Antigenic deletion and prognosis of patients with stage A transitional cell bladder carcinoma

The practical use of tumor marker determination in bladder washing specimens. Assessing the urothelium of patients with superficial bladder cancer

Bladder washing specimens from 81 patients with recurrent multifocal superficial bladder cancer were evaluated for DNA profile by flow cytometry and cell-surface blood group (ABH) antigen reactivity by a modified specific erythrocyte adherence test. The study was conducted in a prospective, blind, nonrandomized fashion. Fifteen patients were treated with transurethral resection (TUR) alone and 66 with TUR and intravesical administration of bacillus Calmette-Guerin weekly for 6 weeks (TUR + BCG). Among the patients treated with TUR only, there was a notably greater rate of tumor recurrence and progression in patients with unfavorable tumor markers (aneuploidy and ABH-negative reactivity) than in those with favorable markers (diploidy and ABH-positive reactivity). The difference was less striking in patients treated with BCG, which reduced the frequency of recurrence or progression at 30 months from 87% to 44% and from 60% to 23%, respectively. This favorable effect of BCG was virtually confined to patients with initially favorable markers and to those whose initially unfavorable markers became favorable during BCG administration. Aneuploidy and negative ABH are phenotypic expressions of undifferentiation that can forecast the potential of the urothelium to form new tumors and predict invasion. To an extent, these markers are independent of the grade and stage of the disease. BCG can induce prognostically favorable conversion of the markers expression. Lack of such conversion indicates lack of response to BCG and should be regarded as evidence of persistent disease even if conventional methods do not reveal it. Therefore, sequential determination of markers is useful in monitoring patients with superficial bladder cancer treated with intravesical BCG.

Blood group ABO and Lewis antigens in fetal and normal adult bladder urothelium: immunohistochemical study of type 1 chain structures

Five monoclonal antibodies specific for structural variants of type 1 chain blood group antigens (H, Lea, Leb, A, ALeb) were used to study the distribution of these particular antigens in normal bladder urothelium. The urothelium samples were taken from seven human fetuses (aged seven to 21 weeks) and 19 adults. The adults were blood group A and O individuals, and their antigen expression was compared to ABO, secretor, and erythrocyte Lewis status. Detailed data on the histological location of the antigens were obtained by means of immunohistochemical methods. In fetuses expression of Lewis a and A antigens was stage-dependent, whereas the Lewis b and H antigens were consistently present at all stages. In adults the urothelial blood group antigen expression seemed to be correlated to ABO and secretor status, but not to erythrocyte Lewis type. Secretors expressed primarily ABO isoantigens on their cell membranes, whereas non-secretors (four individuals) expressed inappropriate Lewis antigens. Examination of the histological distribution of the antigens showed results different from earlier examined epithelia. In adult bladder urothelium from A secretors, only the most complex antigens (Leb, A, ALeb) were present in the basal germinative cell layer, whereas the luminal umbrella cell layer expressed both these antigens and showed a unique expression of less complex precursor antigens (H, Lea), as well as sialylated Lewis a antigens.

ABH isoantigens in bladder carcinoma patients grouped according to DNA changes over time

Eighteen patients with transitional cell bladder carcinoma and increasingly abnormal ploidy were assembled to evaluate the relation over time between ploidy and ABH isoantigen deletion. Fifteen patients with diploid recurrent tumors and 16 with aneuploid tumors over time were used as controls. ABH isoantigen deletion at diagnosis was closely related to cancer death, while isoantigen assessments on recurrences gave less prognostic information. Aneuploidy at diagnosis also indicated an adverse prognosis, as did recurrent bladder carcinoma with deteriorating ploidy. Patients with tumors deleted of isoantigen expression at diagnosis but with normal ploidy had as bad a prognosis as patients with deleted tumors and aneuploidy, indicating that isoantigen deletion may occur earlier than ploidy changes.

Stage T1, grade 3 transitional cell carcinoma of the bladder: an unfavorable tumor?

Transurethral resection only was performed in 172 patients with initial stage Ta, T1 transitional cell carcinoma of the bladder. Additional treatment during the course of disease was given to 9 patients with carcinoma in situ and to 8 patients with tumor progression. The mean followup was 106 months. The 10-year survival rates were 95 per cent for patients with stage Ta, grade 1 disease, 89 per cent for stage Ta, grade 2, 84 per cent for stage Ta, grade 3, 78 per cent for stage T1, grade 2 and 50 per cent for stage T1, grade 3. The percentage of first tumor recurrence at the same site increased with tumor grade (stage T1, grade 3 was 74 per cent). The recurrence rate in stage T1, grade 3 tumors (4.08) differed significantly from the other groups of superficial tumors. The tumor progression rate for stage T1, grade 3 tumors (32.5 per cent) was significantly higher as well. The characteristics of stage T1, grade 3 tumors with and without progression were different in regard to multiplicity, recurrence rate, mean interval to recurrence and type of tumor invasion. Of the 13 patients who died of progressive neoplastic disease 11 presented initially with stage T1, grade 3 tumors. When these results are considered it is obvious that a patient with a stage T1, grade 3 tumor deserves additional therapy, such as chemotherapy, immunotherapy or phototherapy.

Prognostic significance of ABH antigenicity of mucosal biopsies in superficial bladder cancer

ABH antigenicity of mucosal biopsies was studied in 36 patients with superficial bladder cancer. Those with mucosal biopsies positive for antigen had a recurrence rate of 0.33 recurrences per year, compared to 1.97 in those negative for antigen. This difference was highly significant on statistical analysis. ABH antigenicity of mucosal biopsies proved to be a better predictor of recurrent disease than other prognostic indexes, such as number, size, histological grade and ABH antigenicity of primary tumors, as well as histological status of the mucosal biopsies.

Clinical significance of A, B, H isoantigen deletion of urothelial cells in bladder carcinoma

The occurrence and/or deletion of A, B, H isoantigens in cytologic specimens was compared to a number of other clinical parameters commonly used for prediction of prognosis or monitoring of bladder carcinoma. Isoantigens were better preserved by our preparation for cytologic than for histologic specimens. Patients with isoantigen present on urothelial cells were more likely to have small or no visible tumors than large tumors. A strong correlation was found between isoantigen status and cytologic diagnosis (P less than 0.001), but not with ploidy (P = 0.059). For short-term prognosis of recurrence, tumor size appeared to be highly significant, whereas A, B, H isoantigen determinations had no predictive value. Intravesical chemotherapy did not per se influence expression/deletion of isoantigens.

Blood group-related antigens as markers of malignant potential and heterogeneity in human carcinomas

The expression of BGR-Ags is often aberrant in human carcinomas. The observation that BGR-Ag expression in human bladder carcinomas correlates with prognosis for patients with these tumors is especially interesting in light of the numerous reports of correlations between cell surface glycosylation and malignant phenotype in experimental animal tumors. Many observations suggest how this relation might be mediated. It seems reasonable to anticipate that the study of the BGR-Ags and their expression in carcinoma may emerge from its current predominantly descriptive phase and become an important part of the investigation of human tumor biology.

Lewis a antigen in transitional cell tumors of the urinary bladder

The failure of A,B,H antigens as prognostic parameters in noninvasive bladder cancer of blood group O individuals, who constitute 44% of the population, encouraged the evaluation of the closely related Lewis a antigen. Ninety-three tumors of the urinary bladder were stained employing the Tween 20 (Merck)-modified immunoperoxidase staining technique and serial dilution of monoclonal anti-Lewis a antibodies. On the basis of recent findings in non-neoplastic ureter urothelium of erythrocyte Lea+b-, Lea-b+, and Lea-b- individuals, alterations in tumors, except eight from Lea-b- individuals, were quantified on a scale from 0 (normal) to 3 (total loss). Scores were related to the pathologic stage and grade (P less than 0.01), and, in stage Pa tumors, to the clinical course: recurrence rate (P less than 0.10), stroma invasive recurrence, and/or papillomatosis (P less than 0.05). Although further studies are needed the current study points to Lewis a antigen determination as an advantageous prognostic tool in stage Pa tumors of the urinary bladder of Lea-b+ and Lea+b- individuals, who, together, constitute 94% of the population.

A, B, H antigen expression in transitional cell carcinomas of the urinary bladder

The prognostic value of A, B, H blood group antigen determination in superficial bladder cancer is unclear. Recent immunohistochemical studies employing monoclonal antibodies and Ulex Europaeus Agglutinin I (UEA-I) (Vector) have shown that A, B, H detectability and distribution in non-neoplastic urothelium are influenced by methodologic factors and, most importantly, by the secretor status. The authors investigated the A, B, H antigen in 93 tumors of the urinary bladder (78 secretors, 15 nonsecretors) and semiquantified the alterations from the expected normal expression on a scale from 0 to 3. Four O saliva nonsecretors as expected showed no staining and were excluded. Eighty tumors showed abnormal A, B, H expression and in 37 of these, A, B, H antigens were not detected. Tumors of A and O individuals showed statistically different reactivities, probably related to differences in the specificity of the employed A- and H-reagents. A, B, H expression was influenced by stage and grade (P less than 0.05, P less than 0.10) and was correlated to the clinical course of A but not O patients. These results, suggesting that alterations in the A, B, H expression occur early in the neoplastic development and follow the synthetic pathways in an opposite direction, emphasize that reagents recognizing blood group precursor substances, common to all individuals irrespective of the ABO and saliva secretor types, may increase the prognostic accuracy of blood group antigen determination in bladder cancer.

Cell surface antigens in squamous cell carcinoma of the oral cavity

The ABH isoantigen was investigated in 80 patients with squamous cell carcinoma of the oral cavity and in their 46 affected lymph nodes. Isoantigen deletion shows a characteristic pattern of benign to malignant transformation of oral cancer. Total loss of isoantigen was found in anaplastic tumours, in metastatic lymph nodes and in the majority of advanced stage tumours. Total loss of isoantigen in metastatic lymph nodes indicates a frequent discharge of isoantigen-negative metastatic cells from the primary tumours to the lymph nodes and the regional organs. It seems that with the recent techniques a prospective observation of ABH isoantigen added to other pathological and clinical findings could be of prognostic significance in patients with squamous cell carcinoma of the oral cavity.

Blood group isoantigens ABO (H) in transitional carcinoma of the bladder: a clinicopathological study

Blood group A, B and H antigens were investigated in 183 paraffin embedded biopsies from 58 patients with transitional cell carcinoma of the urinary bladder, by a modified specific red cell adherence test, direct immunofluorescence with Ulex Europeus lectin and indirect immunoperoxidase method with monoclonal antibodies against blood group antigens. The results were correlated with pathological grade and stage and with the clinical course of patients evaluating the recurrence index and clinical state. Histological findings were roughly correlated with the expression of red cell tissue antigens but not with the presence of precursor H substance in biopsies from patients of blood group A or B, in which a higher proportion of H positive results was appreciated. The clinical course was also related to the presence or absence of blood group antigens in referential biopsies: 90 per cent of negative biopsies corresponded to patients who had high recurrence index whereas 75 per cent of positive biopsies corresponded to patients who had low recurrence index or did not have recurrence for five years; 25 per cent of recurrences observed in patients with referential positive biopsy were invasive whereas the proportion of invasive tumor in recurrence from negative biopsies rises to 73 per cent. In addition, all the final biopsies from patients who died of bladder tumor were negative for blood group antigens. The diagnostic and prognostic significance of these tissue antigens in transitional cell carcinoma of the urinary bladder is discussed, and we conclude that the analysis of blood group antigens in bladder biopsies by established techniques is a useful tool in clinical pathology for the screening and followup of bladder tumors, as previously suggested.

Urothelial dysplasia and carcinoma in situ of the bladder

Urothelial cells were pepsin-extracted from paraffin-embedded specimens taken from human nontumorous bladder mucosa, dysplasia, and carcinoma in situ. After Feulgen staining for DNA, nuclei were measured with an integrating microdensitometer. The measurements show that normal urothelium consists mostly of diploid nuclei. Dysplasia means that there is a predominance of tetraploid DNA values, whereas carcinoma in situ is characterized by a high percentage of aneuploid cells. In both dysplasia and carcinoma in situ there is a considerable percentage of diploid nuclei. Thus, DNA cytophotometry can be used for standardization of preneoplastic and early stages of tumor development in bladder cancer.

The influence of retinoic acid receptor (RAR) status of bladder tumours on the course of the disease

Retinoids influence bladder tumour development in animals and tumour recurrence in man. Some human tumours contain intracellular receptor proteins for retinoids. The effect of the presence of such retinoic acid receptors (RAR) on tumour response to conventional therapy has been studied in 59 patients. Thirty-two of 36 RAR+ve and 11 of 23 RAR-ve tumour patients were alive after a mean follow-up period of 2.6 years. Higher stage and grade were more commonly associated with RAR-ve tumours. Independent of stage, recurrence was more common in RAR-ve tumours. These studies suggest that RAR-ve tumours are more likely to recur and more likely to become invasive. However, further studies are required to determine the clinical value of RAR receptor status as a prognostic indicator.

Comparison of specific red-cell adherence and immunoperoxidase staining techniques for ABO(H) blood-group cell-surface antigens on superficial transitional cell carcinoma of the bladder

The presence or absence of blood-group antigens have been used to predict the clinical course of patients with superficial transitional cell carcinoma of the bladder. Antigen loss has been associated with neoplastic change. The red-cell adherence test has been the most widely accepted method of antigen determination, but this technique has inherent weaknesses. Recently, the immunoperoxidase assay has been used to detect antigens on tumor cells. We compared 30 patients using the red-cell adherence and immunoperoxidase methods on adjacent microtome cut sections. The red-cell adherence and immunoperoxidase methods performed similarly (86%) when assessing antigen presence or absence. However, the immunoperoxidase method was clearly superior in: 1) specificity for antigens on tumor cells and normal internal controls; 2) localization of antigen; 3) demonstration of cellular morphology; 4) increased objectivity of analysis; 5) ease of reproducibility; and 6) cost effectiveness.

Detection of ABO(H) blood group antigens: a study in tissue culture

The association between malignant transformation and the loss of ABO(H) blood group antigens was documented by several authors. Most of the work was done on paraffin sections, though a small portion was performed on fresh frozen tissues. We suggest that the specific red cell adherance (SRCA) test can be applied to tissues cultivated in tissue culture for determination of malignant transformation. This study supports this assumption.

Expression of blood-group-related antigens in carcinoma in situ of the urinary bladder

Expression of epithelial ABH blood group antigens and the T (Thomsen-Friedenreich)-antigen was quantitatively studied by immunoperoxidase techniques in nine cystectomy specimens containing extensive carcinoma in situ (CIS), and also histologically benign epithelium. CIS areas typically showed abnormal expression of both ABH and T-antigens and a distinctive vascular architecture, revealed by endothelial ABH staining. Histologically normal epithelium generally was antigenically normal, but occasionally showed abnormalities of either ABH or T-antigens. Antigen expression was variable in histologically atypical epithelium, with significant segments showing abnormalities of either ABH or T-antigen, and sometimes of both antigenic markers. It is postulated that histologically benign, but antigenically abnormal, epithelium may represent low-grade CIS of the urinary bladder. Assessment of blood-group-related antigen expression in flat atypical epithelium of the urinary bladder may be useful for predicting the biologic potential of these lesions.

Immunohistological detection of T antigen and ABH blood group antigens in upper urinary tract tumours

The status of T antigen was assessed by means of peanut agglutinin (PNA) used in an immunoperoxidase technique, and the status of ABH blood group antigens was determined by the specific red cell adherence (SRCA) test. Thirty-eight patients with upper urinary tract tumours were examined. Our data indicated that T antigen status did not correlate with conventional prognostic indicators such as grade and stage of tumour and survival of patients, while the expression or deletion of ABH blood group antigens did correlate well. It was concluded that ABH blood group antigen determination might provide a useful prognostic probe in upper urinary tract tumours should it find clinical application.

Quantitative analysis of the A, B and H isoantigens in single transitional carcinoma cells

To obtain objective data on deletion of the ABH isoantigens in bladder carcinoma, microfluorometry was used. Slides were scanned in phase contrast to lessen fading of the immuno- or lectin-fluorescence stained cells. The fluorescence intensity was measured in relation to an external uranyl standard. Staining was most intense in the peripheral and cytoplasmic parts of the cells. The intra specimen fluorescence intensity varied as 1 to 10. In nondeleted cell populations fluorescence intensity means ranged from 1025 to 12,550 and in deleted populations from 304 to 510. Microfluorometry accurately separates deleted cell populations from those with a normal ABH antigen content.

Monoclonal antibodies to detect A, B and H blood group isoantigens in superficial transitional cell carcinoma of the bladder: a means of predicting invasive recurrences

Monoclonal antibodies to A, B and H blood group isoantigens (BGI) have been used in an indirect immunoperoxidase technique to study the expression of BGI in both normal and malignant transitional epithelium in patients of all blood groups. BGI was detectable in all 15 biopsies of normal transitional epithelium and in 28 of 50 (56%) stage pTa and pTl transitional cell carcinomas of the bladder (TCCB). In the tumours failing to express BGI there was a 55% invasive recurrence rate at 5 years compared with 14% in those tumours expressing BGI. The difference was significant at the P less than 0.01 level. The recent availability of a monoclonal antibody to H isoantigen expressed in group O patients, in addition to monoclonal anti A and anti B, has made possible the inclusion of patients of all blood groups into a study using a standard immunoperoxidase technique without the need for specially processed biopsy material. The advantages of this technique compared with the earlier methods are discussed with reference to its possible role in identifying those patients at highest risk of developing invasive recurrence of their tumour.

A, B and H antigens in normal urothelium: an immunohistochemical study using monoclonal antibodies with the avidin-biotin complex technique

Immunohistochemical staining for the A, B and H blood group antigens was studied in 61 normal human ureters using monoclonal antibodies with avidin-biotin complex application. Thirty-seven of these were archival material, and 24 were processed prospectively. In 100 per cent of the prospectively processed ureters, A, B and H antigens were demonstrated corresponding to the blood type of the source. Archival material stained for A, B and H 65 per cent, 50 per cent and 100 per cent of the time, respectively. Serial sampling of prospectively processed ureters showed diminution of staining with prolongation of immersion in formalin. A characteristic staining pattern was found in ureters from patients with type B blood.

Invasive potential of superficial bladder cancer. A study of the relative merits of predictive parameters

The indirect immunoperoxidase test to detect urothelial cell surface blood group antigens was performed in an attempt to assess the loss of these antigens as a prognostic predictor. In our technique A, B and O(H) blood group specific monoclonal antibodies were used. It was possible to perform the test satisfactorily on histological material from 55 cases which were superficial on presentation; 15 subsequently became invasive. The loss of surface antigens correlated well with histological grade--44.4% of G1, 87.2% of G2 and 94.1% of G3 tumours were antigen-negative. The blood group phenotype of 114 patients was studied. In the group that subsequently became invasive, 14 of 26 (54%) were of blood group A phenotype compared with 37 of 88 (42%) in the non-invasive category. Acetylation studies were performed on 47 cases. In the group that subsequently became invasive, 5 of 10 (50%) had the slow phenotype of the enzyme N-acetyltransferase compared with 13 of 37 (35%) in the group that remained superficial.

Further studies on specificity of red cell adherence test: nonmalignant bladder lesions

Specific red cell adherence test for blood group antigens was utilized in 32 nonmalignant bladder lesions, none of which was associated with bladder cancer, to determine the specificity of this test. All of the 14 lesions of cystitis cystica, cystitis glandularis, and chronic cystitis retained their antigens. Of the 18 lesions of squamous metaplasia, 13 (72%) were antigen positive. Testing for blood group antigens showed an overall 84 per cent specific rate in 27 of the 32 nonmalignant bladder lesions.

Estimation of ABO(H) isoantigen expression in bladder tumors

ABO(H) isoantigen expression was estimated semiquantitatively with the red cell adherence test on single epithelial cell suspensions from 89 bladder tumor and 7 normal bladder specimens. Correlations of red cell adherence counts positive for antigen with the pathological findings of the bladder (histology and stage of tumor) were made in a blind fashion at the end of the study. The mean count positive for antigen from normal bladders was 86.0, which was significantly different (p less than 0.001) from those of muscle-invading lesions (12.6) and flat carcinoma in situ (21.6). This study shows a good correlation among the cell counts positive for antigen, histological findings and stage of disease, and provides the basis for a prospective study that may help to determine the role of ABO(H) isoantigen measurement in bladder tumor patients.

Malignant transformation in inverted papilloma

The detection of markers associated with malignancy will help in the early identification of tumors and assessment of the success of treatment in patients suffering from carcinoma. Three characteristics investigated in this study were found to differentiate a premalignant inverted papilloma from a benign simple nasal polyp.

A modified immunoperoxidase method for the detection of ABH tissue isoantigens in patients with bladder carcinoma

Detectable ABH blood group antigens (BGAg) on tumor cells from transitional carcinoma of the urinary bladder, used for diagnosis and prognosis may be evidenced with the existing immunoperoxidase methods. In this study, a modification of the immunoperoxidase method was shown to enable the detection of BGAg in deparaffinized tissue section of normal and malignant human urothelium. To detect antigens A and B a peroxidase-conjugated rabbit anti-human IgM was used and antigen H was visualized by biotinylated lectin.

Correlation of ABH antigenicity and urine cytology results in transitional cell carcinoma of bladder

Loss of ABH antigens from the cell surface of transitional cell carcinoma of the bladder has been proposed as an indicator of increased cellular dedifferentiation and the tendency toward invasive recurrence. An attempt was made to correlate the urinary cytology and the ABH antigen status of 57 patients with histologically confirmed bladder tumors and 28 with only dysplasia on biopsy. A review of the results of surface antigenicity studies and the preoperative urine cytologies showed no significant difference in the diagnostic sensitivity of cytology between comparable antigen negative and positive groups.

Carcinoembryonic antigen in cytological specimens of urothelial carcinoma

A peroxidase-antiperoxidase (PAP) technique was developed for the detection of carcinoembryonic antigen (CEA) in urothelial transitional cells of 52 bladder cancer patients. The percentage of CEA-containing malignant cells varied from 10% to 100%. As a mean, 65% of the malignant cells stained for CEA, while the corresponding figure for benign-looking cells was 24%. The results were compared with cytological evaluations, flow cytophotometric results, and immunofluorescent (IF) staining for CEA. With increasing malignancy, more CEA was detected with the PAP technique, whereas the IF technique failed to show this trend. 18 of 20 malignant-tumors had an aneuploid DNA pattern. The two diploid cases were moderately well differentiated. Samples from bladders with heavy inflammation should be avoided in the PAP technique, since the unspecific staining of granulocytes disturbed a correct evaluation of the transitional cells. The PAP technique used on cytological material is recommended for antigen determinations, since good morphology is obtained.

Double blind comparison of T-antigen and ABO(H) cell surface antigens in bladder cancer

Transitional cell carcinoma of the bladder is a major cause of cancer deaths. Recently, much attention has been focused on ABO(H) antigen deletion in terms of prediction of prognosis. Furthermore, several studies have shown a correlation between T-antigen (a precursor of blood MN glycoprotein) expression in carcinomas of the breast, colon, and stomach. We have studied 56 specimens from 41 patients with transitional cell carcinoma of the bladder for T-antigen expression and ABO(H) antigen deletion. Results were analyzed with respect to tumor grade, tumor stage, and clinical course. The data indicate that T-antigen expression was not completely useful prognostically; it did not correlate with grade, stage, or clinical course. ABO(H) antigen expression or deletion was found to be a better predictor of tumor behavior than tumor grade, despite a false negative rate of 20 to 30 per cent in blood group O patients. We suggest that use of immunoperoxidase techniques will increase the sensitivity in group O patients, thus making ABO(H) deletion a useful predictive parameter of tumor aggressiveness. This is currently being evaluated in our patients.

ABO (H) blood group antigens and carcinoembryonic antigens as indicators of malignant potential in patients with transitional cell carcinoma of the bladder

Immunoperoxidase methods were used to study ABO(H) blood group antigens and carcinoembryonic antigens in patients with transitional cell carcinoma of the bladder. In our study absence of blood group antigens in cancer tissues was not found to be correlated with histologic grade, stage and survival rate in patients with bladder carcinoma, while it was correlated with subsequent intravesical recurrences. In contrast, the presence of carcinoembryonic antigens in cancer tissues was correlated well with histologic grade, stage and survival rate. Our results suggest that immunoperoxidase detection of blood group antigens could not predict poor survival. In contrast, immunoperoxidase detection of carcinoembryonic antigens is of prognostic value in patients with transitional cell carcinoma of the bladder.

ABH cell surface isoantigens in invasive bladder carcinoma associated with schistosomiasis

The immunoperoxidase technique for demonstrating blood group ABH isoantigens was used to compare 33 patients with invasive stages T2 and T3 bladder carcinoma with (18) and without (15) schistosomiasis. Of the 18 patients with schistosomiasis 11 (61 per cent) had cell surface antigens present (9 with squamous cell carcinoma and 2 with transitional cell carcinoma and areas of squamous metaplasia), while isoantigens were absent in the remaining 7 (1 with well differentiated squamous cell, 2 with moderately to poorly differentiated squamous cell and 4 with transitional cell carcinoma). Cell surface isoantigens were present in only 3 of the 15 patients (20 per cent) without schistosomiasis (2 with squamous cell and 1 with transitional cell carcinoma) and absent in the remaining 12 with transitional cell carcinoma. This preliminary study shows that a significant percentage of patients with schistosomiasis-associated invasive bladder carcinoma maintain the blood group isoantigens, in contrast to those with bladder carcinoma not associated with schistosomiasis. The better prognosis of schistosomiasis-associated carcinoma could be linked conceivably to isoantigen maintenance. If this speculation is supported by further studies the determination of blood group isoantigens in these patients would be of prognostic value.

Invasiveness of transformed bladder epithelial cells

The invasiveness of bladder tumors has been studied in man, experimental animals, and in tissue culture by numerous authors. The prognostic importance of cellular markers for invasiveness is stressed, and the usefulness of histopathological and cytologic grading, cytogenetic studies, antigenic investigations, and enzymatic characterization is discussed. The invasiveness of bladder cells has frequently been examined in transplantation and explantation experiments. In human urothelial cell cultures three grades of transformation are defined, and a correlation has been established between the invasiveness of these cell lines in a three-dimensional in vitro model and their tumorigenicity in nude mice. The mechanism of tumor invasion is discussed, and it is recommended in future research to make a distinction between invasion en bloc and cellular infiltration.

Cell surface coat of human and rat bladder urothelium. I. Ruthenium-red studies in non-neoplastic and neoplastic cells

We have studied the ultrastructure of glycocalyx at the luminal surface of normal and diseased urothelium from humans and rats with ruthenium red staining. A correlation between the thickness and staining intensity of the glycocalyx and the surface topography of the luminal surface was observed. An intensely stained thick glycocalyx was associated with prominent surface microvilli seen in the following conditions in humans: some control urothelium, inverted papilloma, well and moderately differentiated transitional cell carcinomas and mucin producing adenocarcinomas. These changes were also present in rats with FANFT-induced preneoplastic and neoplastic changes. A thin glycocalyx was associated with a scalloped luminal surface containing asymmetric unit membrane plaques and was found in some control humans urothelium and in normal rat urothelium. A thin glycocalyx was also associated with the relatively smooth surface seen in poorly differentiated transitional cell carcinomas as well as in some mucin producing adenocarcinomas. We suggest that urothelial glycocalyx, as demonstrated by ruthenium red staining, correlates with the luminal surface topography rather than specific pathological conditions of the bladder.

ABO (H) cell surface antigens in benign and malignant parotid neoplasms

Twenty-two inflammatory, benign, or malignant parotid lesions were studied by means of the specific red cell adherence test (SRCA), a modification of the Coombs' mixed cell agglutination reaction. In 22 normal parotid tissues the acinar structures were devoid of red cell agglutination, but it was present in ductal epithelium. Findings were similar in 2 cases of parotitis, 11 benign mixed tumors, and 1 malignant mixed tumor. All lacked red cell agglutination in areas of neoplastic change. Benign Warthin's tumors (4 cases) demonstrated antigenicity in the columnar epithelial component of the tumor, but lacked red cell agglutination in areas of the lymphoid component. One malignant Warthin's tumor showed agglutination in areas of normal columnar epithelium but not in areas of malignant dedifferentiation. Undifferentiated carcinoma (1 case) and adenoid cystic carcinoma (2 cases) did not possess detectable ABO (H) antigens in neoplastic areas of the gland. The absence of ABO antigens in normal acinar glands supports their suggested myoepithelial or mesenchymal derivation, as the absence of antigen in benign and malignant mixed tumors supports their proposed mesenchymal derivation. Ductular epithelium and the epithelial components of benign Warthin's tumors have ABO (H) antigens, while the loss of antigen in the epithelial portion of the malignant Warthin's tumor is characteristic of epithelial neoplastic dedifferentiation. Loss of antigen in adenoid cystic and undifferentiated carcinomas of the parotid supports the concept that antigen is absent in epithelially derived malignant neoplasms.

A comparison of clinical course with blood group antigen testing by specific red cell adherence and immunoperoxidase in ureteral and renal pelvic tumors

Specimens of transitional cell carcinoma of the ureter and renal pelvis from 20 patients were tested for blood group antigenicity using immunoperoxidase and specific red cell adherence methods. The results of antigen testing were correlated with tumor stage and grade as well as the subsequent clinical course of the patients. The specific red cell adherence test was negative in 80 per cent and the immunoperoxidase test was negative in 40 per cent of all tumors. Of the 4 patients with positive specific red cell adherence tests 3 had high grade (II to III), invasive tumors as did 7 of 12 with tumors that were positive by immunoperoxidase testing. Blood group antigen testing did not prove helpful in predicting the clinical course of our patients. In addition, a careful review of previously published data does not support the conclusion that blood group antigen testing is a valuable predictor of upper tract tumor aggressiveness.

Detection of cell surface antigen in cancer of renal pelvis and ureter

Thirty-five patients with transitional cell carcinoma of the renal pelvis or ureter of all stages and grades were studied for presence or absence of ABO(H) antigens utilizing an improved technique for staining and preserving the slides. Seventy per cent of the grade I tumors retained their antigens. Patients with antigen present had a longer duration of disease-free interval. Specific red cell adherence (SRCA) may predict the clinical course of patients with low-stage, low-grade transitional cell carcinomas and may be helpful in selecting patients for optimal therapy.

Prognostic validity of the specific red cell adherence test in upper urothelial tumours

The specific red cell adherence (SRCA) test for blood group antigens was used in 32 patients with upper urinary tract tumours to determine whether their survival could be predicted by this test. The SRCA results correlated well with survival in each grade and stage of the tumours. Overall, patients with positive tests showed a significantly higher 5-year survival rate than those with negative tests (87.2% vs. 24.6%). These findings add support to the prognostic importance of this test in upper urinary tract tumours.

Hybridoma antibodies reactive with human bladder carcinoma cell surface antigens

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