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血清PSA値4～10ng/mlを示す症例について前立腺癌診断におけるtotal PSA(tPSA), PSA density(PSAD), free to total PSA ratio(F/T比)の有用性を検討した.1999年5月から2001年4月迄に経直腸的エコー下前立腺生検を施行した43例を対象とし, ROC曲線を用いて各検査法の有用性を検討した.43例中, 前立腺癌:12例(27.9%), 非癌:31例(72.1%).tPSA, PSAD値, F/T比のmean±SEMは癌症例で各々7.308±0.636ng/ml, 0.271±0.039ng/ml/cm3, 16.225±4.911%であるのに対し, 非癌症例は6.300±0.289ng/ml, 0.178±0.020ng/ml/cm3, 15.213±0.980%であった.全症例におけるPSAD, tPSA, F/T比のROC曲線右下部分の面積を比較すると有意差をもってPSADのみが高かった(p, Total serum prostate-specific antigen (PSA) levels, free-to-total PSA ratio (F/T ratio) and PSA density (PSAD) were compared to clarify the clinical significance of these parameters in the diagnosis of prostate cancer (CaP) with intermediate PSA concentrations (4-10 ng/ml). PSAD and F/T ratio were obtained during the period from May 1999 to April 2001 from 43 patients with serum PSA concentrations of 4-10 ng/ml who underwent ultrasound-guided systematic sextant biopsies. PSAD was compared with total serum PSA and F/T ratio via receiver operating characteristic (ROC) curves for diagnosis of CaP. Diagnosis of CaP and non-CaP was made in 12 (27.9%) and 31 (72.1%) of the 43 patients, respectively. Mean serum PSA, PSA density and F/T ratio were 7.308 +/- 0.636 ng/ml, 0.271 +/- 0.039 ng/ml/cm3 and 16.225 +/- 4.911% in patients with CaP and 6.300 +/- 0.289 ng/ml, 0.178 +/- 0.020 ng/ml/cm3 and 15.213 +/- 0.980% in those with non-CaP, respectively. The ROC curve analysis demonstrated that PSAD predicted the biopsy outcome significantly better than F/T ratio and total PSA in all 43 patients (p < 0.05). In distinguishing CaP patients, the cutoff value of 0.16 ng/ml/cm3 for PSAD yielded a specificity level of 71.0% at a sensitivity level of 83.3%. Our study revealed that PSAD is a significant predictor in distinguishing CaP from non-CaP in Japanese men.

29歳男, 残尿感, 会陰部痛を主訴として受診.直腸診にて波動を有する前立腺を触知した.MRIでは右腎は欠損し, 同側の精嚢は拡張し嚢胞状変化を伴っていた.経直腸的精嚢穿刺術を施行し, 内容液は血性膿汁であった.初診時, 血清CA19-9が145.8U/mlと異常高値であったが抗生剤投与と穿刺術にて正常化し, 症状も消失した, A case of CA19-9-producing seminal vesicle cyst with ipsilateral renal agenesis is reported. A 29-year-old man was admitted to our hospital for perineal pain and urinary retention. Digital rectal examination revealed a large soft mass that fluctuated in the area of the prostate and seminal vesicles. Magnetic resonance imaging revealed a right kidney defect, and ipsilateral dilation and cystic enlargement of the right seminal vesicle. Transrectal puncture of the seminal vesicle cyst was performed. The contents were pus and old red blood cells. Initially, the serum CA19-9 level was extremely high (145.8 U/ml) but was normalized by the treatment with antibiotics after the puncture. The symptoms subsided without recurrence.

66歳男.左腰背部痛が増強し, 左尿管腫瘍, 膀胱腫瘍, 左重複腎盂尿管を指摘された.排泄性腎盂造影で左上半腎所属尿管は描出されず, 左下半腎所属尿管は軽度拡張し, 膀胱左側に陰影欠損像を認めた.膀胱鏡で左尿管口を1個確認し, その頭側に径3cmの有茎性乳頭状腫瘍を認めた.この腫瘍を経尿道的に切除したところ, 切除部に尿管口を認めた.病理所見で, 核が大型化した異型性の強いN/C比の大きな腫瘍細胞を粘膜上皮内に認めたが, 膀胱固有筋層への浸潤はなく, 移行上皮癌, grade 2, pTaと診断した.1週後に左腎尿管全摘除術及び膀胱部分切除術を施行した.上半腎所属中部尿管に3.0×3.5cmの白色調の非乳頭状広基性腫瘍を認めた.病理所見で核異型の強い悪性細胞が尿管固有筋層を越えて浸潤し, 移行上皮癌, grade 3, pT3であった.術後18ヵ月目に腹部CTで大動脈分岐部に50×40mmの腫瘤を認め, 再発と診断した.切除不能で化学療法を施行し, 術後22ヵ月で生存中である, A 66-year-old man presented at our hospital with left back pain. Intravenous pyelography, computerized tomography and magnetic resonance imaging revealed ureteral tumors of the complete left double renal pelvis and the ureter. An endoscopic examination disclosed a papillary tumor from the left ureteral orifice of the lower pole of the kidney. A transurethral resection of the tumor was done, and the pathological features revealed transitional cell carcinoma (PTa, grade 2). A left nephroureterectomy and a partial cystectomy were also carried out; macroscopic examinations showed a non-papillary tumor on the middle portion of the left ureter originating from the upper pole of the kidney. Microscopic examinations revealed transitional cell carcinoma (PT3, grade 3, PL1, PV1). Adjuvant chemotherapy (M-VAC) was administered but discontinued because of severe side effects. Dispite recurrence with retro-peritoneal lymph node metastasis, the patient is alive and again undergoing M-VAC chemotherapy 22 months after the initial surgery. However, the evaluation of the chemotherapy was "no change".

症例は26歳男で, 7年前にvon Hippel-Lindau(VHL)病に合併した骨髄・小脳血管芽腫及び側頭骨乳頭腫に対して摘出術を受け, 以後外来通院していたが, 両側陰嚢内の無痛性腫瘤を触知した.超音波で両側精巣上体に内部不均一な多房性腫瘤を認めると共に, 膵頭部及び両腎に数個の嚢胞を, 右腎外側に径3cmの内部均一な充実性腫瘍を認めた.MRIでは右腎腫瘍はT1強調像でlow, T2強調像でhigh intensityを呈し, 造影効果は認めなかった.摘出術において, 右腎腫瘍は右腎中央に存在し, 2.5×2.5×2cm, 割面黄色で, 白色の線維性被膜でよく被包されていた.両側精巣上体頭部腫瘍は, 右1×3×1cm, 左1×2×1cmで, 腺構造が密に存在し, ところどころで内腔に向かって核異型のない上皮の乳頭状増殖を認めた.またVHL遺伝子の検査を行ったところ, exon 2 351にGからAへの点突然変異を認めた.術後経過は良好で再発はない, We present a case report of von Hippel-Lindau disease associated with renal cell carcinoma and bilateral cystadenoma of the epididymis. A 26-year-old man appeared with painless tumors of the bilateral scrotal contents. Ultrasonography and other radiographic examinations including computed tomographic scan and dripinfusion pyelography showed multiocular tumors in the bilateral epididymis and a right renal tumor 3 cm in diameter. The tumors of the bilateral epididymis were surgically resected and of the right renal tumor enucleated. Histopathological examination revealed cystadenoma of the epididymis and renal cell carcinoma (clear cell carcinoma, G1, pT1a). He has not received adjuvant therapy, and is doing well with no evidence of metastatic disease 2 years after surgery.

Heparanase, which is an extracellular matrix degradative enzyme, degrades heparan sulfate and heparan sulfate proteoglycans, which are chief components of extracellular matrix and vascular basement membrane. The gene structure of this enzyme was recently determined. The biological functions of this enzyme in vivo were as follows: 1) this enzyme accelerates cancer cell invasion and metastasis though the degradation of vascular basement membrane and extracellular matrix by cancer cells; 2) this enzyme releases and activates heparin-binding growth factors such as bFGF and VEGF from heparan sulfate proteoglycans, and induces angiogenesis; 3) the degradative products of heparan sulfate proteoglycans by this enzyme suppress the biological function of activated T-lymphocytes. Therefore, heparanase is thought to be a favorable molecule for acceleration of cancer invasion and metastasis. The expression of heparanase is strongly correlated with the metastasis of melanoma and fibrosarcoma. Thus, heparanase may play important roles in invasion and metastasis of cancer.

予後不良因子を有する進行性胚細胞腫に対する末梢血幹細胞移植併用超大量化学療法は安全で有用な手段と思われるが, 本療法に問題点も残されている, We examined the clinical results of super high-dose chemotherapy with peripheral blood stem cell transplantation (PBSCT) in 14 patients with poor-risk advanced germ cell tumors. The mean number of nadir white blood cells was 205 +/- 126/microliter; the mean period of number of white blood cells fewer than 1, 000/microliter was at 8-10 days (mean +/- SD; 9.2 +/- 0.92). The nadir number of blood platelet cells was 1.7 +/- 0.70 x 10(4)/microliter; the mean period of number of platelet cells fewer than 5 x 10(4)/microliter was at 12.6 +/- 2.17 days. Of 10 patients treated with super high-dose chemotherapy with PBSCT as induction therapy, 8 patients (80%) showed that the serum tumor marker returned within the normal range after super high-dose chemotherapy. Of 8 patients, 7 underwent resection of the residual tumor. Surgical or pathological CR was obtained in 5 of these 7 patients, 4 patients of whom were alive with no evidence of disease 29 to 49 months after initial consultation: the other patient died with recurrence 20 months after initial visit. On the other hand, super high-dose chemotherapy with PBSCT was performed for one patient as consolidation, and for 3 patients with recurrence. Of these 4 patients, one died from disease 6 months after detection of recurrence. The other 3 patients were alive with no evidence of disease at 7-37 months after initial visit. The 1- and 3-year disease-free survival rates were 88% and 72%, respectively. In conclusion, super high-dose chemotherapy with PBSCT can be done safely and could be useful for patients with poor-risk germ cell tumor.

CD44v8-10 variant isoform is frequently expressed in many kinds of cancers. We have already reported that 77% of bladder cancer specimens expressed CD44v8-10 and using CD44v8-10/CD44v10 competitive reverse transcription-polymerase chain reaction (CC-RT-PCR), we detected exfoliated urothelial cancer cells in urine samples of urothelial cancer patients (Int J Cancer 79: 560, 1998, J Urol 160: 2004). In this paper, we review the expressing of CD44 variant isoform in various kinds of cancers, and the principle of CC-RT-PCR which can be a novel screening method for urothelial cancer.

We report a case of carcinosarcoma arising from a bladder diverticulum. A 71-year-old male was referred to our hospital for macroscopic hematuria. Two diverticula were identified in the left wall of the urinary bladder, one of which showed a broad-based tumor. The bladder tumor was resected using a transuretheral approach and the tumor was histologically diagnosed as leiomyosarcoma. The patient underwent partial resection of the bladder including the two diverticula and the tumor. Pathological examination revealed that the resected specimen was composed of three elements, transitional cell carcinoma (G3), squamous cell carcinoma, and leiomyosarcoma. Thus, the patient was diagnosed with carcinosarcoma. He died 5 months after surgery to remove the panperitonitis carcinomatosa. This case is the 38th reported case of bladder carcinosarcoma in Japan.

プロピベリン(20mg/日, 28日間)の臨床効果を49名の患者を対象に多施設協同研究で調査した.排尿回数の中等度以上の改善を切迫性及び腹圧性尿失禁で52%及び54%の患者で達成出来た.尿意切迫感はそれぞれ91%及び58%の症例で改善した.尿失禁はそれぞれ97%及び71%の症例で改善した.日常生活の制限はそれぞれ94%及び64%の症例で改善が見られた.軽度の副作用を5名に, 臨床検査値の変動を2名に認めた, The efficacy and tolerability of propiverine hydrochloride (20 mg/day) were evaluated in the treatment of a total of 49 Japanese patients (35 with urge incontinence and 14 with stress incontinence) in an open multicenter trial lasting 28 days. The effects on the frequency of urination, urinary incontinence, urinary urgency, and daily living activities were evaluated through the voiding diaries filled out by the patients. Moderate or greater degree of improvement was attained in micturition frequency by 52 and 54% of the patients with urge incontinence and with stress incontinence, respectively, in urinary urgency by 91 and 58%, in urinary incontinence by 97 and 71%, and in daily living activities by 94 and 64%. Although minor adverse reactions (5 patients) and abnormal values in blood chemistry (2 patients) were recorded in 7 patients, all of these patients completed the trial. These results suggest that propiverine hydrochloride is a safe and effective drug of choice for the treatment of not only urge incontinence but also stress incontinence in patients diagnosed in a clinical setting.

前立腺全摘除術を施行した81例について 1)臨床病期のunderstagingは41%であり, T2とされた57例中28例がpT3であった. 2)所属リンパ節転移はpT2で3.3%, pT3で37%に認められた. 3)術後の再発率はpT3, 中分化～低分化型, INFγで高い. 4)術後に再発をきたした7例中, 全例が低又は中分化癌で6例がpT3, 3例がリンパ節転移陽性であった. 5)術後の排尿状態は55例では特別な問題はないが, 23例で軽度～中等度の尿失禁を認めている. 6)術後の勃起能は, 評価可能の18例中4例で維持されていた, We studied 81 patients who underwent radical prostatectomy for prostate cancer. Ten, 57 and 14 patients were clinically diagnosed with stage T1, T2 and T3, respectively. Pelvic lymph node dissection was performed prior to prostatectomy in all cases. The neurovascular bundle was preserved in 21 patients. Compared with pathological stage, the accuracy rate of clinical staging in T1, T2 and T3 was 40, 46 and 64% respectively. Approximately half of the patients clinically diagnosed with stage T2 were pT3. The positive rate of lymph node in pT2 and pT3 was 3.3 and 37% respectively, showing a marked difference between these two pathological stages. The 3-year non-recurrence rates were 89% in patients with pT2 and 79% in pT3. In the well differentiated carcinoma group, no patients had recurrence for up to 3 years. All of the patients with infiltration (INF) gamma showed recurrence within 3 years. Fifty-five patients had no problem on urination post-operatively, while the other 23 patients had a mild or moderate incontinence and the remaining 3 patients had a small urine stream. Regarding erectile potency, 4 out of 18 evaluable patients were potent.

ヒト腎細胞癌の転移には, 腎および肺由来線維芽細胞が分泌するTGF-β1により調節を受けるtype 4collagenaseが重要な役割を演じている, An orthotopic metastatic human renal cell carcinoma model in nude mice was established to evaluate the mechanism of metastasis as a preliminary phase in the development of a treatment to prevent cancer metastasis. The effect of host fibroblasts from different organs on the production of type IV collagenase by human renal cell carcinoma and the factors which influenced the enzyme production and secretion by fibroblasts were also investigated. KG-2 cells were established from human renal cell carcinoma, and produced tumors following implantation to both the subrenal capsular space (orthotopic site) and subcutis (ectopic site). Histologically, the tumors in the subcuit (SC tumors) were well encapsulated with a thick fibrous capsule and did not produce metastasis or invasion, whereas those in the subrenal capsular space (SRC tumors) lacked a fibrous capsule and produced metastasis at the lung or regional lymph nodes. The production of type IV collagenase in conditioned media from metastatic SRC tumors and lung metastatic lesions was larger than that from non-metastatic SC tumors. The conditioned media separated from mouse kidney or lung fibroblasts stimulated the production of type IV collagenase by KG-2 cells, whereas, that separated from mouse skin fibroblasts decreased the enzyme production. The production of type IV collagenase by KG-2 cells was stimulated by cocultured KG-2 cells and fibroblasts from the kidney or lung, whereas it was suppressed by cocultured KG-2 cells and skin fibroblasts.(ABSTRACT TRUNCATED AT 250 WORDS)

76歳男, 健康診断のため施行された腹部CTで左腎腫瘍が疑われ根治的左腎摘出術が施行された。摘除腎の髄質に割面黄褐色で直径約2cmの腫瘍を認め病理組織学的に円柱状で好酸性胞体を有する悪性細胞が乳頭状に増殖していた。レクチンおよび2種のモノクローナル抗体を用いた検討では, Soybean agglutinin, Peanut agglutinin, Dolichos biflorus agglutinin, Lotus tetragonolobus agglutininおよびCytokeratinは弱陽性でTamm-Horsfall proteinが陰性であった。腫瘍の肉眼的および組織学的所見は, 本腫瘍がベリニ管上皮由来であることを強く示唆した。患者は手術後1年を経たが腫瘍の再発を認めず健在である, A case of Bellini duct carcinoma is reported. A left renal tumor was detected by abdominal computerized tomography in a 76-year-old male, although he had no symptoms, such as hematuria, weight loss or flank pain. Radical nephrectomy was performed under the diagnosis of renal cell carcinoma in the left kidney. Macroscopic examination of the resected kidney revealed a tumor 2.0 cm in diameter, with a yellow-brown cut surface, located in the renal medulla. Histological examinations showed malignant tumor cells with eosinophilic cytoplasm with a papillary growth pattern. Immunohistostaining examinations using Lectin and two kinds of monoclonal antibodies demonstrated no significant staining with soybean agglutinin, peanut agglutinin, Dolichos biflorus agglutinin, Lotus tetragonolobus agglutinin or cytokeratin, and negative staining with Tamm-Horsfall protein. Although the results of immunohistostaining did not provide support, both macroscopic and microscopic findings strongly suggested that this tumor originated from Bellini duct epithelium (Bellini duct carcinoma). The patient is alive with no evidence of disease 1 year after surgery. Bellini duct carcinoma is a rare malignant condition and the prognosis is usually poor. Differential diagnosis from other renal or pelvic tumors is difficult and long-term careful follow-up is necessary.

術後3ヵ月以上経過した31例を検討対象とした。生存期間中央値は32ヵ月(3-95ヵ月)で, 5例が死亡した。その死因は2例が前立腺癌, 1例が心筋梗塞, 1例が肺炎, 1例が術後死であった。再発は4例に認められた。stage Bの1例は術後22ヵ月目に骨転移が生じたが, 去勢術と前術したmethotrexate投与にてPR状態で32ヵ月, pN1の1例は術後53ヵ月目に尿道膀胱吻合部に再発し, Honvanの経口投与と局所放射線療法によりCR状態で95ヵ月いずれも生存中である。残りの2例はpN2症例で, 1例は術後34ヵ月目に尿道膀胱吻合部と骨に, 1例は4ヵ月目に頸部リンパ節に再発し, 前者は65ヵ月, 後者は23ヵ月後に癌死した, Total retropubic prostatectomy was performed on 31 patients with prostatic cancer (median age; 70 years). The accuracy of staging was 55% (17 patients). In 11 patients (35%) the staging had been underestimated, and in 3 patients (10%) overestimated. The pathological stage and grade were stage B in 14 patients, stage C in 4 patients, stage D1 in 13 patients (pN1; 8 patients, pN2; 5 patients), well differentiated adenocarcinoma (WDA) in 8 patients moderately differentiated adenocarcinoma (MDA) in 7 patients, and poorly differentiated adenocarcinoma (PDA) in 16 patients. The WDA were all stage B, and 85% of the PDA were stage D1. The positive surgical margin rate was 21% in stage B, 50% in stage C, 85% in stage D1, 13% in WDA, 43% in MDA, and 75% in PDA. Five of the patients died, and the causes of death were prostatic cancer in 2 patients (pN2/PDA), and others in 3 patients (1 patient; stage B/PDA, 2 patients; pN2/PDA). The 5-year survival rate (Kaplan-Meier) was 84% on the whole, 83% for stage B, 100% for stage C, 83% for stage D1, 100% for WDA, 100% for MDA, 71% for PDA, 86% for pN0, 100% for pN1, and 38% for pN2.