[Endometrioid adenocarcinoma of the prostate: a case report].

A 69-year-old man was referred to our department with gross hematuria. Magnetic resonance imaging revealed the tumor directly invading the rectum. Biopsy of the tumor by transurethral resection demonstrated endometrioid adenocarcinoma of the prostate. Serum prostate specific antigen (PSA) level was normal. Because the tumor did not respond to hormonal therapy for a month, radical prostatectomy combined with rectal amputation was performed. Immunohistochemically, carcinoembryonic antigen was detected but PSA and prostatic acid phosphatase were not.

[A case of multilocular cystic renal cell carcinoma treated by partial nephrectomy associated with adrenal tumor].

A case of multilocular cystic renal cell carcinoma was reported. The patient was 69-year-old male who had been examined for postoperative study of gastric cancer by abdominal CT. The abdominal CT incidentally revealed right adrenal tumor which was non-functional and multilocular cysts in the lower pole of the right kidney. Selective renal arteriography showed a hypovascular mass with fine neovascularity. These two findings of CT and arteriography were though to represent a probable malignant tumor but renal function of the patient decreased moderately. Surgical exploration was done and right renal masses were thought to be seen benign multilocular cysts without capsule. Simple excision of the wall of cysts and right adrenalectomy were performed. Pathological examinations showed multilocular cystic renal cell carcinoma and benign adrenal hyperplasia. Additionally partial nephrectomy was done. Surgical margin of the kidney was tumor free and postoperative course was uneventful. Prognosis of multiocular cystic renal cell carcinoma is good, therefore conservative surgery is recommended.

[Primary transitional cell carcinoma in situ of the renal pelvis: a case report].

A 71-year-old female presented with left back pain at our hospital. She had had the same symptom about 1 year previously, but she had been presumed to have undergone stone passage because her symptom had disappeared. At this time a urogram, either excretory or retrograde, showed narrowing of each caliceal infundibulum and dilatation of each calyx in the left kidney, but otherwise normal findings. A cytology of left ureteral urine was class V, and cystoscopy revealed no abnormality. Under the diagnosis of left renal pelvic tumor she underwent nephroureterectomy with resection of a bladder cuff and retroperitoneal lymphadenectomy. The resected specimen had no gross tumor throughout the renal pelvis and ureter, but histological examination revealed transitional cell carcinoma in situ (grade 2) in most of the renal pelvis and infiltration of inflammatory cells in the submucosa. The ureter did not have any cancerous lesion, and no lymph node metastases was found. Four months postoperatively she is thought to have no evidence of disease with negative urinary cytology.

[Late recurrence of renal cell carcinoma: report of three cases].

A 70-year-old woman underwent a left radical nephrectomy. The pathological examination revealed renal cell carcinoma (RCC), grade 1 and no lymph node metastasis. She suffered a recurrence in the renal fossa 11 years after the operation. The doubling time of the recurrent lesion was calculated to be very long for the cancer; about 1.3 years. Another case was in a 61-year-old woman, who underwent a right radical nephrectomy. The pathological examination revealed RCC, grade 1 with vascular invasion and no lymph node metastasis. Eleven years postoperatively she developed metastases in both lungs. The other case was in a 39-year-old woman, who underwent right radical nephrectomy. The pathological examination revealed RCC, grade 1 with vascular invasion and no lymph node metastasis. Eight years postoperatively she developed a recurrence in the left kidney. The doubling time of the recurrent lesion was about 0.9 year. All three patients responded to conservative therapy including interferon. Taking those doubling times into account, the recurrent lesions in the first and third cases seemed to have been growing very slowly and not rapidly immediately before clinically evident recurrence. Patients with a low grade RCC must have life-long followup.

[Clinical study of allylestrenol (Perselin) on patients with prostatic hypertrophy].

The efficacy and safety of allylestrenol were studied in 22 patients with benign prostatic hypertrophy. A 25 mg allylestrenol tablet (Perselin tablet) was administered twice a day. A significant decrease in frequency of nocturnal urination was observed and improvement rates of subjective symptoms, such as sensation of residual urine, delay in start of urination, straining during urination and strength of urinary stream, were 59.1-68.2%. The rate of decrease of maximum area of transverse plane of prostate estimated by transrectal sonography was 13.2% and presumed circle area ratio (PCAR) improved significantly. The incidence of total side effects was 22.7%, whereas a decrease in sexual potency was observed in only 4.5% of the cases. The final global improvement rating of allylestrenol was 72.2% and the rate of usefulness was estimated in 63.6% of the patients. The present findings confirmed that allylestrenol is a useful and safe drug for the treatment of benign prostatic hypertrophy.

[Prostatic cancer after transurethral resection for benign prostatic hypertrophy].

Five cases of prostatic cancer developed after transurethral resection of prostate for benign hypertrophy are reported. Duration of transurethral resection of prostate (TUR-P) to diagnosis of prostatic cancer ranged from one year and seven months to seven years and two months, on average four years and seven months and frequency of prostatic cancer after TUR-P was estimated at 1.2%. Four of five patients complained of macroscopic hematuria. The cystourethrogram showed the mass protruded in the dilated prostatic urethra or bladder-neck in four patients (80%), a remarkable finding, and four cases were at stage D. Risk of development of prostatic cancer is not decreased even after prostatectomy and prostatic carcinoma diagnosed after TUR-P often advances in stage. Therefore, periodical examinations of the patients who had a prior prostatectomy are very important.

Bellini duct carcinoma of the kidney.

We report a very rare case of Bellini duct carcinoma originating from the collecting tubules of the kidney. A left renal tumor was detected during a health examination and radical nephrectomy was performed. Histological examination showed papillary adenocarcinoma. By means of immunohistochemical methods, we felt that the tumor was a renal carcinoma of Bellini duct origin.

[Clinical and pathological study of tumor marker in benign prostatic hypertrophy and incidental prostatic cancer].

To determine the value of prostatic markers for prostate cancer, serum prostatic acid phosphatase (PAP), prostate specific antigen (PSA) and gamma-Seminoprotein (gamma-Sm) were measured in 81 patients with benign prostatic hypertrophy and in 12 patients with incidental prostatic cancer. gamma-Sm was the most sensitive but the least specific of the three markers. Large prostate glands, especially hyper-glandular type tended to be associated with high gamma-Sm levels in our study. Patients with acute urinary retention, acute prostatitis and necrosis also showed positive markers. Out of 12 patients with incidental cancer, 5 patients had more than 2 elevated markers. Four patients with poorly differentiated adenocarcinoma failed to show increased markers.

[Complete remission of lung metastases of bladder tumor treated by small dosage of UFT: a case report].

The patient was a 61-year-old woman with bladder cancer presenting in stage pT3a, N0, M0, T.C.C. (GIII) greater than S.C.C. Following total cystectomy and one course of cisplatin, adriamycin, cyclophosphamide (CAP) as adjuvant chemotherapy, she was started on futraful and uracil (UFT) at a dose of 4 capsules daily and placed on observation. Since she complained of olfactory anesthesia at 2 months of treatment, the dosage of UFT was reduced to 2 capsules daily and the drug was withdrawn after another 2 months of treatment. With the detection of lung metastases one month later UFT was resumed at a dose of 2 capsules daily. At 4 months of resumed treatment the foci of metastasis completely disappeared. She has since shown a complete remission by small dosage of UFT (2 capsules daily) for 12 months or more.

[A case of renal adenocarcinoma with oxalate calcification on long-term hemodialysis].

A 39-year-old man with a 13-year history of hemodialysis was hospitalized with left back pain in May 1989. The plain radiograph showed a calcification in the left kidney. Ct scan demonstrated a round high density area. We could not exclude the possibility of malignancy, therefore, we performed left nephrectomy. Pathological examination revealed that a tumorous mass in the renal parenchyma and renal adenocarcinoma was confined to the mass intermingled with the deposition of the oxalate crystals. It was difficult to diagnose. Therefore we recommend nephrectomy when the diagnosis is uncertain.

[A case of small cell carcinoma of the ureter].

We report a case of primary undifferentiated small cell carcinoma of the ureter. A 62-year-old man showed gross hematuria. Retrograde pyelography and CT scan revealed a tumor in the left ureter. The light microscopic examination revealed small cell carcinoma and transitional cell carcinoma. To the best of our knowledge, this is the first report of a small cell carcinoma originating in the ureter in Japan.

[A case of erythropoietin-producing renal cancer].

A case of renal cell carcinoma with erythrocytosis is reported. A 58-year-old male had a right renal tumor with retroperitoneal lymph node and lung metastases. Preoperative laboratory data revealed a red blood cell count of 6.31 million/mm3, a hemoglobin concentration of 17.2 g/dl, a hematocrit of 52.1, and an erythropoietin (EPO) level of 47.3 mU/ml, which was determined by RIA method (normal range: 8-30). The patient underwent radical nephrectomy and retroperitoneal lymph node dissection without any blood transfusion because blood loss was only 300 g. The removed kidney weighed 400 g. Pathological examination showed a renal cell carcinoma not invading the fibrous capsule with lymph node metastasis. The EPO activities of extracts from the normal kidney and cancer tissues were less than 18 and 50.8 mU/g, respectively. At present, 3 months postoperatively, he receives daily UFT and HLBI every other day for the lung disease left, which does not change in size, and all laboratory data mentioned above have returned to normal ranges. These results enabled us to diagnose the present case as EPO-producing renal cell carcinoma.

[A case of bladder cancer with bilateral ureteral carcinoma in situ].

A case of bladder cancer with bilateral ureteral carcinoma in situ (CIS) is presented. A 55-year-old male had gross hematuria and urinary retention. Cystoscopy revealed diffuse broad-based papillary tumors, which proved to be transitional cell carcinoma (G2) with CIS and submucosal invasion microscopically. Excretory urography showed normal upper urinary tracts except stasis of bilateral lower ureters. Neither lymph node swelling nor distant metastasis was found by computed tomography. Therefore the patient underwent total cystourethrectomy, pelvic lymph-adenectomy, and construction of an ileal conduit. Histological examination of the specimens demonstrated CIS on bilateral ureteral stumps on the renal side, which, however, was not continuous to that of the bladder. Much attention should be paid to upper urinary tracts for ureteral lesions before cystectomy in such bladder tumors and the proximal stump of the ureter should be examined using frozen section at the operation, but these were not sufficient in the present case in which skip lesions of the ureters were seen apart from the bladder.

[Transurethral resection of bladder outlet obstruction from carcinoma of the prostate].

Transurethral resection (TUR) in combination with endocrine therapy was performed on 30 patients who were on initial treatment for carcinoma of the prostate and 6 patients who had previously been treated for this disease, 5 of whom were suffering from relapse after a satisfactory response to endocrine therapy. This paper reports the results viewed from potential promoting of metastasis and improvement in bladder outlet obstruction. Prior to TUR, urinary retention was present in 11 of initially treated patients (36.7%) and in three of the previously treated patients (50.0%). The average duration of postoperative indwelling catheter was 3.9 +/- 1.6 days in the initially treated group and 5.2 +/- 3.1 days in the previously treated group. Among the initially treated group, two patients with poorly differentiated adenocarcinoma advancing from Stage C to Stage D (15.4%) developed postoperative metastases which demonstrated at 14 and 42 months; the timing of their occurrence, however, was thought to preclude relating the metastases to TUR. Although metastasis occurred early in two patients among the previously treated group (33.3%), it was considered a natural disease course in relapse cases. Obstructive voiding symptoms recurred postoperatively in three patients of the initially treated group (10.0%) and three patients of the previously treated group (50.0%) during 6 months or more of follow-up periods. UR performed for carcinoma of the prostate proved to be fully safe and effective in the initially treated patients, while admitting that a considerable number of relapses seen in the previously treated patients degraded its benefit to some extent. We conclude that TUR contributed to the better quality of life in both initially and previously treated groups of patients with carcinoma of the prostate.

[Incidental prostatic carcinoma obtained from the tissue by transurethral resection].

Between January, 1982 and May, 1988, transurethral resection of the prostatic gland diagnosed as clinically benign prostatic hypertrophy was performed on 461 patients at Yokohama Minami Kyosai Hospital. Thirty-eight cases of incidental carcinoma (8.2%) were found by histopathological examination. The patients with well and moderately differentiated adenocarcinoma decreased in proportion to the increase in the number of the tumor chips. Of the 10 patients with more than 11 tumor chips, 7 patients (70%) had histologically poorly differentiated adenocarcinoma. The cases of INF alpha were only found in the group with the ratio of tumor chips to examined chips of less than 5%. The ratio of the cases of INF gamma increased with the increase in the ratio of tumor chips. Uniform substaging criteria of incidental prostatic carcinoma (stage A) obtained from the tissue by transurethral resection should be established.

Sister chromatid differential staining by direct staining in Na2HPO4-Giemsa solution and the mechanism involved.

The direct staining of BrdU-substituted Chinese hamster chromosomes in a Na2HPO4-Giemsa solution without any pretreatments resulted in a B-dark type SCD istituted (TB) chromatids stained light. Detailed examinations of the staining process suggested that the Na2HPO4 solution acts to collapse chromosomes whereas the Giemsa dye works to reconstruct the collapsed chromosomes, and that during the reconstruction process preferential binding of the Giemsa dye to the BB-chromatids occurs to produce the B-dark SCD. It was revealed that not only the time but the temperature at which chromosome preparations are kept prior to use considerably affect the occurrence of SCD.

Differential Giemsa staining of sister chromatids after extraction with acids.

Chromosomes of Chinese hamster strain cells were air-dried on slides after BrdU substitution for two or three rounds of replication. The preparations were treated with 20% PCA at 55 degrees C for 20-30 min, or 5N HCl at 55 degrees C for 15-20 min. After staining with Giemsa, unifilarly BrdU-substituted chromatids stained faintly and bifilarly substituted chromatids stained darkly. Such a pattern of sister chromatid differential staining was confirmed by the examination of metaphase cells grown with BrdU for three rounds of replication.