Anaplastic seminoma

Fourteen patients with anaplastic seminoma were analyzed retrospectively. At the time of presentation anaplastic seminoma has similar prognosis stage for stage as the classic seminoma. However, the distinctive histologic findings and the high rates of local invasion and of elevations of serum beta-subunit human chorionic gonadotropin serve to distinguish anaplastic seminoma from the classic seminoma. These features, suggesting a possibly greater metastatic potential for anaplastic seminoma, warrant its continued identification as a distinct pathologic subtype.

Radiation therapy of carcinoma of the tonsillar region

From 1960 through 1976, 353 consecutive patients with carcinoma of the tonsillar region were primarily treated with radiation therapy. The mean age of patients was 58 years with males predominating (78%). Patients were classified according to a TNM and stage classification. Most of the tumors were large, and the specific site of origin could not be determined in 33% of the patients. The predominant identifiable sites were the soft palate and uvula, 18%, the anterior tonsillar pillar, 18%, and the tonsillar fossa, 13%. Patients were treated with radiation to doses of 6700 rad given in 48 days and 33 fractions using Cobalt 60 radiation. We found a 91.7% control rate for patients with T1 disease and 76.9%, 49.5%, and 25% for T2, T3, and T4 patients, respectively. The overall local control rate was 62.3%. Surgery was used most often in recurrences for Stage III patients. Salvage surgery was carried out in 93 patients. Surgery was more successful in controlling the disease in patients in whom the primary was controlled by irradiation. Overall, the tumors in 43% of the patients who had surgery were subsequently controlled as a result of this treatment. Metastasis occurred rapidly, with 75 of the patients exhibiting metastases by 18 months. Complications were not related to dose but were slightly higher in patients who had surgery (5%). We conclude that radiation therapy is the preferred treatment for Stage I and II squamous cell carcinoma of the tonsillar region. No satisfactory results were obtained in Stage IV; other approaches should be tried.

Role of ovarian and adrenal progesterone in the regulation of ovum transport in pregnant rats

This study was designed to assess the role of postovulatory ovarian and adrenal progesterone secretion in the regulation of ovum transport in pregnant rats. The number and distribution of embryos in the genital tract and the plasma progesterone levels were determined during the first 5 days of pregnancy in ovariectomized (OVX), adrenalectomized (ADX), ovariectomized and adrenalectomized (OVX + ADX), intact control (IC), or sham-operated control (SOC) rats. Some OVX or OVX + ADX rats received subdermal implants of progesterone pellets following surgery. The day of insemination was designated Day 1 of pregnancy. Transport of embryos from the oviduct to the uterus was essentially complete by the morning of Day 5 in IC and SOC. Neither adrenalectomy performed on Day 1, nor ovariectomy done on Day 4 of pregnancy modified the time of passage of ova from the oviduct to the uterus. Retention of some eggs in the oviduct, accompanied by rapid transport of others into the uterus and expulsion through the vagina, was observed when ovariectomy was performed on Days 1, 2 or 3, or when ovariectomy plus adrenalectomy were performed on Day 1. Following ovariectomy plus adrenalectomy or ovariectomy but not adrenalectomy alone, there was a marked and sustained decline in serum progesterone concentration. Subdermal implants of progesterone supplied on Day 1 restored progesterone levels and improved the pattern of ovum transport in OVX or OVX + ADX. It is concluded that postcoital secretion of progesterone by the ovary plays a major role in the physiologic regulation of oviductal embryo transport in the rat. Progesterone secreted by the adrenal is neither essential nor can it substitute for the ovarian source in the regulation of this process.

Bilateral testicular germ cell malignancy

The other testicle was involved in 6 of 235 patients (2.69 per cent) with a history of testicular germ cell tumor. It occurred more often following seminoma (4 of 113, 3.5 per cent cases). The mean age at occurrence of the first tumor (twenty-five years) was earlier than expected, and the mean interval between tumors was 8.8 years. Accurate clinical staging of second tumors is impeded by alteration in the routes of metastatic dissemination, and treatment options are limited by previous therapy for the first tumor.

[Zollinger-Ellison syndrome. Report of a case]

A 61 years old male with Z-E syndrome is reported. He presented gastrointestinal bleeding, abdominal pain, slightly elevated gastrin and hypoglycemia. He underwent total gastrectomy, a non-resectable tumor of the tail of the pancreas with liver metastasis were found. A biopsy of the liver metastasis and the gastric mucosa were reviewed under the light and the transmission electronic microscopes. The gastric mucosa showed abundant parietal cells. The metastatic hepatic tissue was poorly differentiated under the light microscope and the electron micrographs revealed tissue resembling pancreatic islands of Langerhans with granules in the cytoplasm, this means that the neoplasm originated from APUD cells.

CAT scanning in staging of prostatic cancer

Forty-six patients with histologically proved adenocarcinoma of the prostate underwent pelvic lymphadenectomy after CAT scanning. The accuracy, specificity, and sensitivity of the CAT scan in detecting nodal metastasis were 70, 93 and 30 per cent, respectively; this compares favorably with pedal lymphangiography. Seventeen of the patients had radical prostatectomy. The accuracy, specificity, and sensitivity of the CAT scan in depicting local extent of the tumor were 47, 100, and 18 per cent, respectively; although low, no other clinical or biochemical method provides a better result.

Stage A prostate cancer from pathologist's viewpoint

Four hundred sixty-five departments of pathology in the United States were asked the following questions pertaining to Stage A prostatic cancer: (1) If a focus of adenocarcinoma is incidentally found in an enucleated specimen, what is the maximum diameter such a lesion may attain and still be considered an A-1 prostatic carcinoma? (2) If adenocarcinoma is incidentally found in a specimen resected transurethrally, how many chips may contain tumor and the lesion still be considered A-1 prostatic carcinoma? (3) What is your "routine pathologic examination" of a prostatic specimen? The majority of pathologists believe that the maximum diameter of a focal (A-1) lesion in an enucleated specimen is 5 mm., and the maximum number of transurethral chips containing tumor in a focal (A-1) lesion is three. The majority of pathologists section every chip when the specimen weighs less than 10 Gm. However, only 12 per cent of the pathologists section every chip when the specimen is greater than 10 Gm., while the others use a random section technique. There is a great diversity of techniques among pathologists in their methods of examining enucleated prostatic specimens.

The therapeutic role of pelvic lymphadenectomy in prostatic cancer

We have reported our observations in 72 patients with clinically localized prostatic cancer who underwent radical transpubic prostatectomy and pelvic lymphadenectomy. Of the 72 patients, histologic examination revealed that 54 had tumor confined within the capsule, three had extracapsular spread of the tumor, and 15 had nodal involvement. It is not clear whether the removal of uninvolved lymph nodes had any benefit, but it is certain that it induced no adverse effect on short-term survival. It seems that pelvic lymphadenectomy can increase the survival of those patients with minimal lymph node metastases (one to two nodes). Three patients with more extensive involvement (three to nine nodes) have survived more than three years without evidence of recurrence. The hope for the cure of prostatic cancer, however, probably lies in the development of more effective anticancer agents that destroy whatever cancer cells are not either excised by radical prostatectomy in combination with pelvic lymphadenectomy or neutralized by irradiation.

Pulmonary arterial hypertension in male and female chickens at 3300 m

Two-hundred one-dayy-old male (M) and female (F) chickens were exposed to 3300 m (HA). Two-hundred control chickens were raised at sea level (SL). Chickens from both HA and SL were studied each week from the 3rd to the 7th week of age. Pulmonary arterial pressure (Ppa) was measured under local anesthesia in conscious animals. Hb, Hct and red blood cell counts (E) and the weights of the right ventricle (RV), left ventricle (LV) and septum (S) were obtained. HA chickens, both males and females, reached lower body weights than SL chickens. Ppa were 16 and 43 mm Hg (2.13 and 5.73 kPa) while RV/(RV + LV + S) values were 0.195 and 0.347 in SL and HA chickens, respectively. RV was 90% greater and LV 20% smaller in the HA chickens. S was not affected by altitude. Hb, Hct and E were higher in the HA birds. Sixteen HA M and 1 HA F died with signs of right heart insufficiency (RHI), however, M did not show greater values of Ppa or RV/(RV + LV + S) than F at SL or at HA. This indicates that the higher incidence of RHI in the M cannot be attributed to a higher responsiveness of their pulmonary vasculature to hypoxia.

Testicular germ cell tumors. Prognostic factors

A retrospective analysis of clinical and pathologic data of 100 patients with germ cell testicular tumors is presented. The presenting symptoms and their duration prior to orchiectomy are analyzed and categorized. The duration of symptoms correlated with the stage of disease for each tumor. Seventy-five per cent of locally invasive lesions were found in patients with Stage II or III disease.

Stage A2 prostatic carcinoma: should staging system be reclassified?

Seventy patients with clinically localized prostatic carcinoma were studied for histologic differentiation of primary tumor and the incidence of lymph node metastasis. Also the urologic literature was reviewed regarding the survival of such patients under similar treatment. The results indicate that clinically staged A2 tumors are more aggressive biologically than tumors staged as B1, reaffirming the need for a change in the current staging system. The authors propose reclassification of clinically unsuspected, diffuse carcinoma from the A to the B2 stage.

Extended pelvic lymphadenectomy for prostatic cancer

Thirty patients with clinically localized prostatic carcinoma underwent extended pelvic lymph-adenectomy, including the presacral and presciatic (lateral sacral) areas. The first echelon of pelvic nodes to be involved by metastases was the external iliac, obturator, presacral and presciatic. The deep presacral-presciatic nodes were involved almost as often as the more superficial external iliac-obturator group. Metastases limited only to the deep pelvic nodes were found in 14 per cent of the cases.

Anterior urethral valves

Three cases of anterior urethral valves, a rare congenital anomaly are reported. Anterior urethral valves probably represent an attempt at duplication of the urethra in the first twelve to fourteen weeks of intrauterine life. The most common type is cusp-like and most frequently located in the bulbar urethra. The presenting complaints are lower tract symptoms, and the diagnosis is usually made by a voiding urethrogram.

Differences in pathological characteristics and prognosis of clinical A2 prostatic cancer from A1 and B disease

A retrospective study was done of 53 cases of clinical stages A1 to B2 prostatic carcinomas staged by pelvic lymphadenectomy. The study compared the histologic differentiation, degree of lymphocytic infiltration, incidence of lymph node metastases and type of cellular response of clinical stage A2 to stages A1 and B disease. The available data pertaining to the incidence and survival of patients with stage A2 prostatic carcinoma were analyzed. Our study indicates that 1 of every 3 unsuspected carcinomas is of clinical stage A2. The stage A2 tumors are diffused, with a higher degree of undifferentiation and a higher incidence of lymph node metastases than tumors classified clinically as stages A1 and B1. Also the survival of patients with clinical stage A2 tumors is lower than the survival of patients with clinical stage B1 disease. Clinical stage A2 tumors are more advanced biologically than clinical stage B1 tumors.

One-stage hypospadias repair

A surgical technique for correction of hypospadias with chordee in one stage is described. This technique which brings the ectopic meatus up to the tip of the glans was successfully applied in 3 cases of penoscrotal and in 8 cases of penile hypospadias.

Jejunal conduits: technique and complications

Thirty patients underwent jejunal urinary diversion: 27 bilateral cutaneous ureterojejunostomies, 2 cutaneous pyeloureterojejunostomies and 1 bilateral pyelocutaneous jejunostomy. In the majority of the cases this high diversion was indicated for malignant disease with preoperative and postoperative irradiation of the pelvis. Postoperative morbidity in these cases is not different from thatin cases of ileal conduit operation, except for a high incidence of reversible hypochloremic acidosis with hyponatremia, hyperkalemia and uremia. This electrolytic syndrome is the consequence of a continuous exchange of ions between the jejunal content and the extracellular fluid with resultant loss of sodium chloride and absorption of potassium and urea. An important link in the pathophysiology of the jejunal syndrome is the hypersecretion of renin-aldosterone, which aggravates the disturbance. Limited renal function (glomerular filtration rate less than 50 cc per minute), long loop and inadequate salt intake are among contributing factors. The syndrome is correctable by administration of salt. Some patients must be placed on salt supplement indefinitely. The jejunum is not recommended for urinary diversion in patients with limited renal function, those on low salt diet or those in whom a long intestinal loop would be required for diversion.

Colonic urinary diversion: 10 years of experience

Experience with 46 colon urinary conduits is summarized. The transverse colon was used in 39 patients and the sigmoid in 7. Initially, we considered widened uretercolic anastomosis with free reflux desirable but later, upon realizing the dangers of reflux, antireflux procedures were incorporated into the operation. Among the advantages of the colon conduit are minimal stomal stenosis, little residuum, less electrolyte disturbance and availability for high and low diversions.