Lectin histochemistry of classic and spermatocytic seminoma

Six spermatocytic and 13 classic seminomas were studied histochemically with fluorescein isothiocyanate-labeled lectins. Wheat-germ lectin and succinyl concanavalin A reacted with all 19 tumors, whereas other lectins bound to some, but never to all, tumors in either group. Soybean lectin reacted with seven of 13 classic seminomas but with none of the spermatocytic seminomas. On the other hand, Maclura pomifera lectin reacted with two of six spermatocytic and with none of the classic seminomas. Our data thus illustrate some differences between classic and spermatocytic seminomas, but no diagnostic or pathognomonic pattern of lectin binding could be discerned. Neither classic nor spermatocytic seminomas (with a single exception) reacted with the lectins that do not react with normal spermatogenic cells. Spermatocytic seminomas did not react with eight lectins typically recognizing spermatids and spermatozoa. Thus, our data do not support the earlier contentions that spermatocytic seminomas contain malignant equivalents of cells in advanced stages of spermatogenesis.

Mesenchymal and muscle-specific intermediate filaments (vimentin and desmin) in relation to differentiation in childhood rhabdomyosarcomas

Twenty-one childhood rhabdomyosarcomas were divided into three groups on the basis of cytologic composition. The tumors in group P consisted entirely of primitive mesenchymal cells, whereas those in groups M and W were characterized by the additional presence of numerous round rhabdomyoblasts and strap cells, respectively. The tumors were studied for the universal mesenchymal intermediate filament vimentin, and for the muscle-specific intermediate filament desmin. Vimentin positivity, which tended to be more prominent in primitive tumor cells, was found in all tumors, whereas desmin was found especially in round rhabdomyoblasts and strap cells. Desmin-positive primitive cells were found only in groups M and W, not in group P. It was concluded that the differentiation from primitive mesenchymal cells to morphologically recognizable myogenic tumor cells is accompanied by an increase in desmin positivity and, presumably, a decrease in vimentin positivity. Moreover, the observations suggest the existence of a group of "committed" cells that are morphologically primitive, but desmin-positive. These cells might play an important role in the observed further differentiation of rhabdomyosarcomas under chemotherapy.

Viability of tumor cells in the irrigation fluid of the Cavitron Ultrasonic Surgical Aspirator (CUSA) after tumor fragmentation

The Cavitron Ultrasonic Surgical Aspirator (CUSA) (Cooper Medical, Stamford, CT) is a relatively new surgical modality. The risk of tumor seeding during tumor surgery has not been studied until now. Hanks balanced salt solution, normal saline, distilled water, and Dakin's solution were used as irrigation fluids during CUSA fragmentation of Lewis lung carcinoma in C57B1/10 female mice, using the machine at 40% of its maximal output. All four irrigation fluids contained viable tumor cells--growing in vitro as well as in vivo--after tumor aspiration. Normal saline was also used when the machine was operating at its maximal output. Under these conditions, the irrigation fluid contained viable tumor cells as well.

Treatment of malignant fibrous histiocytoma of bone. A plea for primary chemotherapy

Seven patients have been treated for malignant fibrous histiocytoma (MFH) of bone since the end of 1977. One patient received no chemotherapy, and one did not complete attempted chemotherapy. Both died, 7 and 51 months after diagnosis, respectively. The remaining five patients completed chemotherapy. Two first underwent a primary amputation, whereas the other three received primary chemotherapy with histologic evaluation of the effect. These patients showed a complete remission. The five patients who completed chemotherapy are all still alive, without indications of metastases or local recurrence. Although the number of cases is small, a 25- to 58-months (mean, 45) survival, in five patients treated either with chemotherapy alone or chemotherapy and surgery, is surprisingly good in view of previous experience with this tumor. In some of these patients, the authors were able to document an absence of any viable tumor following chemotherapy.

Biopsy of bone tumours

Bone biopsy is not only the most important step in the diagnosis of bone tumours, but since the introduction of chemotherapy, it has also become essential in the evaluation of treatment of highly malignant bone tumours. A total of 206 bone biopsies were performed on 136 patients seen between January 1, 1978 and August 1, 1982 (99 open and 107 drill biopsies). Complications during or after biopsy were relatively rare, and none were of a serious nature. Pathological fractures at sites of biopsies developed exclusively in patients given chemotherapy. In gaining adequate histologic material, the overall result of open bone biopsies (98%) was superior to that of drill biopsies (70%). The choice between both techniques was dependent on individual patient factors. Of the total of 206 bone biopsies, 10% proved not to be representative. It is concluded that, especially in patients given chemotherapy for a malignant tumour of a long bone, the possibility of a spontaneous fracture after a bone biopsy should be borne in mind.

Radiographic imaging of lymph nodes in lymph node dissection specimens

A new method of identifying and locating lymph nodes in lymph node dissection specimens using a radiographic imaging technique is described. The specimen is immersed in 96% ethyl alcohol which possesses a radiographic density similar to fat tissue. Even small immersed lymph nodes contrast well with 96% ethyl alcohol. Thus, a radiograph of a nodal dissection specimen, immersed in 96% ethyl alcohol, does not show the interfering projection of variations in thickness of the specimen. Simultaneously, lymph nodes are clearly imaged. Using this procedure, we could visualize 97% of all lymph nodes present in the fat tissue of lymph node dissection specimens, which were dissected free from large radiodense structures like muscle and submandibular glands. Thus, a simple method was established for radiographic documentation of lymph nodes in lymph node dissection specimens.

Identical chromosome translocations involving the region of the c-myb oncogene in four metastases of a mediastinal teratocarcinoma

A 39-year-old white male presented with a disseminated mediastinal teratocarcinoma. Karyotyping was performed on two mature residual metastatic lesions in the lungs immediately following chemotherapy, on a recurring lung lesion after 5 months, and on a metastasis in the right thigh 5 months after salvage chemotherapy. All four lesions were pseudoeuploid and showed identical chromosomal abnormalities: a translocation with the two chromosomes #6 and one chromosome #11 involved, resulting in 46, XY, t (6;6;11) (q21;q23;q13). The breakpoint in chromosome #6 is in the region to which the oncogene c-myb has been localized, and the breakpoint in chromosome #11 is at a known fragile and possibly oncogenic site, suggesting that the translocations in this case may have played a crucial role in the development of the malignancy.

Immune response of mice exposed to cis-diamminedichloroplatinum

The effects of cis-diamminedichloroplatinum (CDDP) on lymphoid organs and the immune response of young and older adult mice were studied histologically and by functionally assessing the activity of various subpopulations of immune cells. Young adult mice (6-8 weeks old) treated with 2 mg/kg CDDP mounted an enhanced splenic plaque-forming cell (PFC) response to both sheep erythrocytes, a helper T-cell-dependent antigen (HD), and pneumococcal polysaccharide type III a helper T-cell-independent antigen (HI). Older adult mice (18-22 weeks old) treated in the same way exhibited an equally enhanced PFC response to HD antigen and even a more pronounced response to HI antigen. Treatment of mice with 12 mg/kg CDDP resulted in immunosuppression. Thymus, lymph nodes, and spleen of animals treated with the higher dose of CDDP showed a marked cell depletion from both T and B areas, confirming that the immunosuppression was due to an indiscriminate elimination of both T and B lymphocytes. The immunosuppression and the cell depletion from lymphoid organs were more pronounced in younger mice. Thus, the effects of CDDP on the lymphoid organs and the immune response depend both on the age of the animals and on the dose of the drug. CDDP given in small doses enhances the PFC response, whereas a reduced PFC response is obtained following high-dose treatment.

Thoracotomy as a staging procedure after chemotherapy in the treatment of Stage III nonseminomatous carcinoma of the testis

Of 108 patients with a nonseminomatous testicular carcinoma, 28 with lung metastases were studied. After combination chemotherapy with cisplatin, vinblastine, and bleomycin (PVB), 11 patients underwent exploratory thoracotomy. Viable carcinomatous tissue, along with fibrosis, necrosis, and mature teratoma, was found in 4 patients. Three of these patients were successfully retreated with VP 16-213, cisplatin, and actinomycin D. In patients with residual pulmonary or mediastinal masses after chemotherapy, resection of the lesions is mandatory to demonstrate viable carcinoma so that treatment can be readministered. Thus, in our view, thoracotomy is a diagnostic procedure.

CEA and NCA in benign and malignant breast tumors

The involvement of Nonspecific Crossreacting Antigen (NCA) in the immunohistological demonstration of Carcino Embryonic Antigen (CEA) in 56 benign and 92 malignant lesions of the breast was analyzed. For this purpose, the authors utilized both polyclonal antisera and monoclonal antibodies. Polyclonal anti-CEA sera were used after absorption with normal tissue antigens, in order to remove crossreactivity, and without such an absorption. Ninety-three percent of breast carcinomas, 85% of mastopathic lesions not associated with a carcinoma, and 66% of fibroadenomas showed positive reactions with commercial unabsorbed polyclonal anti-CEA serum, which contained antibodies to NCA, whereas incubation with monospecific anti-CEA antiserum resulted in 42% positivity in carcinomas and negativity in mastopathic lesions and fibroadenomas. Forty-eight percent of breast cancer, 84% of mastopathic lesions, and 50% of the fibroadenomas contained NCA in different quantities. The staining pattern of carcinomas and fibroadenomas obtained with unabsorbed anti-CEA antibody and anti-NCA did not run parallel in all cases. Monoclonal antibodies against CEA and NCA confirmed the results obtained with polyclonal antiserum. This study suggests a cancer specificity of CEA in breast lesions.

Cytologic "differentiation" in childhood rhabdomyosarcomas following polychemotherapy

The effectiveness of polychemotherapy in young patients with rhabdomyosarcomas has been well established. The morphologic alterations in the tumor tissue, however, have not been widely reported. Therefore, in a group of 15 patients from 1 to 24 years of age, specimens of tumor tissue obtained before and after polychemotherapeutic treatment were compared. No morphologic changes, other than fibrosis and necrosis, occurred in patients who initially had virtually undifferentiated tumors. When moderately or well-differentiated areas were present in the initial specimens, these areas showed proportionate increases in the follow-up specimens. Moreover, the cellular characteristics of round rhabdomyoblasts and strap cells with or without cross-striations became more distinct after treatment. However, cell types that were not present in the initial specimens were never found in follow-up specimens. It was concluded that the major role of polychemotherapy is the selective destruction of undifferentiated tumor cells; further differentiated cells are stimulated either directly or indirectly to reach their maximal inherent differentiation levels, but it does not appear that transitions from one cell type to the other occur.

Effects ofCIS-platinum on embryonal carcinoma cell linesin vitro

Human and mouse embryonal carcinoma (EC) cells lines were compared with several cell lines of a more differentiated phenotype for their relative sensitivities to the cytotoxic effects of cis-platinum (cis-diamine-dichloroplatinum; CDDP); EC lines were among the most sensitive. Furthermore, several markers of EC cell differentiation were not induced by CDDP, irrespective of the concentration of the drug used. These data provide an explanation for the relative sensitivity of the EC cells in non-seminomatous germ-cell tumors to cis-platinum therapy.

Non-seminomatous germ cell tumors of the testis: morphology of retroperitoneal lymph node metastases after chemotherapy

Gross and histological examination of residual retroperitoneal mature teratoma revealed different findings in patients treated with PVB remission-induction chemotherapy with maintenance chemotherapy followed by an RLND 4-6 months after PVB chemotherapy (group I) as compared to patients who received PVB chemotherapy only and underwent an RLND after 4-6 weeks (group II). RLND specimens in group I predominantly contained mature teratoma with organoid differentiation, whereas the specimens in group II often consisted of small mature teratoma areas with less-differentiated structures next to large areas of fresh tumor necrosis. Our findings suggest that, either due to maintenance chemotherapy or due to a prolonged time interval between PVB remission-induction chemotherapy and RLND, mature teratoma grows and differentiates further from tissue level to organoid level.

Non-seminomatous germ cell tumors of the testis. Analysis of CEA production in primary tumors and in retroperitoneal lymph node metastases after PVB chemotherapy

In the present investigation we compared CEA immunoperoxidase staining in testicular tumors (before PVB chemotherapy) and retroperitoneal tumors (after PVB chemotherapy) with CEA levels in the cyst fluid of retroperitoneal mature teratoma and in the patients' serum. CEA had no value as a serum tumor marker since serum CEA elevations were not associated with tumor activity. Only one elevated CEA level after chemotherapy was associated with bleomycin pneumonitis. Despite normal serum levels, CEA was localized immunohistochemically in yolk sac tumor and mature teratoma in the primary tumors and in retroperitoneal mature teratoma following PVB chemotherapy. The presence of CEA in cells lining cystic mature teratoma was associated with high CEA levels in the cyst fluid.

Improved tissue perfusion during pressure-regulated hyperthermic regional isolated perfusion in dogs

To achieve adequate tissue perfusion during regional isolated perfusion, hind limbs of dogs were perfused for 60 min, regulating the extracorporeal circuit on pressure. The dogs were divided into three groups. In groups I and II perfusions were performed at a delta pressure (systemic mean arterial pressure minus hind limb mean arterial pressure) of respectively 50 and 15 mm Hg; in group III delta pressure was also 15 mm Hg but the cytostatic drug Melphalan was added. Tissue perfusion was determined by means of a multiwire polarographic oxygen electrode. Adequate tissue perfusion was obtained only at subnormal perfusion pressures (groups II and III), although in all groups perfusion flow was higher than preoperative flow. At low perfusion pressures (group I), tissue perfusion was severely impaired. In all groups leakage remained less than 10%. During regional isolated perfusion the extracorporeal circuit must be regulated at a delta pressure of 15 mm Hg to achieve adequate tissue perfusion.

Indications for elective groin dissection in clinical stage I patients with malignant melanoma of the lower extremity treated by hyperthermic regional perfusion

From 1973 through 1979, inguinal node biopsy was performed to stage the disease process in 179 clinical Stage I patients with malignant melanoma of the lower extremity, who were all treated by hyperthermic regional perfusion as well. Of the 179 tumors, 12% were intermediate risk (0.75-1.44 mm) and 88% were high risk (greater than or equal to 1.5 mm); all had a Clark level of IV or V. The Rosenmüller node at the caudal margin of the saphenous hiatus was elected for inguinal node biopsy. This biopsy supplies a fair amount of information about the entire inguinal node region: a malignant node was found in 16 patients (9%); no other metastatic nodes were found in 11 (73%) of 15 subsequent therapeutic node dissections; the 16th had metastatic parailiac nodes as well. Two patients of the remaining 163 had only metastatic parailiac nodes, without metastatic inguinal nodes. Of the remaining 161 histologic Stage I patients, 23 (14%) developed inguinal node metastases in the course of the follow-up. In 17 (74%) these metastases occurred within 2 years of perfusion. Ten of the 23 showed simultaneous general metastases. The vast majority of the inguinal node metastases developed in patients with a tumor greater than or equal to 5 mm. The 5-year survival was 81%, i.e. 84% in females versus 69% in males, the difference being significant (P less than 0.01). A tumor thickness greater than or equal to 5 mm implied a significantly less favorable prognosis as to development of inguinal node metastases associated with general metastases than a tumor thickness less than 5 mm. The benefit of the inguinal node biopsy was related to the difference in 5-year survival between the group with inguinal node metastases at perfusion (69%) and the group who developed inguinal node metastases during the follow-up (24%). The difference was great (45%) but statistically not significant. The data seem to warrant the conclusion that, after perfusion therapy, inguinal node biopsy is sufficient to stage the disease process at a tumor thickness less than or equal to 5 mm. Given a tumor thickness less than or equal to 5 mm, elective groin dissection might improve the chance of survival.

The effects of regional factors on the growth rate and the differentiation of mouse teratocarcinoma

Murine embryonal carcinoma cells, the pluripotent stem cells of teratocarcinoma were injected simultaneously into caudal and cranial sites on the back of syngeneic recipients in order to determine whether regional anatomical differences affect their take and growth rate and differentiation. The overall tumour take rate was higher in caudal than cranial sites, but the initial weight of tumours was higher in the cranial than caudal sites. Tumours developing in the two anatomical sites grew at the same rate with a linear increase in volume. At the end of the 4-week experimental period the differences in the size of anterior and posterior tumours were negligible and no histological differences were noted between the two groups. Our data indicate that regional factors significantly affect the take rate and the initial growth of this murine teratocarcinoma, i.e. the establishment of solid tumours from injected stem cells. The growth rate of established tumours was not affected by regional factors.

Ultrasound observations of a malignant cervical teratoma of the fetus in a case of polyhydramnios: case history and review

A case report is given concerning an extremely rare case of malignant teratoma of the neck with mature and immature metastatic lesions in the lungs in an immature fetus. The ultrasound observations are reported. The differential diagnosis of masses in the fetal neck, as can be observed by ultrasound, is discussed, with a review of the literature on this subject.

Effects of multiple-drug chemotherapy (cis-diammine-dichloroplatinum, bleomycin, and vinblastine) on the maturation of retroperitoneal lymph node metastases of nonseminomatous germ cell tumors of the testis. No evidence for De Novo induction of differentiation

Investigating the mechanisms underlying maturation of metastases of nonseminomatous germ cell tumors on administration of chemotherapy, the histologic characteristics of primary testis tumors was compared to the histologic characteristics of their retroperitoneal metastases in three historical patient groups. The metastases in Group I (20 patients) were not treated; those in Groups II (nine patients) and III (24 patients) were treated, respectively, with three cycles of dactinomycin and with four cycles of cis-diammine-dichloroplatinum, vinblastine, and bleomycin, before retroperitoneal lymph node dissection. In Group III there was a significant increase of metastases consisting of differentiated teratoma only, as compared to the metastases of Group I. However, both with and without chemotherapy, the metastases contained fewer areas of differentiated teratoma than the primary lesions. Metastases containing differentiated teratoma with and without other components, with one exception in Group III, were derived from primary tumors containing mature areas as well. Components other than mature teratoma were almost completely eradicated in Group III. These findings strongly suggest that selective destruction of components other than differentiated teratoma causes the mature histologic characteristics in the metastases upon administration of chemotherapy. The results do not support the hypothesis of induction of differentiation by the chemotherapeutic agents.

Cervical tissue shrinkage by formaldehyde fixation, paraffin wax embedding, section cutting and mounting

To evaluate the efficacy of cryocoagulation as a treatment for cervical intraepithelial neoplasia (C.I.N.), it is necessary to know the maximum depth of the glandular crypts, the maximum crypt involvement by C.I.N. and the extension of the cryolesion, obtained under standardized conditions. In a morphometric study on this subject, one has to take into account the shrinkage of the cervical tissue, caused by processing the tissue for histological examination. In the present study, tissue shrinkage of the cervix in different directions was measured in three separate steps. First shrinkage caused by formalin fixation was determined, second shrinkage caused by dehydration, clearing and paraffin wax embedding and finally that caused by section cutting and mounting. Shrinkage caused by formalin fixation, and by dehydration, clearing and paraffin wax embedding did not differ significantly in the different directions and resulted in an average shrinkage of respectively 2.7% and 12.6% of the original dimensions. The alterations of the dimensions by section cutting and mounting is not a process of shrinkage, but actually a deformation caused by pressure on the tissue during sectioning. Generally the dimension decreases in the cutting direction and increases in the direction perpendicular to it. In the calculation of the total shrinkage these alterations can be neglected, since the changes, although not consistent are small. It follows that in morphometric studies a total shrinkage of about 15% of the original dimensions has to be taken into consideration.

The viability of cells in the waste products of CO2-laser evaporation of Cloudman mouse melanomas

The viability of cells present in waste products originating during CO2-laser evaporation of Cloudman S91 mouse melanomas was investigated. Cytologic smears showed mainly carbonized particles and thermally damaged cells but some morphologically intact cells as well. Viability was tested with the trypan blue test, by in vitro culture and intramuscular and intraperitoneal inoculations in syngeneic mice. No dye-excluding cells were found in the trypan blue test. Growth was noted neither in vitro nor in vivo in the 127 mice, intramuscularly or intraperitoneally injected with 10(5) x 10(5)/10 microliter smoke or debris particles, and killed four weeks after inoculation. Viable tumor cells, derived from a Cloudman melanoma cell line and added to the smoke and debris suspensions, remained viable. Thus, a toxic influence of smoke and debris particles in viable tumor cells, which would make the viability tests meaningless, was excluded. It is highly unlikely that viable tumor cells do occur in the waste products of CO2-laser tumor vaporization.

Local recurrence and survival in patients with (Clark Level IV/V and over 1.5-mm thickness) stage I malignant melanoma of the extremities after regional perfusion

During the period 1965-1974, 110 patients with stage I malignant melanoma of the extremities were treated by regional isolated perfusion with L-phenylalanine mustard and local excision. In order to study local recurrence and survival, only patients with a primary melanoma Clark Level IV or V and a tumor thickness of more than 1.5 mm were accepted in this study. The determinate survival in patients followed for 5-14 years in 78%; 17% developed positive regional lymph nodes. The local skin recurrence rate was 9% (9 patients); four of these 9 patients simultaneously had distant metastases; the other five patients are alive with NED after retreatment. This series of patients, too, shows that tumor thickness determines the prognosis, both as to local recurrence and as to survival. The mean tumor thickness in the hyperthermically perfused patients was found to clearly exceed that in the normothermically perfused, the mean values being 4.85 mm and 3.87 mm, respectively. Yet local recurrence and regional lymph node metastases proved to be less frequent after hyperthermic than after normothermic perfusion, although the difference was not statistically significant.

Carcinoma in hyperfunctioning thyroid nodule in recurrent hyperthyroidism

A patient with an invasive thyroid carcinoma located within a hot thyroid nodule is reported. Only four similar cases have been described in the literature. It is emphasized that a hot thyroid nodule per se should not be used as an argument against the diagnosis of thyroid carcinoma.

Experimental surgery on the Cloudman S91 melanoma with the carbon-dioxide laser

The continuous wave CO2 laser lacks a number of draw-backs of the pulsed Ruby laser, and seems attractive for tumor surgery. We compared the CO2 laser with conventional surgery in experiments on mice bearing the Cloudman S91 melanoma. We had the same rate of local recurrence and lung metastasis in both techniques.

An analysis of histology and DNA-ploidy in primary wilms tumors and their metastases and a study of the morphological effects of therapy

In children with Wilms' tumours the length of survival is greatly influenced by success in preventing or controlling metastatic disease. The current study focuses on the morphological aspects of metastases when compared with the primary tumour. In 8 patients it appeared that blastema is the most likely component to metastasize, whereas epithelial and stromal components were hardly, if at all, represented in metastases. Furthermore, flow cytometric DNA ploidy determinations on 4 cases showed that both the primary tumours and the metastases had stemlines in the diploid and low aneuploid (hyperdiploid) range. Finally, in four cases the influence of therapy on morphology of the primary tumours was analyzed. In these cases blastema seemed to be the component most sensitive to therapy. Thus, blastema seems to play a central role in prognosis of Wilms' tumours; either reacting to therapy or, if insensitive, by metastasizing.