Biomedical subjects

K Tobisu

Publications and source records attributed to K Tobisu.

At least 37 records · Page 2Linked to original sources

PubMed1998

Recurrence of a germ cell tumor 12 years after initial treatment: a case report.

Patients with testicular germ cell tumors who have disease-free remission for more than 2 years are usually considered to be cured of their disease. This report describes a case of a germ cell tumor recurring 12 years after initial diagnosis and its treatment in a 35-year-old man who developed a retroperitoneal mass adhering to the abdominal aorta with a bout of severe colic in the left flank. Although tumor markers were not elevated and histology of the biopsy specimen was initially diagnosed as adenocarcinoma, we finally concluded that the retroperitoneal tumor was teratoma developing as a recurrence of the germ cell tumor for the following reasons: (1) the histology of the specimen was similar to an epithelial component of teratoma found in the tissue resected 12 years before; (2) systemic survey failed to detect any other primary site; (3) the young age of this patient was consistent with germ cell tumor rather than adenocarcinoma; and (4) the retroperitoneum is the most frequent site of late recurrences of testicular cancer. He was treated successfully with combination chemotherapy of cisplatin, etoposide and bleomycin followed by surgery. It is important to differentiate this treatable disease from metastasis from an unknown primary, because the latter responds poorly to therapy and survival is usually short.

Adult↗

PubMed1998

Transitional cell carcinoma of the urethra in men and women associated with bladder cancer.

Multifocal tumor occurrence in the entire urinary tract in time and space is a well-recognized characteristic of transitional cell carcinoma. Synchronous and asynchronous urethral transitional cell carcinoma, in relation to bladder cancer in male and female patients, is the subject of the present mini-review. It is imperative to rule out male and female patients having a high risk for urethral involvement or urethral recurrence. In male patients, prostatic urethral involvement and stromal invasion mainly due to in situ extension of carcinoma seems to be the most important risk factor. In female patients, bladder neck involvement by cancer seems most important. By excluding male and female bladder cancer patients having these characteristics for simultaneous urethrectomy, other patients are good candidates for reconstruction of the urinary tract after cystectomy by an orthotopic neobladder which will offer a good quality of life to bladder cancer patients.

Carcinoma, Transitional Cell↗

PubMed1998

Preoperative predictors for organ-confined disease in Japanese patients with stage T1c prostate cancer.

BACKGROUND: In order to define the characteristics of patients with clinical stage T1c prostate cancer in Japan, clinicopathologic data obtained from patients treated by radical prostatectomy were reviewed. METHODS: Fifty-four stage T1c cancers were evaluated for tumor volume, Gleason grade, tumor location and pathologic stage from prostatectomy specimens in association with preoperative clinical parameters. RESULTS: The mean tumor volume was 3.94 mL (range, 0.07 to 33.4 mL), and 11 of the 54 tumors had a tumor volume of less than 0.5 mL. Thirty-two tumors (59%) were organ-confined, while 7 (13%) involved the seminal vesicle and/or regional lymph nodes. Multivariate logistic regression analysis of the pretreatment variables, including age, pretreatment PSA level, prostate volume, biopsy grade, and number of cancer-positive cores revealed that the serum PSA level and the number of cancer-positive biopsy cores were independent factors to predict organ-confined tumors (P = 0.036 and 0.044, respectively). For T1c cancer with less than 4 cancer-positive biopsy cores, the sensitivity and specificity for predicting organ-confined tumors were 90% and 70%, with a cut-off value of 17 ng/mL for the serum PSA level. CONCLUSION: The clinicopathologic features of T1c prostate cancer in Japanese patients were similar to those of whites reported elsewhere. Both serum PSA levels and the number of positive biopsy cores may be useful as pretreatment parameters to identify patients with the potential to benefit from radical treatment.

Aged↗

PubMed1997

Involvement of the anterior urethra in male patients with transitional cell-carcinoma of the bladder undergoing radical cystectomy with simultaneous urethrectomy.

Histological tumor extension into the prostate, urethra and ureters was examined in 52 specimens obtained by cystourethrectomy for transitional cell carcinoma of the bladder with one or more risk factors for urethral involvement. In four (21.1%) of 19 patients with diffuse carcinoma in situ in the bladder extending to the internal urethral orifice and prostatic urethra, the anterior urethra was affected by transitional cell carcinoma, including one specimen with invasion into the corpus spongiosum. However, none of 33 patients without these findings had synchronous anterior urethral transitional cell carcinoma involvement. It is recommended that patients with diffuse carcinoma in situ extending into the prostatic urethra undergo careful preoperative assessment of the anterior urethra before cystectomy. In other cases, the anterior urethra can be preserved and used for orthotopic neobladder replacement.

Adult↗

PubMed1997

[Significance of transrectal ultrasound and sextant systematic core biopsy for performing radical prostatectomy].

BACKGROUND: To estimate the usefulness of sextant systematic core biopsy or transrectal ultrasonography (TURS) for performing radical prostatectomy. METHODS: The findings of sextant biopsy and TRUS were compared with 52 step-sectioned specimens obtained from radical prostatectomy. RESULTS: In 34 cases with no influence of hormonal therapy at the time of TRUS and biopsy, sextant systematic core biopsy provided tumor distribution rather precisely. In 33% of the cases who had received hormonal therapy, tumor cells were not detected by this sextant biopsy series. In these cases, majority of residual cancer existed in transition zone, paraurethral or fibromuscular stroma. Six cases showed small adenocarcinoma in only one biopsy tip obtained from sextant biopsy, while 4 cases were revealed well differentiated adenocarcinoma (Gleason score less than 4) by these core biopsies. Comparing with tumor mapping, Gleason score, PSA level and pT stage of the radical prostatectomy specimens, these tumors presented as, not clinically insignificant, but clinically significant prostate cancer. Playing special attention to distraction of normal ultrasound zonal configuration, TRUS detected neurovascular invasion with 94.7% sensitivity, 78.3% positive predictive value and 90. 9% negative predictive value, while seminal vesicle invasion with 75% sensitivity, 50% positive predictive value, 90.9% negative value. CONCLUSION: Sextant biopsy tended to underestimate the tumors located in the transition zone, paraurethral and fibromuscular lesion. Additional or direct biopsies in transition zone are indispensable for accurate diagnosis. Findings of TRUS and distribution of positive core biopsy from sextant biopsy enable to extract stage C prostate cancer providing negative surgical margin.

Biopsy↗

PubMed1996

[The efficacy of neoadjuvant chemotherapy and morphological classification of invasive bladder cancer according to chemoresponse].

BACKGROUND: We investigated the propriety of neoadjuvant chemotherapy and the possibility of bladder preservation based on clinical and pathological responses in invasive bladder cancer. METHOD: Nineteen cases of invasive bladder cancer which had been subjected to two courses of neoadjuvant chemotherapy followed by radical cystectomy were analyzed. RESULTS: The overall response rate was 79% (5/19), and 7 cases (37%) had a pathological complete response (pCR). Many cases showed degeneration or necrosis of cancer cells and infiltration of lymphocytes around the original cancer sites. Foamy macrophage or fibrous change was observed in high response cases. Thickening of the bladder wall were found after chemotherapy in such cases, which led to over-staging of the CT scan. We divided invasive bladder cancers into four different types based on gross tumor appearance and histology from TUR biopsy specimen: Type 1 which has an nodularly elevating pedunculated structure: Type 2A which has an elevating nonpedunculated structure with partly papillary component and no lymph vessel invasion: Type 2B which has an elevating nonpedunculated structure with partly papillary component and marked lymph vessel invasion: and Type 3 which has a nonelevating diffuse invasive structure with CIS lesion. The therapeutic effect was greater than grade 2 in 7 cases out of 8 (88%) Type 1, 2 cases out of 3 (67%) Type 2A, no case out of 6 (0%) type 2B, and 1 case out of 2 (50%) type 3. CONCLUSION: This classification will indicate the appropriate preoperative treatment for invasive bladder cancer, and will be useful when formulating criteria for bladder preservation. In particular, Type 1 or Type 2A is chemosensitive and may be considered for bladder preservation.

Adult↗

PubMed1995

Intraductal tumor involvement and renal parenchymal invasion of transitional cell carcinoma in the renal pelvis.

Surgical specimens obtained from 21 patients with renal pelvic cancer, in which the tumor was located on the side of the renal parenchyma, were reviewed with special reference to tumor involvement with renal collecting ducts and/or renal parenchyma. Four distinct entities were found: 1) 4 tumors that involved the collecting ducts without invasion of renal parenchyma, 2) 4 tumors that involved the collecting ducts with microscopic invasion of renal parenchyma, 3) 5 tumors that invaded the renal parenchyma by less than 5 mm. and were microscopically identified as being without ductal involvement and 4) 6 tumors that exhibited extensive renal parenchymal invasion. The patients with intraductal tumors had good prognosis as did those with microscopic invasion except for 1 who died of lymph nodes metastases. Conversely, 6 patients with extensive invasion had a poor prognosis, 5 (88%) of whom died of recurrent tumor or distant metastases. The differences in these 4 entities may be important, especially if large numbers of patients are examined, and they may ultimately be shown to have a different prognosis.

Adult↗

PubMed1995

[Prognosis after radical surgery in prostatic cancer patients with lymph nodes metastases].

We investigated prognosis of clinically localized prostatic adenocarcinoma patients who revealed to have had lymph nodes metastases by undergoing radical surgery. Eighty six patients were operated during the last 15 years under the clinical diagnosis of A2, 9 patients, B1, 15 B2, 13 and C, 49, respectively. Total prostatectomy was done to 51, total cystoprostatectomy to 33 and total pelvic excentration to 2 patients. Of these patients, 22.2% with stage A2, 20.2% with B1, 7.7% with B2 and 43.8% with C had positive nodes and the rate of positive nodes in stage C was significantly higher than that in other stages (p < 0.01). Regarding histological differentiation, 15.4% of well, 23.7% of moderate and 51.6% of poor by differentiated had positive nodes and the rate of positive nodes in poor by differentiated was significantly higher (p < 0.01). In 2 of 21 cases whose lymph nodes were dissected to the level of the aortic bifurcation, positive nodes were detected only in the external and common iliac areas. These two cases were missed, i.e., "false negative" if limited nodes dissection was performed. All patients with positive nodes were treated with hormonal therapy. The 5-year cancer specific survival rate of patients with positive (n = 27) and negative (n = 59) nodes were 66.4% and 92.4%, respectively. The prognosis of patients with positive nodes were significantly worse than that of patients with negative nodes (p < 0.001). Among 27 patients with positive nodes, significant prognostic factor was not number or extent of positive nodes, but histological differentiation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed1995

Solitary renal melanoma? A case with long survival after initial treatment.

A case of a solitary melanocytic renal tumor with no apparent primary lesion or metastasis is reported. Pathologically the tumor was composed of cells with brown pigmentation that strongly reacted to monoclonal antibody HMB-45 immunohistochemically. Few mitotic figures, mild nuclear atypia and nucleolar prominence were observed. These findings confirmed that the tumor cells were melanogenetic but the malignant potential of the tumor was low in comparison to that of typical malignant melanoma. The patient is doing well 44 months after partial resection of the renal tumor and postoperative chemotherapy. The interesting pathological feature may account for the unique clinical course.

Female↗

PubMed1994

Markedly increased amounts of messenger RNAs for vascular endothelial growth factor and placenta growth factor in renal cell carcinoma associated with angiogenesis.

The presence of mRNAs for vascular endothelial growth factor (VEGF) and a VEGF-related protein, placenta growth factor (PIGF) was examined in 29 cases of renal cell carcinoma tissues and adjacent normal kidney tissues and in 4 human renal cell carcinoma cell lines. Northern blot analysis showed that 26 of 27 hypervascular renal cell carcinoma tissues (96%) exhibited a markedly elevated level (3-13 fold) of VEGF mRNA compared to the adjacent normal kidney tissues. Even tumors of small size, whenever they were hypervascular, overexpressed VEGF mRNA. We also demonstrated that mRNA for PIGF was expressed in 21 of 23 hypervascular renal cell carcinoma tissues (91%) but was not detected in the adjacent normal kidney tissues. Two hypovascular carcinoma tissues neither overexpressed VEGF mRNA nor had PIGF mRNA. VEGF mRNA was detected in four human renal cell carcinoma cell lines, while PIGF mRNA was not. There was no difference in the level of basic fibroblast growth factor mRNA between tumor tissues and normal kidney tissue, although our previous study demonstrated elevated basic fibroblast growth factor protein in the serum of renal cell carcinoma patients (K. Fujimoto et al., Biochem. Biophys. Res. Commun., 180: 386-392, 1991). Taken together, these results suggest that VEGF, PIGF, and basic fibroblast growth factor are cooperatively working to increase the angiogenesis in renal cell carcinoma in vivo.

Angiogenesis Inducing Agents↗

PubMed1994

Urethral involvement in female bladder cancer patients: mapping of 47 consecutive cysto-urethrectomy specimens.

We reviewed 47 consecutive step-sectioned cysto-urethrectomy specimens of bladder cancer in female patients to determine the incidence and characteristics of urethral involvement. Of the 47 cases 43 were transitional cell carcinoma: 10 (23%) papillary, 9 (21%) papillo-nodular and 18 (42%) nodular cancer, and 6 (14%) primary or secondary carcinoma in situ. There were 23 cases (54%) of invasive carcinoma of more than stage pT1 and 27 (63%) were grade 3 lesions. Urethral cancer was observed in only 3 cases: 1 stage pT4, grade 3 papillo-nodular cancer developed widely in the bladder and, overriding the bladder neck and proximal urethra, stage pTa, grade 2 papillary cancer was detected, while in 2 with nodular invasive lesions of the bladder (including the bladder neck) urethral cancer was detected either as a direct invasive extension via urethral carcinoma in situ or as an intralymphatic spread without urethral mucosal change. These findings indicate the necessity for prophylactic urethrectomy in cases of papillary or papillo-nodular cancer encroaching on the bladder neck, and nodular invasive cancer infiltrating the bladder neck and trigone. In other cases, preservation of the urethra seems possible for bladder reconstruction in female bladder cancer patients to ensure normal voiding after cystectomy.

Adenocarcinoma↗

PubMed1994

[Clinical study of the advanced testicular tumor non-achieved complete response by primary chemotherapy and relapse cases. The East Japan Testicular Tumor Study Group].

The East Japan Testicular Tumor Study group has studied advanced testicular tumors. Treatment and prognosis of the patients who did not achieved complete response on the primary chemotherapy were discussed in this paper. Also 8 patients who had once reached complete response by primary treatments and relapsed later have been clinically analyzed. 1. Concerning the patients non-achieving complete response on the primary chemotherapy: Two cases who had resection of the residual tumors and 4 cases who had radiation therapy had reached NED in 7 cases of seminoma stage II. Nine of 10 cases in non-seminoma stage II reached NED on resection of the residuals. Moreover, 10 out of 17 cases in stage III showed NED on excision of the residuals. On the other hand, recuperating was very difficult in the cases who could not have excision of residual tumor. The histological findings of the residual tumors after chemotherapy were necrosis and fibrosis in 13 cases, viable cells in 4 cases, teratoma in 6 cases and other 2 cases were not clear. Five out of 15 who had teratoma in the primary lesion had teratoma in the resected residuals on metastatic lesion. On the other hand 5 patients who did not have teratoma originally had no any teratoma elements in the residuals. 2. Concerning the relapse cases by primary treatments: Although relapses were possible in any stages, they were more common with stage IIIB and IIIC cases. Those who achieved complete response after chemotherapy alone fewer relapse than those who had partial response after chemotherapy and there after had excision of residual tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗

PubMed1994

A prospective randomized trial for treating stages B2 and C prostate cancer: radical surgery or irradiation with neoadjuvant endocrine therapy.

A randomized clinical trial of neoadjuvant endocrine therapy followed by either surgery or irradiation and a resumption of endocrine therapy for stages B2 and C prostate cancer has been in progress since 1989. A hundred patients entered the trial between 1989 and 1993, and 95 cases were evaluated. Forty-six patients received surgery and 49 were treated with irradiation. Neoadjuvant endocrine therapy for two months resulted in prostate shrinkage and prostate specific antigen lowering. Except for two patients, one dying of a progression of disease and the other of another concurrent cancer, all are alive with an average follow-up term of 25 (range 3-53) months. The good prognostic results obtained from both treatment groups at present seem to be due in part to the neoadjuvant endocrine therapy; but in order to reach a final conclusion further comparisons need to be made.

Aged↗

PubMed1993

A feasible method for expansion of peripheral blood lymphocytes by culture with immobilized anti-CD3 monoclonal antibody and interleukin-2 for use in adoptive immunotherapy of cancer patients.

Cultivation of T lymphocytes with immobilized anti-CD3 monoclonal antibody and human recombinant interleukin-2 induced a rapid proliferative response. This procedure was applied to expansion culture of peripheral blood lymphocytes obtained from cancer patients for use in adoptive immunotherapy. Peripheral blood mononuclear cells were separated from 20 ml of blood and cultured in anti-CD3 coated flasks with rIL-2 for 6 days, then transferred to a gas-permeable culture bag and culture continued for an additional 8 days with an increasing volume of medium. Cell numbers increased about 2000-fold during this 2-week culture. The final population contained about 30% CD4+ and 60% CD8+ cells, and all were CD3+ & HLA-DR+. NK cells comprised less than 5%. In clinical trials involving 12 cases receiving 35 infusions, the mean number of harvested T cells after 14 days culture was 3.5 x 10(10) (R = 1.6-6.8 x 10(10)), and the mean expansion index was 1560-fold (R = 409-4091). This method could be of benefit not only in immunotherapy but also for obtaining somatic cells from a small volume of blood for use in molecular or genetic analysis instead of having to perform EB virus transformation of B cells.

Antibodies, Monoclonal↗

PubMed1993

[Tumor recurrence and grade and/or stage progression in low grade tumor. Analysis of 154 patients with superficial transitional cell carcinoma of the bladder].

The clinicopathological findings of 154 patients with initially superficial (stage pTa or pT1) transitional cell carcinoma in the bladder were analyzed to study risk factors for tumor recurrence or progression in grade and/or stage of the low grade tumor. The number, size, grade and stage of tumor at the first presentation were the significant predictors for the first tumor recurrence. However, only the tumor grade and size at the first recurrence were the predictors for the second recurrence. In 19 (33%) of 57 patients with recurrence, low grade superficial tumor progressed in tumor grade and/or muscle invasion. The progression of low grade tumor correlated with short tumor free intervals and tumor size. Grade and/or stage progression was observed in 14% of the tumor of 1 cm or less in diameter, whereas in 42% of the tumor more than 1 cm in diameter (Chi-square test: p < 0.25). These results indicate that tumor grade and size are important predictors for recurrences. Short tumor free intervals and sizes of tumors in the second recurrence are significant predictors for grade and/or stage progression in low grade superficial cancer.

Adult↗

PubMed1993

Chromosome 3p deletion in a renal cell carcinoma cell line established from a patient with von Hippel-Lindau disease.

von Hippel-Lindau disease (VHL) is an autosomal dominant inherited disease, frequently accompanied by occurrences of renal cell carcinoma (RCC). Both the VHL gene and tumor suppressor genes for RCC have been mapped to the short arm of chromosome 3, although the genes have not yet been identified. An RCC cell line, KC12, was established from a VHL patient. Molecular genetic analyses in conjunction with cytogenetic studies revealed that the short arm of chromosome 3 distal to the D3S4 locus at 3p11 was lost in the RCC cell line as a result of an unbalanced translocation between chromosomes 3p and 5q. Structural and numerical aberrations, including those on chromosome 3p, were not detected in T-lymphocytes from the patient, suggesting that the inherited mutation of the VHL gene at 3p25-26 in this patient was too subtle to be detected by either Southern blot or karyotype analysis. Since no permanent RCC cell line has been established from a VHL patient, this cell line will be a useful source for analyzing the VHL gene at 3p25-26 and tumor suppressor gene(s) at 3p13-21.

Adult↗

PubMed1993

Transitional cell carcinoma of the upper urinary tract: analysis of morphology and distribution for surgical management.

Two series of transitional cell carcinomas (TCC), one including 49 renal pelvic and/or ureteral cancers and the other 29 bladder cancers with concomitant ureteral involvement, were reviewed to establish the criteria for nephron-sparing surgery and for selecting the most appropriate surgical intervention for TCCs at the ureterovesical junction. The following categorization of tumors was made possible by histological mappings of step-sectioned surgical specimens from various surgical modes: 1) low grade papillary superficial tumor, 2) high grade papillary or non-papillary tumor with adjacent or skipped carcinoma in situ (CIS), 3) high grade non-papillary invasive tumor without CIS, 4) high grade papillary superficial tumor without CIS. We can, by comparing postoperative clinical courses, select the mode of surgery in the following manner: 1) nephron-sparing surgery could be indicated in cases of low grade papillary tumor so far as a complete resection is possible; 2) in a case of high grade papillary or non-papillary tumor with adjacent or skipped CIS, extended resection of the urinary tract is required; 3) in a case of high grade non-papillary tumor without CIS, complete en bloc resection of the tumor site, including surrounding organs, will be necessary. The possibility of organ-sparing surgery for early stage cancer without CIS at the ureterovesical junction has been suggested. Preoperative consideration of the above classifications for conservative surgery is also discussed.

Adult↗

PubMed1993

A ureteral small cell carcinoma mixed with malignant mesodermal and ectodermal elements: a clinicopathological, morphological and immunohistochemical study.

A 60-year-old male with a small cell carcinoma of the right lower ureter is presented. The tumor mainly comprised a small cell carcinoma but also included a full variety of histological types such as transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma, leiomyosarcoma and chondrosarcoma. Immunohistochemical staining was positive for neuron specific enolase and cluster 1 small cell lung cancer antigen/N-CAM in the small cell carcinoma and S-100 in the chondrosarcoma component. The patient underwent a right nephroureterectomy, and received prophylactic radiation of the pelvic and para-aortic lymph node regions and cisplatin and etoposide combination chemotherapy. Eight months after the chemotherapy, a transitional cell carcinoma was found in the bladder neck, and a cystectomy with urethrectomy performed. To our knowledge, this is the second report of a small cell carcinoma originating from the ureter.

Biomarkers↗