Isolated testicular leukemic relapse. Response to radiation therapy

Between January, 1975, and December, 1984, at the University of Michigan Medical Center, 17 boys with leukemia presented with overt or occult isolated testicular relapse. Diagnosis was obtained by bilateral open-wedge biopsies of the testes. All the patients were treated with combined local testicular irradiation and systemic chemotherapy. In only 1 of the 17 patients (6%) testicular leukemia developed as the only site of relapse. It appears that doses in the range of 2,000 to 2,400 cGy in 10 to 12 fractions achieve optimum control of leukemic infiltration of the testes.

Cell-specific ribosomal DNA spacer variability in human urothelial carcinoma cultures

Length variation of a ribosomal DNA "spacer" region in four chromosomally characterized transitional cell carcinoma cultures was analyzed by restriction endonuclease cleavage and Southern blotting. Cell lines with relative karyotypic conservation, such as UM-UC-2 (modal chromosome number 48, four marker chromosomes) demonstrate little change in the genetically regulated pattern of rDNA spacer length polymorphisms (7.6, 6.7 and 6.0 kilobases) which may be found in normal cells. Cell lines with more aberrant karyotypes, such as UM-UC-3 (modal chromosome number 86, 12 marker chromosomes) and UM-UC-4 (modal number 51, ten marker chromosomes) show fewer ribosomal DNA length variants (7.6, 6.7 kilobases for the former, 7.6 kilobases for the latter), consistent with relaxed constraints on the drive for ribosomal gene homogeneity through inter and intrachromosomal exchange. Uncharacterized rDNA length variants of low copy number were observed in cell lines with many marker chromosomes. Analysis of repetitive DNA structure provides an additional criterion for tumor diagnosis and staging, and a characterized series of tumor cell lines may provide a useful system for understanding repetitive DNA evolution.

Preoperative devascularization of advanced renal adenocarcinoma using a sclerosing agent

Sodium tetradecyl sulfate is a sclerosing agent used currently as therapy for varicose veins. Animal experiments have demonstrated this drug to be a useful agent for renal tissue destruction. We have used sodium tetradecyl sulfate with or without steel coils for preoperative renal devascularization in 6 patients with advanced renal adenocarcinoma. In all patients sodium tetradecyl sulfate effectively caused renal infarction and was tolerated well. No complications were associated with the use of this agent. Sodium tetradecyl sulfate is an efficient fluid embolic agent that can be a useful adjunct to nephrectomy in selected cases.

Improved growth of human urothelial carcinoma cell cultures

From January, 1981 through June, 1982 specimens from 21 patients with bladder (urothelial) cancer were placed in tissue culture, and one long term cell line was established (5%). From July, 1982 through February, 1984, using an improved culture medium, seven long term cell cultures were established from 21 patients (33%). In addition, one long term culture from a patient with a bladder melanoma was established using the standard culture medium. The nine cell cultures were derived from the following types of tumors: transitional cell carcinoma (6), adenocarcinoma (1), squamous cell carcinoma (1) and melanoma (1). All of the cell lines have produced tumors in athymic nude mice except for one transitional cell carcinoma. All of the cultures demonstrate aneuploidy. Homogeneously staining regions have been seen in some cell cultures. A common marker chromosome has not been identified.

Adverse reactions to the intravesical administration of doxorubicin hydrochloride: report of 6 cases

We report 6 cases of adverse systemic reactions to the intravesical instillation of doxorubicin hydrochloride for the treatment of recurrent superficial transitional cell carcinoma of the bladder. Although local reactions to this drug are common they rarely are life-threatening. Significant systemic toxicity has not been reported.

Clinical applications of monoclonal antibody technology

Although monoclonal antibody technology has only been with us for slightly more than 10 years, it has already had a great impact on both basic science and clinical medicine. The ability to use these antibodies as highly specific and sensitive reagents that are consistent from batch to batch is invaluable. Because of this ability, monoclonal antibodies are assuming an ever more important role in laboratory assays. In addition, immunohistochemical techniques employing monoclonal antibodies enhance the histologic characterization of pathologic specimens. These clinical benefits are real but are often hidden from the eyes of the physician taking care of his patient. However, other newer uses of monoclonal antibodies are much more spectacular. Clinical imaging with monoclonal antibodies has been shown to be feasible in a variety of systems. Antibodies to colon cancer and melanoma have detected metastatic tumors that were otherwise hidden clinically. Despite these triumphs, the routine use of radioimmunodetection employing radiolabeled monoclonal antibodies has not yet arrived. However, the preliminary data obtained so far are very promising, and radioimmunodetection may well serve to be an important method for diagnosing a variety of cancers in the near future. Immunotherapy is actively being explored in a number of centers but at this stage is strictly experimental. Whether this will be an important addition to our therapeutic armamentarium should be defined over the next several years. The monoclonal antibodies that are currently used for clinical studies are murine, that is, they are mouse antibodies. Although these antibodies have been well tolerated in a number of studies, human monoclonal antibodies would be theoretically more desirable. Preliminary efforts to produce human monoclonal antibodies reactive with tumor-associated antigens have been reported. Future directions of monoclonal antibody technology will employ greater production of human monoclonal antibodies. In addition, the evaluation of antibody conjugates for clinical diagnosis and therapy will continue to be explored.

Diagnosis and treatment of bladder carcinoma

A variety of diagnostic techniques has enhanced our ability to detect and accurately stage urothelial carcinoma. Urine cytology is a sensitive method for detecting occult high-stage tumors in both the upper and lower tracts. Rigid ureteroscopy has extended direct visualization from the bladder (with cystoscopy) to the renal pelvis. The evaluation of metastatic disease has been improved by CT and MRI. However, caution must be applied in interpreting bladder masses demonstrated by these studies after transurethral resections. The mainstay of local therapy continues to be transurethral resection. This established technique has been aided by intravesical chemotherapy and immunotherapy. Intravesical instillation of chemotherapeutic drugs or BCG may help preserve some bladders that would otherwise be sacrificed. The appropriate role of laser therapy as a primary form of treatment remains to be defined. Photodynamic therapy appears to be a powerful new treatment modality for carcinoma in situ. However, photodynamic therapy should still be considered a clinical experiment at this time. Patients with more advanced local disease will require either cystectomy or definitive radiation therapy. The survival results with primary surgical therapy appear to be slightly better than radiation therapy, particularly when younger individuals are being treated. Persons with metastatic disease are best treated with chemotherapy. Combination cisplatin-based regimens appear to be particularly promising and offer a high incidence of objective remissions with good duration of response. Although the five-year survival of patients with bladder carcinoma has steadily improved, there is still room for additional progress. The basis for any such improvement rests in accurate diagnosis and treatment and careful surveillance for recurrent disease.

Complications of 125I implantation: inability to deflate Foley catheter

Obstruction of the balloon inflation tract of a Foley catheter by an 125I seed is reported. An endoscopic method for catheter removal is described.

Staging of bladder carcinoma: MRI-CT-surgical correlation

Eleven patients with transitional cell carcinoma of the bladder were examined with spin-echo MRI using a superconductive magnet operating at a field strength of 0.35 T. MRI results were compared with the CT findings in 10 of the patients. All subjects later underwent radical cystectomy including pelvic lymph-node dissection. MRI accuracy for staging was 64% using the TNM classification and 73% by the Jewett-Strong-Marshall system while CT accuracy was 40%. MRI provided improved demonstration of tumor invasion of perivesical fat planes, prostate, and seminal vesicles and greater anatomic detail was afforded by direct sagittal and coronal views.

Stomal construction and reconstruction

Urinary diversion plays an important role in the therapeutic repertoire of urologists. The stoma is often the weak link of any diversionary procedure. Some of the more common stomal problems include peristomal dermatitis, stomal stenosis, parastomal hernias, malposition, prolapse, and retraction. Depending on the nature and severity of the problem, it may be treated by local wound care, urinary appliance adjustment, dilatation, or surgical intervention. Careful site selection and stomal creation will keep stomal problems to a minimum.

Renal cell carcinoma as an incidental finding

We reviewed the manner of presentation and tumor stage in 56 consecutive patients with renal cell carcinoma treated surgically between 1961 and 1973 (group 1) and compared them to 46 patients treated similarly between 1980 and 1984 (group 2). In group 1, 7 cases (13 per cent) were discovered incidentally compared to 22 cases (48 per cent) in group 2. The tumor stage was lower in the incidentally discovered cases than in cases when the diagnosis was suspected. The 5-year survival rates of the incidental cases in group 1 tended to be better. Routine use of excretory urography, computerized tomography, ultrasound, bone scans and other effective diagnostic studies has led to earlier diagnosis, lower stage and possibly better survival in incidentally found cases of renal cell carcinoma than in cases when the diagnosis was suspected.

Salvage cystectomy following failed definitive radiation therapy for transitional cell carcinoma of bladder

Between 1971 and 1983 we performed 18 salvage cystectomies on patients with recurrent transitional cell bladder cancer initially treated with definitive radiation therapy (5,500-6,820 R). The interval between tumor diagnosis and radiation ranged from zero to twenty-one years (mean 3.5 years), and the interval between radiation therapy and cystectomy ranged between six months and twelve years (mean 2.5 years). Early major complications occurred in 5 patients, and there was one early and one late postoperative death. The overall patient survival from the time of diagnosis to death or the present (1985) ranged from two to thirty-one years (mean 9.8 years), and from the time of radiation to the present or death ranged from one to nineteen years (mean 6.2 years). The overall crude five-year survival from the time of cystectomy excluding 2 patients operated on in 1982 and 1983 was 50 per cent, however 3 of these patients died of cancer after five years. Breakdown of survival of these patients by stage demonstrated the best survival in patients with carcinoma in situ and Stage A or no neoplasm at the time of cystectomy. This report confirms the value of salvage cystectomy after radiation failure in invasive transitional cell bladder cancer.

Comparison of tissue culture cells and histological sections for use in screening monoclonal antibodies

Monoclonal antibodies have been screened using either tissue culture cells or histologic sections as a source of antigen. We evaluated and compared these two methods using six murine monoclonal antibodies on human kidney cultures and histologic sections of human normal kidney and renal carcinoma. Antibody binding demonstrated shared antigens on kidney culture cells, renal tubular cells and renal carcinoma cells. The patterns of antibody binding were generally similar with either cultured cells or histologic sections. However, certain antibodies demonstrated significant differences in antibody binding depending on the method used for screening.

Visual disturbances in TUR reaction

Visual disturbances during transurethral resection (TUR) of the prostate are described and possible causes of this phenomenon are discussed. Awareness of this unusual manifestation of the TUR reaction may offer the first clue to excessive systemic absorption of irrigation fluid.

Infarction-nephrectomy for metastatic renal carcinoma. Southwest oncology group study

Thirty patients with metastatic renal cell cancer were treated by renal infarction, followed by delayed nephrectomy. All cases were collected over an eighteen-month period, with a minimum follow-up of one year. There were no complete remissions and only one partial remission, which lasted twenty-one months before progression of disease. Three patients had stable disease for at least six months, but eventually all patients showed evidence of progression. After tumor progression was documented patients were treated with intramuscular medroxyprogesterone acetate (Depo-Provera) 800 mg per week. No patient responded to this therapy. Overall, a 28 per cent one-year survival and a seven-month median survival were realized, which is similar to other series in which no therapy or palliative nephrectomy was performed. We conclude that infarction and nephrectomy is not an effective modality in the treatment of metastatic renal cell carcinoma. In addition, medroxyprogesterone was not shown to be significantly active against renal cancer in this study.

Human renal carcinoma: characterization of five new cell lines

Five human renal carcinoma cell lines have been established in long-term tissue culture. Two of the cell lines, UM-RC-2 and UM-RC-3, produced clear cell tumors in athymic nude mice. The cell lines have been characterized by staining with oil red O, doubling time in vitro, and number of chromosomes. Although protein A assay reactivity of autologous combinations of patient's sera and tumor cells were seen with all five cell lines, similar binding was also found with autologous normal kidney cultures. However, the immune adherence assay demonstrated low titer autologous reactivity with two renal carcinoma cell lines but not with the corresponding normal kidney cultures. This strongly suggest host recognition of tumor-associated antigens. Characterization of cell surface antigens with murine monoclonal antibodies demonstrated shared reactivity between normal kidney tubular cells and renal carcinoma cells. Antibody A68.11 reacted strongly with all five cell lines. Antibody A80 bound to only UM-RC-3 and UM-RC-6.

Radioimmunodetection of a transplantable human bladder carcinoma in a nude mouse

The results of an in vitro mixed hemadsorption (MHA) assay predicted the success of in vivo tumor localization using a radioiodinated, monoclonal, IgG1 antibody (A2) with reactivity to the human bladder carcinoma cell line RT4. In vitro, murine monoclonal antibodies A2 and G6, demonstrated reactivity to RT4 with titers of 1/1024 and 1/4 by MHA assay, respectively. In vivo results obtained with RT4 xenografts in athymic nude, Balb/c, mice indicated tumor uptakes of 1.10% dose/gram with A2 and 0.29% dose/gram with G6 at seven days after radiotracer injection. Successful scintigraphic imaging of tumor xenografts was achieved with A2 but not with G6 or radioiodinated mouse serum albumin.

Carcinosarcoma of bladder. Evaluation by electron microscopy and immunohistochemistry

A case of carcinosarcoma of the urinary bladder characterized by electron microscopy and immunohistochemistry is described. The use of these studies in poorly differentiated bladder neoplasms and in suspected cases of carcinosarcoma is encouraged. Increased accuracy in characterizing these tumors will permit a better understanding of their natural history and response to therapy.

UM-UC-1 and UM-UC-2: characterization of two new human transitional cell carcinoma lines

Two new human transitional cell carcinoma lines have been established in long term tissue culture. UM-UC-1 was derived from a bladder cancer metastasis, and UM-UC-2 originated from a ureteral carcinoma. Both cell lines produce tumors in athymic nude mice. The cell lines have been characterized by isoenzyme phenotype and karyotype. Both of these methods differentiate UM-UC-1 from UM-UC-2.

UM-SCP-1, a new human cell line derived from a prostatic squamous cell carcinoma

A permanent cell line (UM-SCP-1) has been established from a primary squamous cell carcinoma of the prostate. UM-SCP-1 has been passaged 40 times and has been in culture for 22 months. The doubling time of this aneuploid cell line is approximately 36 hr. In nude mice, UM-SCP-1 produces rapidly growing tumors with distinct histological features of squamous cell carcinoma. UM-SCP-1 cells express pemphigus and pemphigoid antigens and bind antibodies to beta 2 microglobulin and HLA-A,B,C common antigen. Cells of this line are unreactive with anti-A and anti-B blood group typing sera, autologous serum, and monoclonal anti-HLA-DR antibodies.

Malignant melanoma of the penis and male urethra

We report 3 new cases of penile and 2 of male urethral melanoma, increasing the total numbers of reported cases to 56 and 23, respectively.

Incidental adenocarcinoma of the prostate: the role of repeat transurethral resection in staging

Accurate staging of patients with incidental prostatic adenocarcinoma (A1 vs A2) is crucial to the selection of appropriate treatment. To evaluate the potential sampling error in specimens obtained by transurethral resection, repeat resection was performed on 31 patients pathologically staged as A1 (five or less chips with tumor). Second specimens showed no tumor in 22 (71%), stage A1 in six (20%), and stage A2 in three (9%). The weight of tissue removed at reresection was greater in patients found to have more extensive involvement (P less than 0.005). No patient with initial Gleason score 2, 3, or 4 had stage A2 at reresection. Repeat resection is not routinely necessary, but may be helpful when the tumor is high grade but of minimal extent, in an anxious younger patient who may wish therapy if disease persists, or where some suspicion of an incomplete resection exists.

Hybridoma antibodies reactive with human bladder carcinoma cell surface antigens

Hybridoma antibodies to the human bladder cancer cell line RT4 were prepared by fusing spleen cells from RT4-immunized BALB/c mice with the murine plasmacytoma line NS-1. When antibodies were characterized by direct serological testing, antibody A2 exhibited highly restricted specificity for an antigen found only on RT4. However, further analysis with absorption, a standard serologic technique that has not been widely applied to hybridoma antibodies because of their monoclonal nature, revealed that the antigen could also be found on 1 other bladder cancer cell line, 5637, and on the human cervical carcinoma line ME-180. Quantitative absorption assays suggest that this phenomenon of absorption-positive, direct test-negative cells may be related to the amount of antigen present on the cell surface. Another antibody, A80, detected an antigen with broader distribution. Both antibodies described heat-labile, trypsin-resistant antigens present on a restricted range of cells. The role of these antibodies in identifying subsets of malignant urothelial cells is being investigated.