Micropapillary variant of transitional cell carcinoma of the bladder

A 77-year-old man visited the Kobe City General Hospital complaining of macroscopic hematuria. A computed tomography scan found a bladder tumor with left iliac and para-aortic lymph node metastasis. Two courses of cisplatin, cyclophosphamide and doxorubicin chemotherapy resulted in a minimal response. Radical cystectomy and a retroperitoneal lymph node dissection with bilateral ureterocutaneostomy reconstruction were then performed. A pathological examination revealed a micropapillary variant of transitional cell carcinoma (Grade 3, pT1pN2M1). The patient died of pelvic recurrence 7 months after the initiation of chemotherapy. Peritonitis carcinomatosa and lung metastases were observed at autopsy.     

Disturbed voiding associated with von Recklinghausen''s neurofibroma

Abstract The incidence of von Recklinghausen's disease is most frequent among neurocutaneous syndrome. It is an intractable neurological disease. About half of the disease is caused by an autosomal dominant inheritance and another half by mutation. It is characterized by neurofibroma which arises on various parts of the body and gradually increases with age. We recently encountered a case where a growth of neurofibroma within the foreskin had disturbed voiding.     

Cadmium nephrotoxicity and evacuation from the body in a rat modeled subchronic intoxication

BACKGROUND: Cadmium (Cd) is an important industrial pollutant, although its mechanism of toxicity has not been completely clarified. We studied Cd-induced subchronic nephrotoxicity and the cadmium evacuation system in rats and cultured human renal tubular cells. METHODS: Male Sprague-Dawley rats were subcutaneously injected with 0.6 mg Cd/kg per day for periods of 3, 5 and 8 weeks. The concentration of Cd in urine, serum and kidneys was measured by atomic absorption spectrophotometry. Nephrotoxicity was evaluated based on the urinary concentration of beta2 microglobulin (B2MG) and histopathological findings. Apoptotic cells were detected by nick-end labeling and DNA laddering, and were based on the level of caspase-3 activity. Cadmium-induced toxicity was also studied in cultured human renal tubular cells. RESULTS: Nephrotoxicity was detected after 4 weeks of exposure to Cd, because Cd and B2MG appeared in urine. The tissue concentration of Cd increased linearly throughout the 8 weeks of exposure to Cd. The concentration of renal Cd did not change in the 3-week exposure group, but it decreased after withdrawal of Cd in the 5-week exposure group, suggesting an active Cd excretion mechanism started after the 4th week. The threshold Cd concentration for nephrotoxicity was 150 micrograms/gram wet tissue, at which concentration histological tubular damage started. Although the kidneys presented mainly necrosis, apoptosis was observed at weeks 4 and 5, before renal tubular necrosis occurred. In vitro DNA laddering was observed and peak caspase-3 activity was detected when the cells were exposed to the threshold concentration of Cd. CONCLUSION: Cadmium was effectively evacuated from the body by exfoliation of damaged renal tubular cells presenting focal tubular necrosis after the renal Cd concentration reached the threshold. Apoptosis may be involved in the regulation of Cd-induced nephrotoxicity.     

Ovarian Burkitt's lymphoma diagnosed by a combination of clinical features, morphology, immunophenotype, and molecular findings and successfully managed with surgery and chemotherapy

Abstract.   Chishima F, Hayakawa S, Ohta Y, Sugita K, Yamazaki T, Sugitani M, Yamamoto T. Ovarian Burkitt's lymphoma diagnosed by a combination of clinical features, morphology, immunophenotype, and molecular findings and successfully managed with surgery and chemotherapy. Int J Gynecol Cancer 2006; 16(Suppl. 1): 337–343.
Ovarian involvement as an initial manifestation of lymphoma, without detectable extraovarian disease, is a rare occurrence. The diagnosis of ovarian lymphoma is almost invariably unsuspected until the tumor has been examined histologically. A 25-year-old null gravid woman presented with abdominal distension. Presence of abnormal lymphoid cells in pleural effusion led to presurgical assumption that the pelvic mass noted on computerized tomography examination might be an ovarian lymphoma. We performed left salpingo-oophorectomy. Clinical, histologic, and molecular examination revealed Burkitt's lymphoma of the ovary with c-myc gene rearrangement and mRNA expression of multiple cytokines. She received dose-intensified combination chemotherapy. She is alive and free of disease 30 months after the diagnosis. Immunophenotype and molecular findings allowed reliable discrimination of Burkitt's lymphoma from diffuse large B-cell lymphoma and other lymphomas. If an ovarian tumor is solid and suspected to be of lymphoid origin, we suggest that it is necessary to obtain samples for genetic examination at surgery. This strategy often provides important information to establish therapeutic regimen and predict patient prognosis.     

Urodynamic study on postsurgical bladder function in cervical cancer treated with systematic nerve-sparing radical hysterectomy

The objective of this study was to assess the postsurgical bladder function by urodynamic study in patients with cervical cancer treated with nerve-sparing radical hysterectomy. A total of 27 consecutive patients were included in the study. Of the 27 patients, autonomic nerves had been completely preserved at least on one side in 22 patients (group A), and autonomic nerves could not be successfully preserved in five patients (group B). In group A, there was no significant difference in compliance at the moment of strong desire to void, maximum flow rate, and residual urine volume between before the operation and at 12 months after the operation. However, abdominal pressure at maximum flow had significantly increased in patients of group B than of group A. Detrusor contraction pressure at maximum flow had significantly decreased in patients of group B than of group A. Bladder sensation was diminished in three cases (60%) of group B but preserved in all the patients of group A. Although it is still preliminary, our surgical technique described in this report is thought to be effective for preservation of bladder function. For further evaluation of the efficacy of nerve-sparing radical hysterectomy in terms of quality of life and survival of patients, a prospective randomized trial needs to be performed.     

p120 catenin is associated with desmogleins when desmosomes are assembled in high-Ca2+ medium but not when disassembled in low-Ca2+ medium in DJM-1 cells

We recently showed that p120 catenin (p120ctn), which is an armadillo family protein member that binds to E-cadherin (E-cad), is also localized to desmosomes by directly or indirectly binding to desmogleins (Dsg). We examined whether p120ctn is associated with Dsg1 and Dsg3, as compared with E-cad and plakoglobin (PG), in keratinocytes grown in high or low Ca²⁺, using a human squamous cell carcinoma cell line, DJM-1 cells. The cell lysate of DJM-1 cells grown in high- or low-Ca²⁺ media was immunoprecipitated with anti-Dsg1/2 and Dsg3 antibodies, and we examined whether p120ctn is associated with Dsg1 and Dsg3. Then, we observed the co-localization between Dsg3 and p120ctn in cells grown in high- or low-Ca²⁺ medium on double-staining immunofluorescence microscopy using anti-p120ctn and anti-Dsg3 antibodies. Immunoprecipitates with anti-Dsg1/2 and Dsg3 antibodies in cells grown in high-Ca²⁺ medium contained p120ctn. In contrast, in low-Ca²⁺ medium, p120ctn was co-immunoprecipitated with neither Dsg1 nor Dsg3, but was co-immunoprecipitated with E-cad in cells grown in both high- and low-Ca²⁺ media. Dsg3 was associated with PG in cells grown in both low- and high-Ca²⁺ media. On immunofluorescence microscopy, p120ctn and Dsg3 were independently observed in cells grown in low-Ca²⁺ medium; p120ctn, but not Dsg3, was observed in a linear pattern at the cell–cell boundary. However, they were co-localized at cell–cell contacts in cells grown in high-Ca²⁺ medium. Thus, these proteins are not co-localized in low Ca²⁺ medium. These results suggest that p120ctn plays an important role in Ca²⁺-induced desmosome formation.     

Case of localized scleroderma successfully treated with bath psoralen and ultraviolet A therapy

The patient was a 12-year-old girl with linear scleroderma distributed on the right abdomen, dorsal aspect of the right thigh, lower leg and foot. The initial regimen of oral prednisolone and methotrexate, or i.v. methylprednisolone failed in the treatment of the scleroderma. Then bath psoralen and ultraviolet A therapy (bath-PUVA) therapy of 0.2 J–4.0 J/cm² daily to total doses 62.8 J/cm² combined with oral prednisolone was started. After bath-PUVA therapy, regression of the skin sclerosis was observed, the possible mobile range of the right ankle was increased and histological examination confirmed improvement of the sclerosis. The successful results of bath-PUVA therapy in this case suggest its utility for localized scleroderma.     

Evolution of prognostic factors in hepatocellular carcinoma in Japan

Aliment Pharmacol Ther 31 , 407–414

Summary

Background The surveillance of hepatocellular carcinoma (HCC) has become prevalent, and the modalities for its treatment have improved. Aim To understand the changes that occur in the characteristics and prognostic factors of HCC with time. Methods Newly diagnosed HCC patients were divided into two groups; patients treated before 31 December 2000 (n = 504), and after 1 January 2001 (n = 746), and their clinical backgrounds and prognostic factors were analysed. Results The number of patients negative for both Hepatitis B surface antigen (HBsAg) and Hepatitis C virus antibody (HCVAb) increased with time (NBNC‐HCC). The size of HCC decreased in patients who were positive for HBsAg (B‐HCC) or HCVAb (C‐HCC), whereas no difference was observed in NBNC‐HCC. The patient survival of C‐HCC improved; however, no difference was detected for NBNC‐HCC. In multivariate analysis, low albumin, high aspartate aminotransferase (AST), ascites, large tumour size, multiple tumour number and high alpha‐fetoprotein were risk factors for survival before 2000, whereas the presence of HBsAg was additionally selected as a good prognostic factor and AST was excluded after 2001. Conclusions The prognostic factors as well as clinical background of HCC changed with time, and the presence of HBsAg was found to be an additional good prognostic factor after 2001.