Adenocarcinoma of the urachus: CT features

The CT findings of adenocarcinoma of the urachus in three patients were reviewed and correlated with pathologic features. The tumor was composed of two parts: supravesical and intravesical. The supravesical portion showed a cystic appearance with a capsule in the space of Retzius. The intravesical portions invading the dome of the bladder were polypoid and unencapsulated. These findings were consistent with pathologic findings in all three patients.

Locally advanced unresectable gastric cancer successfully resected after neoadjuvant chemotherapy with FADE regimen

The prognosis of unresectable advanced gastric cancer is extremely poor. We tried a neoadjuvant chemotherapy in locally advanced unresectable stomach cancer diagnosed by initial explo-laparotomy. After chemotherapy with the FADE regimen (5-fluorouracil + adriamycin + cisplatin + etoposide), the patient was diagnosed clinically as a complete response state on re-staging with radiological gastrointestinal study, fiber-gastroscopy and computerized tomography. During the second-look operation, the advanced cancer was completely resected and the pathological diagnosis was early gastric cancer (EGC) type IIc, stage II (T1N2Mo).

Adjuvant treatment of operable stomach cancer with polyadenylic.polyuridylic acid in addition to chemotherapeutic agents: a preliminary report

A randomized trial of polyadenylic.polyuridylic acid [poly(A).poly(U)] in addition to chemotherapy was undertaken in patients with stomach cancer following curative gastrectomy. They were randomized into a group of 108 patients receiving chemotherapy plus poly(A).poly(U) and a control group of 116 patients receiving chemotherapy alone. Chemotherapy consisted of injections of 5-fluorouracil, 12 mg/kg once weekly and adriamycin, 40 mg/m2 once every 3 weeks, continuously after operation. Poly(A).poly(U) was infused in a 100 mg dose, once a week six times from 5 days after the first injection of chemotherapeutic agents and 6 months later in a half dose similarly. At 55 months after initiation of the trial, the mean follow-up periods were 24 months for both groups. It has been revealed that patients who received the combined treatment postoperatively showed a lesser mortality and lower rate of recurrence, both reflecting significant increases in overall (P less than 0.05) and relapse-free (P less than 0.02) survivals as compared to those who received chemotherapy alone. This effect is more pronounced in patients having moderately advanced lymphnode involvement (N1) than in patients without (N0) or more advanced (N2) involvement. Thus, poly(A).poly(U) appears to be an effective agent when used postoperatively with chemotherapy in stomach cancers.

Anticancer effect of liposome incorporated with methotrexate and antibody against tumor specific surface antigen of rat hepatoma

antibody against tumor specific surface membrane protein was produced by immunizing a New Zealand White rabbit with antigen (66 kDa) prepared from the plasma membrane of rat hepatoma induced by feeding a diet containing 3'-methyl-4-dimethylaminoazobenzene, and was purified by protein A-Sepharose 6MB affinity chromatography. The purified antibody was incorporated into liposomes by a reverse phase evaporation vesicle method in order to prepare a tumor specific anticancer drug carrier. The effect of the antibody against tumor specific antigen was evaluated by comparing the inhibition of DNA synthesis in hepatoma cells with different preparations of methotrexate. Methotrexate encapsulated into liposome showed a stronger inhibitory effect on DNA synthesis (1.4-1.7 times) than free methotrexate. Liposomes having the antibody showed stronger inhibitory effect (3.1 times) on DNA synthesis than free methotrexate group in hepatic nodular area. From these results, it is concluded that tumor specific antibody inserted into liposomal membrane would be recognized by surface antigens which were expressed on the plasma surface membrane of rat hepatoma cells and thereby increase the carrying efficiency of drugs to the target cells. This could be useful in cancer chemotherapy.

Immunosuppressive effects of 2-acetylaminofluorene and 2-aminofluorene on murine splenocytes culture

The immunosuppressive effects of 2-acetylaminofluorene (AAF) and 2-aminofluorene (AF) were studied in BALB/c mouse splenocyte culture. Direct addition of AAF and AF to the splenocyte culture produced a dose-related suppression of the in vitro antibody response to sheep erythrocytes(SRBC), DNP-Ficoll, and lipopolysaccharide(LPS). AAF and AF also produced suppression on lymphoproliferative responses to LPS and concanavalin A(Con A). The immunosuppressive effects of AAF and AF, however, were diminished when AAF and AF were incubated in the splenocyte-hepatocyte coculture system for 4 hr. When hepatocyte cultures were pretreated with SKF 525A, a cytochrome P-450 inhibitor, before coculture with spleen cell along with AAF and AF, the suppression of in vitro antibody response reappeared. Meanwhile, both AAF and AF produced a dose-related DNA single-strand breaks in spleen cells only if AAF and AF were treated to spleen cells cocultured with hepatocytes. These results indicate that the immunosuppression by AAF and AF is not mediated by the reactive metabolites implicated to DNA damage.

Chlorophyll derivatives--a new photosensitizer for photodynamic therapy of cancer in mice

The in vivo photosensitizing efficacy of chlorophyll derivatives (CpD), which had been developed as a new photosensitizer, was compared with that of hematoporphyrin derivatives (HpD). A murine tumor model implanted subcutaneously with S-180 cells on the abdomen was used. The CpD or HpD was administered by intratumoral injection, and light of appropriate wavelength was irradiated on the tumor areas for 10 minutes at 1h and 24h or 24h and 48h after the injection of photosensitizer. When CpD was injected, the early irradiation group (1h and 24h) showed a 100% tumor cure rate; however, the late irradiation group (24h and 48h) showed a 60% tumor cure rate (p less than 0.01). This showed that the early irradiation with light after injection of CpD was an important factor for obtaining better results. With HpD, there was no difference in tumor cure rate between early (1h and 24h, 80%) and late irradiation (24h and 48h, 80%) groups. Thus, in early irradiation groups, the tumor cure rate using CpD (100%) was superior to that of HpD (80%) (p less than 0.05). However, in late irradiation groups, the tumor cure rate using CpD (60%) was inferior to that of HpD (80%), but this difference was not statistically significant (p greater than 0.1). Pathologic sections of these tumors were made before treatment and 48h and 3 weeks after treatment. These showed geographic necrosis at 48h after treatment and no viable tumor tissue at 3 weeks after treatment. Our results showed that CpD was as effective as HpD as a photosensitizer for in vivo photodynamic therapy.

Incidence and survival of cancer in Kangwha County (1983-1987)

To measure incidence and survival rates of cancer in Kangwha County, 663 cancer patients registered in the Kangwha County Cancer Registry Program for the past 5 years (1983-1987) were analyzed. The average annual cancer incidence rate per 100,000 population was 183.0 in males and 99.5 in females. The common cancers were stomach (37.3%), lung (14.8%), and liver cancer (11.1%) in males and stomach (25.6%), cervix uteri (20.9%), and liver cancer (9.7%) in females. The median survival times of all cancer patients after diagnosis and onset of the first symptom were 8.4 +/- 0.8 months and 15.0 +/- 1.1 months respectively. Female cancer patients survived significantly longer than male cancer patients. The median survival times of the stomach, lung, and liver cancer in males were 7.7 +/- 0.9, 4.9 +/- 0.9, and 2.3 +/- 0.4 months respectively. In females, the median survival times of the stomach and liver cancer patients were 9.2 +/- 1.5 and 2.5 +/- 0.5 months. The 5 year survival rate of cervical cancer was 67.1%. Those cancer patients who received anticancer therapy survived significantly longer than cancer patients without treatment.

Production of DNA single-strand breaks in unstimulated splenocytes by dimethylnitrosamine

In an attempt to elucidate the mechanism whereby primary hepatocytes, but not liver S9 homogenates, generate immunosupprssive metabolites of dimethylnitrosamine (DMN), the production of DNA single-strand breaks (SSB) in unstimulated splenocytes was investigated with alkaline-elution analysis. Both hepatocytes and S9 homogenates induced SSB in cultured splenocytes by DMN - minimum detectable doses with the two metabolic activation systems (MAS) were 1 microM and 5 mM, respectively. DNA elution profiles were linear in splenocytes co-cultured with DMN and hepatocytes and convex in splenocytes incubated with DMN and S9 homogenates. Aminoacetonitrile (AAN; 10 mM), a DMN demethylase inhibitor, reversed SSB in splenocytes when incubated with either MAS. Addition of exogenous calf-thymus DNA to the hepatocyte co-culture medium did not affect the production of SSB. Rocking the hepatocyte-splenocyte cultures changed the elution profile from linear to convex. All of these treatments have been previously shown to block the immunosuppression by DMN in the hepatocyte co-culture system. These results indicate that the immunosuppression by DMN is not related to DNA damage, as measured by the production of SSB, and suggest that the metabolism of DMN to intermediates capable of producing genotoxicity and immunotoxicity may be qualitatively and/or quantitatively different.

Suppression of humoral immune responses by dialkylnitrosamines: structure-activity relationships

Comparisons between chemical structure of N,N-dialkylnitrosamine congeners and their ability to alter the Day 4 IgM antibody response to sRBC, body weights, and organ weights of female B6C3F1 mice were investigated. Short-chain nitrosamine congeners were selected for these studies on the basis of two criteria: (1) congeners with symmetrical aliphatic chain length [N-nitrosodimethylamine (DMN), N-nitrosodiethylamine (DEN), N-nitrosodipropylamine (DPN), N-nitrosodibutylamine (DBN)] and (2) congeners possessing an N-methyl group [N-nitrosomethylethylamine (MEN), N-nitrosomethylpropylamine (MPN), and N-nitrosomethylbutylamine (MBN)]. The immunotoxicity of each congener was evaluated based on the compound's ability to suppress the in vivo sRBC antibody response following 7 consecutive days of treatment. An ED50 dose was calculated, using a linear regression analysis, for each congener and represents the millimoles of congener per kilogram body weight required to cause a 50% suppression of the sRBC response. These studies demonstrated two general trends: (1) those dialkylnitrosamine congeners that possessed an N-methyl group were most immunotoxic and exhibited comparable ED50 concentrations (42-183 mumol/kg); and (2) dialkylnitrosamine congeners possessing symmetrical aliphatic chains demonstrated an inverse relationship between aliphatic chain length and immunotoxic potency--DMN (62 mumol/kg) greater than DEN (276 mumol/kg) greater than DPN (467 mumol/kg) greater than DBN (1557 mumol/kg). Comparisons were also made between the immunotoxic potency of various nitrosamine congeners in the whole animal and their potency in an in vitro hepatocyte-spleen cell coculture system.

A case of subcutaneous seeding of hepatocellular carcinoma after fine needle aspiration biopsy

Cancer spread along the needle track following fine needle aspiration biopsy is said to be a rare complication. The authors report a case of subcutaneous implantation of hepatocellular carcinoma following ultrasono-guided fine needle aspiration biopsy. The patient, a 67-year-old Korean male was found to have a large hepatocellular carcinoma diagnosed by fine needle aspiration biopsy. Four months later, the patient felt two subcutaneous growing lumps at the previous aspiration site. The authors confirmed them histologically 11 months after aspiration.

Current status and future aspects on treatment of liver cancer

Among 80 patients with advanced hepatocellular carcinoma, treated by systemic chemotherapy, 19 patients (24%) achieved partial response or stable disease. The median survival time of responders was 20 weeks. Radioiodinated fatty acid esters ([131I]lipiodol) are localized in hepatoma tissue for a considerable time. Taking advantage this phenomenon, there is a potential therapeutic effect of [131I]lipiodol, since the radioactive oil can deliver a therapeutic dose of internal radiation. The response rate of patients who had a small hepatoma (less than 5 cm in diameter) was 80%. Among 25 responders, 12 cases are alive after more than 1 year. A pilot study of hyperthermia, using a heating device capable of delivering radiofrequencies, combined with radiotherapy or chemotherapy, demonstrated that this modality is safe and effective in the treatment of advanced hepatocellular carcinoma. Of the 19 patients treated, 47% showed partial remission or stable disease. The median survival time of 9 responders was 9 months. Among the 9 responders 3 patients survived for over 1 year.

Cooperative clinical studies of hyperthermia using a capacitive type heating device GHT-RF8(Greenytherm)

Yonsei Cancer Center developed an RF(Radiofrequency) capacitive type heating device, GHT-RF8(Greenytherm) in cooperation with Green Cross Medical Corp., Korea in 1986 for the first time in Korea. Cooperative clinical studies of hyperthermia for the treatment of cancer using GHT-RF8 were conducted by Yonsei Cancer Center in collaboration with the Presbyterian Medical Center, Chonju, Korea. A total of forty patients with various histologically proven malignant tumors, including superficial (N = 13) and deep-seated tumors (N = 27), were treated with this newly developed heating device in conjunction with radiotherapy (N = 38) or chemotherapy (N = 2) at two different institutes between October 1986 and September 1987. These patients were locally far advanced or recurrent cases and considered to be refractory to conventional cancer treatment modalities. Radiotherapy was given in 200cGy per day, five times a week fractionations with a total tumor dose of 50-60Gy in 5-6 weeks. Within an hour after radiotherapy, the RF capacitive type of hyperthermia was given two times a week for a total of 4-10 treatment sessions and an attempt was made to maintain the tumor temperature at 41-45 degrees C for 30-60 minutes. Of forty patients treated, 14 patients with deep-seated tumors showed complete response and 20 patients showed partial response. The overall response rate was 85% (34 out of 40 patients) and only 6 patients showed no response. Complications from this treatment were mainly burns, superficial first degree burn in 2 cases, second degree in 4 cases and subcutaneous fat necrosis was observed in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary malignant lymphomas of the central nervous system: radiotherapy results in 12 cases

Twelve patients with primary lymphomas of the central nervous system were treated in the Department of Radiation Oncology, Yonsei University College of Medicine, between 1976 and 1987. There were seven males and five females ranging from 19 to 63 years of age. They had single (6 cases) or multiple (6 cases) discrete intracerebral nodules. All patients were treated with radiation therapy. Surgical resection was performed in five cases and intrathecal chemotherapy with methotrexate was performed in seven cases after radiotherapy. All patients except one had received whole brain irradiation with a median dose of 4000 cGy. The radiation dose for a primary tumor was 4800-6000 cGy (median 5560 cGy). Initial response to radiation was excellent with a 91.7% complete response rate, but late recurrences were noted and the median survival was 42.3 months. Intracranial recurrences were observed in two patients who received less than 4000 cGy to the whole brain without intrathecal chemotherapy. Although intracranial recurrence was not seen in the patients receiving intrathecal chemotherapy after radiation, a high incidence of necrotizing leukoencephalopathy was noted. High dose irradiation with a minimum of 4000 cGy to the whole brain and more than 5000 cGy to the primary tumor is recommended for the treatment of primary CNS lymphomas. Combined use of chemotherapy should be carefully attempted because of the increased toxicity.

Radioiodinated fatty acid esters in the management of hepatocellular carcinoma: preliminary findings

Radioiodinated fatty acid esters, such as lipiodol or ethiodol, are localized in the hypervascular hepatocellular carcinoma (HCC) for a long time following intra-arterial hepatic injection, enabling delivery of high internal radiation to the tumor. The desired radiation can easily be delivered to small HCC, less than 5 cm in diameter, in single or multiple procedures with an 8-week interval. For larger tumors, [131I]lipiodol or [131I]ethiodol in conjunction with chemotherapy emulsion, Ivalon embolization or all three combinations should be considered for maximal clinical results. A strong beta emitter with shorter physical half-life, i.e. 90Y will be more effective in the management of HCC if one can label lipiodol with 90Y.

Coexistence of antigen-specific and idiotype-specific suppressor T cells in mice injected neonatally with a mixture of antigen and anti-idiotype antibody

Specific tolerance to phosphorylcholine (PC) can be induced in BALB/c mice by neonatal injection with either pneumococcal C-polysaccharide (PnC) containing PC or anti-TEPC-15 idiotype (T15id) antibody which recognizes the predominant idiotype of anti-PC antibody of BALB/c mice. Suppressor T cells (Ts) induced after treatment with anti-T15id antibody react with the T15id and PnC-induced Ts cells appear to recognize PC. A brief incubation of anti-id-induced, T15id-specific Ts with PnC-induced, PC-reactive Ts resulted in complete cancellation of their suppressor functions. However, both types of Ts were present in mice neonatally injected with mixtures of PnC and anti-T15id antibody. Neutralization experiments using either PnC-induced or anti-id-induced suppressor T cells strongly suggest that only one of the Ts cell types is functionally dominant in those mice: most frequently, T15id-specific Ts cells. The suppressor function of the other population is detectable only when the predominant Ts cell population is removed by anti-id or monoclonal IgM anti-PC (SP45) plus complement. However, both suppressor activities are completely eliminated when one of the Ts populations is removed by adherence to either antigen or T15id. These results suggest that mice neonatally injected with a mixture of antigen and anti-id antibody possess both types of suppressor T cells, yet only one type is functionally dominant.

Ocular angiostrongyliasis in Japan: a case report

A small motile worm was found in the posterior pole of the eye of a patient, producing a decrease in visual acuity. The patient had signs of meningitis and had cerebrospinal fluid eosinophilia. His serum was positive for antibodies to Angiostrongylus cantonensis. Without surgical intervention, the patient recovered and his visual acuity returned to normal.

Treatment of hepatocellular carcinoma (HCC) with radiolabeled Lipiodol: a preliminary report

Fatty acid esters such as Lipiodol or Ethiodol (Savage Laboratories, Melville, New York) are known to selectively localize in vascular hepatocellular carcinomas (HCC), following intra-arterial hepatic administration. Lipiodol was labeled with radioactive 131I and administered in 47 patients with HCC for both imaging and therapy. The short term preliminary results suggest radiolabeled Lipiodol is effective in eliminating ascites, shrinking the tumor by a high internal radiation dose, and in improving symptomatology of these tumors. In the future, 90Y, which is a stronger pure beta-emitter (maximum beta energy of 2.27 MeV, a half life of 64 h, and a maximum penetration or beta range of 11mm), than 131I will be used for more effective treatment of HCC.

Safety and immunogenicity of a new heat-inactivated hepatitis B virus vaccine in adult recipients

A new heat inactivated HBV vaccine has been evaluated for safety and immunogenicity in 203 adult recipients. The vaccine was found to be safe and highly immunogenic. Three doses of 3 micrograms given at 0, 1 and 6 months, resulted in 96% seroconversion. Three doses of 3 micrograms given at 0, 1 and 2 months produced, more rapidly, seroconversion in 92% of those immunized. Antibody to a pre-S determinant developed in four of six subjects tested.

Clonogenic assay of gastric adenocarcinoma stem cells--clonogenic assay, stomach cancer

Clonogenic assay is the culturing of tumor stem cells, which are responsible for tumor growth by self renewal and differentiation to tumor end cells. Elimination of the malignant stem cells or their self renewal will lead cure of the tumor. Thus, the behavior of the stem cells by clonogenic assay has been correlated with prognosis and outcome of therapy.

We studied clonogenic assay by means of double agar system for 21 patients with advanced stomach cancer. The colony formation evaluted on 14th day of the culture was grown from 14 of 19 malignant effusions plated and 1 of 2 tumor nodules plated. The number of the colonies ranged from 5 to 96 per petri dish, and the median number was 20. The plating efficiency ranged from 0.001 to 0.036%, and the median was 0.003%. In the morphologic studies, the colonies made of tightly packed cells were grown from the poorly differentiated adenocarcinoma, whereas the colonies made of loosely packed cells with mucin formation were grown from the mucin secreting adenocarcinoma of stomach. The chemosensitivity in vitro tests to cisplatin were performed in 5 patients, and the results showed 4 sensitive and 1 resistant patient. The result of in vivo study with instillation of intraperitoneal cisplatin revealed that 3 patients “in vitro sensitive” were “responsive in vivo”, and 1 patient “in vitro resistant” was “non-responsive in vivo”.

We conclude that clonogenic assay of stomach cancer is useful method to understand the biology of the stem cell pool and select proper chemotherapy according to the chemosensitivity test.