Autoreactive T cell-dependent polyclonal hypergammaglobulinemia in mantle cell lymphoma

We investigated the mechanism of polyclonal B cell differentiation in mantle cell lymphoma (MCL) using peripheral blood mononuclear cells (PBMC) from a patient with MCL in leukemic stage presenting polyclonal hypergammaglobulinemia. Patient T cells not only responded to autologous non-T cells but induced polyclonal production of IgG in vitro. Flow cytometric analysis of PBMC showed the increased conversion of CD4+ T cells from the naive to the memory state. We propose the possible mechanism that autoreactive T cells may be involved in polyclonal B cell differentiation in this monoclonal B cell disorder.

[Yersinia enterocolitica serotype O:8 infections at the Hirosaki district in Aomori Prefecture from 1984 to 1991]

During the period from January 1984 to December 1991, 118 strains of Yersinia enterocolitica were isolated from the specimens which were requested for bacterial examination from various medical practitioners. The results of bacteriological examination of these isolates showed that 11 of Y. enterocolitica serotype O:8 sporadic infections were confirmed at Hirosaki district in Aomori Prefecture. Of the eleven isolated strains, nine were from feces, two were from contents of extracted appendix. These strains were biovar (Wauters) 1, harboring 42 megadalton virulence plasmid, positive for autoagglutination and calcium dependency. Patients were under fifteen years old except one case of a 45 year old. Seven patients were living in the inter-mountain area, three in the urban area and one in the plain area. The infectious source was not found.

The effects of intravenous clonidine on regional myocardial function in a canine model of regional myocardial ischemia

This study was performed to investigate the effects of clonidine on regional myocardial function in a canine model of regional myocardial ischemia. Myocardial systolic shortening (%SS) was used as an index of regional myocardial function. In eight dogs after thoracotomy, the left circumflex coronary artery (LCX) was occluded by screw clamp until regional myocardial function became impaired. After partial occlusion of the LCX, cumulative doses of clonidine (1.25, 2.5, and 5.0 micrograms/kg) were administered intravenously. After administration of clonidine, heart rate, mean arterial blood pressure (MAP), and norepinephrine concentration decreased in a dose-dependent manner. At a dose of 5.0 micrograms/kg of clonidine, the LCX flow and systolic shortening of the LCX area decreased to 76% and 81% of the poststenotic values (P < 0.05, respectively), whereas no significant changes were observed at a dose of 1.25 and 2.5 micrograms/kg. These results suggest that clonidine administration and an associated decrease in arterial blood pressure deteriorates regional myocardial function of the ischemic myocardium.

Clinical significance of prostate specific antigen for early stage prostate cancer detection

The characteristics of serum prostate specific antigen (PSA) in normal Japanese men were studied in 1480 subjects examined by mass screening (MS) for prostate cancer (Pca) in Gunma Prefecture in 1992. The serum PSA concentration was correlated with patient age. The average serum PSA level increased by 0.04 ng/ml/year. The upper normal limits (95 percentiles) of age specific PSA for normal men are 1.33 ng/ml for those aged 39-49 years, 3.65 ng/ml for those aged 50-59 years, 4.06 ng/ml for those aged 60-69 years, 5.09 ng/ml for those aged 70-79 years and 5.66 ng/ml for those aged 80-89 years. Among 227 normal men examined by our MS in 1991 and 1992, the PSA velocity (PSAV) was calculated to be 0.05 ng/ml/year. Among 10 Pca patients with normal PSA levels (< 6 ng/ml) detected previously by our MS, three had an abnormal PSAV. We demonstrated the possibility that PSA density could distinguish between Pca and benign prostate hypertrophy. The significance of PSA as a Pca screening modality should be evaluated across multiple age ranges and in combination with previous PSA data and/or prostate volume estimated by sonography.

Acute, subchronic and chronic toxicity studies of a synthetic antioxidant, 2,2'-methylenebis(4-methyl-6-tert-butylphenol) in rats

General toxicity studies on 2,2'-methylenebis(4-methyl-6-tert-butylphenol) (MBMBP) were conducted using male and female Wistar rats. LD50 values were greater than 5 g/kg BW by oral administration for both sexes. Diarrhea was observed until 5 days. In the subchronic test, rats were fed diet containing MBMBP at 0, 0.12, 0.6 or 3.0% for 12 weeks. Severe suppression of body weight gain was observed in both sexes of 0.6 and 3.0% groups. Death accompanied by hemorrhage from nasal cavity was observed in 0.6 and 3.0% males and 3.0% females. Dose-dependent toxicity to the liver in both sexes was observed in blood chemical analysis. Histopathologically, testicular atrophy and decrease of spermatogenesis were dose- and time-dependently observed in all treated males. Atrophy of ovaries was evident in 0.6 and 3.0% females. Thymus atrophy and bone marrow hypoplasia were observed in both sexes of 0.6 and 3.0% groups. In the chronic test, rats were fed diet containing MBMBP at 0, 0.01, 0.03 and 0.1% for 18 months. Body weight gain was only suppressed in both sexes receiving 0.1%. Histopathologically, testicular atrophy and decrease of spermatogenesis were apparent in 0.1% males. No neoplastic response by MBMBP administration was noted. NOAEL was concluded to be 0.03% in the diet (12.7 mg/kg BW/day for male rats and 15.1 mg/kg BW/day for female rats).

Kinetic analysis of focal hypoechoic lesion in the prostate treated by castration

Dynamic changes in the focal hypoehoic lesion (FHL) in the prostate, visualized by transrectal sonography (TRS), were determined in five patients with prostatic cancer (PC) after treatment by castration. In all cases, the volume of FHL, as well as the volume of the whole prostate, decreased exponentially after castration. In four out of five cases, the volume (not including the FHL, which might suggest the volume of the normal tissues) increased slightly in the early postoperative weeks, and decreased thereafter. In the remaining one case, it decreased consecutively. According to the formula established in our previous study, the reduction time (tau) of the volume of the whole prostate and of the volume of the FHL was calculated, indicating that the tau of the FHL was remarkably shorter than that of the volume not indicating the FHL. This evidence suggested that not only the cancerous tissues but also the normal prostatic tissues might reduce in volume after castration.

Laminin localization and gelatinolytic activity of epithelial rest of Malassez grown on titanium

The purpose of this study was to examine laminin localization in epithelial rests of Malassez grown on titanium and their gelatinase activity. Laminin localization was confirmed by immunocytochemistry in all epithelial cells grown on titanium. The conditioned medium from the epithelial cells grown on titanium exhibited 72kD- and 92 kD-gelatinase activities by gelatin zymography. Those results suggest that laminin contributes to the epithelial cell attachment to titanium and that gelatinases may be mobilized for epithelial cell movement on titanium.

Effect of mannose, fructose and lactate on the preservation of synaptic potentials in hippocampal slices

We investigated the effect of fructose, mannose and lactate on the preservation of synaptic transmission in the granule cell layer of guinea pig hippocampal slices during deprivation of glucose. After replacement of glucose with lactate (5 mM) or fructose (10 mM), population spikes (PS) extinguished transiently and thereafter recovered to 60-70% of the original amplitude. Replacement of glucose with mannose (10 mM) decreased the PS amplitude by 50-60% within 20 min. and was followed by recovery to 80% of the original amplitude. The levels of ATP and CrP (creatine phosphate) in fructose, mannose and lactate containing medium were maintained at 80-90% of the original levels. PS of the slices exposed to both glucose and lactate showed a similar pattern to that observed in lactate medium with deprivation of glucose. These results suggest that lactate, mannose and fructose could be metabolic substrates for energy production and are able to preserve the synaptic potentials, however, it takes 20-30 min for the functional replacement of glucose with these sugars or metabolites to occur.

Percutaneous biopsy for adrenal tumors using ultrasonically guided puncture

Percutaneous biopsy for adrenal tumors was performed on 12 patients using ultrasonically guided puncture. Of the 12 tumors, 11 were detected incidentally by ultrasonography or computed tomography. In 11 cases, cytological or pathological diagnosis was obtained without any complication. Among these, surgical operation was carried out in 4 cases, in which biopsy findings were confirmed by the examination of the surgical specimens. The other 7 cases were being followed up without surgery. The rate of correct discrimination between benign and malignant adrenal tumors by biopsy was 91% (10/11 cases) in this series. It is accordingly considered that adrenal biopsy is the choice to confirm the diagnosis of nonfunctioning adrenal tumors because of its efficacy and ease of use.

Dietary gamma-linolenic acid-enriched oil reduces body fat content and induces liver enzyme activities relating to fatty acid beta-oxidation in rats

The objectives of this study were to examine the effects of dietary gamma-linolenic acid-enriched oil extracted from fungi on rat body composition and on the various enzyme activities relating to fat metabolism in the liver. The oil contained 25.3 g gamma-linolenic acid/100 g fatty acids. The levels of gamma-linolenic acid-enriched oil in the diets were 0, 1.5 and 4%, to give 0, 2.88 and 7.68 g gamma-linolenic acid/kg diet. The control diet contained 8% soybean oil. The rats were given free access to these diets for 4 wk. Body weight gain was less in the gamma-linolenic acid oil-fed groups than in the control group, although food intake was similar among the three groups. Absolute and relative carcass fat weights were significantly lower in the gamma-linolenic acid oil-fed groups than in the control group. Carcass protein and water contents were not different among the three groups, although values were slightly greater than controls in gamma-linolenic acid-fed groups when expressed relative to body weight. Plasma total cholesterol and free fatty acid concentrations generally were lower in the gamma-linolenic acid oil-fed groups than in the control group. In the liver, there were no significant differences in activities of malic enzyme and citrate cleavage enzyme among the three groups. However, the activities of carnitine palmitoyl-transferase and peroxisomal beta-oxidation were significantly higher in the gamma-linolenic acid oil-fed groups than in the control group. These results clearly demonstrate that dietary gamma-linolenic acid oil reduces body fat content and facilitates fatty acid beta-oxidation in the liver.

Cervical dural arteriovenous malformation presenting with right-sided occipitalgia: before and after successful treatment by embolization

We report a 52-year-old man who had a 2-year history of right-sided occipitalgia. His pain was induced by anteroflexion of the neck. Neurologic examinations showed mild right C2 and C3 root signs. Cervical MR imaging disclosed an extra-medullary intradural crooked shadow at the level between C2 and C3 vertebrae, which was proven by selective angiogram of the ascending cervical artery to be a dural arteriovenous malformation located in the right C3 root sleeve. Embolization by an endovascular approach resulted in angiographic and clinical cure. These findings indicate that headache due to arteriovenous malformation in upper cervical region may be surgically treatable.

[Bronchial carcinoid tumor with multiple brain metastasis]

Carcinoid tumor is regarded as a tumor with low grade malignancy, mostly originating from the gastrointestinal tract with little danger of metastasis. The authors encountered a very rare case of bronchial carcinoid tumor that had multiple metastasis to the intracranial space. The characteristics of radiological and hormonal examinations of this tumor are reported and discussed. The patient was a 73-year-old woman who gradually developed unsteadiness in walking and somnolence in daytime one month prior to admission. Those symptoms were aggravated and she began to vomit. On admission, neurological examination showed slight ataxia of left upper and lower extremities and dominant truncal ataxia. Chemical and hormonal examinations of blood and urine showed, gastrin was 230 pg/ml (37-172), ACTH was 67 pg/ml (< 60), serotonin was 565 ng/ml (53-200), and urinary 5-HIAA was 9.9 mg/day (0.8-4.8). Tumor markers (CEA, AFP, HGG, NSE) were all negative. Radiological examinations (chest X-P, CT scan) of her lung demonstrated a 3 x 3 cm tumor mass adjacent to the hilum of the left lower lobe. CT-scan of the head demonstrated cystic tumor in the vermis of the cerebellum (3 x 3 cm), the right posterior parietal lobe and the right temporal lobe. The wall of each tumor was enhanced by contrast medium. T1 weighted MRI demonstrated the walls of cystic tumors as iso intensity and the contents as low and high intensity with niveau formation. Little edema was recognized around the tumors. The wall of each cystic tumor was enhanced by Gd-DTPA.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasonic volume monitoring in patient with prostate cancer treated by external beam radiation therapy

OBJECTIVE

To determine whether or not tumor volume estimates are useful in predicting and detecting disease progression following radiation therapy in patients being treated for adenocarcinoma of the prostate.

METHODS

Compare preradiation therapy ultrasound determined volumetric analysis of the prostate gland, the hypoechoic tumor lesion, and prostate-specific antigen (PSA) values to sequential post-therapy determinations.

RESULTS

The average percent volume reduction rates at three months postradiation therapy of the entire prostate gland and the hypoechoic tumor lesion were 18.1 and 60 percent, respectively. The serum PSA value at three months decreased by 69.3 percent. After the first three months, further reductions in all three parameters were minimal. The volume of the histologically confirmed cancer lesions in progressing patients decreased at a slower rate than that of nonprogressing patients during the initial six months of follow-up (p = 0.03). Among the 14 progressing patients, a new hypoechoic lesion (5 of which were biopsy-positive) developed in 7, and 7 had persistent lesions. An elevated PSA was observed in 10 of the progressors.

CONCLUSIONS

The volume change of the hypoechoic lesion was sensitive in detecting disease progression and mirrored the change in PSA levels. The monitoring of hypoechoic lesion volume is useful both to predict and to detect disease progression following radiation therapy while volume change of the prostate gland was not sensitive for these purposes.

[Risks and benefits of gonadotrophin therapy for infertile patients with ovulatory cycles]

In an attempt to evaluate the risks and benefits of human menopausal gonadotrophin (hMG) therapy for patients with unexplained infertility, the response and outcome of hMG therapy for anovulatory patients and ovulatory patients with unexplained infertility were analyzed in a group of successful cases of pregnancy. The number of follicles grown and the total doses of hMG were not significantly different in the two groups. The rate of spontaneous abortion in unexplained cases was twice as high (13.2%) as in anovulatory cases. However, the rate of multiple pregnancy was 8.8% for unexplained cases which was significantly lower than that for anovulatory cases (39.0%). In addition, ovarian hyperstimulation syndrome (OHSS) occurred in 11.8% of unexplained cases and that was much lower than that for anovulatory cases (25.8%). This study justifies the application of gonadotrophin therapy to ovulatory patients with unexplained infertility in terms of the risks and benefits of the therapy in achieving pregnancy.

Liver fluke infection and cholangiocarcinoma: model of endogenous nitric oxide and extragastric nitrosation in human carcinogenesis

Cancers arising during bacterial, viral and parasitic infection provide useful models to investigate the link between inflammation and carcinogenesis. Because the inflammatory agent is known, relationships between immune responses, the production of DNA-damaging agents, such as nitric oxide, oxygen radicles and N-nitroso compounds, and cancer risk can be explored. This paper first describes the close relationship between infection with the liver fluke, Opisthorchis viverrini, and cholangiocarcinoma in humans. Data are then presented which demonstrate an elevation in levels of salivary nitrite and urinary and plasma nitrate among men with moderate and heavy liver fluke infections compared to uninfected controls which was absent 4 months after the parasites were cleared with praziquantel. Because of the strict control over subject selection and dietary intake plus the absence of the increase following treatment, we conclude that the higher levels of nitrate and nitrite reflect endogenous generation of nitric oxide resulting from liver fluke infection. Excess nitric oxide generation in the inflamed tissue is likely to lead directly to the formation of N-nitroso compounds mediated by activated macrophages. Further work will attempt to demonstrate a link between this increase and both parasite-specific immune responses and the risk of cancer.

Evaluation of mixed chimaerism and origin of bone marrow derived fibroblastoid cells after allogeneic bone marrow transplantation

We assessed the origin of bone marrow derived fibroblastoid cells (BMF) in long-term cultures of 13 samples obtained from nine patients after allo-BMT by polymerase chain reaction (PCR) amplification of MCT118, one of the variable number of tandem repeats regions (VNTR). BMF showed a complete recipient pattern in nine samples obtained from seven patients; however, a recipient-predominant mixed chimaeric pattern was detected in BMF from four patients. Also, two of the four patients died with bone marrow hypoplasia. These data suggest that mixed chimaeric pattern of BMF may be correlated with bone marrow hypoplasia.

Inhibition of the soluble and the tumor cell receptor-bound plasmin by urinary trypsin inhibitor and subsequent effects on tumor cell invasion and metastasis

The present study was undertaken to determine whether highly purified human urinary trypsin inhibitor (UTI) efficiently inhibits the soluble and the tumor cell receptor-bound plasmin. The ability of plasmin inhibitors to regulate invasion by tumor cells which express membrane-associated plasmin was also examined. UTI and two other plasmin inhibitors [alpha 2-anti-plasmin (alpha 2AP) and alpha 2-macroglobulin (alpha 2M)] were used. alpha 2AP and alpha 2M, as well as UTI, rapidly inactivate the soluble plasmin that is not bound to cells. Experiments were performed in vitro using cultures of ovarian cancer HOC-I cells and gestational choriocarcinoma SMT-ccl cells. HOC-I and SMT-ccl cells had plasmin(ogen) on their cell surface, and the plasmin activity was detected on their cell surface enzymologically and immunologically. Receptor-bound plasmin reacted effectively with UTI and was directly inactivated by UTI. In contrast, receptor-bound plasmin was not inhibited by alpha 2AP and alpha 2M. Using a modified Boyden chamber and an artificial basement membrane, Matrigel, it was found that UTI, but not alpha 2AP or alpha 2M, can inhibit HOC-I and SMT-ccl cells invasion in vitro. Furthermore, in the experimental lung metastasis model, UTI inhibited the formation of lung metastasis by Lewis lung carcinoma cells. The inhibition of tumor cell invasion was not due to direct antitumor effects of UTI. These results suggest that inhibition of receptor-bound plasmin by UTI is associated with significantly reduced tumor cell invasiveness in vitro and with a decreased number of metastasis in vivo.

Bilateral ovarian metastasis from left renal cell carcinoma

We report a case of left renal cell carcinoma with bilateral ovarian metastasis which was demonstrated 3 years after radical nephrectomy. The patient is alive without any evidence of disease 36 months after bilateral salpingo-oophorectomy.

[Treatment of acute lymphoblastic leukemia in adults by the modified protocol of L-10M (Sloan-Kettering): long-term outcome]

From January 1984 to April 1988, we treated 20 patients with adult lymphoblastic leukemia (ALL) and 2 patients with lymphoblastic lymphoma with a protocol which we modified L-10M of Sloan-Kettering Cancer Center. Since the median follow up time is now over 5 years, we report the most recent outcome. Thirteen patients were male and 9 were female. The median age was 31, ranging from 15 to 71 years of age, and there were no Ph1 positive patients. The complete remission (CR) rate was 81.8%. Median CR duration was 32 months and the 5-year continuous CR rate was 33.3%. No significant prognostic factor for CR rate was found. Age at achievement CR and duration were significant prognostic factors. The 5-year continuous CR rate of patients below 35 years old was 54.5%. In this group the leukocyte count was a significant prognostic factor. All patients with a leukocyte count above 1 x 10(4)/microliters relapsed. However, in patients with a WBC below 1 x 10(4)/microliters, the 5-year continuous CR rate was 75%. Based on these results, it seems reasonable to treat patients with ALL by different therapeutic strategies according to the risk factors.

Identical blood pressure levels and slower heart rates among nurses during night work and day work

To investigate the effects of shift work on circadian BP variation, ambulatory 24h BP monitoring was performed during the day shift and night shift on 17 normotensive nurses. On both shifts, BP and heart rate increased in the working phase and decreased during sleep. The mean 24h BP and heart rate were identical in the two shifts. During sleep, BP was lower and the heart rate was slower in the day shift (night sleep) perhaps because of deeper sleep than during daytime sleep associated with the night shift. During work, BP was identical but the heart rate was significantly slower during the night shift. These data suggest that the circadian BP variation is determined largely by the sleep-wakefulness cycle and that the heart rate is also influenced by the internal body clock.

Thermal properties of glass ionomer cement

Five currently available glass ionomer cements (BASE CEMENT, DENTIN CEMENT, HY-BOND GLAS IONOMER-F, KETAC CEM, TOKUSO IONOMER) were studied with regard to the relationship between thermal properties and powder-liquid ratio (P/L ratio). The experiments were performed using five different P/L ratio of 0.8, 0.9, 1.0, 1.1 and 1.2 (P/L = 1.0: manufacturer's instruction) and measured with a xenon flash thermal-constant measuring device. Thermal diffusivity of the glass ionomer cements ranged from 0.212 to 0.303 x 10(-2) cm2 s-1; it increased according to the increase in the P/L ratio. The specific thermal capacity of the glass ionomer cements ranged from 1.011 to 1.369 Jg-1 K-1; it decreased with the increase in the P/L ratio. Thermal conductivity of the glass ionomer cements ranged from 0.505 to 0.712 Wm-1 K-1; it increased according to the increase in the P/L ratio.

Effects of an angiotensin-converting enzyme inhibitor, alacepril, on cardiovascular and sympathetic nervous responses to mental stress in patients with essential hypertension

The effects of an angiotensin-converting enzyme inhibitor, alacepril, on cardiovascular and plasma catecholamine responses to mental stress were studied. A mental arithmetic test (MAT) was carried out in 9 patients with essential hypertension before and after treatment with alacepril, 25 mg once daily for 2 weeks, and in 9 age- and sex-matched normal subjects. Systolic blood pressure at rest and during MAT and the change in plasma norepinephrine concentrations during MAT were significantly greater in the hypertensive subjects than in the normal subjects. Alacepril significantly reduced systolic blood pressure, both at rest and during MAT, as compared to before treatment in the hypertensive subjects. Furthermore, alacepril significantly attenuated the change in plasma norepinephrine concentrations during MAT (from 127 +/- 76 pg/ml to 66 +/- 42 pg/ml, p < 0.05). These results suggest that alacepril significantly suppresses the augmented cardiovascular and sympathetic nervous responses to mental stress in patients with essential hypertension.

Intraarterial infusion of high-dose adriamycin for unresectable hepatocellular carcinoma using direct hemoperfusion under hepatic venous isolation

A 67-year-old man with an extensive hepatocellular carcinoma (HCC) was treated successfully with intraarterial infusion of high-dose adriamycin (ADR), 150 mg/m2, five minutes continuous infusion using an extra-corporeal system consisting of direct hemoperfusion (DHP) under hepatic venous isolation (HVI). During drug infusion, hepatic effluent was isolated and adsorbed by the DHP for 30 mins. Plasma ADR levels in the radial artery reached a peak of 2.00 micrograms/ml at five mins after the initiation of drug infusion. Peak values at the inlet and outlet of the DHP were 19.71 micrograms/ml and 1.75 micrograms/ml, respectively, indicating substantial drug adsorption by the DHP. The estimated drug removal rate was 31.1%. This treatment led to a marked regression of tumors with tolerable systemic toxicities. Although the patient subsequently died 9 months after treatment of progression of disease, this treatment resulted in a remission of significant duration.

Determination of the phylogenetic relationships among Pacific salmonids by using short interspersed elements (SINEs) as temporal landmarks of evolution

Several subfamilies of the salmonid Hpa I short interspersed element (SINE) family were isolated from salmonid genomes and were sequenced. For each genomic locus that represented the subfamily, amplification by PCR of the orthologous loci in the 12 fish allowed us to determine the order of branching of the Pacific salmonid species. The deduced phylogeny suggests three evolutionary lines, namely, a line of chum salmon, pink salmon, and kokanee; a line of coho salmon and chinook salmon; and a line of steelhead trout. Our data also support a change in the phylogenetic assignment of steelhead trout from Salmo to Oncorhynchus. We present here an extensive phylogenetic tree constructed from an analysis of differential insertion of SINEs, and we propose that SINE insertion analysis is one of the best available methods for clarifying the order of divergence of closely related species.

[Brain metastasis of testicular yolk sac tumor with massive hemorrhage: case report]

A rare case of yolk sac tumor of the testis which metastasized to the brain parenchyma with repeated intra-tumoral hemorrhage is reported. The patient was a 38 year-old-man admitted to the Department of Urology with the chief complaint of painless swelling of the left testis for a period of one year. He underwent orchiectomy with highly suspected malignancy, because chest X-ray examination demonstrated metastatic coin lesions. Pathological examination of the operated specimen showed typical yolk sac tumor of the testis. Postoperative clinical course was uneventful. However, on the 4th postoperative day, the patient suddenly fell into a coma with left hemiplegia and dilated right pupil. CT scan demonstrated an intra-parenchymal hematoma in the right parietal lobe. Emergency craniotomy with evacuation of the hematoma clot was performed. Histological examination of the hematoma clot showed the same histology (yolk sac tumor) as found in the operative specimens of the left testis. After regaining full consciousness, chemotherapy (PEB and PVB) was started. It was effective to reduce the high serum AFP level and the size of the metastatic coin lesions in the lung. However, it was not effective in preventing brain metastasis. He again relapsed into coma due to a newly-developed intra-tumoral hematoma with multiple brain metastasis and died 6 months after the orchiectomy. Yolk sac tumor of the testis is rare in adult Japanese and there is no previous report of its metastasis to the brain parenchyma with intratumoral hemorrhage. We have reviewed the previously reported cases and discussed the brain metastasis of this malignant urogenic tumor.