A rare benign genitourinary tumor in a Japanese male: urinary retention owing to aggressive angiomyxoma of the prostate

Close examination of a 67-year-old Japanese man, who complained of persistent nocturia, revealed that a semitransparent polypoid tumor had developed from the bladder neck to the prostatic urethra obstructing the internal urethral meatus, which resulted in excessive urinary retention and post-renal dysfunction. The tumor was resected by a transurethral procedure and a pathological examination of specimens revealed aggressive angiomyxoma (AAM) of the prostate. AAM usually develops in the intrapelvic and perineal organs of females. So far as we know, this is the second case of primary prostatic AAM reported in the English literature, and is the first case where the patient encountered urethral obstruction

A case of primary renal angiosarcoma

A 78-year old man was diagnosed with a left bleeding renal cyst from CT scan results. Serial CT scans revealed the left kidney mass to be increasing in size and a new lesion in the liver. Renal cell carcinoma with liver metastasis was diagnosed and a radical nephrectomy performed. The initial pathological diagnosis was a benign chronic hematoma. However, the liver mass increased in size and multiplied, while another mass emerged in the twelfth thoracic vertebra with spinal paralysis and was immediately removed. Pathological findings for that specimen showed malignancy of stromal cell origin but low atypia. The renal specimen was re-evaluated using whole cross-section analysis and immunohistochemistry, and diagnosed as a primary renal angiosarcoma. Recombinant interleukin-2 therapy was started immediately; however, the patient died of metastatic disease 13 months after the initial operation. Although contrast imaging depicted the primary lesion as a non-specific hematoma with little focal pooling, and low-grade cytological atypia was shown pathologically, the angiosarcoma was extremely aggressive

前立腺癌患者における骨転移および続発性骨粗鬆症診断に対する尿中NTX測定の有用性

〔目的〕骨代謝マーカーであるtype I collagen cross-linked N-telopeptides(NTX)の尿中濃度は骨粗鬆症,副甲状腺機能亢進症および悪性腫瘍の骨転移診断に有用であると言われている.今回我々は前立腺患者の尿中NTXを測定し,骨転移やホルモン療法による続発性骨粗鬆症の診断に対する有用性について検討を行った.〔対象と方法〕前立腺癌と診断された51症例に対して骨代謝マーカーである尿中NTX,血中pyridinoline cross-linked carboxyterminal telopeptide of type I collagen(ICTP),血中carboxyterminal propeptide of type I procollagen(PIPC),血中bone specific alkaline phosphatase(BAP)の測定を行い,それぞれのマーカーとの相関,ホルモン療法および骨転移との関係について検討した.〔結果〕ホルモン療法の期間と尿中NTXには有意な相関(p=0.008)を認めた.治療法に従って2群に分け,各骨代謝マーカーについて検討した.尿中NTXはホルモン療法群で非ホルモン療法群に比して有意に高値を示した.骨転移の有無で2群に分け,各骨代謝マーカーについて検討した.2群間で各骨代謝マーカーに有意差は認められなかった.〔結論〕ホルモン療法の期間と尿中NTXに相関が認められた.長期ホルモン療法の患者では尿中NTXの定期的な測定により,早期の続発性骨粗鬆症の診断および治療に有用であると思われた.[Aim] A high urinary level of type I collagen cross-linked N-telopeptides (NTX), a bone metabolism marker, is associated with osteoporosis, hyperparathyroidism, and bone metastasis in patients with malignant tumors. We investigated the significance and usefulness of measuring the urinary NTX concentration for detection of bone metastasis (BM) and secondary osteoporosis due to hormone therapy (HT) in prostate cancer patients. [Methods] The levels of four bone metabolism markers, urinary NTX, blood ICTP, blood PIPC, and blood BAP, in 51 patients with prostate cancer, were compared with whether patients received HT and the status of bone metastasis. [Results] The duration of HT was significantly correlated with urinary NTX concentration (p=0.008). The urinary NTX concentration was significantly higher in patients who received HT than in patients who did not. There were no significant differences in the levels of the four metabolism markers between patients who did or did not have bone metastasis. [Conclusion] The duration of HT was correlated with the urinary NTX concentration. In patients who have received long-term HT, periodical measurement of urinary NTX level is considered to be useful for early detection and treatment of secondary osteoporosis

前立腺癌患者における骨転移および続発性骨粗鬆症診断に対する尿中NTX測定の有用性

〔目的〕骨代謝マーカーであるtype I collagen cross-linked N-telopeptides(NTX)の尿中濃度は骨粗鬆症,副甲状腺機能亢進症および悪性腫瘍の骨転移診断に有用であると言われている.今回我々は前立腺患者の尿中NTXを測定し,骨転移やホルモン療法による続発性骨粗鬆症の診断に対する有用性について検討を行った.〔対象と方法〕前立腺癌と診断された51症例に対して骨代謝マーカーである尿中NTX,血中pyridinoline cross-linked carboxyterminal telopeptide of type I collagen(ICTP),血中carboxyterminal propeptide of type I procollagen(PIPC),血中bone specific alkaline phosphatase(BAP)の測定を行い,それぞれのマーカーとの相関,ホルモン療法および骨転移との関係について検討した.〔結果〕ホルモン療法の期間と尿中NTXには有意な相関(p=0.008)を認めた.治療法に従って2群に分け,各骨代謝マーカーについて検討した.尿中NTXはホルモン療法群で非ホルモン療法群に比して有意に高値を示した.骨転移の有無で2群に分け,各骨代謝マーカーについて検討した.2群間で各骨代謝マーカーに有意差は認められなかった.〔結論〕ホルモン療法の期間と尿中NTXに相関が認められた.長期ホルモン療法の患者では尿中NTXの定期的な測定により,早期の続発性骨粗鬆症の診断および治療に有用であると思われた.[Aim] A high urinary level of type I collagen cross-linked N-telopeptides (NTX), a bone metabolism marker, is associated with osteoporosis, hyperparathyroidism, and bone metastasis in patients with malignant tumors. We investigated the significance and usefulness of measuring the urinary NTX concentration for detection of bone metastasis (BM) and secondary osteoporosis due to hormone therapy (HT) in prostate cancer patients. [Methods] The levels of four bone metabolism markers, urinary NTX, blood ICTP, blood PIPC, and blood BAP, in 51 patients with prostate cancer, were compared with whether patients received HT and the status of bone metastasis. [Results] The duration of HT was significantly correlated with urinary NTX concentration (p=0.008). The urinary NTX concentration was significantly higher in patients who received HT than in patients who did not. There were no significant differences in the levels of the four metabolism markers between patients who did or did not have bone metastasis. [Conclusion] The duration of HT was correlated with the urinary NTX concentration. In patients who have received long-term HT, periodical measurement of urinary NTX level is considered to be useful for early detection and treatment of secondary osteoporosis

透析腎におけるSuperoxide Dismutase発現の抑制

透析腎における酸化的DNA損傷の蓄積,特に後天性嚢脆性腎疾患(ACDK)患者に伴う酸化的DNA損傷の蓄積については既に報告されている.今回我々は,透析腎および正常機能の腎において,活性酸素の最上流にあるスーパーオキシド(O_2)を消去する反応を触媒するスーパーオキシド・ジスムターゼ(SOD)の発現について検討した.免疫組織化学法を用いてSODの局在性を評価すると同時に,酵素免疫測定法とRT-PCR法を個々に使用し,腎組織中におけるSODの発現について蛋白質レベルとmRNAレベルで検討した.本研究の対象は維持血液透析患者29名と正常腎臓機能を有していた患者16名の合計45名であった.mRNAレベルでのCuおよびZn-SODの発現は,正常機能腎よりも透析腎において有意に低かったが,Mn-SODの発現は正常機能腎と同等であった.しかしながら,蛋白質レベルでのMn-SODの発現は正常機能腎よりも透析腎において有意に低下していた.免疫組織化学的には,透析腎の大多数の尿細管において,CuおよびZn-SODとMn-SODがともに不連続性または斑点状の染色パターンを示し,SOD陽性細胞密度は,正常機能腎よりも透析腎において低かった.透析患者の腎臓におけるSOD発現の低下は,O_2スカベンジャー反応の障害を示唆し,同障害によって酸化的DNA損傷が誘導され,その結果としてこれらの患者において腫瘍の発生リスクが増大するものと考えられる.Accumulation of oxidative DNA damage in the dialyzed kidney, particularly in acquired cystic disease of the kidney (ACDK), was previously demonstrated. Here, we assessed expression in dialyzed and normally functioning kidneys of superoxide dismutases (SODs), which catalyze the dismutation of O_2 to start the reactive oxygen species chain reaction. We evaluated expression of SODs in renal tissue at the protein and mRNA levels using enzyme-linked immunosorbent assay and RT-PCR, respectively, as well as its localization using immunohistochemistry for 45 patients (maintenance hemodialysis, 29 and normal kidney function, 16). Levels of Cu- and Zn- SOD, but not Mn-SOD mRNA expression, were significantly lower in dialyzed kidneys than in normally functioning kidneys. At the protein level, however, Mn-SOD expression was lower in dialyzed kidneys than in normally functioning kidneys. Immunohistochemically, the majority of tubules in dialyzed kidneys were shown to have discontinuous or patchy staining patterns for both SODs, and the density of SOD-positive cells was lower compared to normally functioning kidneys. Decreased expression of SODs in kidneys of dialysis patients suggests impairment of O_2 scavenger reactions, which may induce oxidative DNA damage and subsequently increase the risk of neoplastic lesions in these patients

巨大副腎悪性褐色細胞腫の1例 : 大型の褐色細胞腫の管理について

69歳男.直径約30cmの左側腹部腫瘤の診断及び治療の為, 当科へ紹介された.血中ノルエピネフリン値及びその尿中代謝産物の高値, CTスキャンにより巨大な嚢胞性後腹膜腫瘤, 大動静脈リンパ節の腫大が認められ, 悪性褐色細胞腫と診断.血行動態学的に循環血液量の低下と血管抵抗値の上昇が認められた為, 血管拡張剤の使用と共に循環血液量の補充が行われた.これらにより血行動態は正常化し, 腫瘍摘除術が施行された.病理学的に, リンパ節転移を伴う褐色細胞腫と診断され, 腫瘍重量は5, 930gであったA 69-year-old man was referred to our hospital for a left abdominal tumor measuring about 30 cm in diameter. Laboratory examination revealed an elevation of norepinephrine in plasma and of its metabolites in urine. CT scan disclosed a huge cystic tumor in the retroperitoneal space and an enlarged aortocaval lymph node, suggesting a diagnosis of malignant pheochromocytoma. The hemodynamic studies showed low blood volume and high vascular resistance, and therefore, he was treated with vasodilators and volume expansion. His hemodynamic status normalized and a complete excision was performed. Pathological examination revealed that the patient had a pheochromocytoma with metastasis to a lymph node. The total weight of the tumor was 5, 930 g. Since pheochromocytomas can become a large with a risk of malignancy, they should be surgically excised as completely as possible with further treatment after making a definite diagnosis