Search

Serum haptoglobin levels were measured in 116 patients with renal cell carcinoma. The overall accuracy of correlation between haptoglobin levels and the presence or absence of known disease was 68% (normal in 87% of patients without clinically apparent disease, and elevated in 58% of patients with disease). The levels appear to correlate with the extent of tumor burden: stable when clinical disease is stable, rising as disease progresses, and falling after effective therapy. Serum haptoglobin is rarely falsely elevated, which suggests an excellent potential for disease surveillance. This nonspecific tumor marker appears to merit further evaluation in patients with renal cell carcinoma.

This is a retrospective review of 62 patients with Stage II testicular seminoma treated either by initial radiation therapy (48 patients) or by platinum-containing chemotherapy (14 patients). For all 62 cases, disease-free survival from 2 to 20 years was 86%, uncorrected survival was 86% at 5 years and 83% at 15 years, and survival corrected for deaths from intercurrent disease was 90% from 2 to 20 years. There were no significant differences in outcome between the two treatment groups. An analysis of potential prognostic factors for the initial radiation therapy group and for the whole group revealed that age, site of primary, cryptorchidism, ipsilateral hernia repair, contralateral testicular atrophy, scrotal incision, elevated postorchiectomy beta-human chorionic gonadotropin level, epididymal invasion, spermatic cord involvement, and vascular invasion in the primary were not significant. However, bulk of abdominal disease was a prognostic factor. Patients with small-volume abdominal disease defined as nonpalpable disease or as a mass less than 10 cm in largest diameter accounted for two-thirds of the series and had a disease-free survival of 95% when treated with initial radiation therapy. Patients with bulky disease, either palpable or greater than or equal to 10 cm in diameter, had a disease-free survival of 64%. The relative roles of the two treatments in bulky abdominal disease are discussed, but in the absence of a prospective study it is not possible to definitively answer the question of which modality is best in this setting. In our series, the patients treated with platinum-containing chemotherapy fared as well as the primarily irradiated patients, but 71% of the former had palpable masses, compared with 22% of the latter. The chemotherapy-treated patients who relapsed were treated with radiation therapy for salvage, leading to a 100% survival corrected for intercurrent death. We have therefore elected to continue the policy of initial radiation therapy for small-volume (less than 10 cm) disease and platinum-containing chemotherapy for bulky disease (greater than or equal to 10 cm), with irradiation used for residual masses.

Sixty-two men who presented with previously untreated metastatic carcinoma of the prostate (D0: 10 patients; D1: 29 patients; D2: 23 patients) received oral megestrol acetate (80 mg twice daily) and minidose estrogen (diethylstibestrol 0.1 mg or ethinyl estradiol 0.05 mg once daily) as a means of achieving total androgen ablation (testicular and adrenal). A high incidence of feminizing side effects (70-74%), a higher than expected rate of cardiovascular complications (18%), an unexpected need for cortisone replacement (13%), and failure of patients with Stage D2 disease to obtain results better than those of standard therapy during the first year of observation suggest this regimen offers no advantage over other more conventional therapy.

Three cases of mixed mesodermal tumors of the urinary bladder characterized by the simultaneous occurrence of malignant epithelial and mesenchymal elements in the same tumor are reported. Integrated therapy consisting of preoperative radiotherapy followed by radical cystectomy is recommended. Chemotherapy is best withheld until the nature of any metastatic disease has been confirmed histologically in order that the appropriate drugs can be administered.

Sonographic detection of early prostatic carcinoma is based on the depiction of a hypoechoic focus. Thirty-seven correlations between in vitro sonographic patterns and pathologic mapping of prostatectomy specimens could be obtained in 26 patients. It was assumed that carcinomas smaller than 5 mm in diameter could not be visualized on sonography. Sonography identified 4 to 8 carcinomas greater than 5 mm in size (sensitivity, 50%). Of 18 hypoechoic foci, only 4 were carcinomas (positive predictive value, 22%). Among false positive results, 79% corresponded to normal prostatic tissue at pathology. The specificity of the hypoechoic focus as an indicator of cancer was 52% in this series. 36% of the carcinomas were located in the anterior half of the prostate. The carcinomas that were detected on sonography were all hypoechoic.

We describe 16 patients who underwent conservative surgical treatment of the ilioinguinal region after transscrotal orchiectomy had demonstrated a non-seminomatous germ cell tumor. Treatment consisted of an en bloc partial scrotectomy and removal of the remaining spermatic cord, usually through 2 incisions. Residual disease was present in 3 patients (19%) but malignant disease has not recurred in any. It is concluded that an inguinal lymphadenectomy is not warranted routinely in such patients.

Between 1974 and 1978, 258 patients with clinical Stage C adenocarcinoma of the prostate were treated at the U.T. M.D. Anderson Hospital in Houston. Of these, 208 were considered evaluable for a review of the impact of transurethral resection (TUR) on the dissemination of disease. After TUR, the incidence of disease progression was 38.9 per cent, compared with 36.4 per cent for patients who did not undergo TUR. There were significant differences in both incidence of progression (31.2% versus 55.6%, p = 0.002) and time to progression (p less than 0.001) when patients were divided into Stages C1 and C2 (presence or absence of pelvic side wall fixation) irrespective of their TUR status. Therefore, it appears that for patients with locally advanced prostate cancer, the degree of tumor burden and not the TUR status has a significant influence on disease progression.

Records were reviewed for 44 patients with primary carcinoma of the ureter. The lesion was transitional cell carcinoma in 40 patients, squamous carcinoma in 3 and unclassified carcinoma in 1. The distal ureter was the site of origin in 73 per cent of the patients. The over-all 5-year survival rate of 67 per cent was influenced by the grade and the stage of the tumors, did not have a significant influence on survival. The results suggest that conservative management should be limited to patients with low grade noninvasive tumors confined to the distal ureter. Adjuvant radiation therapy and/or chemotherapy deserves further evaluation in the management of patients with invasive disease.

We have evaluated immunoscintigraphy in cancer patients using four 111In-labelled murine monoclonal antibodies (MoAb): 96.5 (anti-P97 of melanoma), ZME-018 (anti-high molecular weight antibody of melanoma), ZCE-025 (anti-CEA for colon cancer) and PAY-276 (anti-prostatic acid phosphatase for prostatic cancer). The effect of increasing the doses of unlabelled MoAb (co-infused with 1 mg labelled MoAb) on the relative body distribution of each labelled MoAb was assessed. Localization in the liver decreased significantly in all cases, with increasing MoAb dose, except for ZME-018. Localization in other organs increased significantly as the liver activity decreased. The spleen activity, however, fell in the case of MoAb ZME-018. Blood-pool activity increased with MoAb dose in all four MoAbs. These findings correlated with the rise in the detection rate of metastases, the plasma half-life, and other pharmacokinetic parameters. However, the dose level at which this correlation occurred varied with each antibody. These data demonstrate that co-infusion of unlabelled MoAb with 111In-labelled MoAb could alter the organ distribution, pharmacokinetics and tumour uptake in a favourable manner, though the degree to which this occurs depends on the antibody in question.

Although there are numerous references in the medical literature suggesting that calification associated with renal masses is indicative of malignant disease, our recent experience with four cases emphasizes that it is not possible to predict the nature of these lesions. The significance and etiology of renal calcification are discussed as well as the indications for clinical evaluation.

Thirty patients with clinically localized adenocarcinoma of the prostate underwent simultaneous staging pelvic lymphadenectomy and interstitial irradiation. Patients were followed for eighteen to forty-five months with regard to progression of disease and development of long-term complications. Upstaging to Stage D1 by virtue of discovering pelvic node involvement was noted in 16 patients (53.3 per cent). Subsequent disease progression (defined as development of bone or soft tissue metastasis) was seen in 9 of 16 upstaged patients with an average time to progression of 12.2 months. Three Stage D1 patients have died with an average time to death of 19.6 months. Only 1 patient whose lymphadenectomy was negative has experienced disease progression, and none has died. Adjuvant chemotherapy (cyclophosphamide and doxorubicin hydrochloride) was given to 9 upstaged patients, in only 3 did disease progress. In contrast, in 6 of 7 upstaged patients not receiving chemotherapy metastatic disease developed, with an average time to progression of 10.3 months. In an attempt to improve local tumor control achieved by interstitial irradiation alone, 18 patients received additional external beam radiation therapy to the prostate, in doses ranging from 2,000 to 4,000 rad. There were sixteen long-term complications in the 30 patients, 75 per cent of which were seen in patients receiving added external beam irradiation.

Carcinoma metastatic to the ureter, representing hematogenous or lymphatic spread from a distant primary neoplasm, was diagnosed in 39 patients. Although the lesions are uncommon and usually represent late manifestations of malignant disease, earlier recognition and relief of urinary tract obstruction may allow for improvement in symptoms and survival.

The light-microscopic, immunohistochemical, and ultrastructural features of two examples of a pseudosarcomatous fibromyxoid tumor of the urinary bladder are reported. Both patients were women, 56 and 52 years old. Gross hematuria was the chief complaint and occurred for two days and two weeks, respectively, before presentation. Cystoscopy revealed a 2 X 1 X 1 cm mass located at the dome in case 1 and a 4 X 3 X 3 cm mass at the left posterior lateral wall in case 2. Microscopically, the lesions were composed of spindle, plump, or stellated fibroblast-like cells embedded in myxoid stroma with little collagen; mitotic figures were about 2 per 10 high-power fields, and both cases showed encroachment of the superficial muscle bundles. Because of bizarre spindle cell proliferation, occasional mitoses, and invasion to the underlying muscle, these lesions were initially diagnosed as embryonal rhabdomyosarcoma. However, follow-up examination disclosed the benign nature of these lesions. There was no previous instrumentation or surgery on the genitourinary tract. Immunohistochemical and ultrastructural studies revealed the fibroblastic-myofibroblastic nature of these lesions. These cases illustrate that clinicopathologic correlation is essential to define certain pseudosarcomatous lesions.

Prostate biopsy and total prostatectomy specimens from 31 patients with adenocarcinoma of the prostate were compared using the Gleason histopathologic grading system. The overall accuracy when grouping the scores into three categories (2-4, 5-7, and 8-10) was 81 per cent. The incidence of critical undergrading was 6 per cent while the incidence of critical overgrading was 13 per cent. Eighty-seven per cent of the biopsy scores were plus or minus 1 Gleason unit of the prostatectomy scores. Intraobserver variation was less than 1 Gleason unit. The mean absolute difference between the biopsy and the total prostatectomy specimen was 0.77 Gleason units. The Gleason category score of the total prostate specimen can be predicted from the biopsy tissue with reasonably good accuracy. The limitation of this grading system in predicting the presence or absence of pelvic node involvement is discussed.

In this prospective study we examined the oral electrolyte-overload method of bowel preparation for patients who were to undergo radical cystectomy and ileal conduit urinary diversion. We found it to be a safe and effective mechanical bowel preparation that can be used by outpatients. It was well tolerated and resulted in adequate bowel cleansing and a low incidence of postoperative wound infections and pyelonephritis. A major advantage of this method is that it reduced the period of preoperative hospitalization.

Intussusception ureterectomy has been used to excise prophylactically the distal ureter in 10 patients with carcinoma of the renal pelvis. The procedure has proved safe and expeditious, as well as permitting more precise excision of the surrounding vesical mucosa.

In 107 patients who died of metastatic transitional cell carcinoma, the most common sites for metastases at necropsy were the lymph nodes, liver, lung, bone, and adrenal gland. Metastases first were documented clinically in multiple-organ sites in one third of the patients; solitary metastases were present in only 9 patients at necropsy. The mean duration of survival for patients was thirteen months from the diagnosis of the primary tumor. The metastatic lesion(s) generally were evident clinically within eleven months of the primary diagnosis; death ensued usually within three months. Our finding that the majority of patients presented initially with high-grade tumors suggests that a high-grade lesion, regardless of its clinical stage, warrants early aggressive therapy.

Pathologic evaluation of tumor extent in a radical prostatectomy specimen for prostatic adenocarcinoma is extremely important in staging and planning further therapy. We studied whole-organ sections of 50 prostate glands, obtained at either radical prostatectomy for adenocarcinoma or cystoprostatectomy for bladder cancer, to evaluate the so-called capsule of the prostate, the prostatic apex, and the surgical margins. The outer surface of the prostatic portion of the specimen was totally inked with different colors for the anterior, posterior, left, and right areas. Cross sections were processed for histologic examination, and the apex (distal 1.5 cm) was amputated and radially sectioned (like a cervical cone). We found that the "capsule" is made up of a band of concentrically placed fibromuscular tissue that is an inseparable component of the prostatic stroma. The outer surface of this tissue gives rise to a few bundles of fibromuscular stroma that penetrate and disappear into the periprostatic connective tissue stroma. The apex is sparse in glandular elements, particularly in the anterior portion, and the outer fibromuscular layer is no longer present. Thus we conclude that the prostate does not have a true capsule, but only an outer fibromuscular band.

Twenty-five consecutive patients who had an abnormal prostate examination were subjected to transrectal biopsy of the prostate gland. The day prior to biopsy the patients were started on a modification of the Nichols-Condon bowel preparation utilizing only neomycin and erythromycin base. Although none of the patients became febrile, 3 patients had a positive post-biopsy blood culture (2 anaerobic and 1 aerobic). None of the 24 patients with a negative pre-biopsy urine culture had a positive post-biopsy culture. This regimen effectively reduces the reported incidence of both fever (95% confidence limit of 0 to 13.7% for the true proportion) and bacteremia (95% confidence limit of 2.6 to 31.2% for the true proportion).