Cisplatin-induced changes of selenium levels and glutathione peroxidase activities in blood of testis tumor patients

Haematocrit and glutathione peroxidase activity in blood, as well as selenium levels in blood, erythrocytes and plasma, were determined in 15 patients during four courses of cisplatin combination treatment for testicular teratoma. The haematocrit steadily declined, necessitating frequent blood transfusions during or after treatment. For patients without blood transfusions during treatment the reduction of the haematocrit averaged 40%. Glutathione peroxidase activity in blood declined also; for patients without blood transfusion the reduction was 30%, which is fully explained by the decrease of the haematocrit. The enzyme activity per volume of erythrocytes remained constant during the treatment. Erythrocyte selenium level did not change significantly, but plasma selenium levels of all patients dropped within each course of chemotherapy, and progressively with each subsequent course. Between cycles the levels were largely restored to almost normal values. These results may be explained by a decreasing availability of selenium in the body to maintain the normal plasma level, due to increased retention of cisplatin in tissues and subsequent alteration of selenium metabolism.

High frequency of incomplete human chorionic gonadotropin in patients with testicular seminoma

We measured human chorionic gonadotropin by 2 immunometric assays that require that the entire human chorionic gonadotropin molecule is intact, and by a competitive radioimmunoassay that measures intact human chorionic gonadotropin and its free beta-chain. The sera tested were samples from male cancer patients with elevated human chorionic gonadotropin levels obtained by the radioimmunoassay method. Elevated levels were confirmed in 67 of 92 samples (72 per cent) with the immunometric methods. However, in 25 of 97 patients (28 per cent) elevated human chorionic gonadotropin was found with the radioimmunoassay, whereas the values were in the normal range when measured with the immunometric assays. These discrepancies were found in 22 patients with seminomatous tumors, including 2 extragonadal germ cell tumors, which constitutes 42 per cent of all seminoma patients tested. Of the remaining 3 discrepant patients 2 had lung cancer and 1 had metastases from an unknown primary cancer.

Sarcoidosis and testicular tumors

A thirty-five-year-old white man presented with hilar adenopathy and elevated alpha-fetoprotein after retroperitoneal node dissection and chemotherapy for mixed embryonal seminomatous testicular tumor. A biopsy completed by mediastinoscopy demonstrated sarcoidosis.

Profiles of epitope-defined markers in sera from patients with testicular germ cell tumors

Epitope-defined tumor markers of AFP (FA), HCG (PM), PLAP (H7) and CEA (D/AH) were determined by monoclonal antibodies in sera of patients with germ cell tumors of the testis. Characteristic profiles of PLAP (H7) were seen in localized and metastatic seminoma and in sera of patients with mixed tumors with seminoma components. PLAP (H7) levels started to rise 10 months before clinical detection of recurrence in one case. Persisting elevated levels of PLAP (H7) in several cases were indicative of metastatic seminoma. PLAP (H7) occurred rarely in sera of patients with metastasing non-seminomatous tumors. AFP (FA) detected in seminoma sera led to identification of non-seminomatous disease in one case. High AFP (FA) alone occurred in yolk sac tumors, HCG (PM) with AFP (FA) or PLAP (H7) in patients where the tumors had components of teratoma and/or embryonal carcinoma, moderately elevated levels of AFP (FA) and sometimes also HCG (PM) occurred.

False positive beta-human chorionic gonadotropin in testicular cancer

Persistent elevations in serum markers after chemotherapy for germ cell testicular carcinoma indicate residual disease. We report on a patient with advanced seminoma with choriocarcinoma who had elevated serum beta-human chorionic gonadotropin (beta-HCG) and residual masses on computerized tomography scan after chemotherapy. Wedge liver resection and retroperitoneal node dissection yielded only necrotic tissue which assayed and immunoperoxidase stained positively for beta-HCG. Serum beta-HCG fell to undetectable levels postoperatively, and the patient remains disease-free after three years. Phagocytosis of necrotic tumor apparently released entrapped beta-HCG resulting in a false positive tumor marker.

[Clinical observation of twelve cases of testicular cancer]

Twelve cases of testicular cancer were treated at our Department of Urology between 1984 and 1985. The mean age of the patients was 35.2 years old. Eight of them were pure seminoma in histology, other cases were non-seminomatous germ cell tumors (NSGT). Seven cases were of stage I testicular cancer, 3 cases were of stage IIA, and 2 cases were of stage IIB. Patients with stages I and IIA seminoma were given radiation to the ipsilateral iliac and bilateral paraaortic caval nodes to the crura of the diaphragma. Two patients with stage IIB seminoma were treated with PVB therapy and retroperitoneal lymph node resection. Chemotherapy containing CDDP was effective to reduce the tumor size. Two cases were of stage I NSGT, one case was treated with high orchiectomy only, and the other case was treated with chemotherapy after high orchiectomy. Chemotherapy and retroperitoneal lymph node resection were given to two patients with stage IIA NSGT. Abnormally elevated values of lactate dehydrogenase were observed in cases with a primary tumors weight larger than about 100 g. Six of the 8 cases of pure seminoma had slightly elevated beta-human chorionic gonadotropin levels. Two cases with bilateral testicular cancer were found among the 12 cases so that necessity of meticulous palpation of remaining testis was felt. Recurrent change was not observed in any of the 12 cases so that testicular cancer is considered to be an almost curable disease.

The diagnostic value of human chorionic gonadotrophin in patients with testicular seminoma

Human chorionic gonadotrophin (HCG) was measured in sera from seminoma patients by an immunoassay which recognised both free beta-chains and intact HCG molecules. This seemed to increase the sensitivity of the assay without affecting its specificity. The HCG values were correlated to the clinical course in 151 patients. Pre-orchiectomy samples were assayed in 57 patients. Elevated pre-operative HCG levels were found in 15 of 38 patients (39%) in stage I and in 13 of 19 patients (68%) in stages II to IV. After orchiectomy the HCG values were normal in 114 of 115 patients in stage I and elevated in 13 of 36 patients (36%) in stages II to IV. Relapses were observed more often in stage II to IV patients who produced HCG at the time of diagnosis than in non-producers (3 of 13 patients versus 1 of 23 patients). In 7 of 11 relapses the serum HCG was elevated. HCG positive relapses were seen in patients both with and without initially elevated serum HCG.

Surveillance after orchiectomy for stage I seminoma of the testis

Between February 1983 and July 1985, 52 patients with Clinical Stage I seminoma were observed after orchiectomy without lymph node irradiation. Seven patients (13%) have relapsed, six in retroperitoneal lymph nodes and one with abdominal node and pulmonary metastases. Relapses were diagnosed 6 to 23 months after orchiectomy, four occurring in the first year and three in the second year. Of eight patients with raised serum concentrations of HCG prior to orchiectomy none has relapsed, whereas of 14 patients with normal HCG levels one has relapsed. The significance of these observations for future management policy is discussed.

Angiotensin I-converting enzyme in a suprasellar germinoma

High levels of angiotensin I-converting enzyme (ACE) were found by both direct radioimmunoassay and enzyme activity evaluation in a patient's plasma that had suprasellar germinoma. ACE levels returned to normal values after surgery, suggesting the tumor was the cause of the elevated plasma ACE. ACE was found in the tumor, and ACE activity was measured in a tumor extract. With the use of specific antihuman ACE antibodies, ACE was localized by immunohistochemistry in the tumoral germinal cells. Because ACE was also found in testicular germinomas, it appears to be a possible marker for germ cell tumors.

Quantification of alpha-fetoprotein and beta-HCG in testis tumor patients

Patients with testis tumor were investigated for serum and tissue levels of alpha-fetoprotein and beta-human chorionic gonadotropin (beta-HCG). The tissue immune peroxidase-antiperoxidase staining for the tumor marker was quantitated by computer-assisted immunohistophotometry and immuno-gamma ray histospectrometry. The results supported the general view that mostly polynuclear giant cells produce beta-HCG in 66% of nonseminoma cancer. This finding qualifies beta-HCG as relatively unspecific in the absence of chorioepithelial cells in the tumor. Discrepancies of tissue and serum beta-HCG values may be caused by deglycolysation of beta-HCG while penetrating the perivascular tissues. Alpha-fetoprotein (AFP) appears helpfully to discriminate the true seminoma cancer, which is constantly negative. Histologically pure seminoma which reacts for AFP therefore suggests sclerotic teratoma compartments. A constant finding is the significantly reduced synthesis rate of tumor markers in metastasis compared to primary tumor.

Biologic tumor markers in management of testicular and bladder cancer

The role of biologic markers in the management of testicular and bladder cancer has been described. alpha--fetoprotein (AFP) and human chorionic gonadotropin when used together have been extremely helpful in detecting recurrence, staging, and monitoring of testicular cancer. The cellular localization of these markers by immunoperoxidase has also been an aid in understanding the natural history of these tumors. The cell surface antigens in bladder cancer have been useful predictors as to whether or not Stage A bladder cancer will develop into more invasive cancer when compared with the conventional histopathologic examination of the bladder tumor. In the last six years we have prospectively utilized these markers in the management of testicular and bladder cancer. The clinical and laboratory findings of these prospective studies are reviewed.

[Lectin binding in immunohistologically AFP/HCG positive and negative testicular carcinoma]

The morphologic display of testicular cancer is a heterogenous cellular pattern. A biological heterogeneity is also true for the expression of tumor markers. The biosynthesis of tumor marker proteins alpha-fetoprotein (AFP), ferritin, Schwangerschaftsprotein (SP 1) glycoprotein, tissue polypeptide antigen and of hormones (beta-human chorionic gonadotropin (HCG) = significantly present in nonseminoma germ cell tumors--does, however, define only a small number of cancer cells. To better visualize the majority of cancer cells, lectin binding was studied. During the oncogenic transformation a distinct change of cell membrane glycoproteins has been observed. Reactions of WGA/PNA lectins which get attached to glycoproteins with cancer tissue sample from seminomas (n = 20) and nonseminomas (n = 20) were analyzed. The results were correlated to AFP/beta-HCG positive (negative) immunohistology to establish further subgroups of biological homogeneity. The binding of WGA lectin appears relatively more frequent in both seminoma and nonseminoma than that of PNA. Lectin binding of WGA and/or PNA can be stained in 3/11 AFP- and beta-HCG-negative nonseminoma tissues while lectin staining is positive in 7/18 beta-HCG-negative seminomas. The fact that lectin binding is dependent on the spermatozoogenesis and on androgens in normal testis tissues asks for more detailed studies in this field.

Immunosuppressive acidic protein in patients with testicular cancer

Serum immunosuppressive acidic protein was compared to lactic dehydrogenase as a marker for testicular cancer in 54 patients with testicular cancer, 62 with benign urological diseases and 203 healthy controls. The mean value of serum immunosuppressive acidic protein in patients with testicular cancer (598 +/- 293 micrograms. per ml.) was statistically higher than that in patients with benign disease (429 +/- 163 micrograms. per ml.) and healthy controls (368 +/- 73 micrograms. per ml.). There were statistically significant differences in serum immunosuppressive acidic protein levels between controls and patients with stage 2 (p less than 0.0001) or stage 3 (p less than 0.001) testicular cancer, and between those with stage 1 and stage 2 (p less than 0.0001) or stage 3 (p less than 0.001) disease, respectively. The usefulness of immunosuppressive acidic protein as a marker for testicular cancer also was compared to that of lactic dehydrogenase. Immunosuppressive acidic protein and lactic dehydrogenase levels were elevated almost equally in patients with stage 2 or 3 disease (range 71 to 92 per cent). However, immunosuppressive acidic protein levels were elevated in only 3 of 25 patients with stage 1 cancer (12 per cent), compared to 11 of 25 (44 per cent) with elevated lactic dehydrogenase levels. Immunosuppressive acidic protein was correlated better with tumor stage. In conclusion, serum immunosuppressive acidic protein determinations may be useful in patients with testicular cancer for staging, monitoring treatment results and predicting recurrence.

The value of cancer antigen-125 as a tumor marker in malignant germ cell tumors of the ovary

The value of cancer antigen-125 (CA-125) as a tumor marker for malignant germ cell tumors (MGCT) of the ovary was investigated and compared with the other recognized tumor markers (human chorionic gonadotrophin (hCG), alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and lactate dehydrogenase (LDH) isoenzymes. In the 10 months following June 1984, 4 new cases with MGCT and 1 patient with active disease on treatment were evaluated. In all cases prior to planned surgery the levels of CA-125 were significantly elevated. The serum values ranged from 154 to 617 U/ml (normal less than 20 U/ml). In 1 case (pure dysgerminoma) CA-125 was the only tumor marker. In 3 patients (2 mixed germ cell tumors and 1 immature teratoma) serum LDH (LD 1, 2, and 3) was elevated, and AFP was elevated in 1 of these. In the fifth case (mixed germ cell tumor), on treatment, serum AFP was used to monitor the disease. Four patients underwent cytoreductive surgery followed by combination chemotherapy. The changes in the serum levels of CA-125 paralleled those of the other tumor markers while on therapy. In our experience CA-125 is an invaluable indicator of the clinical status of the patient and could be a new tumor marker in patients with MGCT.

Diagnosis of anterior chamber metastasis by serologic marker found during anterior chamber paracentesis

A 29-year-old man developed anterior uveitis unresponsive to intensive topical and systemic therapy. He had recently completed a course of chemotherapy with apparent response and resolution of metastasis from a mixed germ cell tumor (embryonal carcinoma and seminoma). Anterior chamber paracentesis was nondiagnostic on two occasions for metastatic cells. At the time of his second paracentesis a tumor marker, human chorionic gonadotropin-beta subunit, was used to confirm the diagnosis of anterior chamber metastasis to the eye.

[Clinical studies of testicular tumor. I. Analysis of 27 patients with seminoma: the clinical significance of hCG-beta determination and of retroperitoneal lymph node dissection for stage I patients]

Between August, 1968 and March, 1985, we treated 27 patients with testicular seminoma. The histopathological type was typical seminoma in 23 (85%) and anaplastic seminoma in 4 (15%). Their clinical stages were classified into stage I for 17 patients (63%), 7 patients (25%) in II and 3 (12%) in III. Tumor markers, alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG-beta), were determined in 16 patients. None of them showed an elevated level of AFP, but 7 (43.8%) had elevated hCG-beta in the peripheral vein. The hCG-beta in the spermatic vein on the tumor side was elevated in 12 out of 14 patients (88.9%). The hCG-beta level in the spermatic vein on the tumor side was significantly higher than that in the peripheral vein in 10 patients with stage I seminoma. This finding suggests that the determination of hCG-beta in the spermatic vein would give us more accurate information on the production of hCG-beta in seminoma. Although the elevation of the hCG-beta level in pure seminoma has been supposed to be a poor prognostic factor, our results indicated that a mild to moderate elevation of hCG-beta in stage I seminoma did not always imply a poor clinical course, first, because none of these 10 patients, even with an elevated hCG-beta, who underwent retroperitoneal lymph node dissection (RPLND), had microscopic metastasis, and second, because none of these have had a recurrence of the disease up to now.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical studies of testicular tumor. II. Analysis of 30 patients with nonseminomatous testicular tumor]

Clinical findings and results of various treatments were discussed for 30 patients with nonseminomatous testicular tumor (NSTT) who had been treated from August, 1968 to March, 1985. Radioimmunoassays were positive for AFP in 19 of the 22 evaluated patients (86.4%) and were positive in 14 of the 19 evaluated patients (73.7%). These positive rates are consistent with those reported by others. Abnormal pre-treatment level of hCG-beta did not always indicate poor clinical courses, since in patients under stage III A pre-treatment level of hCG-beta did not correlate to either treatment results or clinical courses, even in patients with bulky metastasis such as stage IIIB1, B2 or C their treatment results and clinical courses seemed to be primarily determined by the size and extent of metastasis. However, pre-treatment measurement of hCG-beta was useful to predict in primary and/or metastatic tumor the presence of choriocarcinoma element which could not be found with conventional histopathological studies. Most of our 14 patients at stage I were subjected to radical orchiectomy and retroperitoneal lymph node dissection followed by post-surgical management with radiotherapy or chemotherapy. With these treatments only one of the stage I patients had a recurrence. However, adjuvant therapy may not be necessary for them because of a low recurrence rate following retroperitoneal lymph node dissection and the high cure rate with intensive chemotherapy including CDDP for the early stage of recurrence, when a close follow-up would be possible. We treated only 2 patients at stage II A. One of these 2 patients became free of the disease by intensive chemotherapy including CDDP (24 months after the start of treatment). In stage II A, a high recurrence rate has been reported, following retroperitoneal lymph node dissection without post-surgical adjuvant chemotherapy, which indicates that these patients should be treated with adjuvant chemotherapy, including CDDP. All 4 patients in stage II B or III treated mainly by chemotherapy without CDDP died of the disease at around one year after treatment. However, the five-year survival rate was improved to 40% in 10 advanced patients with these stages who had been treated mainly with recent chemotherapy regimen including CDDP. The recent development of chemotherapy regimen including CDDP has been able to lead many patients with advanced stage to a curable status. However, the appropriate treatment for some patients with bulky and extensive metastasis remains to be established. More aggressive treatment such as cytoreductive surgery may be necessary for such patients.

[Assay of chorionic gonadotrophin, follicle-stimulating hormone and alpha-fetoprotein in the efferent blood in germinal tumors of the testis]

Assays of human chorionic gonadotrophin (hCG), follicle-stimulating hormone (FSH) and alpha-foetoprotein were performed in peripheral blood and spermatic vein in 73 cases of testicular germ cell tumors. This study showed that the detection sensitivity of hCG is up to 40 times higher in the efferent blood of the tumor than in peripheral blood and that the drop in FSH concentrations often precedes a trophoblastic transformation. These results are of particular interest in the search for a minor trophoblastic or embryonic component. As a result, we propose a new strategy leading to a more efficient diagnosis and an adequate therapy.

Pregnancy-associated plasma protein-A concentrations in men with testicular and prostatic tumors

Pregnancy-associated plasma protein-A (PAPP-A) is a macromolecular glycoprotein produced during pregnancy by the trophoblast and the decidua. It is not specific to pregnancy, since immunoreactive PAPP-A is in the circulation of normal women and men and in seminal fluid. Immunohistochemically, PAPP-A is localized in some Leydig cells, in the epididymis, in the rete testis, and in seminal vesicles. This study was conducted to learn whether circulating levels of PAPP-A can be used as a marker for the monitoring of human testicular cancer. PAPP-A was increased only in certain nonseminomatous germ cell tumor [malignant teratoma undifferentiated (MTU) + seminoma, malignant teratoma intermediate (MTI)], but the overlap with the normal values was too big for PAPP-A to have any clinical significance. After orchidectomy or prostatectomy, PAPP-A decreased but the levels were were similar to those of normal men. In men, PAPP-A can be produced by certain nonseminomatous germ cell tumors, but its origin in disease-free males is probably not the testis or the prostate.

Serum copper level in ovarian carcinoma

Serum copper levels (SCL) were determined before any diagnostic procedure was performed or treatment given in 40 women admitted for the investigation of a pelvic mass and, later, in those patients with ovarian carcinoma after chemotherapy and before a second-look operation was performed. Patients with ovarian carcinoma were found to have significantly higher SCL than patients with benign ovarian lesions. A SCL of 150 micrograms/dl clearly separated patients with a pelvic mass on the basis of ovarian carcinoma and those with benign noninflammatory pelvic lesions. The same SCL of 150 micrograms/dl separated patients with ovarian carcinoma that responded to chemotherapy and those with residual disease. It is suggested that SCL be included as a member of the screening panel of biologic tumor markers in general and in ovarian carcinoma in particular.

Preliminary observations on the application of carcino-placental alkaline phosphatase to the investigation of patients with seminoma of the testes

Suitable tumour markers for monitoring the treatment of seminoma of the testis have not yet been established in clinical practice. Carcino-placental alkaline phosphatase (CPAP) has been suggested for this purpose but it is difficult to detect and specifically analyse this enzyme. We have devised an immunoenzymatic method of analysis in which cross-reactions with liver type and intestinal alkaline phosphatase are minimal and we have applied this test to seven patients with histologically proven seminoma. CPAP was raised in 4 patients prior to treatment and chorionic gonadotrophin in two of these. Alpha-fetoprotein was normal in all cases. We conclude that the use of CPAP in monitoring treatment of testicular seminoma is worthy of further attention.

Placental alkaline phosphatase as a tumour marker in seminoma using the H17 E2 monoclonal antibody assay

Serum samples from 62 patients with seminoma were assayed for placental alkaline phosphatase-like activity using the monoclonal antibody H17 E2, in order to evaluate its utility as a serum tumour marker. Fifteen of 16 patients (94%) with active seminoma had elevated serum PLAP levels. Sixteen of 46 (35%) of patients considered to be in remission had elevated PLAP levels (false positive rate 35%). Fifteen false positive results were considered attributable to concomitant smoking, and if these patients are excluded, only one false positive case was detected. In 7 out of 7 patients sequential PLAP assays reflected clinical response to treatment.

The management of metastatic germ cell tumours and the clinical utility of lactate dehydrogenase estimations

Forty-five patients with metastatic germ cell tumour were treated with chemotherapy. Complete remission was achieved in 63% of all cases and in 65% of patients whose primary tumour arose in the testis or ovary. Surgical resection of abdominal masses persisting after chemotherapy was performed in seven patients, two of whom were found to have persistent tumours. Twenty-seven of the 33 patients with teratoma originating in the gonads remain in complete remission. Total serum LDH activity was elevated in 28 of the patients with measurable disease. The increased LDH was not accompanied by significant alteration in other hepatic enzymes nor were hepatic metastases demonstrable in these patients. Fractionation of the LDH demonstrated that the increased LDH in these patients was located in either iso-enzymes 1 or fractions 1 + 2. Alteration of the serum LDH activity correlated with the response to therapy and warrants further study.

Seminoma with elevated human chorionic gonadotropin. The case for retroperitoneal lymph node dissection

An elevated serum level of human chorionic gonadotropin (HCG) in a patient whose primary tumor histologically appears to be a pure seminoma implies the presence of syncytiotrophoblastic giant cells either detectable by careful step sectioning of the primary tumor or present in metastatic disease. Inasmuch as the malignant potential and radioresponsiveness of syncytiotrophoblastic giant cells are unknown and the serum elevation of HCG may signal metastatic embryonal carcinoma, retroperitoneal lymph node dissection with adjuvant chemotherapy dependent on pathologic staging should be considered for patients with seminoma and postorchiectomy elevated HCG levels. An illustrative case is herein reported.

Pure dysgerminoma of the ovary with elevated serum human chorionic gonadotropin: diagnostic and therapeutic considerations

Pure ovarian dysgerminomas with associated elevation of human chorionic gonadotropin (hCG) are rare, and their optimum management is unclear. We report here a 24-year-old woman with stage III dysgerminoma of the ovaries, with bulky intrapelvic disease, paraaortic adenopathy, and elevated pre- and postsurgical serum beta-hCG titers. Following administration of whole abdominal-pelvic and mediastinal irradiation therapy, the patient's adenopathy regressed, her serial beta-hCG titers returned to normal, and she has remained free of disease for the past 30 months. Histopathological studies revealed a pure dysgerminoma with scattered giant cells which were negative for hCG by immunoperoxidase staining. The literature is reviewed with reference to the significance of elevated hCG levels, the presence of giant cells in association with dysgerminoma of the ovary, and therapeutic implications. Serial determinations of beta-hCG titers may prove to be as valuable in the management of these patients as they are in patients with testicular tumors.