RESUMEN
Intratumoural steroidogenesis may play a significant role in the progression of prostate cancer (PC) in the context of long-term ablation of circulating testosterone (T). To clarify the mechanism accounting for the progression of PC in a 74-year-old man who had undergone bilateral orchiectomy when he was 5 years old, we performed immunohistochemical studies of androgen receptor (AR) and steroidogenic enzymes in the prostate. We also measured steroid hormone levels in the serum and prostate, as well as mRNA levels of genes mediating androgen metabolism in the prostate. Positive nuclear staining of AR was detected in malignant epithelial cells. The levels of androstenedione (Adione), T, and 5-alpha dihydrotestosterone (DHT) in the serum of the patient were similar to those in PC patients receiving neoadjuvant androgen deprivation therapy (ADT), but were higher in the patient's prostate than in PC patients not receiving ADT. The gene expression of CYP17A1 and HSD3B1 was not detected, whereas that of STS, HSD3B2, AKR1C3, SRD5A1, and SRD5A2 was detected. Moreover, cytoplasmic staining of HSD3B2, AKR1C3, SRD5A1, and SRD5A2 was detected in malignant epithelial cells. Hence, in the present case (a man with primary hypogonadism), steroidogenesis in PC tissues from adrenal androgens, especially dehydroepiandrosterone sulphate, was the mechanism accounting for progression of PC. This mechanism might help elucidate the development of castration-resistant PC.
Asunto(s)
Hormonas Esteroides Gonadales/metabolismo , Hipogonadismo/etiología , Orquiectomía/efectos adversos , Neoplasias de la Próstata/metabolismo , Anciano , Androstenodiona/metabolismo , Dihidrotestosterona/metabolismo , Progresión de la Enfermedad , Regulación Enzimológica de la Expresión Génica , Regulación Neoplásica de la Expresión Génica , Hormonas Esteroides Gonadales/sangre , Humanos , Hipogonadismo/metabolismo , Inmunohistoquímica , Masculino , Neoplasias de la Próstata/etiología , Neoplasias de la Próstata/genética , Neoplasias de la Próstata/patología , ARN Mensajero/metabolismo , Receptores Androgénicos/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Testosterona/metabolismoRESUMEN
A 27-year-old female patient consulted us with chief complaints of difficulties of sexual intercourse and urination. On examination, the labia was found to be extensively fused at the midline, with a pinhole opening. We diagnosed it as labial adhesion. We operated on it under lumbar anesthesia. Four months after the operation, there were no symptoms of recurrence. Labial adhesion is thought to be caused by inflammation, lack of sexual activity and estrogen deficiency. It is not uncommon in children and post-menopausal women, but is extremely rare in reproductive women.
Asunto(s)
Coito , Disfunciones Sexuales Fisiológicas/etiología , Trastornos Urinarios/etiología , Enfermedades de la Vulva/etiología , Adulto , Femenino , Humanos , Inflamación/complicaciones , Factores de Tiempo , Adherencias Tisulares/etiología , Adherencias Tisulares/cirugía , Resultado del Tratamiento , Enfermedades de la Vulva/cirugíaRESUMEN
A 48-year-old man consulted us with the chief complaints of right flank mass. On examination, there was a soft bulge on the right superior lumbar area. Since computed tomographic scanning showed subcutaneous fatty tissue, we suspected a superior lumbar hernia. The diagnosis was confirmed by magnetic resonance imaging (MRI) that revealed a lumbar muscle defect and prolapsed fatty tissue around the kidney. During the operation, a small hernia hiatus, 2 cm in width, opened in the superior lumbar triangle. The herniated fatty tissue was excised, and the defect of fascia was closed by overlapping the adjacent fascial structure. No signs of recurrence were found at 3 months postoperatively. The usefulness of MRI for the diagnosis is discussed and previous literature is reviewed.
