Cytogenetic analysis of murine embryo-derived tumors

The possible relationship among malignancy, differentiation, and chromosomal constitution of primary embryo-derived tumors was studied. Tumors were induced by transplanting 7-day-old mouse embryos under the kidney capsule of syngeneic BALB/c recipients. Transplantation of 101 embryos resulted in 18 tumor-bearing mice: 36 teratocarcinomas; 18 teratomas; and 27 yolk sac tumors. Some of the yolk sac tumors proved to be retransplantable for several generations. Cytogenetic investigation of the primary embryo-derived tumors revealed that the majority of teratocarcinomas (82%) were chromosomally normal, whereas almost all (83%) karyotyped teratomas and yolk sac tumors had a highly abnormal chromosomal constitution. Most common aberrations were polyploidy; overrepresentation of chromosome 1, 6, 15, or 19; and an underrepresentation of chromosome 2, 4, 14, or a sex chromosome.

Cytogenetics of carcinoma in situ of the testis

Carcinoma in situ (CIS) of the testis is the precursor lesion of most testicular germ cell tumors (TGCTs). Karyotyping of CIS is important for a better understanding of the pathogenesis of TGCTs and the progression to invasive cancer. We karyotyped three cases of CIS. All three cases showed a numerical abnormal chromosomal pattern. In one case, two copies of the germ cell tumor marker i(12p) were found.

Femoropopliteal arterial fibrodysplasia

Fibrodysplasia is a rare and unusual cause of obstruction of the superficial femoral or popliteal artery. Three young patients with intermittent claudication due to occlusion of the femoropopliteal artery are described. Histological examination showed destruction of the elastic and muscle fibres of the media. In one patient secondary fibrosis of the intima was seen. The adventitia showed an increase in elastin fibres in all cases. The lesions described can be respectively classified as perimedial fibroplasia, as medial dissection and as intimal fibroplasia. This is the first description of a patient with histopathologically proven perimedial fibroplasia and medial dissection of the femoropoliteal artery and the second case of intimal fibroplasia.

Cytogenetics of thyroid follicular adenomas

We present the results of a cytogenetic study of three cases of follicular adenoma of the thyroid. All three cases had a numerical strongly abnormal karyotype with most abnormalities (eg, +4 or +5, +7, +9, +12, +16) in common, possibly indicating that this cluster of abnormalities might be specific for follicular adenomas. For benign tumors, the three cases showed a remarkably abnormal karyotype. These cases are another example of benign tumors with chromosomal abnormalities that might be specific for follicular adenomas.

Minimum extension and appropriate topographic position of tissue destruction for treatment of cervical intraepithelial neoplasia

Minimum extension and topographic position of tissue destruction for treatment of cervical intraepithelial neoplasia (CIN) is determined by the extension and the localization of the pathologic epithelium. In 65 cone specimens, we studied the depth of CIN II crypt involvement and the linear extent and topographic position of the CIN III lesions. The topographic position of the CIN III lesion was related to a reference point R, the most caudal point of the ectocervix. The mean maximum depth of CIN III crypt involvement appeared to be 1.6 +/- 1.0 mm, and the mean linear extent of the CIN III lesion was 7.4 +/- 3.7 mm. The distal border of the CIN III lesion was located at a mean distance of 8.2 +/- 4.4 mm from the reference point R, and the proximal border at a mean distance of 13.3 +/- 3.7 mm. Taking the mean + 2 SD values as directives (97.7% of the population) suggests that in almost all patients, the depth of crypt involvement did not exceed 3.6 mm; the linear extent of the CIN III did not exceed 14.8 mm. Furthermore, this implies that in almost all patients, the CIN III lesion was located between 0.6 mm distally (mean - 2 SD) and 20.7 mm proximally (mean + 2 SD) from the reference point R. Based on these results, we conclude that minimum local tissue destruction for treatment of CIN should have a depth of 4 mm over a distance of 15 mm, and should be localized at least between 1 mm distally and 21 mm proximally from the most caudal point of the ectocervix.

Karyotyping and DNA flow cytometry of metastatic ovarian yolk sac tumor

We karyotyped a metastasis composed of pure yolk sac tumor derived from a primary ovarian germ cell tumor with two components: a dermoid cyst [DNA index (DI) 1.0] and a pure yolk sac tumor (DI 1.88). The metastatic yolk sac tumor had a hypertriploid karyotype and a DI of 1.78 and lacked the germ cell tumor marker i(12p). The absence of this marker in a metastasis from a tumor with a dermoid cyst component might be indicative for a pathogenesis of the yolk sac tumor similar to that of a dermoid cyst and different from that of dysgerminoma.

Analysis of cryolesions in the uterine cervix: application techniques, extension, and failures

Although cryosurgery is regularly used for treatment of cervical intraepithelial neoplasia (CIN), there are few data concerning freeze technique and attendant extension of the cryolesion. This study evaluated how to create cryolesions extensive enough to eradicate the CIN lesion completely. The way the extension of the cryolesion was influenced by type of probe, anatomical position in the cervix, shape of the external os, and freeze time was analyzed. Furthermore, we examined whether localization of the cryolesions corresponded with the CIN III location. Cryosurgery was applied to the cervix of 64 women the day before hysterectomy was performed for benign disease. Four types of probes were tested and freezing was done with a double freeze cycle. After extirpation of the uterus, slides were cut at the 3-, 6-, 9-, and 12-o'clock positions. With a computerized graphic tablet, the depth and linear extension of the cryolesion were measured morphometrically. After short freeze times, it appeared that an adequate lesion was present in only 67.4% of the slides. The large cone probe gave the best results; the small flat cervix probe the worst. At the 3- and 9-o'clock positions, a significantly higher percentage of inadequate lesions was found (60.8 and 65.3%, respectively). This proved to be due primarily to the extensive vascular supply at those positions. Longer freeze times gave an excellent result within all slides, even at the 3- and 9-o'clock positions. The topographic position of the cryolesion corresponded completely in all cases with that of the CIN III lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Yolk-sac carcinoma develops spontaneously as a late occurrence in slow-growing teratoid tumors produced from transplanted 7-day mouse embryos

Seven-day embryos of BALB/c mice transplanted underneath the kidney capsule of adult syngeneic recipients form either benign teratomas or teratocarcinomas, which can be distinguished from one another histologically at 8 weeks post-embryonic transplantation. Embryo-derived (ED) teratomas were allowed to remain in the host for an additional period up to 1 year after embryo transplantation, to test their malignant potential. It was found that a considerable number of slow-growing small tumors derived from embryonic transplant give rise to parietal yolk-sac carcinomas. A proportion of these tumors contained foci of visceral yolk-sac and trophoblastic differentiation, which gradually disappeared in successive transplantations. We conclude that parietal yolk-sac carcinoma develops as a late event in some ED teratomas. These malignant tumors originate either from small foci of yolk sac originally included in the grafted embryo or, more likely, from the yolk sac formed from the differentiating embryonic stem cells.

Localization and polymorphism of a chromosome 12-specific alpha satellite DNA sequence

The isolation and localization of a chromosome 12-specific alpha satellite DNA sequence, p alpha 12H8, is described. This clone contains a complete copy of the 1.4-kb HindIII higher-order repeat present within the alpha satellite array on chromosome 12. The specificity of p alpha 12H8 was demonstrated by in situ hybridization and Southern blot analysis of a somatic cell hybrid mapping panel, both performed under high-stringency conditions. Polymorphic restriction patterns within the alpha satellite array, revealed by the use of the restriction enzymes BglII and EcoRV, were demonstrated to display Mendelian inheritance. These properties make p alpha 12H8 a valuable genetic marker for the centromeric region of chromosome 12.

Successful surgical treatment of parathyroid carcinoma in two haemodialysis patients

Parathyroid carcinoma is rare, occurring in less than 2-3% of the patients with clinical features of primary hyperparathyroidism. In haemodialysis patients parathyroid carcinoma has only once been described, although secondary hyperparathyroidism in these patients is common. We discuss two female haemodialysis patients with parathyroid carcinoma. Both were treated surgically: in one patient only local excision of the malignancy was performed; the other patient underwent a modified neck dissection on the side of the tumour as well. Physical, biochemical and radiological evaluation for 4-7 years after operation gave no evidence of recurrence of the malignancy.

Chromosomal changes in human primary testicular nonseminomatous germ cell tumors

A cytogenetic analysis of 14 primary testicular nonseminomatous germ cell tumors has been carried out after short term tissue culture. The modal chromosome numbers ranged from 53 to 113, in agreement with flow cytometric determination of the DNA content of the tumors. At least one copy of an i(12p) was present in 12 tumors. Two tumors, however, lacked that marker. Some chromosomes are apparently overrepresented, whereas others are underrepresented, although some differences between seminomas and nonseminomas were noticed.

Magnetic resonance imaging (MRI) in evaluating in vivo response to neoadjuvant chemotherapy for osteosarcomas of the extremities

Limb-saving procedures for patients with osteosarcomas of the extremities are based on the anatomical localization and extent of the tumor. The effectiveness of neoadjuvant chemotherapy, high-dose methotrexate (HD MTX), was prospectively analyzed in patients using magnetic resonance imaging (MRI) and histologic evaluation of bone biopsies. Evaluation of in vivo response to neoadjuvant chemotherapy for osteosarcomas with MRI is a method which seems promising in predicting the histologic tumor reaction.

A malignant mixed gonadal stromal tumor of the testis with heterologous components and i(12p) in one of its metastases

A malignant mixed gonadal stromal tumor with mesenchymal heterologous elements of the testis is presented. This entity has been described in the ovary, but not hitherto in the testis. Karyotyping and ploidy measurement was done of the primary tumor and of an inguinal and lung metastases. The DNA ploidy and modal chromosome numbers were in agreement with each other in all samples. The most significant cytogenetic finding was the presence of the metacentric germ cell tumor marker i(12p) in an inguinal metastasis. This marker has been demonstrated in testicular and ovarian germ cell tumors and in a mixed Müllerian tumor, which raises the question of a possible relationship between the pluripotency of these tumors and the presence of i(12p).

Chromosome 12q heterozygosity is retained in i(12p)-positive testicular germ cell tumor cells

Restriction fragment length polymorphism analysis is used to demonstrate that formation of the i(12p) chromosome, characteristic of testicular germ cell tumors, does not lead to loss of heterozygosity of various loci on the q arm of chromosome 12. This result suggests that during the etiology of these tumors, aneuploidization precedes the formation of the i(12p) marker chromosome.

Isolated regional perfusion in the treatment of subungual melanoma

Subungual melanoma is rare and represents only 1% to 3% of all diagnosed melanomas in Western countries. The tumor is frequently mistaken for a benign lesion and the delay in diagnosis and final treatment may be responsible for the high local recurrence rate and the low disease-free survival rate. From 1965 to 1982 the combined-modality therapy of amputation and adjuvant isolated regional perfusion with melphalan with or without dactinomycin was used in the treatment of 22 patients with subungual melanoma. Disease was staged according to the M. D. Anderson classification, as follows: stage I (primary melanoma), 11 patients; stage IIIA (in-transit metastases and/or satellitosis), three patients; stage IIIB (regional lymph nodes), seven patients; and stage IIIAB (in-transit metastases and/or satellitosis and regional lymph nodes), one patient. There were no cardiovascular complications and no treatment mortality. During a follow-up of at least 4.5 years, 12 patients (55%) developed distant metastases, including four patients with stage I disease (36%) and eight patients with stage III disease (73%). There were no locoregional recurrences. The median survival was three years (range, 0.5 to 12.5 years) and the overall five-year survival was 40%, with 56% of patients having stage I disease and 27% having stage III disease. The prognosis of subungual melanoma is determined by the stage of the disease. Isolated regional perfusion may prolong disease-free survival in patients with subungual melanoma compared with previously published data.

Megaprostheses in the treatment of primary malignant and metastatic tumors in the hip region

Twenty patients with malignant bone tumors of the hip region were treated surgically by resection and reconstruction with an endoprosthesis. Histologic types included five primary bone tumors and 15 metastatic lesions. At review four primary bone tumor patients are still alive without evidence of disease. The length of the observation period varied from 26 to 104 months. Eleven patients with metastatic bone disease died. The average postsurgical survival time was 23 months. All patients were able to walk with or without a cane. Failure of an endoprosthesis occurred in one case. According to the Enneking Evaluation System 11 patients had a good and 9 a fair result.

Bone marrow embolism following cryosurgery of bone: an experimental study

Cryosurgery is commonly used in medicine for treatment of benign and malignant lesions. We had clinical and experimental data indicating that cryosurgery of intact bone could cause bone marrow intravasation and embolism, i.e., particles of bone marrow entering extraosseous veins and occluding pulmonary vasculature. This study was designed to investigate the pathogenesis of bone marrow intravasation and embolism after cryosurgery. Three hypotheses on the pathogenesis of bone marrow intravasation were tested using a model of cryosurgical continuity lesion in rats and rabbits. Influence of physical and circulatory factors were excluded supporting a mechanical-biological hypothesis; the intravasation of bone marrow after cryosurgery of bone is caused by an increased intramedullary pressure. The increased intramedullary pressure is due to edema in the medullary cavity caused by cryosurgical damage to cell membranes. It is demonstrated that the bone marrow intravasates can embolize to the lungs causing respiratory insufficiency. This can be a serious complication following cryosurgery of intact bone. Prophylactic decompression of the medullary cavity can possibly prevent the rise in intramedullary pressure and thus intravasation and embolisation of bone marrow after cryosurgery of intact bone.

The use of DNA flow cytometry in the diagnosis of triploidy in human abortions

The ploidy of placental tissue from 59 abortions was determined using DNA flow cytometry. The specimens were also screened histologically for features considered to be characteristic of a partial mole. Triploidy was found in six cases; three of these cases presented histologically as partial moles. From the four specimens histologically classified as partial moles, three appeared to be triploid. The most specific histologic features of triploidy were cystic change of the placental villi and trophoblastic hyperplasia with vacuolation of the syncytiotrophoblast; however, these changes were also found in some of the nontriploid abortions. Irregularity of villous contours was less specific.

Dedifferentiated parosteal osteosarcoma of the femur with aneuploidy and lung metastases

In this report, the pathologic findings and the results of cellular DNA measurements of a tumor that on first presentation seemed to be a classical parosteal osteosarcoma are described. After resection 8 months later, part of the tumor appeared to display highly malignant features. DNA flow cytometry of this part of the tumor showed an aneuploid cell population. The aggressive nature of the tumor was confirmed by the development of lung metastases approximately 1 year after resection of the primary tumor.

Chromosomal changes in mature residual teratomas following polychemotherapy

A cytogenetic analysis of 13 mature residual teratomas following chemotherapy revealed modal chromosome numbers ranging from 52 to 85, in agreement with the flow cytometric determination of the DNA content of the tumors. At least one copy of an i(12p) was present in 12 tumors. One tumor, however, lacked that marker. The comparison between the chromosomal abnormalities found in mature residual teratomas following chemotherapy and those from primary testicular nonseminomas suggests that residual teratomas result from selection of clones from the primary tumor with a less abnormal karyotype.

Epithelioid sarcoma in children and adolescents: a report of four cases

Epithelioid sarcoma is an uncommon soft tissue tumor, most prevalent in the extremities of young adults. Youth has been described as a favorable prognostic factor. We describe four patients (two children aged 10 years and two adolescents aged 18 years) with extremity epithelioid sarcoma. Both 10-year-old children had rapid disease evolution and died 3 and 6 months after the diagnosis was made. Both tumors were strict diploid at DNA flow cytometry, but one had an abnormal karyotype (trisomy 2). Both adolescents are disease-free 18 months and 18 years after combined treatment consisting of local resection, regional lymph node dissection, and isolated regional perfusion with cytostatic agents.

Cytogenetic analysis of ten human seminomas

A cytogenetic analysis of ten seminomas has been carried out after direct harvesting of the tumor cells. Modal chromosome numbers ranged from 63 to 112. These numbers were in agreement with flow cytometric determination of the DNA content of the tumors. Eight tumors had at least one copy of an i(12p) among other chromosomal abnormalities. Two seminomas lacked the i(12p).

Ploidy of primary germ cell tumors of the testis. Pathogenetic and clinical relevance

The ploidy of testicular germ cell tumors (GCT), a heterogeneous group of neoplasms, was studied by DNA flow cytometry. The DNA index for infantile yolk sac tumor (N = 10), seminomas (N = 20), and nonseminomas (N = 36), was: 1.91, 1.66, and 1.43, respectively. These values differed significantly one from another (p less than 0.01). The seminoma and nonseminoma components of combined tumors (N = 16) had a significantly different median DNA index of 1.61 and 1.40, respectively. Three of the 10 infantile yolk sac tumors, but only one of the 72 testicular GCT of adults were diploid. The consistent aneuploidy of testicular GCTs of adults might be helpful in the differential diagnosis of primary nongerm cell tumors of the testis, and in differentiating between metastases of testicular GCTs and primary extragonadal malignant GCTs. These data fit into a model of pathogenesis of testicular GCTs of adults in which all tumors, with the possible exception of spermatocytic seminoma, pass through a seminoma stage. Tumor evolution seems to result from net loss of chromosomes from a (near)tetraploid carcinoma in situ cell. The pathogenesis of infantile yolk sac tumor might be different from that of testicular GCTs of adults.

Late recurrence of mature teratoma in nonseminomatous testicular tumors after PVB chemotherapy and surgery

We present the case histories of 3 patients in whom a growing mature teratoma developed twenty-eight, thirty-one, and thirty-three months after successful remission-induction chemotherapy with cisplatinum, vinblastine, and bleomycin (PVB) for a disseminated nonseminomatous testicular tumor (NSTT). The serum tumor markers were not increased. The teratomas were all localized retroperitoneally, two being found near the site of excision of a residual tumor after remission-induction chemotherapy. Two of the 3 patients were alive without further treatment after excision of the teratoma; the third patient did not die of tumor progression, but mature teratoma was still present. Even if the serum tumor markers are not increased, recurrent tumors in patients previously given PVB chemotherapy because of a disseminated NSTT should be excised to establish their histology. En-bloc excision of the recurrent tumor is sufficient. It is pointed out that a mature teratoma can become a large cystic tumor in the course of time: the so-called growing mature teratoma syndrome. We believe that, after remission-induction chemotherapy of disseminated NSTT with a teratoma component in the primary testicular tumor, any residual tumor should be excised to prevent subsequent tumor progression.

Karyotyping and DNA flow cytometry of an orchidoblastoma

The first karyotype of an orchidoblastoma is described. The most striking finding is the absence of the i(12p) marker chromosome, considered specific for testicular germ cell tumors of adults. Differences between infantile and adult testicular germ cell tumors are discussed, as are features that infantile testicular germ cell tumors have in common with extragonadal germ cell tumors.

Cytogenetic study of a combined germ cell tumor of the testis

The cytogenetic findings in both components of a combined germ cell tumor of the testis are described. The only structural chromosomal abnormality in common was an i(12p).

i(12p)-negative testicular germ cell tumors. A different group?

Cytogenetic analysis was performed of three seminomas, two primary nonseminomas, and two mature residual teratomas following chemotherapy, all lacking i(12p). Testicular germ cell tumors without an i(12p) may represent a subgroup of germ cell tumors, also in their clinical course, compared with those having i(12p).

Results of adjuvant surgery in patients with stage III and IV nonseminomatous testicular tumors after cisplatin-vinblastine-bleomycin chemotherapy

From January 1978 to April 1983, 53 patients were treated with cisplatin-vinblastine-bleomycin chemotherapy because of advanced nonseminomatous testicular tumor (NSTT). After the chemotherapy, the serum tumor markers were back to normal in 41 patients, of whom 35 were eligible for surgical removal of the residual tumor. In four patients, vital tumor tissue was found in the residual tumor. Salvage chemotherapy resulted in complete remission. Residual mature teratoma was encountered after the chemotherapy in 15 of the 25 patients with a teratomatous component and in one of the ten patients without a teratomatous component in the primary tumor. On completion of the study, 38 of the 53 patients (72%) are still alive, with a median follow-up of 65 months. Subdivided by tumor volume, survival is found to amount to 92% for small-volume disease, 67% for large-volume disease, and 64% for very-large-volume disease. Six patients (11%) developed a recurrence in the course of the follow-up. Exploratory laparotomy after remission induction chemotherapy is necessary in all patients with a teratomatous component in the primary testicular tumor who have become tumor marker negative, irrespective of the roentgenographic findings of the retroperitoneum. Patients without a teratomatous component in the primary tumor should have exploratory laparotomy only in case of roentgenographic evidence of retroperitoneal residual tumor. A thoracotomy is needed only in the presence of roentgenographic evidence of pulmonary residual lesions.

Direct molecular analysis of a deletion of 3p in tumors from patients with sporadic renal cell carcinoma

Normal and tumorous nephrectomy specimens from seven renal cell carcinoma patients were subjected to a Southern analysis using chromosome #3-specific polymorphic probes. Three patients were not informative because of homozygosity at all loci studied. One patient showing heterozygosity at 3q in normal tissue had a tumor that remained heterozygous. In three patients the tumor showed loss of heterozygosity for a short arm market at 3p21. In one of them heterozygosity for a second short arm marker was also lost. Another of these three patients retained heterozygosity for this second short arm marker, as well as for a long arm marker, suggesting a chromosomal breakpoint between the loci for the two short arm markers. Our results demonstrate that the known involvement of a short arm region of chromosome #3 in the development of renal cell carcinoma can readily be further evaluated by direct molecular methods.

Cytogenetics of a case of osteosarcoma

We present the result of the cytogenetic study of a case of osteosarcoma that revealed a very complex karyotype with a modal chromosome number of 93 and several structural chromosomal abnormalities.

A residual mature teratoma with a more balanced karyotype than the primary testicular nonseminoma?

We have been able to study the karyotypes and measure the DNA content in both the primary nonseminomatous germ cell tumor of the testes and the residual mature teratoma after chemotherapy of the same patient. Based on these and other studies, the mechanism of therapy-related differentiation in germ cell tumors of the testes is discussed.

Cytogenetics of 12 cases of renal adenocarcinoma

The cytogenetics of 12 cases of renal adenocarcinoma are presented. Clonal abnormalities were found in nine patients. Worth mentioning are abnormalities of the X chromosome (1 X) and the chromosomes #1(3 X), #3(3 X), #7(4 X), #8(4 X), and #14(2 X). From our data and data from the literature it appeared that the chromosomal regions 3p11-p21, 1q21, 14q22, and Xp11 are important for the oncogenesis of renal cell carcinoma as well as increased dosage of chromosome #7 and loss or abnormalities of chromosomes #8 and #14.

Malignant struma ovarii treated by ovariectomy, thyroidectomy, and 131I administration

A 36-year-old woman presented with an intraperitoneally disseminated malignant struma ovarii, diagnosed by histopathology and 131I scintigraphy. The serum thyroglobulin level was elevated, and immunoperoxidase staining for thyroglobulin was positive for disease both in the tumor cells lining the follicles and in the colloid. The patient was treated successfully by a bilateral ovariectomy followed by a total thyroidectomy and administration of radioactive iodine. The clinical behavior and the presence of thyroglobulin in both serum and tumor tissue demonstrate the similarity between neoplastic thyroid tissue in the ovary and in the thyroid gland.

[Regional isolation perfusion with cisplatinum in dogs with osteosarcoma of an extremity]

In the treatment of osteosarcoma, it is possible to differentiate between systemic therapy and local regional treatment. Systemic treatment of human patients with osteosarcomas consists in adjuvant chemotherapy. This has considerably improved the prognosis in these cases. The primary object in local regional treatment is to prevent local recurrences and to preserve function. As regards extremities, the aim is to preserve the limbs. In the present investigations, the value of regional chemotherapy by isolated regional perfusion with cis-platinum to dogs is studied. This approach was based on the hypothesis that considerable necrosis of tumours may be produced after perfusion with cis-platinum, thus making extremity-saving surgery possible. Isolated regional perfusion with cis-platinum (30 mg/litre of extremity volume) was performed in nine dogs with osteosarcomas of an extremity. A marked effect on the tumour was detectable on the basis of clinical, radiological and histological parameters. In the opinion of the present authors, regional perfusion with cis-platinum may contribute to extremity-saving treatment of osteosarcomas in dogs and human subjects. However, further studies will be required in order to achieve more adequate quantitation an improvement of local effects. In view of the synergy with cis-platinum, the latter may possibly be attained by the addition of hyperthermia (temperatures above 41.5 degrees C).

Orchidectomy alone in stage I nonseminomatous testicular germ cell tumors

Fifty-four patients with Stage I nonseminomatous testicular germ cell tumors (NSTGCT) were treated from 1982 to 1984. In 1982 and 1983, the orchidectomy was followed by an exploratory laparotomy to conclude the dissemination study. In 1984, laparotomy was performed only if indicated. The mean follow-up was 29 months. A relapse occurred in 11 patients (20%). The relapse rate in patients who underwent exploratory laparotomy was as high as that in patients who did not. All patients treated for relapse by chemotherapy and surgery entered a complete remission for at least 1 year. It proved impossible to establish criteria for prediction of a subsequent relapse. Both serum tumor marker assays and roentgenography are important aids in diagnosing a relapse. With careful follow-up of Stage I NSTGCT patients, a wait-and-see attitude can be adopted until a relapse occurs.

Treatment of retroperitoneal residual tumor after PVB chemotherapy of nonseminomatous testicular tumors

Twenty-five patients with nonseminomatous testicular tumors stages IIB and IIC were treated at the Groningen University Hospital between January 1978 and April 1983. One patient died from his extensive tumor during chemotherapy. The remaining 24, treated by combination chemotherapy with cisplatin, vinblastine, and bleomycin as well as by surgery, are all alive after a mean follow-up period of 56 months. A laparotomy was performed after chemotherapy in each of the 24 cases. In four patients no residual tumor was found. Residual tumor was resected in 20 patients, in 13 the tumor contained only necrosis and fibrosis, 7 had mature teratoma. Comparison of the histologic features of the primary testicular tumor with those of the retroperitoneal residual tumor after chemotherapy, revealed that if the primary tumor did not contain a teratoma component the residual tumor showed only necrosis and/or fibrosis. When the primary tumor contained a teratoma component, mature teratoma was found in 50% (7/14) of the residual tumors.

Wait-and-see policy in clinical stage I non-seminomatous germ cell tumors of the testis

Thirty-three patients with a non-seminomatous germ cell tumor of the testis in clinical stage I were treated only by orchidectomy. The very careful follow-up--with tumor marker assays every 3 weeks, chest X-rays every 6 weeks and CT-scans of the lungs and retroperitoneum every 3 months--revealed metastases in 7 of the patients (21%). All these relapses were diagnosed within 6 months of the orchidectomy. Para-aortic node metastases were found in 5 of the 7 patients, with additional inguinal node metastases in 1 and additional lung metastases in 1; 2 patients had only lung metastases. Six of the 7 patients with a relapse were given chemotherapy (PVB); 1 patient refused chemotherapy. In view of residual disease a surgical excision was performed; it revealed necrosis as well as mature teratoma. All 33 patients are still alive, the post-orchidectomy follow-up period being 12-38 months.

Histology and DNA contents of a secondary malignancy arising in a mature residual lesion six years after chemotherapy for a disseminated nonseminomatous testicular tumor

The current report describes a secondary malignancy developing in a retroperitoneal mature residual lesion 6 years after chemotherapeutic treatment of a disseminated nonseminomatous testicular tumor. The histologically malignant component was not present in the primary tumor and consisted of polygonal and fusiform cells with focal tubular formations, resembling primitive neuroectodermal tissue. Immunoperoxidase staining for alpha-fetoprotein and the beta-subunit of human chorionic gonadotropin remained negative, whereas focal positivity for S100 protein was observed. Neuron specific enolase positivity was equivocal. The DNA contents of both the mature components in the primary and the metastatic retroperitoneal tumor and in the various malignant components of the primary tumor, were in the hypotriploid range. In the malignant component of the retroperitoneal metastasis, a hypertriploid peak was observed. These findings suggest further clonal evolution in a phenotypically mature, genotypically abnormal residual metastatic tumor after chemotherapy. It is stressed that the mature appearance of the residual lesions may be deceiving and that these lesions are highly susceptible to resume malignant behavior.

Differentiation of TERA-2 human embryonal carcinoma cells into neurons and HCMV permissive cells. Induction by agents other than retinoic acid

Retinoic acid induces the differentiation of NTERA-2 cl. D1 human embryonal carcinoma (EC) cells into neurons, cells permissive for the replication of human cytomegalovirus (HCMV), and other cell types that cannot as yet be classified but are distinguishable from the stem cells. We tested several additional agents for their ability to induce the differentiation of these EC cells. No differentiation was induced by butyrate, cyclic AMP, cytosine arabinoside, the tumor promoter 12-0-tetradecanoylphorbol 13-acetate (TPA), or the chemotherapeutic agent cis-diaminedichloroplatinum, although morphological changes were detected at the highest concentrations of these agents that permitted cell survival. However, retinal, retinol, 5-bromouracil 2'deoxyribose (BUdR), 5-iodouracil 2'deoxyribose (IUdR), hexamethylene bisacetamide (HMBA), dimethylacetamide (DMA), and dimethylsulfoxide (DMSO) all induced some neuronal differentiation, but to a lesser extent than retinoic acid. Also, BUdR, IUdR, HMBA, and DMA induced the appearance of many cells permissive for the replication of HCMV. Differentiation was, in all cases, accompanied by the loss of SSEA-3, a globoseries glycolipid antigen characteristically expressed by human EC cells. However, another glycolipid antigen, A2B5, which appears in 60%-80% of differentiated cells 7 days following retinoic acid induction, was detected in less than 20% of the cells induced by the other agents studied. This implies that the HCMV-permissive cells induced by retinoic acid are not identical to those induced by BUdR, IUdR, and DMA.

Karyotyping and DNA flow cytometry of mature residual teratoma after intensive chemotherapy of disseminated nonseminomatous germ cell tumor of the testis: a report of two cases

Karyotyping and DNA flow cytometry was performed on mature residual teratoma cells following intensive chemotherapy of disseminated nonseminomatous germ cell tumor of the testis to study its biology. We report herein a successful method for short-term tissue culture and karyotyping of retroperitoneal residual mature teratoma in two cases. In vitro morphology confirmed that the cultured cells were nonembryonal carcinoma cells. Both mature residual teratomas were highly aneuploid and possessed the i(12p) marker characteristic of testicular germ cell tumors. A clone in the retroperitoneal residual lesion of one of the patients showed a DNA-index different from the primary tumor and might represent a clone unmasked by chemotherapy. In view of these data, which are in agreement with recent reports on secondary non-germ cell malignancies arising in mature residual teratoma, aggressive surgery of mature residual lesions seems justified.

Comparison of two methods of treating primary malignant melanomas Clark IV and V, thickness 1.5 mm and greater, localized on the extremities. Wide surgical excision with and without adjuvant regional perfusion

A comparative retrospective study of patients with primary malignant melanomas of the extremities, Clark level IV/V and tumor thickness greater than or equal to 1.5 mm, was performed in Sydney (Australia) and Groningen (The Netherlands). The efficacy of wide local excision combined with adjuvant regional perfusion (Groningen) was compared with that of wide surgical excision only (Sydney). Patients were classified by sex and tumor location. There were only sufficient numbers of female patients with a tumor of the lower extremity available for this comparative study. All patients were stage I and none received prophylactic lymph node dissection. Age, tumor location, tumor thickness, depth of infiltration and ulceration were taken into account and the factors studied within this group were 10-year disease-free rate, 10-year survival rate, and local and regional recurrences. Women with a melanoma of the leg (excluding the foot) who had been treated by excision and adjuvant regional perfusion, had a significantly better 10-year disease-free rate (P less than 0.0005), a significantly higher 10-year survival rate (0.010 less than P less than 0.025) and significantly fewer local/regional recurrences (P less than 0.0005) than women treated by wide local excision only. For tumors of the foot, however, no significant differences in 10-year disease-free rate, 10-year survival rate or local/regional recurrences were observed after perfusion.

Cytogenetics of a renal adenocarcinoma in a 2-year-old child

Chromosomal abnormalities in a 2.4-year-old boy with renal adenocarcinoma (Grawitz tumor) are described. Renal adenocarcinoma is extremely rare in childhood, compared with nephroblastoma (Wilms' tumor). In all tumor cells the same 46,XY,t(X;1) (p11.2;q21.2) karyotype was found. This karyotype is compared with the cytogenetic descriptions of renal adenocarcinoma in adults.

The effect of chemotherapy on osteosarcoma of the extremities as apparent from conventional roentgenograms

The introduction of chemotherapy has greatly changed the treatment of osteosarcoma. During the preoperative phase the tumor response to chemotherapy can be assessed in various ways. This paper discusses the clinical, histological and radiological response to preoperative chemotherapy in three patients. Changes in conventional roentgenograms following chemotherapy can reflect the effect of chemotherapy on the primary tumor. This can be important in planning further chemotherapy or surgery.

Sublocalization of c-myb to 6q21----q23 by in situ hybridization and c-myb expression in a human teratocarcinoma with 6q rearrangements

We have sublocalized the human proto-oncogene c-myb by applying two different techniques: in situ hybridization of metaphase spreads and chromosome spot hybridization of flow-sorted chromosomes. For this we used a teratocarcinoma cell line carrying specific chromosome translocations involving the two chromosomes 6 and one chromosome 11. The distribution of the c-myb gene copies on the different translocation chromosomes revealed that c-myb is located in the region 6q21----q23. Because of the close proximity of the c-myb locus to the chromosomal breakpoints in the teratocarcinoma, we investigated whether c-myb was implicated in the development of this tumor. No rearrangement, deletion, or amplification of the gene was detected in the teratocarcinoma cells. Furthermore, the level of c-myb expression was comparable to that of other cell lines of nonhematopoietic origin. These results suggest that c-myb was not affected by the translocation and played no significant role in the development of this teratocarcinoma.