RESUMEN
Late relapse of testicular tumor is rare. We report a case of recurrence of seminoma at left inguinal lymph node 18 years after initial treatment. A 63-year-old man had a left orchiectomy for left testicular tumor (T1N0M0) in February 1985, with no past history of scrotal or inguinal surgery. Histological examination revealed seminoma (pT1), and prophylactic radiotherapy (34.2 Gy) to para-aortic and left hemi-pelvic regions was perfomed. In November 2003, the patient presented with left inguinal swelling, and was referred to our hospital with suspicion of metastasis to left inguinal lymph nodes. Serum markers (AFP, hCG, hCGbeta and LDH) were normal. Computerized tomography (CT) showed three masses in the left inguinal region, but no other abnormal mass was detected at chest, abdomen or pelvis. Lymphoidectomy of the left inguinal region was perfomed in January 2004, and the mass revealed to be metastasis of seminoma by histological examination.
Asunto(s)
Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Seminoma/secundario , Neoplasias Testiculares/patología , Humanos , Conducto Inguinal , Metástasis Linfática , Masculino , Persona de Mediana Edad , Orquiectomía , Seminoma/radioterapia , Seminoma/cirugía , Neoplasias Testiculares/radioterapia , Neoplasias Testiculares/cirugía , Factores de TiempoRESUMEN
Obstructive nephropathy refers to the mechanical or functional changes in the urinary tract that interfere with normal urinary flow. Once obstruction is set, it leads to progressive renal damage that is mainly characterized with tubulointerstitial fibrosis. Here we reviewed the pathophysiology of urinary tract obstruction and indicated future therapeutic options. Following complete unilateral ureteral obstruction, there is a progressive fall in renal blood flow and glomerular filtration rate, and is a increase in intratubular pressure. These events activate the plasma and tissue renin-angiotensin systems (RAS). It has been proved that upregulated angiotensin II is one of the crucial factors those are responsible for the subsequent deleterious process. Angiotensin II induces transforming growth factor-beta, which causes overproduction of extracellular matrix (ECM) proteins like collagen, fibronectin, etc. The ECM proteins are dominantly accumulated in tubulointerstitium and result in deterioration of renal function. Along with the activation of the RAS, tissue ischemia and mononuclear leukocyte infiltration also modulate the fibrotic changes. The process from the RAS activation to renal fibrosis is observed not only in obstructive nephropathy but also in other renal diseases and is called the Final Common Pathway. Mechanical release of the obstruction is to perform in terms of the treatment, however, several promising pharmaceutical options are now under investigation.
Asunto(s)
Enfermedades Renales/fisiopatología , Obstrucción Ureteral/fisiopatología , Angiotensina II/fisiología , Animales , Fibrosis/etiología , Humanos , Hidronefrosis/etiología , Enfermedades Renales/patología , Túbulos Renales/patología , Ratones , Ratas , Receptores de Angiotensina/fisiología , Circulación Renal , Sistema Renina-Angiotensina/fisiologíaRESUMEN
OBJECTIVES: To study the natural background of prostate cancer in Japan and China, mass checks with prostate-specific antigen (PSA)-based screenings were performed using identical procedures in Natori, Japan and Changchun, China. METHODS: For 7 years (1995 to 2001) in Natori, Japan, and for 3 years (1998 to 2000) in Changchun, China, 2212 Japanese and 3566 Chinese men older than 55 years were mass checked by PSA-based screening (serum PSA cutoff value 4.1 ng/mL). RESULTS: The PSA-positive rates (PSA 4.1 ng/mL or greater) and cancer detection rates in the screened persons of Natori and Changchun were 8.5% and 5.2% (P <0.0005) and 2.1% and 0.8% (P <0.0001), respectively. When the number of cancer cases detected was adjusted to a 100% biopsy rate for men who were PSA positive in both cities, the cancer detection rate was estimated at 2.3% and 1.3% in Natori and Changchun, respectively. This difference was also significant (P <0.01). CONCLUSIONS: The results indicate that the percentage of PSA-positive men 55 years or older in Changchun was lower than that in Natori. The analysis of the results suggests that the prostate cancer incidence and prevalence in Changchun, China are lower than those in Natori, Japan.
Asunto(s)
Pueblo Asiatico , Tamizaje Masivo/estadística & datos numéricos , Neoplasias de la Próstata/epidemiología , Factores de Edad , Biopsia con Aguja , China/epidemiología , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Próstata/patología , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/patologíaRESUMEN
Tubulointerstitial fibrosis is a major cause of irreversible renal damage in the obstructed kidney. The effects of release of obstruction on the obstructed kidney are not clearly understood. We investigated the effects of the release of ureteral obstruction on renal fibrosis and the expression of fibrogenic factors. Rats underwent 5 day of unilateral ureteral obstruction (UUO). After release of obstruction by removing an encased rubber tube, changes in interstitial volume were morphologically evaluated and the mRNA expression of transforming growth factor-beta (TGF-beta), type IV collagen (collagen IV), and plasminogen activator inhibitor-1 (PAI-1) were examined by reverse transcription-polymerase chain reaction (RT-PCR) up to 28 days. Renal interstitial volume, collagen IV and PAI-1 mRNA gradually decreased from 7 days to 28 days after release of obstruction. However, increased expression of TGF-beta mRNA persisted up to 14 days, and then declined 28 days after release. In conclusion, obstruction-induced renal fibrosis was recovered with diminished expression of TGF-beta and collagen IV. Decreased PAI-1 expression in the post-obstructed kidney may contribute to the degradation of extracellular matrix proteins and recovery of tubulointerstitial fibrosis, at least partly, after release of ureteral obstruction.
Asunto(s)
Colágeno Tipo IV/metabolismo , Riñón/metabolismo , Inhibidor 1 de Activador Plasminogénico/metabolismo , Factor de Crecimiento Transformador beta/metabolismo , Obstrucción Ureteral/terapia , Animales , Colágeno Tipo IV/genética , Femenino , Riñón/patología , Inhibidor 1 de Activador Plasminogénico/genética , Ratas , Ratas Sprague-Dawley , Factor de Crecimiento Transformador beta/genética , Regulación hacia Arriba , Obstrucción Ureteral/metabolismoRESUMEN
PURPOSE: The plasminogen activator (PA)-plasmin system has been shown to influence turnover of the extracellular matrix in various tissues. We examined the alteration of plasminogen activator inhibitor-1 (PAI-1) and tissue-type plasminogen activator (t-PA) in kidneys with unilateral ureteral obstruction in rats. MATERIALS AND METHODS: Female rats that underwent ligation of the left ureter were sacrificed 12 hours, 1, 5 or 10 days later. The expressions of PAI-1 and t-PA was determined by reverse transcription-polymerase chain reaction and immunohistochemical studies in the obstructed and contralateral kidneys in each group. RESULTS: Control kidneys showed no PAI-1 messenger (m)RNA expression. After days 1 through 10 of unilateral ureteral obstruction the amount of PAI-1 mRNA significantly increased in obstructed compared with contralateral kidneys (p <0.01). Meanwhile, slight polymerase chain reaction products of t-PA were observed in control kidneys. After 12 hours through 10 days of unilateral ureteral obstruction, t-PA mRNA in obstructed and contralateral kidneys was significantly elevated compared with in control kidneys (p <0.05). No significant difference in t-PA was observed in the obstructed and contralateral kidneys in each group. Immunoreactivity to PAI-1 and t-PA was identified in obstructed kidneys. CONCLUSIONS: PAI-1 and t-PA are up-regulated in obstructed rat kidneys. Our results indicate that the PA-plasmin system has a role in the process of matrix accumulation and degradation during rat obstructive nephropathy.