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ABSTRACT: Objective: To assess the incidence of difficulty in complete dissection between the right adrenal gland and the liver at the time of laparoscopic surgery for adrenal tumor and to elucidate its cause histopathologically. Patients and methods: Thirty six patients underwent laparoscopic right adrenalectomy during the period between 2004 and 2011 at our institution. Two reviewers independently assessed difficulty in dissection for the 36 non-edited video records of laparoscopic right adrenalectomy in blind fashion. Twenty-seven records were evaluable for the judgment of difficulty in dissection between the lower surface of the liver and the right adrenal gland. On the other hand, gross and microscopic relationship between right adrenal gland and surface of the liver was investigated in 32 cadavers. Results: Incomplete resection of adrenal gland was found in 11 of 27 patients (40.7%). Difficulties in dissection due to adhesions between the liver and the adrenal gland were apparently recognized in 5 out of 27 patients (18.5 %). Pathological assessment for cadavers revealed that capsules between these two organs are partially fused in 10 out of 32 cases (31.3%). Histopathologically, intermingling of parenchymal cells (infiltration through the fibrous capsules) was observed in 9 cases (28.1%). Conclusions: The tight adhesion between lower surface of the liver and the adrenal gland due to intermingling of parenchymal cells of both organs is a major cause of incomplete resection of right adrenalectomy. Surgeons have to keep this fact in mind during right adrenalectomy for avoiding unnecessary adverse events.
Journal of endourology / Endourological Society 01/2013; · 1.75 Impact Factor
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Futoshi Kunieda,
Hiroshi Kitamura,
Masashi Niwakawa,
Kentaro Kuroiwa,
Nobuo Shinohara,
Kenichi Tobisu,
Kenichi Nakamura,
Taro Shibata,
Toyonori Tsuzuki,
Taiji Tsukamoto, Yoshiyuki Kakehi
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ABSTRACT: A Phase III clinical trial has been started in Japan to determine the optimal treatment strategy for patients with high-grade pT1 bladder cancer who have pT0 histology after second transurethral resection. The aim of this trial is to demonstrate the non-inferiority of relapse-free survival (excluding Tis or Ta intravesical recurrence) for watchful waiting compared with intravesical bacillus Calmette-Guérin therapy for pT0 after second transurethral resection. Patients with high-grade pT1 bladder cancer at the first registration and pT0 after second transurethral resection at the second registration are randomized to either a watchful waiting arm or an intravesical bacillus Calmette-Guérin therapy arm. A total of 575 patients at the first registration and 260 patients at the second registration will be accrued for this study from 38 institutions over 5 years. The primary endpoint is relapse-free survival (excluding Tis or Ta intravesical recurrence), and the secondary endpoints are overall survival, metastasis-free survival with bladder preserved, annual proportion of intravesical relapse-free survival, annual proportion of T2 or deeper relapse-free survival, adverse events and serious adverse events.
Japanese Journal of Clinical Oncology 09/2012; 42(11):1094-8. · 1.78 Impact Factor
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Asian Journal of Andrology 07/2012; 14(4):522-4. · 1.52 Impact Factor
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Kazuo Nishimura,
Norio Nonomura,
Katsuyoshi Hashine,
Hiro-Omi Kanayama,
Seiichiro Ozono,
Takeshi Miura,
Tsuneharu Miki, Yoshiyuki Kakehi,
Yoichi Arai,
Osamu Ogawa,
Ryuji Fujita,
Katsuya Nonomura,
Atsushi Mizokami,
Senji Hoshi,
Hideyuki Akaza
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ABSTRACT: BACKGROUND: There are few reports of long-term treatment with docetaxel in castration-resistant prostate cancer (CRPC) because of the limit of a maximum of ten cycles of treatment in TAX327 showing a survival benefit. Therefore, this study, ARD6563, was conducted to evaluate the safety of more than ten cycles of docetaxel in metastatic CRPC. METHODS: We enrolled patients who had received ten cycles of docetaxel in the preceding study, ARD6562. For ARD6563, patients received docetaxel every 3 weeks, at the last dose (70, 60, or 50 mg/m(2)) received for cycle 10 in ARD6562, with prednisolone 5 mg orally twice daily. RESULTS: The safety analysis set comprised 15 patients (median age, 64 years; performance status, 0 in 87%) out of 43 patients treated in ARD6562. The median initial dose of docetaxel was 60 mg/m(2), and the median number of additional cycles administered was 8 (range, 1-42). The relative dose intensity was 78.0% for docetaxel and 98.0% for prednisolone. Dose reduction was needed in 3 cycles because of grade 3 infection, febrile neutropenia, and grade 2 neuropathy. Administration delay was necessitated in 6 cycles because of grade 1-2 nonhematological toxicities. The major grade 3-4 toxicities were myelosuppression. Five patients who had an observed partial response or stable disease in ARD6562 maintained their clinical response in ARD6563. The study treatment was discontinued in 10 patients because of disease progression and in 4 patients for serious toxicities. There were no treatment-related deaths. CONCLUSIONS: Long-term docetaxel with prednisolone is feasible in selected Japanese patients with CRPC.
International Journal of Clinical Oncology 02/2012; · 1.41 Impact Factor
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Yongnan Li,
Xiudong Jin,
Jinhua Li,
Xinghua Jin,
Jianbo Yu,
Xiaodong Sun,
Yanhui Chu,
Chunyan Xu,
Xiaoxia Li,
Xijun Wang, Yoshiyuki Kakehi,
Xiuxian Wu
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ABSTRACT: To explore the interrelationship of human tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) and its death receptors DR4 and DR5 expressions level with patient prognosis and the response to adjuvant therapy in bladder cancer, the synergism function that is between chemotherapy and TRAIL on apoptosis induction in tumor cells.
The expression of TRAIL, DR4, and DR5 was studied using immunohistochemistry of paraffin-embedded tumor specimens from 229 bladder cancer patients who had undergone transurethral resection.
Cytoplasmic TRAIL, DR4, and DR5 expressions were detected in 35%, 75.1%, and 74.2% of bladder cancer patients, respectively. Patients with bladder cancer with either high DR4 or DR5 expression had a significantly longer postoperative recurrence-free rate than those with low expression of both during the 10-year follow-up. Multivariate analysis revealed that the expression of DR4 (P < .001), DR5 (P < .001) and epirubicin therapy (P = .034) were independent prognostic indicators of bladder cancer. Furthermore, epirubicin therapy significantly improved recurrence-free rate for the patients with DR4-high (P = .006) or DR5-high (P = .042) tumor.
The results of the present study have shown for the first time that a combination of DR4 and DR5 expression have significant value in predicting the prognosis of bladder cancer. In addition, patients with high expression of both DR4 and DR5 might benefit from epirubicin therapy.
Urology 01/2012; 79(4):968.e7-15. · 2.43 Impact Factor
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ABSTRACT: Lexatumumab, a human agonistic monoclonal antibody against tumor necrosis factor (TNF)-related apoptosis-inducing ligand receptor-2 (TRAIL-R2), is a promising molecular-targeted therapeutic agent. Our past study indicated that low concentrations of doxorubicin sensitized renal cell carcinoma (RCC) cells to lexatumumab-mediated apoptosis. The present study was designed to examine the cellular and molecular effects of lexatumumab and anthracyclines in RCC cells. The treatment of human RCC cells with lexatumumab in combination with anthracyclines, epirubicin, and pirarubicin had a synergistic cytotoxicity. A marked synergistic apoptosis was induced by lexatumumab in combination with epirubicin or pirarubicin. Epirubicin and pirarubicin significantly increased the TRAIL-R2 expression at both the mRNA and the protein levels. The combination-induced cytotoxicity was significantly suppressed by the human recombinant DR5:Fc chimeric protein. To further explore the molecular mechanisms in this synergistic cytotoxicity with lexatumumab and anthracyclines, the changes in 84 apoptosis-related genes were evaluated by a quantitative polymerase chain reaction (PCR) array. Among these genes, 18 (CD40LG, FASLG, LTA, TNSF7, FAS, BAG3, BAK1, BAX, BID, BIK, BCL10, caspase-1, caspase-5, caspase-6, caspase-10, TNF receptor-associated factor 1, PYCARD, and CIDEA) were significantly upregulated and eight (TNF receptor-associated factor 4, TNFRSF11B, TNF, BCL2, BCL2L1, BNIP3L, caspase-9, and DAPK1) were downregulated at mRNA levels in RCC cells cotreated with lexatumumab and epirubicin. Furthermore, the upregulation of mRNA levels of PYCARD and CIDEA was confirmed using real-time reverse transcriptase-PCR analysis. The present study demonstrates that anthracylines sensitize RCC cells to lexatumumab-mediated apoptosis by inducing TRAIL-R2 expression, and the utility of PCR array to elucidate the mechanism of synergistic apoptosis.
Anti-cancer drugs 12/2011; 23(4):445-54. · 2.23 Impact Factor
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ABSTRACT: Acquired cystic disease (ACD)-associated renal cell carcinoma (RCC) has been recently identified. However, there are only a few genetic studies to date. In this article, we performed an immunohistochemical and fluorescence in situ hybridization (FISH) study for six cases including one case with sarcomatoid change. As a result, we observed frequent immunohistochemical expression of AMACR. FISH of chromosome 3 showed trisomy for three cases, monosomy for two cases, and disomy for one case. Additionally, FISH of chromosome 16 showed trisomy for three cases, monosomy for two cases, and both trisomy and monosomy for one case. Furthermore, both the carcinomatous area and the sarcomatoid area of one ACD-associated RCC with sarcomatoid change revealed monosomy of chromosomes 3, 9, and 16 but showed disomy of chromosome 14. In conclusion, the numerical abnormalities of chromosomes 3 and 16, irrespective of gain or loss, may be characteristic of ACD-associated RCC.
Medical Molecular Morphology 12/2011; 44(4):228-32. · 1.39 Impact Factor
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ABSTRACT: A 49-year man, with past history of right total nephroureterectomy due to urothelial carcinoma of the right renal pelvis in September 2006 and left partial ureterectomy due to contralateral ureteral recurrence in October 2007, underwent TUR-BT due to superficial high-grade recurrent bladder cancer. After TUR-Bt, he was treated with intravesical Bacillus Calmette-Guérin (BCG) instillation at weekly intervals. Just after 5th instillation, he suffered a continuous high fever up to 38 degrees C and complained of general fatigue. Chest CT showed diffuse micronodular shadows in both lungs, and serum liver enzyme was markedly elevated. All cultures from his sputum and urine were negative for mycobacterium tuberculosis. TB-PCR test and quantiferon were also negative. These findings together with no improvement of the symptoms with anti-tuberculous treatment finally made us to judge that this was due to a hypersensitivity reaction to BCG. Soon after pulse steroid therapy, body temperature was normalized and the abnormal findings of the lung and liver disappeared.
Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 09/2011; 102(5):691-5.
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Yoshiyuki Kakehi
European urology 07/2011; 60(1):178-9. · 7.67 Impact Factor
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ABSTRACT: To examine the effect of the phytotherapeutic agent Eviprostat on the stromal-to-epithelial (S/E) ratio, level of macrophage infiltration, expression of the macrophage inhibitory cytokine-1 (Mic1) gene, and tumor necrosis factor-alpha (TNF-α) and interleukin-8 (IL-8) concentrations in prostate tissues in a rat model of nonbacterial prostatitis (NBP).
Ten-month old Wistar rats were divided into 4 groups of 10: (1) NBP non-mixed feed (prostatitis control group); (2) NBP Eviprostat (0.1%) mixed feed (prostatitis Eviprostat group); (3) non-NBP non-mixed feed (nonprostatitis control group); and (4) non-NBP Eviprostat mixed-feed (nonprostatitis Eviprostat group). NBP was induced by castration followed by daily subcutaneous injection of 17β-estradiol for 30 days. Ventral prostate lobes were histopathologically examined with Masson's trichrome staining or immunostaining with antimacrophage antibody. Mic1 mRNA levels were quantified by real-time reverse transcriptase polymerase chain reaction. Tissue concentrations of TNF-α and IL-8 were determined by enzyme-linked immunosorbent assay.
Stroma was the most abundant in prostatitis control rats. The mean S/E ratio in prostatitis Eviprostat rats was significantly lower than in prostatitis control rats (P < .0001). The high levels of macrophage infiltration found in prostatitis control rats were significantly reduced in prostatitis Eviprostat rats (P < .0001). The up-regulation of the Mic1 gene observed in prostatitis control rat prostates was significantly suppressed in prostatitis Eviprostat rats (P < .0001). A marked suppression of TNF-α and IL-8 secretion was also observed in prostatitis Eviprostat rats (P < .05).
Eviprostat significantly suppressed the S/E ratio, level of macrophage infiltration, Mic1 gene expression, and proinflammatory cytokines/chemokines in the prostate in a rat NBP model.
Urology 06/2011; 77(6):1507.e15-20. · 2.43 Impact Factor
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ABSTRACT: Chronic inflammation in the prostate has recently been recognized as an important component of the symptom progression of benign prostatic hyperplasia. The objective of this study was to evaluate a range of cytokines/chemokines in prostate tissue and urine to identify markers of prostate inflammation in a prostatitis model and to investigate the effect of a phytotherapeutic agent, Eviprostat®, on these markers.
Ten-month-old male Wistar rats were divided into four groups. Nonbacterial prostatitis (NBP) was experimentally induced in groups 2-4 by castration followed by daily subcutaneous injection of 17β-estradiol for 30 days. Control rats were fed a standard diet, while animals in the Eviprostat groups were fed a diet containing 0.05 or 0.1% Eviprostat for 30 days. The levels of cytokines/chemokines in prostate tissue on the 31st day and in urine collected the day before castration and the day before removal of the prostate were determined.
Experimentally induced NBP increased the prostatic levels of the cytokines interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α). The levels of the chemokines CCL2/monocyte chemoattractant protein-1 (MCP-1), CCL3/macrophage inflammatory protein-1α (MIP-1α), CXCL1/CINC-1, CXCL3/CINC-2, and CXCL5/LIX were elevated in both prostate and urine. Eviprostat significantly suppressed the increases in prostate IL-1β, TNF-α and CCL3/MIP-1α and prostatic and urinary CCL2/MCP-1 and CXCL1/CINC-1.
Chemokines, including CCL2/MCP-1 and CXCL1/CINC-1, were elevated in the prostate and urine of NBP rats, and Eviprostat potently suppressed the increases in CCL2/MCP-1 and CXCL1/CINC-1. These chemokines are therefore candidate diagnostic biomarkers for nonbacterial chronic prostatic inflammation.
The Prostate 03/2011; 71(4):438-44. · 3.48 Impact Factor
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ABSTRACT: Disseminated carcinomatosis of the bone marrow is caused by metastasis to the bone marrow and can cause disseminated intravascular coagulation (DIC), leucoerythroblastosis, and microangiopathic hemolytic anemia (MHA). The prognosis of this syndrome is poor. We report herein two rare cases of disseminated carcinomatosis of the bone marrow in association with prostate cancer. Case 1 involved a 61-year-old man admitted to our department with elevated prostate-specific antigen (PSA) levels. Prostate biopsy revealed prostate cancer, and imaging studies were performed. Under a diagnosis of prostate cancer (T3N1Mx), the patient was treated using hormonotherapy, but died 2 months after admission due to gastrointestinal bleeding of unknown cause, refractory DIC, and cachexia. Bone marrow biopsy after his death revealed metastasis of the prostate cancer to the bone marrow. Case 2 involved a 68-year-old man admitted to our department with gross hematuria. Cystoscopy revealed non-papillary tumor in the prostatic urethra. Transurethral biopsy was performed and histology identified prostate cancer. Treatment was initiated with hormonotherapy and zoledronate. After 8 months, he complained of general fatigue and blood testing identified anemia and thrombocytopenia. Bone marrow biopsy revealed adenocarcinoma in the bone marrow. Alternative androgen therapy and chemotherapy with docetaxel was started, and the patient recovered from pancytopenia and general fatigue.
Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 01/2011; 102(1):28-33.
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ABSTRACT: Recent studies have suggested that primary aldosteronism (PA) is a common form of hypertension. However, some cases of PA are overlooked because microadenoma is difficult to detect by imaging. The author report 2 cases in which aldosterone-producing microadenoma was diagnosed by selective adrenal venous sampling (AVS) and furosemide plus upright test. These adenomas were resected by laparoscopic adrenalectomy. Both cases presented with hypertension and hypokalemia. Experimental data, including those obtained from furosemide plus upright test, suggested PA. In both cases, computed tomography imaging revealed a normal adrenal gland without any tumor. However, selective AVS indicated unilateral hypersecretion of aldosterone. Laparoscopic adrenalectomy was performed, and clinical symptoms of the patients improved. The histopathologic findings revealed aldosterone-producing microadenomas with diameters of 6 and 3 mm, respectively, in cases 1 and 2. In conclusion, AVS should be performed to confirm the diagnosis of PA when computed tomography imaging does not provide definite results.
The American Journal of the Medical Sciences 10/2010; 340(4):335-7. · 1.39 Impact Factor
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ABSTRACT: To clarify the contemporary clinical outcome of stage I seminoma and to provide information on treatment options to patients.
A retrospective analysis of 425 patients who underwent orchiectomy for stage I seminoma between 1985 and 2006 at 25 hospitals in Japan. Relapse-free survival rates were calculated using the Kaplan-Meier method and clinicopathological factors associated with relapse were examined by univariate and multivariate analyses using the Cox proportional hazards model.
A total of 30 out of 425 patients had relapsed. Relapse-free survival rates at 10 years were 79, 94 and 94% in the surveillance, chemotherapy and radiotherapy groups, respectively. Post-orchiectomy management and rete testis invasion were identified as independent predictive factors associated with relapse. Rete testis invasion remained to be an independent predictive factor, even if the cases with relapses in the contralateral testis were censored. Only one patient, who relapsed after adjuvant radiotherapy, died of the disease. Overall survival at 10 years was 100, 100 and 99% in the surveillance, chemotherapy and radiotherapy groups, respectively. More than half of the patients were lost to follow up within 5 years.
The outcome of Japanese patients with stage I seminoma is similar to previously published Western reports. Surveillance policy is becoming a popular option in Japan, although the relapse rate in patients opting for surveillance policy is higher than those opting for adjuvant chemotherapy or radiotherapy. Rete testis invasion is an independent predictive factor associated with relapse regardless of the post-orchiectomy management. Long-term follow up is mandatory for detection of late relapse.
International Journal of Urology 10/2010; 17(12):980-7. · 1.75 Impact Factor
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ABSTRACT: The present study was carried out to analyze pathological features of prostatectomy specimens performed at different timing and trigger during active surveillance.
One hundred and thirty-four patients that fit a selection condition similar to the so-called Hopkins' criteria were enrolled into the present study between January 2002 and December 2003. Patients were recommended to start curable treatment when they showed prostate-specific antigen-doubling time of 2 years or shorter or pathological progression at 1-year re-biopsy. Median observation period was 61 months.
Fourteen patients underwent radical prostatectomy immediately after enrollment (Group A) whereas 28 patients underwent radical prostatectomy after substantial periods of active surveillance (Group B). Of the 28 Group B, trigger of radical prostatectomy was on protocol in 17 patients (Group B1) whereas 11 patients underwent radical prostatectomy by their preference (Group B2). Upgrade from initial biopsy was observed in 43% of Group A and 68% of Group B. Upgrade was more frequently observed in Group B1 than B2 with border line significance (P = 0.075). Perineural infiltration and positive surgical margin rates of Group B1 were significantly higher than those of B2 (P < 0.05).
Unfavorable pathological features of surgical specimens were more frequently observed in patients who underwent radical prostatectomy due to short prostate-specific antigen-doubling time or biopsy findings than those who underwent radical prostatectomy because of other reasons including patients' preference. Rates of unfavorable pathological features at radical prostatectomy that deviate initial selection criteria was high enough to support integration of frequent biopsies into active surveillance program.
Japanese Journal of Clinical Oncology 10/2010; 40(10):973-9. · 1.78 Impact Factor
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ABSTRACT: To assess the efficacy and safety of dietary supplements in patients with early stage prostate cancers who are managed expectantly.
Seventy-four patients with early prostate cancer, who were treated with expectant management, enrolled in the study. A mushroom mycelium extract was given at a dose of 4.5 g/day for 6 months. The primary endpoint was the proportion of patients in which the prostate specific antigen level decreased by 50% or more following treatment. The adverse events, change of prostate specific antigen value and quality of life were also evaluated.
In only one of 74 patients (1.4%), the prostate specific antigen value decreased more than 50%. Grade 2 diarrhea and grade 1 itching were observed in one patient, and patient ingestion compliance was maintained near 100%. The alternation of prostate specific antigen values was stable before and after treatment. In subjects with strong anxiety prior to supplement ingestion, these feelings were significantly alleviated (state anxiety, P = 0.0018; trait anxiety, P = 0.0099).
In this phase II study of early prostate cancer patients who were managed expectantly, a mushroom mycelium extract was an ineffective treatment for reducing 50% or more the patient prostate specific antigen values.
Japanese Journal of Clinical Oncology 10/2010; 40(10):967-72. · 1.78 Impact Factor
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ABSTRACT: EPIDEMIOLOGY OF BLADDER CANCER: Bladder cancer is the 7th most common cancer in men and the 17th most common in women in the world. The incidence of bladder cancer varies considerably among countries, with the highest incidence rates seen in Western countries and the lowest rates in Asian countries. In recent years, the mortality rate due to bladder cancer has been stable or decreased gradually. LIFESTYLE AND UROTHELIAL CARCINOMA: Occupational risks, environmental risks, dietary habits and cigarette smoking are lifestyle factors known to influence the development of urothelial carcinoma. Although the relative risk of bladder cancer associated with occupations is small, the public health impact may be significant. The Western pattern of diet is associated with a significant increase in the risk of bladder cancer. It has been found that smoking accounts for more than 50% of bladder cancers in men and 30% in women. Urological patients' awareness of smoking as a risk factor for bladder cancer is lower than their awareness regarding other smoking-related disease entities. Counseling patients regarding the risk of tobacco is a role for urologists. GENETIC SUSCEPTIBILITY TO UROTHELIAL CARCINOMA: Recent single-nucleotide polymorphism genetic studies in relation to bladder carcinogenesis have revealed several associated genetic polymorphisms of detoxification or DNA repair genes, such as NAT2, GST and OGG1. That information is important in relation to environmental risk factors and ethnic differences and will help predict the prognosis of patients with bladder cancer. Further studies are needed to confirm potential gene-gene and gene-environmental interactions leading to bladder carcinogenesis.
Japanese Journal of Clinical Oncology 09/2010; 40 Suppl 1:i57-64. · 1.78 Impact Factor
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ABSTRACT: A 69-year-old woman, who had been undergoing treatment for hypertension, was admitted to the hospital for the evaluation of a tumor in the right adrenal gland and of episodic hypertension. She was diagnosed with pheochromocytoma on the basis of elevated urine catecholamine and metabolite concentrations and positron emission tomography (PET) results; however, the results of I-metaiodobenzylguanidine (I-MIBG) scintigraphy were negative. The patient underwent laparoscopic right adrenalectomy. Malignancy was suspected on the basis of histopathologic studies. After surgery, the elevated catecholamine and metabolite concentrations and the blood pressure returned to normal; furthermore, the symptoms, including severe headache, reduced. The authors report a case of pheochromocytoma that was suspected to be malignant on the basis of histopathologic analysis and was detected by F-fluorodeoxyglucose (FDG)-PET but not by MIBG. Thus, FDG-PET may be a prognostic marker for malignant pheochromocytomas with or without metastasis.
The American Journal of the Medical Sciences 08/2010; 340(2):160-3. · 1.39 Impact Factor
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ABSTRACT: We report the case of an 85-year-old woman who has been undergoing treatment for hypertension but has not received anticoagulation therapy. The patient was admitted to our hospital for the evaluation of a right adrenal tumor (size, 10 × 9 cm²). Preoperative contrast-enhanced computed tomography and magnetic resonance imaging findings were indicative of adrenal hemorrhage (AH). Laboratory data revealed mild anemia but no adrenal dysfunction. The final pathological diagnosis was simply idiopathic adrenal hematoma. There is no case report of exactly idiopathic AH over 80 years old. We report an unusual case of idiopathic unilateral adrenal hematoma in an elderly patient. It is important to distinguish this benign lesion from a neoplasm and to consider idiopathic AH in an adrenal tumor during differential diagnosis in elderly patients who have not received anticoagulation therapy or suffered from trauma.
Endocrine 04/2010; 37(2):249-52. · 1.42 Impact Factor
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ABSTRACT: Warty (condylomatous) carcinoma (WC) is a rare specific variant of invasive squamous cell carcinoma that shows hybrid features of condyloma with invasive cell carcinoma. As compared with conventional squamous cell carcinoma, WC tends to run a less aggressive clinical course. A case is presented here in which squash smears of a penile foreskin tumor in a 65-year-old male revealed small cohesive clusters and sheets of tumor cells in papillary configurations. The neoplastic cells were polygonal to elongated and contained oval nuclei, coarse chromatin pattern, and distinct nucleoli. Nuclear pleomorphism and loss of nuclear polarity were observed. Characteristically, there were also many koilocytes demonstrating mild to moderate nuclear atypia and perinuclear cytoplasmic halos. A cytologic diagnosis of a verruciform penile tumor was suggested. Histologic examination of the tumor showed a hyper-parakeratotic arborizing papillomatous growth with thin fibrovascular cores and the tips were variably rounded or tapered. Obvious koilocytic cytopathic change, nuclear pleomorphism, and focal stromal invasion were observed. Immunohistochemically, the tumor cells showed diffuse and strong membranous staining for cytokeratin (AE1/AE3) while the MIB-1 and p53 immunoreactive cells were confined to the basal areas of the papillae. No lymphovascular invasion was detected in D2-40 or elastic Van-Gieson stains. On the basis of the overall features, we confirmed a final diagnosis of penile WC. We demonstrated here for the first time the cytopathological features of penile WC with emphasis on differential diagnostic considerations.
Diagnostic Cytopathology 03/2010; 38(11):841-5. · 1.16 Impact Factor
