-2. The expression of active MMP-2 and MMP-2 activation ratio (active MMP-2/[proMMP-2 and active MMP-2]) were higher in T3 tumors than in T1 and T2 tumors. There were no significant differences in the expression of proMMP-2, active MMP-2 or MMP-9 for any of the clinico-pathological parameters. Patients with high MMP-2 activation ratio or high MMP-9 had significantly worse cause-specific survival. Interestingly, among patients with stage III RCC, those with high MMP-2 activation ratio or high active MMP-2 had significantly worse cause-specific survival. Univariate analysis showed that histological grade (P = 0.0001), histologic type (P = 0.0005), MMP-2 activation ratio (P = 0.0159), stage (P = 0.0001), MMP-9 (P = 0.0316), and T (primary tumor) category of TNM (primary tumor, lymph node, metastasis) classification (P = 0.0021) were significant predictors of clinical outcome. Multivariate analysis showed that only histological grade (P = 0.002) and stage (P = 0.0099) were independently significant predictors of clinical outcome. CONCLUSION: Activation of MMP-2 appears to play important roles in initiating metastasis, as shown by results obtained with stage III RCC patients. However, further study is needed to confirm this.

Expression of angiostatin cDNA in a murine renal cell carcinoma suppresses tumor growth in vivo.

OBJECTIVES: To investigate the effectiveness of angiostatin gene therapy for renal cancer using a mouse model. The generally poor prognosis of advanced renal cancer indicates the need for new therapeutic modalities. The dependency of solid tumor growth on angiogenesis suggests that antiangiogenic therapy would be effective against renal cell carcinoma, which is generally a hypervascular tumor. METHODS: Murine renal cancer cells (Renca) transfected with murine angiostatin cDNA (AST-Renca) were subcutaneously implanted in BALB/c mice. Subsequently, the macroscopic appearance and volume of tumors were evaluated once per week. Renca cells transfected with empty plasmid DNA (mock-Renca) were used as a control. In addition, histologic sections of tumor were analyzed for neovascularization on the basis of an immunohistochemical analysis for CD31. The antitumor effect of AST-Renca on a parental Renca tumor at a distant site was also evaluated. RESULTS: The mean volume of AST-Renca tumors was significantly less than that of the control vector-transfected tumors 3 weeks after implantation. In the cell proliferation assay, the expression of angiostatin did not inhibit the proliferation of Renca cells in vitro. Immunohistochemical analysis of neovascularization by staining with anti-CD31 antibody revealed that angiostatin suppressed tumor vessel formation. Moreover, implantation of AST-Renca inhibited the growth of parental Renca implanted simultaneously at a distant site. CONCLUSIONS: Expression of an angiostatin transgene can suppress the growth of murine renal cancer through the inhibition of tumor-induced angiogenesis. Angiostatin gene therapy may be effective against renal cancer.

Linkage between prostate cancer incidence and different alleles of the human Y-linked tetranucleotide polymorphism DYS19.

We studied the allele frequency distribution of the Y-chromosome linked tetranucleotide polymorphic microsatellite locus DYS19 in 90 prostate cancer Japanese patients from both Tokushima University hospital (Tokushima) and Saint Marianna University hospital (Kawasaki), Japan, comparing them to 99 matched male controls. Y-chromosomes from Japan as well as others from different geographical regions worldwide showed the five different alleles (A-E) with sizes varying from 186-202 bp, respectively. Comparison between DYS19 allelic frequency distribution among Japanese patients with prostate cancer and that of normal controls revealed significant differences regarding susceptibility or resistance to prostate cancer. We found that males with allele C of DYS19 are more susceptible to develop prostate cancer than males with other alleles (p = 0.02). The Odds Ratio was 2.04 with a 95% confidence interval (0.75-2.42), compared with males having other alleles. In contrast, males with the D allele of DYS19 were less exposed to prostate cancer than other males (p = 0.002); the Odds Ratio was 0.26 with a 95% confidence interval of (0.65-3.71). These findings support our hypothesis that male descendants from different Y-chromosomal origins are different regarding their susceptibility or resistance to develop prostate cancer (as a male-specific cancer).

Deoxycorticosterone-secreting adrenocortical carcinoma.

A case of DOC-secreting adrenocortical carcinoma in a 66-year-old man is reported. He had hypertension, hypokalemia, suppressed PRA, and excessive serum levels of DOC. His serum aldosterone level was normal. The resected adrenal mass weighed 230 g. Histologically, the tumor was mainly composed of compact cells associated with necrosis and atypical mitoses. Invasion of venous structure, sinusoids, and capsule was also present. Immunohistochemically, P450 C21 (21 -hydroxylase) was positive in many tumor cells, and P450 C17(17 α-hydroxylase) was intensely positive in a relatively small number of tumor cells. The patient died 9 months after operation due to rupture of metastatic liver tumor.Endocr Pathol 4:165-168, 1993.