特異な増殖形態を呈した巨大腎血管筋脂肪腫の1例

特異な増殖形態を呈した巨大腎血管筋脂肪腫の1例神戸大学医学部泌尿器科学教室(主任=守殿貞夫教授)郷司和男, 後藤章暢, 守殿貞夫66歳女性に見られた特異な増殖形態を有する巨大腎血管筋脂肪腫の1例を報告する.腫瘍は左腎上極より発生し上方へ増殖し横隔膜を挙上すると共に腎の背側ヘシート状に増殖していた.MRIは本症の診断に有用で腫瘍と周囲臓器との関係を明瞭にすることができた.腎血管筋脂肪腫の診断のもとにCUSAを用いて腫瘍摘出術を施行した.腫瘍は重量1, 380gで弾性硬, 黄色調を呈し, 組織学的に血管筋脂肪腫であった.術後経過順調で術後2年を経たが明らかな再発を認めていない,A case of a giant renal angiomyolipoma with uncommon growth pattern in a 66-year-old female is reported. The tumor originated from the upper pole of the left kidney and simultaneously grew posteriorly in a sheet-like fashion while a spheroid mass projected upwards. With magnetic resonance imaging (MRI), the relationship between the tumor and adjacent organs was clear. Tumorectomy employing cavitron ultrasonic surgical aspirator (CUSA) was performed, and proved to be a safe and simple procedure. There has been no recurrence of the growth 2 years post-operatively

Adenovirus as a Vector and Oncolytic Virus

Adenoviral vectors, both oncolytic viruses and gene delivery vectors, are among the earliest approved and commercialised vectors for gene therapy. Adenoviruses have high cytotoxicity and immunogenicity. Therefore, lentiviruses or adeno-associated viruses as viral vectors and herpes simplex virus as an oncolytic virus have recently drawn attention. Thus, adenoviral vectors are often considered relatively obsolete. However, their high cargo limit and transduction efficiency are significant advantages over newer viral vectors. This review provides an overview of the new-generation adenoviral vectors. In addition, we describe the modification of the fiber knob region that enhances affinity of adenoviral vectors for cancer cells and the utilisation of cancer-cell-specific promoters to suppress expression of unwanted transgenes in non-malignant tissues

ベリニ管由来が示唆された乳頭状腺癌の1例

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

術前内分泌療法を施行した根治的前立腺全摘出術症例の臨床病理学的検討

限局性前立腺癌と診断し, 術前内分泌療法に引き続き根治的前立腺全摘術を施行した24例で臨床病理学的検討を行った.LH-RHアゴニストによる3ヵ月間の術前内分泌療法施行後, 24例中22例でPSAが2μg/l以下に低下, 術前には治療前平均値の約5%に低下した.臨床病期がT2a以下, 治療前PSAが10μg/l以下, 或いは内分泌療法施行3ヵ月後のPSAが2μg/L以下の症例では, 病理学的にもpT2以下であることが多かったが, Gleason scoreとは相関しなかった.術後PSA failureを6例に認め, 3年非再発率は79%であった(観察期間の中央値:49ヵ月)が, 非再発率と病理学的病期との間に相関はなかった.以上より, 臨床病期がT2b以上, 治療前PSA値が10μg/lを超える, 或いは内分泌療法施行3ヵ月後のPSA値が正常化しない症例では, 術前内分泌療法を施行しても病理学的にpT3以上である可能性が高いThe objective of this study was to evaluate the long-term biochemical and pathological effects induced by neoadjuvant hormonal therapy (NHT) in patients with clinically localized disease. Between March 1993 and May 1997, 24 patients with clinically localized prostate cancer received NHT for 3 to 11 months (median: 5 months) using luteinizing hormone-releasing hormone analogue prior to radical prostatectomy and pelvic lymphadenectomy. The clinical stage was T1 in 1 patient, T2 in 17 and T3 in 6, the pretreatment serum prostate-specific antigen (PSA) value was 20 ng/ml in 15 (mean: 34.7 micrograms/l), and the Gleason score was 8 in 3. The mean prostate specific antigen (PSA) value 3 months after NHT had reduced below 2 ng/ml in 18 of the 24 patients (67%), and finally decreased by an average of 95% (i.e., 1.9 ng/ml) prior to surgery. The pathological stage was pT0 in 2 patients, pT2 in 10 and pT3 in 12. The incidence of organ-confined disease (OCD) was significantly higher in patients with clinical stage T1 or T2a than with T2b or T3, with pretreatment PSA values 10 ng/ml, and with PSA values 2 at 3 months after NHT; in contrast, the Gleason score had no significant impact on the rate of OCD. After a median follow-up of 49 months (range 34 to 85 months), 6 patients (25%) had a recurrence evidenced by rising PSA, and the 3-year recurrence-free survival rate was 79%. These results suggest that NHT appears not to be of significant additional benefit to patients who have a higher clinical T stage, higher pretreatment PSA values and/or in patients whose PSA values do not normalize early in the treatment process

Biosafety studies of carrier cells infected with a replication-competent adenovirus introduced by IAI.3B promoter

The use of carrier cells infected with oncolytic viruses in cancer gene therapy is an attractive method because it can overcome viral immunogenicity and induce tumor immunity and significant antitumor activity. To enable human clinical trials of this treatment, acute and chronic toxicity tests must first be performed to ensure safety. IAI.3B promoter, oncolytic adenovirus AdE3-IAI.3B introduced by IAI.3B promoter, and A549 carrier cells infected with AdE3-IAI.3B were highly active in cancer cells but not in normal cells. Freeze-thawing increased the antitumor effect of A549 carrier cells by promoting the translocation of oncolytic adenovirus particles from the nucleus to the cytoplasm following the rupture of the nuclear membranes. No deaths or abnormal blood test data resulted from acute toxicity tests conducted in nude mice after a single dose. In chronic toxicity tests in rabbits, there were no serious side effects after eight doses of 1.25 × 107 cells/kg or less for 4 weeks; a significant immune response is known to elicit increased numbers of antiadenovirus antibodies and enlarge the spleen. From these results, it could be concluded that cancer gene therapy of recurrent solid tumors using carrier cells can be safely trialed in humans