UA_36_14R2

1 Commentary 1
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Urological concern after nuclear accidents 5
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9 This article[1] has cited the letter[2] along with several reports on These percentages are obviously unrealistic and indicative of 9
10 the urinary bladder carcinogenesis.[3-6] Moreover, the statement false-positivity. 10
11 at least, chronic exposure to ionizing radiation is considered 11
12 as an important stress and can result in deoxyribonucleic acid Looking at the figures in the earlier articles,[10,11] it appears 12
13 probable that overdiagnosis of dysplastic and neoplastic 13
dysfunction,[1] given with references to,[2,4] does not agree
14 bladder lesions could have happened also before: both 14
15 with.[2] In fact, the letter[2] is commenting on the studies.[4,6] 15
The following should be added to the previously published articles [10,11] used one and the same image of bladder
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17 comments.[2,7] leukoplakia with invasion (according to the legend). However, 17
18 invasive growth is not clearly recognizable [Figure 1]. 18
19 In the research series,[3-12] in different groups of patients with Furthermore, the illustrations from the article,[3] available 19
20 benign prostatic hyperplasia (BPH), from the contaminated online, should be commented (compare Figures 2 and 20
21 3 available at http://www.carcin.oxfordjournals.org/ 21
areas after the Chernobyl accident and the city of Kiev (not
22 content/30/11/1821.long Figure 2. From the caption: 22
23 officially counting to the contaminated territories), severe 23
urothelial dysplasia and/or carcinoma in situ (CIS) were Small developing papillary urothelial carcinoma with severe
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25 found by bladder biopsy as frequently as in 56-96% of dysplasia (G-L),[3] our comment: thick sections; in some plates 25
26 all randomly selected cases.[3,6] The random character of the nuclei are insufficiently stained. No severe dysplasia is 26
27 the bladder specimens was pointed out: The Institute of recognizable. A small papilloma or papillary cystitis cannot be 27
28 excluded [Figure 3]. From the caption: dysplasia (A-D) and 28
Urology (Academy of Medical Sciences of Ukraine) in Kiev
29 small papillary urothelial carcinoma (E-G),[3] Comment: mild 29
30 during 1994-2006 collected all BPH patients who underwent 30
to moderate atypia might be present; but neither severe dysplasia
31 suprapubic prostatectomy and all these patients were included 31
nor carcinoma are recognizable. All the slides are obviously too
32 in our study in different years without exception, along with 32
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thick for reliable diagnostics. Insufficient quality of specimens 33
a small number of females with chronic cystitis.[3] The
34 could have been caused also by fixation, processing-related 34
following was stated about the patients with BPH studied by factors and electrocoagulation. The same is true for the similar
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the bladder biopsy: Irradiation cystitis with multiple foci of images in the article[9] available at http://www.onlinelibrary. 36
37 severe urothelial dysplasia/CIS and some invasive transitional wiley.com/doi/10.1002/(SICI) 1097-0215 (20000615) 37
38 cell carcinoma (TCC) were observed in 96/66, 76/56 and 86:6%3C790:AID-IJC6%3E3.0.CO; 2-Q/full. Figure 4a 38
39 56/8% of patients in groups I, II and III respectively (the 39
40 group III was from non-contaminated areas).[8] In the Handout 40
41 by the same authors, distributed at the XXIII International 41
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Congress of the International Academy of Pathology on 43
44 October 15-20, 2000 in Nagoya, Japan, the following was 44
45 written: Histologically the different forms of proliferative 45
46 cystitis, which were frequently combined and had features of 46
47 irradiation cystitis with multiple areas of severe dysplasia and 47
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CIS, sometimes associated with small TCC, occurred in 97%
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50 of patients from the radiocontaminated areas of Ukraine. 50
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52 Access this article online 52
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Website:
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www.urologyannals.com
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Figure 1: Bladder leukoplakia with invasion. Poor quality of the
57 DOI:
images and obviously also of the specimens. The invasive growth 57
58 *** is not clearly recognizable. The images top left and bottom right are 58
59 identical. Commented in the text 59

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 Jargin: Letter from Russia

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5 g
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a m
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31 f l r 31
32 Figure 2: Histological and imunohistochemical findings: CIS (a-f), 32
33 small developing papillary urothelial carcinoma with dysplasia (g-r). 33
34 (a, g and m) H and E, (b, h and n) p53 expression, (c, l and o) Cox2 d 34
35 expression, (d, j and p) iNOS expression, (e, k and q) H-ras expression Figure 3: Urothelial dysplasia (a-d) and small papillary urothelial 35
36 and (f, l and r) 8-OHdG expression. Magnification 100 carcinoma (e-g). (a) H and E, (b) p65 expression, (c) p50 expression, 36
37 (d) p38 expression, (e) H and E, (F) p65 expression and (g) p50 37
38 from[9] and Figure 2g from[3] are identical. Note that overdiagnosis expression. Magnification 100 38
39 could have entailed over-manipulation (cystoscopy) and 39
40 overtreatment. It cannot be excluded that the above-mentioned papers[3-6] should consider retraction to prevent repetition of 40
41 suboptimal practices.[16] Although some screening programs 41
irradiation cystitis or Chernobyl cystitis,[3,12] characterized
42 are very effective at saving lives, excessive screening for cancer 42
43 among others by the reactive epithelial proliferation associated 43
with hemorrhage, fibrin deposits, fibrinoid vascular changes and and precancerous lesions can be associated with a risk of
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45 multinuclear stromal cells[12] was at least in part caused and/ overdiagnosis and overtreatment,[17] especially if diagnostic 45
46 or maintained by repeated cystoscopies with mapping biopsies, facilities are not perfect, including at the same time invasive 46
47 electrocoagulation etc. manipulations. 47
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49 Furthermore, the cesium-137 activity concentration in Pathology of the prostate gland and erectile dysfunctions 49
50 urine (the mean value in the most exposed group was 6.47 after the Chernobyl accident, discussed[1] are different topics, 50
51 Bq/L), reported ,[3,6] and possible radiation doses that could deserving a separate review of the literature. However the 51
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have resulted from it, were discussed .[7,13] It was concluded that study,[18] not cited in,[1] should be mentioned, the more so as
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54 the doses would be too low to cause any increase in bladder histopathological data are absent from the PubMed abstract 54
55 malignancy or the radiation induced chronic proliferative of this article published in the principal journal of Russian 55
56 atypical cystitis, reportedly characterized by multiple areas of pathologists Arkhiv Patologii (Archives of Pathology): in 56
57 severe dysplasia and CIS.[3] Retractions are on the up today,[14] 75.6% of testicles picked at random (forensic cases, residents 57
58 but not in the former Soviet Union, where, as far as we know, of Kaluga district of Russian Federation) was found paucity or 58
59 no articles have been retracted so far.[15] The authors of the absence of germ cells, affecting > 10% of spermatic tubules, 59

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 Jargin: Letter from Russia

1 humans and Re: DNA damage repair in bladder urothelium after the 1
2 Chernobyl accident in Ukraine. J Urol 2007;177:794. 2
3 3. Romanenko A, Kakehashi A, Morimura K, Wanibuchi H, Wei M, Vozianov A, 3
et al. Urinary bladder carcinogenesis induced by chronic exposure
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to persistent low-dose ionizing radiation after Chernobyl accident.
5 Carcinogenesis 2009;30:1821-31.
5
6 4. Romanenko A, Morimura K, Wei M, Zaparin W, Vozianov A, Fukushima S. 6
7 DNA damage repair in bladder urothelium after the Chernobyl accident in 7
a b
8 Ukraine. J Urol 2002;168:973-7. 8
9 5. Romanenko AM, Morimura K, Kinoshita A, Wanibuchi H, Takahashi S, 9
10 Zaparin WK, et al. Upregulation of fibroblast growth factor receptor 3 and 10
11 epidermal growth factor receptors, in association with Raf-1, in urothelial 11
12 dysplasia and carcinoma in situ after the Chernobyl accident. Cancer Sci 12
2006;97:1168-74.
13 13
6. Romanenko AM, Kinoshita A, Wanibuchi H, Wei M, Zaparin WK,
14 Vinnichenko WI, et al. Involvement of ubiquitination and sumoylation in 14
15 c d bladder lesions induced by persistent long-term low dose ionizing radiation 15
16 in humans. J Urol 2006;175:739-43. 16
17 7. Jargin SV. Overestimation of Chernobyl consequences: Biophysical aspects. 17
18 Radiat Environ Biophys 2009;48:341-4. 18
19 8. Romanenko A, Fukushima S. Prediction of urinary bladder cancer induction 19
20 in Ukraine after the Chernobyl accident. XXIII International Congress of the 20
International Academy of Pathology and 14th World Congress of Academic
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and Environmental Pathology, 15-20 October 2000, Nagoya, Japan. Pathol
22 e Int 2000;50 Suppl: A70.
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f
23 9. Romanenko A, Morimura K, Wanibuchi H, Salim EI, Kinoshita A, Kaneko M, 23
Figure 4: Small developing papillary TCC with severe dysplasia.
24 et al. Increased oxidative stress with gene alteration in urinary bladder 24
(a) H and E. (B) p53 expression. (c) H-ras expression. (d) COX-
25 2 expression. (e) iNOS expression. (f) 8-OHdG expression. urothelium after the Chernobyl accident. Int J Cancer 2000;86:790-8. 25
26 Magnification x100 10. Romanenko AM, Klimenko IA, Iurakh GIu. Leukoplakia of the bladder. Arkh 26
27 Patol 1985;47:52-8. 27
28 11. Romanenko AM. Chronic cystitis in the aspect of its relationship with 28
which was interpreted as hypospermatogenesis associated precancerous conditions. Arkh Patol 1982;44:52-8.
29 29
30 with decreased fertility and attributed to the radiation exposure 12. Romanenko A, Vozianov A, Morimura K, Fukushima S. Correspondence
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due to the Chernobyl accident.[18] re: W. Pailes letter to the editor. Cancer Res., 60:1146, 2000. Cancer Res
31 2001;61:6964-5. 31
32 13. Jargin SV. On overestimation of Chernobyl accident effects: Urinary bladder 32
33 Sergei V. Jargin tumors. Med Radiol Radiat Safety (Moscow) 2007;52:83-4. 33
34 14. Van Noorden R. Meeting targets lab lapses. Nature 2013;497:300-1. 34
35 Department of Pathology, Peoples Friendship University 15. Jargin S. Criticism of scientific misconduct in the former SU. 35
36 of Russia, Clementovski per 6-82, 115184 Moscow, Russia Retraction watch. Available from: http://www.retractionwatch.com/ 36
37 what-people-are-saying-about-retraction-watch/. [2014 Feb 22]. 37
Address for correspondence: 16. Jargin SV. Renal biopsy research in the former Soviet union: Prevention of
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Dr. Sergei V. Jargin, a negligent custom. ISRN Nephrol 2013; Volume 2013, Article ID 980859,
39 Department of Pathology, Peoples Friendship University of 5 pages, http://dx.doi.org/10.5402/2013/980859
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40 Russia, Clementovski per 6-82, Moscow 115184, Russia. 17. Early warnings. Nature 2009;458:679. 40
41 E-mail: sjargin@mail.ru 18. Lysenko AI, Kirpatovski ID, Pisarenko SS. Morphological changes in male 41
42 sexual glands in Kaluga regions contaminated with radionuclides. Arkh Patol 42
43 REFERENCES 2000;62:27-31. 43
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45 1. Wiwanitkit V. Urological concern and postcrisis Japanese nuclear accident. How to cite this article: ??? 45
46 Urol Ann 2012;4:135-6. 46
2. Jargin SV. Re: Involvement of ubiquitination and sumoylation in bladder
47 Source of Support: Nil, Conflict of Interest: None. 47
lesions induced by persistent long-term low dose ionizing radiation in
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