[Multiple chromophobe renal cell carcinoma: a case report]

A 46-year-old woman with gross hematuria was referred to our hospital with suspicion of bilateral renal cell carcinoma. Computed tomography (CT) showed multiple renal tumors with contrast enhancement and multiple lung nodules. Based on a diagnosis of bilateral multiple renal cell carcinoma with multiple lung metastases, a combination therapy with interferon-alpha (IFN-alpha) and 5-flurouracil (5-FU) was initiated. Six months later, all the renal and pulmonary lesions remained the same, and IFN-alpha alone was continued thereafter. One tumor in the right upper pole decreased in size during the next six years, while all the other lesions remained unchanged. Then the immunotherapy was discontinued on the basis of possibility that the tumors could be benign lesions. Three years later,the right upper renal tumor disappeared on CT, but, one of the left renal tumors showed progressive disease. The patient underwent left partial nephrectomy together with resection of neighboring small tumors. All the excised tumors were diagnosed as chromophobe renal cell carcinoma on histological examination. There has been no change with the remaining tumors for 1.5 years postoperatively.

[Health-care seeking behavior related to lower urinary tract symptoms : a population-based study in Japan]

We aimed to investigate health-care seeking behavior related to lower urinary tract symptoms (LUTS) using a questionnaire-based survey. The questionnaire included questions related to 5 demographic issues, 9 past histories, 8 LUTS, and others about health-care seeking related to LUTS. We sent the questionnaire to 6,000 residents, 41 to 70 years old, in three Japanese communities (Tobetsu, in a subarctic zone, Kumiyama, in a temperate zone, and Sashiki, in a subtropical zone). Of the questionnaires, 36.5% were valid for analyses. The prevalence of desire for treatment for LUTS was 15.6% (still-treated health-care seeker : 4.5%, never-treated health-care seeker : 11.1%). This finding suggested that, among residents with a desire for treatment, only 29% actually had treatment for LUTS. Multivariate analyses revealed that incomplete emptying, weak stream, and straining for males, and urinary frequency, nocturia, and incontinence for females were independently significant factors associated with health-care seeking related toLUTS.

[A case of elderly donor in living kidney transplant after radical radiotherapy for prostate cancer]

A 72-year-old man came to our clinic as a candidate of the donor of renal transplantation for his 44-year-old daughter. However, his serum PSA was found elevated, and he was diagnosed with stage C prostate cancer. He received neoadjuvant androgen deprivation therapy and subsequent IMRT as a definitive curative therapy. Since his PSA remained at a very low level after IMRT for three years, we performed systematic 16-site prostate biopsy, which revealed no viable prostate cancer cells. His renal function seemed to be normal and no functional difference was noted between the two kidneys. Then, his left kidney was harvested by hand-assisted retroperitoneal laparoscopic approach, and transplanted to his daughter successfully. The suitability of a donor with two potential problems-advanced age and a history of prostatic cancer-was discussed, together with a review of the literature.

[Renal artery pseudoaneurysm following retroperitoneal laparoscopic partial nephrectomy]

We report a case of a 59-year-old woman who presented with gross hematuria due to development of a pseudoaneurysm that was diagnosed using Doppler ultrasonography 16 days after retroperitoneoscopic partial nephrectomy for renal cell carcinoma. Hematuria resolved after the patient was treated with selective angioembolization of the pseudoaneurysm. There has been no recurrence of the pseudoaneurysm for 28 months after the procedure.

[Two-stage nephron-sparing surgery for bilateral T2 renal cell carcinoma and von Hippel-Lindau disease: a case report]

A 32-year-old man was referred to our hospital for evaluation of bilateral renal tumors 8 cm each in diameter. His cousin also had a renal tumor, and she had been genetically diagnosed as von Hippel-Lindau (VHL) disease. Bilateral nephron-sparing surgery was performed in separate stages under clinical diagnosis of renal cell carcinoma and VHL disease. Histological examination revealed clear cell renal cell carcinoma (pT2). There was no evidence of local recurrence or metastasis 6 months after the second operation. In the treatment of renal cell carcinoma and VHL disease, nephron-sparing surgery is recommended to achieve a disease-free status without renal replacement therapy.

[A case report: recurrence of urothelial cancer in an ileal conduit]

A 48-year-old man presented complaining of lower abdominal pain, and was diagnosed with invasive bladder cancer. After neoadjuvant chemotherapy, cystoprostatourethrectomy and ileal conduit diversion were performed. At 53 years of age, bladder cancer recurred in the upper urinary tract and he underwent complete urinary tract extirpation. Histological examination revealed an urothelial carcinoma in an ileal conduit. Three years later, a local recurrence led to combined modality therapy including chemotherapy and radiotherapy. He is receiving maintenance chemotherapy for metastatic tumors. Urothelial carcinoma arising in an ileal conduit after radical cystectomy for bladder cancer is infrequently reported. To our knowledge, only 12 cases, including ours, have been reported.

Genetic polymorphisms in glutathione S-transferase T1 affect the surgical outcome of varicocelectomies in infertile patients

Glutathione S-transferases (GSTs), superoxide dismutase 2 (SOD2) and NAD(P)H:quinone oxidoreductase 1 (NQO1) are anti-oxidant enzyme genes. Polymorphisms of GSTs, SOD2 and NQO1 have been reported to influence individual susceptibility to various diseases. In an earlier study, we obtained preliminary findings that a subset of glutathione S-transferase T1 (GSTT1)-wt patients with varicocele may exhibit good response to varicocelectomy. In this study, we extended the earlier study to determine the distribution of genotype of each gene in the infertile population and to evaluate whether polymorphism of these genes affects the results of surgical treatment of varicocele. We analyzed 72 infertile varicocele patients, 202 infertile patients without varicocele and 101 male controls. Genotypes of GSTs were determined by polymerase chain reaction (PCR). Genotyping of SOD2 and NQO1 was performed using the PCR-restriction fragment length polymorphism (PCR-RFLP) method. A significantly better response to varicocelectomy was found in patients with the GSTT1-wt genotype (63.2%) and NQO1-Ser/Ser genotype (80.0%) than in those with GSTT1-null genotype (35.3%) and NQO1-Pro/Pro or NQO1-Pro/Ser genotype (45.2%), respectively. The frequencies of glutathione S-transferase M1/T1, SOD2 and NQO1 genotypes did not differ significantly among the varicocele patients, idiopathic infertile patients and male controls. GSTT1 genotype is associated with improvement of semen parameters after varicocelectomy. As the number of patients with NQO1-Ser/Ser genotype was not sufficient to reach definite conclusions, the association of NQO1 genotype with varicocelectomy requires further investigation.

[Sperm cryopreservation for cancer patients: 5-year experience in a private hospital in Japan]

Private hospitals in Japan appear to play an important role in the fertility preservation in cancer patients. However, only a few university-related institutions have published their data about sperm banking. Here we report our experience in a private hospital. The database of 5 years of experience with sperm cryopreservation for male cancer patients was reviewed. We assessed the type of cancer, timing of collection, sperm quality, and utilization for reproductive purposes. There were a total of 88 oncology patients who underwent sperm banking at our institution during the study period. Types of cancer were various, with testicular cancer and hematological malignancies comprising the largest groups. Nearly 90% of the testicular cancer patients had their sperm preserved prior to the therapy, while only 53% of those with hematological disease did so. Evaluation of semen parameters for these groups revealed that oligozoospermia in testicular cancer patients, even prior to initiation of cancer therapy, was common. Five patients utilized their specimens for reproductive purposes. Of these, 3 patients successfully fathered a child. Our results suggest that sperm cryopreservation before initiation of cancer therapy in male oncology patients is under-utilized. Additionally, there is minimal use of cryopreserved specimens for reproductive purposes. This under-utilization is supposed to be due to physicians', especially hematologists', insufficient awareness toward chemotherapy-related infertility and the paucity of reports regarding reproductive outcome after freezing. More data should be compiled to help both physicians and patients who are considering sperm cryopreservation.

[Post-operative recurrence patterns of urothelial tumors in the upper urinary tract: comparison between renal pelvic and ureteral tumors]

To determine treatment outcomes for renal pelvic and ureteral tumors, we retrospectively evaluated the correlations between stage, area oflymphadenectomy (LND) and the recurrence pattern. Of 162 patients treated surgically for a urothelial tumor of the upper urinary tract from 1990 to 2006, we reviewed 57 renal pelvic and 55 ureteral, diagnosed as having either renal pelvic or ureteral tumors. We defined local recurrence as metastasis to the retroperitoneum, pelvis, and abdominal lymph nodes. Of the 112 patients, LND was performed in 76. No patient with pTis/a/1 disease showed pN(+); however, in pT2 < or = disease, 39% of the renal pelvis and 23% of the ureter cases exhibited nodal involvement. During follow up, 35 patients had relapse; 25 distant metastasis, 5 local recurrence, and 5 synchronous recurrence at both sites. In pT2/3 disease, the frequency of distant metastasis of a ureteral tumor was significantly higher than that in renal pelvic cases (55% vs. 19%, P = 0.0237). Local recurrence was found in 7 renal pelvic and 3 ureteral cases. Although all of these patients had previously undergone LND, local recurrence adjacent to the dissected area was confirmed in 6 cases. In pT2 < or = disease, ureteral tumors showed more frequent occurrences of distant metastasis, whereas local relapses adjacent to the dissected nodal areas were more prominent in renal pelvic cases. When deciding a therapeutic strategy in renal pelvic cases, careful consideration about an adequate region for LND appears important.

Septins as diagnostic markers for a subset of human asthenozoospermia

PURPOSE

Septins are the major constituents of the annulus, a submembranous ring that separates the middle and principal pieces of spermatozoa. We previously reported its essential role in spermiogenesis and reproduction in mice. In the current study we investigated septin abnormality in infertile men.

MATERIALS AND METHODS

Semen samples from 108 infertile patients and 21 healthy volunteers were analyzed for sperm concentration and motility. Spermatozoa were immunostained for the 2 representative septin subunits SEPT4 and SEPT7. Peripheral blood DNA from 8 patients with asthenozoospermia who had defective SEPT4 and/or SEPT7 labeling in the annuli was analyzed by direct sequencing. Clinical information and a followup review of pregnancy were obtained retrospectively from medical records.

RESULTS

Specific antibodies for SEPT4 and SEPT7 consistently labeled the annuli in spermatozoa from the 21 healthy volunteers, while 14 of 108 samples (13%) from infertile patients showed defective labeling. In 33 patients with asthenozoospermia 10 samples (30%) demonstrated defective labeling for SEPT4 and/or SEPT7. We could not detect exon mutations in the SEPT4 gene by sequencing peripheral blood DNA from 8 patients with asthenozoospermia who had defective SEPT4 and/or SEPT7 labeling. During followup 8 of 14 patients (57%) with SEPT4 and/or SEPT7 labeling defects achieved successful pregnancies.

CONCLUSIONS

Annulus defects were found exclusively in infertile patients. Although their prognoses do not differ from those without annulus defects, annulus labeling by septin antibodies may serve as an index for classifying a subset of spermatogenesis defects and monitoring sperm quality.

[Questionnaire survey in Japan for sperm cryopreservation before chemotherapy ]

Questionnaires were mailed to 104 urological departments in universities, colleges, and cancer centers in February 2008. Ninety institutions returned answers to the questionnaire. Sperm cryopreservation before chemotherapy was performed in 24 institutions (26.7%) mainly in the gynecological department, whereas the others introduced the candidates to other institutions including private hospitals and clinics. Fifty-eight institutes gave information about fertility preservation routinely to young patients with testicular cancer before chemotherapy. Urological doctors in 57 institutions (63%) had no experience in consultation of patients with hematological/pediatric malignancies for fertility-preservation. Among 24 institutions performing sperm cryopreservation before chemotherapy, 18 preserved motile sperm even if during chemotherapy, as well as before chemotherapy but 2 institutions replied that patients during chemotherapy were contra-indication for sperm cryopreservation. For the patients with azoospermia, 2 institutions replied they tried to preserve testicular sperm before chemotherapy. The fee for sperm cryopreservation was free in 10 institutions. This nation-wide questionnaire survey clarified that the systems and indications for sperm cryopreservation before chemotherapy were different among institutions.

Propagation of bovine spermatogonial stem cells in vitro

The access to sufficient numbers of spermatogonial stem cells (SSCs) is a prerequisite for the study of their regulation and further biomanipulation. A specialized medium and several growth factors were tested to study the in vitro behavior of bovine type A spermatogonia, a cell population that includes the SSCs and can be specifically stained for the lectin Dolichos biflorus agglutinin. During short-term culture (2 weeks), colonies appeared, the morphology of which varied with the specific growth factor(s) added. Whenever the stem cell medium was used, round structures reminiscent of sectioned seminiferous tubules appeared in the core of the colonies. Remarkably, these round structures always contained type A spermatogonia. When leukemia inhibitory factor (LIF), epidermal growth factor (EGF), or fibroblast growth factor 2 (FGF2) were added, specific effects on the numbers and arrangement of somatic cells were observed. However, the number of type A spermatogonia was significantly higher in cultures to which glial cell line-derived neurotrophic factor (GDNF) was added and highest when GDNF, LIF, EGF, and FGF2 were all present. The latter suggests that a proper stimulation of the somatic cells is necessary for optimal stimulation of the germ cells in culture. Somatic cells present in the colonies included Sertoli cells, peritubular myoid cells, and a few Leydig cells. A transplantation experiment, using nude mice, showed the presence of SSCs among the cultured cells and in addition strongly suggested a more than 10 000-fold increase in the number of SSCs after 30 days of culture. These results demonstrate that bovine SSC self-renew in our specialized bovine culture system and that this system can be used for the propagation of these cells.

[A case of small cell carcinoma of the ureter]

A 69-year-old man was referred to our hospital with a chief complaint of asymptomatic gross hematuria. After radiological evaluations, left nephroureterectomy with bladder cuff was performed under a clinical diagnosis of a left ureteral tumor (2 cm). Histological examination revealed a small cell carcinoma of the ureter (pT3, pN1). After the operation, adjuvant chemotherapy with irinotecan, etoposide and cisplatin was administered in combination with radiation therapy. At 14 months after the operation, there has been no evidence of recurrence. To our knowledge, this is the 22nd report of a small cell carcinoma originating from the ureter.

[Bilateral maxillary sinus metastasis of renal cell carcinoma: a case report]

A 58-year-old man presented with lasting nasal obstruction. He had undergone right nephrectomy for renal cell carcinoma 11 years ago and right lobectomy for pulmonary metastasis 10 years ago. Paranasal sinus CT scans showed a soft tissue mass in the bilateral maxillary sinus. Abdominal CT showed left renal mass. Each mass was enhanced on the contrast-enhanced viewing. The paranasal mass biopsy was performed and resulted in profuse bleeding. Pathological examination was a metastasic renal cell carcinoma. After embolization of feeding artery, debulking surgery was performed. Postoperatively he was given radiotherapy and interferon therapy.

[Xanthogranulomatous pyelonephritis presenting a subcutaneous mass in the lower abdomen: a case report]

A 72-year-old female presented with the complaint of left lower abdominal swelling in May, 2005. Laboratory analysis revealed elevated white blood cell counts and C-reactive protein. Abdominal computed tomography showed left ureteral calculi, left hydronephrosis and a mass extending through the perinephric space, psoas major muscle into the left flank and lower abdomen. Echo-guided needle mass biopsy was performed. Histopathological findings revealed xanthogranulomatous changes. Under the diagnosis of diffuse xanthogranulomatous pyelonephritis extended into psoas muscle and subcutaneous tissue, antibiotic therapy was given for 5 months. After reduction of subcutaneous mass, left nephroureterectomy was performed. Histopathological findings revealed xanthogranulomatous pyelonephritis and ureteritis. Postoperative course was uneventful without any relapse of inflammation.

[Hemorrhagic adrenocortical adenoma with myelolipoma: a case report]

We present a case of hemorrhagic adrenocortical adenoma with myelolipoma. A 66-year-old woman was admitted to our hospital for left retroperitoneal mass. Based on abdominal computed tomography, magnetic resonance imaging and blood tests, preoperative diagnosis was a sarcoma of renal capsule origin. En bloc resection of adrenal gland, tumor, and the kidney with lymph node dissection was performed. Histologically, the mass was diagnosed as hemorrhagic adrenocortical adenoma with myelolipomatous foci.

Basic features of bovine spermatogonial culture and effects of glial cell line-derived neurotrophic factor

Spermatogonial stem cells (SSC) are a small self-renewing subpopulation of type A spermatogonia, which for the rest are composed of differentiating cells with a very similar morphology. We studied the development of primary co-cultures of prepubertal bovine Sertoli cells and A spermatogonia and the effect of glial cell line-derived neurotropic factor (GDNF) on the numbers and types of spermatogonia, the formation of spermatogonial colonies and the capacity of the cultured SSC to colonize a recipient mouse testis. During the first week of culture many, probably differentiating, A spermatogonia entered apoptosis while others formed pairs and chains of A spermatogonia. After 1 week colonies started to appear that increased in size with time. Numbers of single (A(s)) and paired (A(pr)) spermatogonia were significantly higher in GDNF treated cultures at Days 15 and 25 (P < 0.01 and 0.05, respectively), and the ratio of A(s) to A(pr) and spermatogonial chains (A(al)) was also higher indicating enhanced self-renewal of the SSC. Furthermore, spermatogonial outgrowths in the periphery of the colonies showed a significantly higher number of A spermatogonia with a more primitive morphology under the influence of GDNF (P < 0.05). Spermatogonial stem cell transplantation experiments revealed a 2-fold increase in stem cell activity in GDNF treated spermatogonial cultures (P < 0.01). We conclude that GDNF rather than inducing proliferation, enhances self-renewal and increases survival rates of SSC in the bovine spermatogonial culture system.

Segregation and coactivation of developing neocortical layer 1 neurons

Layer 1 in the developing cerebral cortex is populated by two basic neuronal cell types, Cajal-Retzius (CR) cells and non-CR cells. We generated transgenic mice in which green fluorescent protein (GFP) was driven by the promoter of metabotropic glutamate receptor subtype 2 and expressed specifically in CR cells during cortical development. On the basis of the precise identification of CR cells with GFP fluorescence, we pursued developmental changes and synaptic mechanisms of both CR and non-CR cells during the postnatal period. Immunostaining in combination with GFP fluorescence imaging showed that GFP and reelin, a protein involved in corticogenesis, completely overlap in CR cells at postnatal day 0. At the subsequent postnatal stage, reelin-positive neurons are segregated and categorized into GFP-positive/GABA-negative CR cells and GFP-negative/GABA-positive non-CR cells. Individual and simultaneous whole-cell recordings of CR and non-CR cells in developing cerebral slices revealed that spontaneous and electrically evoked postsynaptic currents (sPSCs and ePSCs) measured in CR and non-CR cells are differentially mediated by GABA(A) receptors versus GABA(A), AMPA, and NMDA receptors, respectively. Furthermore, CR and non-CR cells show synchronized repetitive barrages of sPSCs that reflect a network-driven activity in the developing cerebral cortex. These findings imply that the layer 1 neurons dynamically change and play a distinct and integral role in the postnatal developing neocortex.

Tamalin, a PDZ domain-containing protein, links a protein complex formation of group 1 metabotropic glutamate receptors and the guanine nucleotide exchange factor cytohesins

In this investigation, we report identification and characterization of a 95 kDa postsynaptic density protein (PSD-95)/discs-large/ZO-1 (PDZ) domain-containing protein termed tamalin, also recently named GRP1-associated scaffold protein (GRASP), that interacts with group 1 metabotropic glutamate receptors (mGluRs). The yeast two-hybrid system and in vitro pull-down assays indicated that the PDZ domain-containing, amino-terminal half of tamalin directly binds to the class I PDZ-binding motif of group 1 mGluRs. The C-terminal half of tamalin also bound to cytohesins, the members of guanine nucleotide exchange factors (GEFs) specific for the ADP-ribosylation factor (ARF) family of small GTP-binding proteins. Tamalin mRNA is expressed predominantly in the telencephalic region and highly overlaps with the expression of group 1 mGluR mRNAs. Both tamalin and cytohesin-2 were enriched and codistributed with mGluR1a in postsynaptic membrane fractions. Importantly, recombinant and native mGluR1a/tamalin/cytohesin-2 complexes were coimmunoprecipitated from transfected COS-7 cells and rat brain tissue, respectively. Transfection of tamalin and mutant tamalin lacking a cytohesin-binding domain caused an increase and decrease in cell-surface expression of mGluR1a in COS-7 cells, respectively. Furthermore, adenovirus-mediated expression of tamalin and dominant-negative tamalin facilitated and reduced the neuritic distribution of endogenous mGluR5 in cultured hippocampal neurons, respectively. The results indicate that tamalin plays a key role in the association of group 1 mGluRs with the ARF-specific GEF proteins and contributes to intracellular trafficking and the macromolecular organization of group 1 mGluRs at synapses.