Bladder Metastasis of Renal Cell Carcinoma 7 Years after Ex Vivo Partial Nephrectomy and Auto-Transplantation : A Case Report

Metastasis of renal cell carcinoma (RCC) to urinary bladder is extremely rare. We report a case of metastasis arising from RCC to the urinary bladder 7 years after treatment of bilateral RCC. A 74-year-old man was diagnosed with bilateral multiple renal tumors (T1aN0M1, PUL, OSS) with two lesions in the right kidney and a solitary lesion of the left kidney in 2008. He underwent laparoscopic radical nephrectomy for the right side in September 2008. The next month, ex vivo partial nephrectomy and auto-transplantation was performed for the left kidney because the tumor was located very close to the collecting system. Metastatectomies for the lung and bone followed and the histopathological findings of all lesions were clear cell carcinoma. The following years went well without any recurrence. Seven years after the surgery, the patient complained of asymptomatic gross hematuria and cystoscopy revealed a solitary non-papillary tumor of the bladder. Transurethral resection of the tumor was performed in June 2015 and the histopathological diagnosis of the resected specimens was clear cell carcinoma. Because the additional immunohistochemical examinations were positive for CD10 and negative for CK7, we diagnosed the bladder tumor as metastasis arising from RCC. Direct dissemination of the tumor cells into the urinary tract during partial nephrectomy followed by implantation to the bladder mucosa is a probable mechanism of metastasis in this case

EVALUATION OF OSTEOGENIC CAPACITY OF CUIJURED BONE GRAFT USING CRYOPRESERVED MARROW CELLS

To investigate the osteogenic capacity of cryopreserved marrow cells, rat bone marrow cells obtained from femora were culturedin a standard medium for ten days. The cultured cells were released by trypsin treatment and stored at -196-C (liquid nitrogen) in a preservative culture medium containing lO％ dimethylsulfoxide. After 3 months, the cryopreserved cells were thawed and subcultured in porous hydroxyapatite (HA; Interpore500). The medium consisted of Eagle-MEM containing 15％ fetal bovine serum, antibiotics, ascorbic acid, b-glycerophosphate and dexamethasone. After 2 weeks of the subculture, the composites of the cells and porous HA were subcutaneously implanted into syngeneic rats. These implants were harveSted 2 and 4 weeks postimplantation and prepared for histological, biochemical and gene expression analyses. These implants showed bone formation together with active osteoblasts in many pore regions. Northern hybridization showed osteoblast marker of alkaline phosphatase (ALP) and osteocalcin in cryopreserved marrow cells. The course of ALP activities and amounts of osteocalcin derived ftom cryopreserved marrow cells were comparable to those derived　from fresh marrow cells. These results indicate the osteogenic capacity of cryopreserved marrow cells in porous HA

The Development of the Preoperative Nomogram Predicting Major Perioperative Complications after Radical Cystectomy with Ileal Conduit or Orthotopic Neobladder

Radical cystectomy (RC) is the gold standard for managing muscle-invasive and high-risknon-muscleinvasive bladder cancer, but is accompanied by non-negligible operative risk. The aim of this study is to identify preoperative variables to predict major perioperative complications after RC and to develop a nomogram using the cohort from multiple institutions in Japan. We retrospectively reviewed 668 patients who underwent open RC with ileal conduit or neobladder at Hokkaido University hospital and 20 affiliated institutions between 1997 and 2010. Complications occurring within 90 days of surgery were graded using modified Clavien classification system. We defined modified Clavien grade 3 or more as major complications and performed univariate and multivariate logistic regression analyses. Predictive accuracy of the nomogram was evaluated with the area under the receiver operating characteristics curve (AUC). A total of 528 men and 140 women were included in this study. There were a total of 160/668 patients (24%) with major perioperative complications. A multivariate model identified gender (OR : 1. 63, p=0. 04), cardiovascular comorbidity (OR : 1.48, p=0.03) and simultaneous nephroureterectomy (OR : 2.81, p=0. 01) as independent predictors. Using these 3 variables, a nomogram was developed with the AUC of 0.58. Predictive performance of our nomogram showed only fair performance ; but at least, we identified male, cardiovascular comorbidity and simultaneous nephroureterectomy as independent predictors of perioperative major complications