Clinical staging of cancer of the penis: by size? By localization? Or by depth of infiltration?

Two hundred and thirty-nine patients with squamous cell carcinoma of the penis were grouped into the existing different clinical classifications and staging systems, i.e. the UICC-TNM (1978 and 1987), Jackson's and that used in Heidelberg. Because of shortcomings observed in the previous systems, a new classification and staging system was developed. The present authors' classification and staging system were found applicable and all patients except 2 with unknown tumor size were classifiable. The distribution into different stages was more even in the proposed staging system than in the previous ones. A good correlation and a gradient for survival rate according to stages were also obtained. We propose that the systems presented should be examined and applied prospectively for clinical classification and staging of carcinoma of the penis.

A comparison of cis-platinum-vindesine and cis-platinum-etoposide combined with radiotherapy for previously untreated localized inoperable non-small cell lung cancer

Seventy-two previously untreated patients with localized inoperable non-small cell lung cancer were randomized to a study comparing the efficacy of cis-platinum-vindesine (P-VDS) and of cis-platinum-VP16 (P-VP16), both combined with split-course radiotherapy. Fifty-nine patients were evaluable for response after the minimum requirement of two chemotherapy cycles. Both arms were further randomized to two split intervals, 3 or 5 weeks. The response rate to chemotherapy only (three cycles) was 66% for P-VDS and 50% for P-VP16. Radiotherapy increased the response rates to 83 and 67%, respectively. A Karnofsky score of 80% or more and the 3-week split interval were significant positive prognostic factors. Of all patients, 66% had local or combined recurrences and 17% relapsed at a distant site only. Since the 2-year survival rates are not strikingly better than those obtained by radiotherapy alone, we feel that these regimens should be restricted to further investigations of the role of chemotherapy in the treatment of different clinical presentations of NSCLC.

Toremifene, a new antiestrogenic compound, for treatment of advanced breast cancer. Phase II study

Forty-six postmenopausal women with estrogen receptor positive advanced breast cancer were treated with the novel antiestrogen toremifene in this phase II study. The patients had no prior or concurrent hormonal or cytostatic treatment. Sixty milligrams of toremifene was given as a single daily dose for a minimum treatment period of 6 weeks. Eight patients (17%) achieved complete response, 17 (37%) partial response and 12 (26%) showed no change. The median durations of responses were 93, 66 and 24 weeks, respectively. Three patients still continue the treatment in complete response, four patients in partial response. No significant differences in response rates could be seen when related to different estrogen receptor concentrations. The treatment was well tolerated, only two patients had remarkable side-effects; one of the patients interrupted the treatment mainly because of tremor. Our conclusion is that toremifene is an effective, safe and in clinical practice easily applied choice of treatment in estrogen receptor positive advanced breast cancer.

Serum immune complexes and rheumatoid factors in superficial bladder tumours

Serum immune complex (IC) and rheumatoid factor (RF) levels of 39 patients with a transitional cell tumour of the bladder were analyzed using 4 different IC and 2 RF assays. Elevated serum immune complex and rheumatoid factor levels were observed in the majority of the patients (95%). Conglutinin-binding (KgB), C1q-binding (C1qB), platelet iodinated protein A test (PIPA) and RF-enzyme immunoassay (RF-EIA) gave positive results in 31%, 62%, 23% and 31% of the cases, respectively and separated cancer sera from normal blood donors (p less than 0.001). Elevated titers were also observed with platelet aggregation test (PAT) and latex agglutination for RF in 23% and 67% of the cases, respectively. A negative correlation (p less than 0.01) was observed with the stage of the disease and RF-values. Other IC tests did not correlate significantly with stage, histological grade or progression of the disease. The best prognostic marker was the histological grade of the tumour. Males had more undifferentiated tumours than females. Multivariate analysis was carried out to correlate several laboratory parameters simultaneously with clinical variables and it revealed that elevated IC tests values (KgB, C1qB and PIPA) and low RF-values correlated to stage (p = 0.009) but not to histological grade or progressive course of the disease.

Localization of melanoma with radiolabelled monoclonal antibody fragments and iodoamphetamine

In two melanoma patients, metastases accumulated both 99mTc-labelled monoclonal anti-tumor F(ab')2 fragments and N-isopropyl-p-(123I)-iodoamphetamine. Small metastatic deposits were localized only by labelled antibody, for which a higher target-to-nontarget ratio was observed than for radioiodoamphetamine, indicating that immunoscintigraphy may be the more sensitive method. In these two patients positive immunohistochemical staining for the antibody used was observed, whereas in a third patient, with no concentration of labelled antibody, the staining result was negative showing the specificity of the immunoscintigraphy findings. It is possible that the accumulation of radio-iodoamphetamine is due to binding to melanin but this is not certain as tissue samples from one of the two patients with positive scintigrams did not contain stainable melanin.

Sexual behaviour of women with human papillomavirus (HPV) lesions of the uterine cervix

To analyse the epidemiological aspects contributing to the transmission of human papillomavirus (HPV) lesions (flat, inverted, and papillomatous condylomas) of the uterine cervix, we recorded the sexual behaviour of 146 women who consecutively attended the department of obstetrics and gynaecology of Kuopio University Central Hospital with a cervical HPV lesion (with or without concomitant cervical intraepithelial neoplasia (CIN]. Similar data were collected from an age matched group of women with no signs of gynaecological infection. The sexual habits of the women infected with HPV differed from those of healthy controls in most aspects studied, including an earlier onset of sexual activity (p less than 0.05), lower number of deliveries (p less than 0.05), less regular use of contraceptive measures (p less than 0.05), and use of the condom instead of intrauterine contraceptive device (IUCD) (p less than 0.0001). They also differed from controls in giving histories of more frequent episodes of: CIN (p less than 0.005), abnormal Pap (Papanicolaou) smears (p less than 0.0001), sexually transmitted disease (STD) (p less than 0.05), and genital warts (p less than 0.001). Furthermore, they had more multiple sexual partnerships (both past and current) than the controls (p less than 0.0001 and 0.005 respectively), they had not established permanent partnerships as often as the controls (p less than 0.001), and they had a higher frequency of casual relationships (p less than 0.0001). In addition, their own and their partners' sexual hygiene was poorer than in the control subjects (p less than 0.05 and 0.001 respectively). The results show the dramatic influence of sexual behaviour on the transmission of cervical HPV lesions, which are known to be intimately associated with CIN in many cases.

Morphological and immunohistochemical evidence suggesting human papillomavirus (HPV) involvement in oral squamous cell carcinogenesis

Human papillomavirus (HPV) is an agent responsible for squamous cell tumors (verrucae, condylomata and papillomas) at various sites of the body, the oral cavity included. Due to the recently pointed-out association between these HPV lesions and the squamous cell dysplasias and malignancies in the uterine cervix, in the bronchus and in the larynx, the present work was carried out to assess, whether morphological signs (cytopathic effects of HPV) or HPV antigens could be found in lesions of oral squamous cell carcinomas. Biopsies from 40 cases of oral squamous cell carcinomas were surveyed by light microscopy with special emphasis on the presence of the histopathological features suggesting an HPV lesion, i.e. whether flat, inverted or papillomatous condylomas are present concomitantly with the malignancy. All specimens were also subjected to immunoperoxidase staining with anti-HPV serum to disclose the possible HPV antigens in the lesions. Morphological signs of the flat-type HPV lesion were found in 4 cases (10%), those of an inverted type in 3 cases (7.5%), and those of a papillomatous type in 9 cases (22.5%). Epithelial cells (mostly koilocytes) showing HPV-positive nuclei were disclosed in 5 papillomatous lesions, in 2 inverted lesions and in 1 flat lesion. The results suggest that HPV might be the agent involved in the development of at least certain special types of oral squamous cell carcinomas; albeit further confirmatory evidence with other techniques (DNA hybridization) is still needed.

Morphological and immunohistochemical evidence of human papilloma virus (HPV) involvement in the dysplastic lesions of the uterine cervix

A series of 110 biopsies of the uterine cervix containing dysplastic and/or in situ changes were assessed morphologiccally with reference to presence or absence of the coexistent condylomatous lesions, and using the immunoperoxidase-PAP technique to disclose the HPV (human papilloma virus) antigens in the cells. Morphologically, 79 biopsies contained condylomatous (CO) lesions (63 flat, 12 inverted and 4 papillomatous ones), and 31 were non-condylomatous (NCO) dysplasias/in situ carcinomas. The mean age of the CO group was more than 10 years less than that of NCO women (P less than 0.0001). Of the papillomatous COs, 75% were associated with mild or moderate dysplasia only, whereas 42% of the inverted ones contained an associated in situ carcinoma. Most of the flat lesions were found in very young women (10-39 years of age). HPV antigens were demonstrated in all papillomatous lesions (100%), in 83% of the inverted ones, and in 67% of the flat COs. In generally, the frequency of the HPV-positive cases decreased when epithelial atypia increased. None of the NCO lesions showed HPV positive cells. The results support earlier morphological findings on the frequent association of cervical condylomas and epithelial dysplasias, as well as those on the HPV as the etiologic agent of the former. The role of HPV as a possible etiologic agent of the cervical squamous cell neoplasia deserves further attention.

Immunohistochemical demonstration of human papilloma virus (HPV) antigens in oral squamous cell lesions

Six oral squamous cell tumours classified as focal epithelial hyperplasia (FEH), Condyloma acuminatum (CA) and squamous cell papilloma (SQP) were subjected to indirect immunoperoxidase staining with anti-human papillomavirus (anti-HPV) antiserum to demonstrate the possible presence of HPV antigens in these lesions. The results are discussed in the light of the observations on HPV-lesions elsewhere in the body (in uterine cervix), and a suggestion is made to adopt the name condyloma for all those tumours where HPV aetiology can be established by ultrastructural or immunohistochemical means.

Evidence suggesting human papillomavirus (HPV) etiology for the squamous cell papilloma of the paranasal sinus

An extensive squamous cell papilloma of the nasal cavity and also filling the entire left maxillary sinus is reported, which showed cytological features identical to the known cytopathic effects of Human papillomavirus (HPV). Immunoperoxidase staining disclosed a few cells with nuclei positive for HPV antigens. The findings are discussed in the light of other evidence suggesting a possible viral etiology of these lesions, i.e. the high recurrence rate. The present observations together with the reports on the malignant transformation of nasal squamous cell papillomas emphasize the relevance of the recent concept on the possible involvement of HPV in human squamous cell carcinogenesis.

Tigason (etretinate) in prevention of recurrence of superficial bladder tumors. A double-blind clinical trial

The effect of Tigason (etretinate) in the prevention of the recurrence of superficial bladder tumors (Ta-T1, grade 0 papilloma and grade 1 and 2 carcinoma) was studied in 30 patients in a double-blind, placebo-controlled study. Before beginning treatment, the bladder was cleared from all visible tumors by electrocoagulation or TUR. The duration of treatment ranged from 10 to 26 months. The overall preventive effect was significantly better (p less than 0.01) in Tigason-treated patients than in patients given placebo. Tigason was more effective in preventing the recurrence of grade 1 and 2 carcinoma than placebo. On grade 0 papilloma this difference was not so marked. Side effects were common and disturbing at high doses (50 mg/day), but Tigason was well tolerated at the final maintenance dose (25 mg/day). The results obtained from this first clinical study with Tigason in the prevention of recurrence of superficial bladder tumors are promising.

Demonstration of human papilloma virus (HPV) antigens in a case of urethral condyloma

A 33-year-old women is reported, in whom a urethral condyloma was found 2 years after a preceding condylomatous lesion in the uterine cervix. The urethral condyloma was of the flat type, not previously described in this location, and it was found by an indirect immunoperoxidase-PAP method to contain cells positive for human papilloma virus (HPV) antigens. The role of HPV in the etiology of such condylomas is briefly reviewed and the suggested involvement of HPV in human squamous cell carcinogenesis is discussed.

Immunoperoxidase demonstration of human papilloma virus (HPV) in dysplastic lesions of the uterine cervix

Routinely processed sections of 47 unselected cervical dysplasias and in situ carcinomas (both condylomatous, CO, and noncondylomatous, NCO) were subjected to staining with indirect immunoperoxidase-PAP technique using anti-human papilloma virus (anti-HPV) immune serum to demonstrate HPV antigens in these lesions. Anti-HPV was raised in guinea pigs immunized with highly purified virions from a pool of human skin wart tissues. Positive reactivity for HPV (brown intranuclear precipitates) was disclosed in 72% of the CO dysplasias and in only one case (5.6%) of the NCO group. The frequency of HPV-positive lesions was inversely related to the degree of epithelial dysplasia, being consistent with the disappearance of ultrastructurally detectable virus particles in lesions turned malignant. HPV-containing cells were characteristic koilocytes or dyskeratotic superficial cells. The present technique provides definite evidence for the HPV etiology of the flat, inverted, and papillomatous condylomas, and seems to offer an advantage as a diagnostic tool of these lesions. When applied to malignant tumors in the near future, the method will undoubtedly bring more light on the suggested role of HPV in the etiology of human squamous cell carcinomas of the uterine cervix and other sites as well.

Squamous cell papilloma of the esophagus: a tumour probably caused by human papilloma virus (HPV)

The third well-documented case of an oesophageal squamous cell papilloma in the literature is studied by light microscopy and using an indirect immunoperoxidase-PAP technique. Human papilloma virus (HPV) antigens were found within the nuclei of the superficial dyskeratotic cells and of koilocytes, both of which are characteristic cells found in HPV lesions elsewhere in the body. The findings are discussed in the light of current concepts of HPV lesions in general. It is suggested that this tumour is potentially malignant and that the possible role of HPV in human oesophageal carcinogenesis deserves further study.

Fanconi's anemia. Tumor-like warts, hyperpigmentation associated with deranged keratinocytes, and depressed cell-mediated immunity

A 27-year-old man had had Fanconi's anemia (FA) for 20 years. The patient had pancytopenia, retarded growth, hypogonadism, and chromosomal aberrations. He had freckle-like and darker pigmented macules scattered on his chest, shoulders, upper part of the back, and hips, with interspersed, hypopigmented areas. Biopsy specimens taken from both the hyperpigmented and hypopigmented spots showed a derangement of keratinocytes and nuclear abnormalities, more notable on sun-exposed skin sites. The patient also had numerous tumor-like, recalcitrant, viral warts. Immunologic studies showed normal humoral immunity, but there was evidence of depressed cell-mediated immunity. We speculate that the chromosomal aberrations, the depressed cell-mediated immunity, and the increased frequency of malignant neoplasms known to occur in patients with FA also reflect changes related to an increased susceptibility to viral infections.

Human papilloma virus (HPV) antigens in lesions of laryngeal squamous cell carcinomas

Paraffin sections from 36 laryngeal squamous cell carcinomas with histological features of coexistent condylomatous changes (the flat, inverted and papillomatous lesions caused by human papilloma virus; HPV) were stained for HPV antigens with an indirect immunoperoxidase technique. The HPV antiserum used was prepared in guinea pigs immunized against the purified HPV virions from human common wart tissue. Of the tumors studied, 36% showed the presence of HPV antigens. In that, one-third of the flat and inverted lesions and 42% of the papillomatous lesions contained cells with intranuclear HPV-staining reaction. The role of HPV as the etiologic agent of laryngeal squamous cell papillomas is discussed, as is the potential malignant transformation of them. Based on the present results, the previously expressed view on the probable role of HPV in the development of laryngeal squamous cell carcinoma seems to gain further substantiation.

Demonstration of human papilloma virus antigen in the condylomatous lesions of the uterine cervix by immunoperoxidase technique

Routine histological sections of characteristic condylomas (showing dysplasia of different degrees) collected from the uterine cervix of 10 women were subjected to staining with indirect immunoperoxidase technique using antihuman papillomavirus (anti-HPV) serum to demonstrate the HPV antigens in these lesions. The anti-HPV immune serum was raised in guinea pigs immunized with highly purified viruses from a pool of skin wart lesions collected from various anatomical sites. 8 out of the 10 condylomas studied showed a definitely positive staining (brown precipitate) with the HPV anti-serum, indicating the presence of HPV antigens within the nuclei of a few cells (mostly koilocytes and dyskeratotic cells) near to the surface of the lesions. The present technique provides further confirmation to the HPV etiology of cervical condylomas, and seems to offer a definite advantage as a diagnostic tool of these lesions and other squamous cell lesions as well. The application of this technique on malignant tumors will most probably cast light on the possible role of HPV in the etiology of human squamous cell carcinomas in the near future.

Clinical trial of a subunit influenza vaccine

A double-blind field trial was performed comparing a subunit influenza vaccine (A/Victoria/75 and B/Hongkong/73) with placebo. A good protection against influenza was induced by the vaccine. On the basis of serological determinations (enzyme immunoassay, EIA) the incidences of influenza A and B infections were reduced within a period from 3 weeks up to 5 months after the vaccination by 88 and 68%, respectively. Three weeks after the vaccination 79% of the vaccines had acquired protective serum antibody levels (greater than or equal to 32 x 10(2) by EIA) against influenza A and 62% against influenza B, while in the control subjects protective antibody levels were measured in frequencies from 4 to 13% in subsequent serum samples. With a few exceptions antibody levels were still present in 5-month samples. Side effects were recorded within the first 3 days following the vaccination. Some minor symptoms like redness and tenderness at the vaccination site and muscle ache were reported more frequently by the vaccines than by the controls, but no more harmful systemic reactions.

Pulmonary apical fibrocystic disease. A serologic study

Common aetiopathogenic factors were sought in 12 patients with progressive pulmonary apical fibrocystic changes, active human-type tuberculosis excluded. HLA-typing did not reveal any clear-cut trends; only the three patients with ankylosing spondylitis or Reiter's disease were HLA-B27 positive. Six patients had HLA-Cw3, which exceeds the prevalence in referents, antibodies, as well as other tissue antibodies, were mainly negative so that autoimmune aetiology is not likely. Similarly, antimicrobial antibodies were found occasionally, while low-titred influenza antibodies were positive in all patients. Serum proteins, immunoglobulins, rheumatoid factor and C-reactive protein were suggestive of chronic inflammation, as were low positive titres of smooth muscle antibodies in nine patients. In spite of the uniform clinical picture and course of the disease, no uniform aetiopathogenic factors were found, but possible unidentified slow- and low-grade viral or fungal infection is discussed.

Immune reactions in epidermodysplasia verruciformis

Serum antibodies against human papilloma virus have been measured using immunodiffusion and enzyme linked immunosorbent assay in twelve patients with epidermodysplasia verruciformis (EV). The results were compared with those from sixty-six patients with other types of human papilloma virus diseases. Antibody prevalences were slightly lower in patients with EV than in the control patients. More remarkable was the difference between EV patiens and control subjects in tests of non-specific cell-mediated immunity, which was markedly depressed in the majority of patients with EV, but in the main preserved in patients with common warts. No specific immunological parameter was shown to be associated with malignant conversion of EV lesions, but malignancy was linked to the character of the inducing virus, and particularly to HPV type 5.

The occurrence of human wart-virus antibodies in dogs, pigs and cattle

Using the immunodiffusion method, antibodies against human wart-virus were detected in dog, pig and cattle sera but not in horse and reindeer sera. Antibodies were found in 25 percent (28/114) of the dog sera, the prevalence of antibodies being fairly similar to that in children of the same age. By electron microscopy the antibodies in dog sera were shown to attach to and precipitate the human wart-virus particles, and in immunodiffusion the precipitation lines of human and dog sera were shown to be identical. Of the cattle sera studied, 10 percent (10/97) and of the pig sera 13 percent (5/40) gave a faint precipitation line, having identity with that given by the human sera, against human wart-virus. Conversely 18 percent (9/50) of adult human sera contained precipitating antibodies against a bovine papilloma antigen, probably bovine papilloma virus.

BK and Herpes simplex virus antibodies in renal cell carcinoma

Serum antibodies against BK virus (BKV) and seven other viruses were studied in 76 patients with renal cell carcinoma using either the haemagglutination inhibition or the complement fixation techneque. BKV and herpes simplex virus (HSV), but no other virus antibodies, showed a clear correlation with the clinical course of renal carcinomas. The patients without BKV antibodies or with marginal antibody titres (titre less than or equal to 10), had a significantly longer observed expectation of life (O.E. life, 44.1 months) than the O.E. life (26.7 months) of the patients with BKV antibodies of titre less than or equal to 20. Similarly, patients with low or undetectable HSV antibodies (titre less than or equal to 8) also had significantly longer O.E. life (54.0 months) than the rest of the patients (32.7 months). The results suggest that BKV and HSV have an as yet underfined relationship to renal cell carcinomas.

Lack of measurable complement fixing antibodies against viral antigens

A serological and clinical study was performed to find the common features of 130 patients without antibodies against 11 or more different antigens in the complement fixation (CF) test. These patients (=1.6%) were discovered during hte screening of 8,021 adult patients. Rheumatoid factor(s) (RF) were found in the sera of 113 of the patients. In the remaining 17 patients no common serological or clinical markers were found. Myeloma M-components were found in three cases. The lack of measurable CF antibodies in RF positive cases was apparently due to the inhibitory effect of RF(s) in the CF test. This was indicated by a positive reaction in CF after centrifugal separation of IgM and IgG fractions and also by the detection of antibodies using immunodiffusion method. Possible immune complexes were sought using the platelet aggregation test, which was positive for the sera of 47 (=37%) of the patients. The clinical diagnosis of the 130 CF-nonreactors was rheumatoid arthritis (RA) (ARA criteria) in 23 cases and pulmonary diseases in 65 cases. In a comparison group of equal size there were only 3 RA patients and 15 with pulmonary disease. RA was thus found in 20% of the RF positive CF-nonreacting patients. In the comparison group of 52 RA patients 8 CF-nonreactors were found (=15%). This suggests that the effect of RF(s) from RA patients in CF reaction varies greatly.

Warts and wart virus antibodies in patients with systemic lupus erythematosus

Warts were found in 25 out of 56 patients with definite or probable systemic lupus erythematosus (SLE) but in only 19 out of 160 control patients. Warts were particularly prevalent in elderly patients with SLE. The corticosteroid and antimalarial drugs used to treat SLE did not influence the frequency of warts. Wart-virus antibodies were found significantly less often in patients with SLE than in controls: antibodies were detected in 23 out of 51 patients and in 40 out of 54 controls. Ihe findings suggest that some deficiency in the immune mechanisms of patients with SLE predisposes them to develop warts. There was an inverse correlation among the patients with SLE between the occurrence of warts and rheumatoid factor activity. This suggests that rheumatoid factor may interfere with resistance to warts.

Treatment of Condyloma acuminata in male patients

The treatment of 101 male patients with venereal warts is described. Prior to the study 33 patients had been treated unsuccessfully with podophyllin. 57 of the patients showed urethral lesions while 2 also showed venereal warts in the bladder. The primary treatment was electrocoagulation in 100 patients, 58 of these being cured. Chemical agents such as ethoglucid, Verruxin and thiotepa seemed to be effective in the treatment of resistant, especially intraurethral condylomas. In 8 patients autogenous vaccination was used, 6 responding completely to the vaccination alone while the remaining 2 were cured after vaccination and excision.