Biomedical subjects
Publications and source records attributed to G Hamami.
We report a case of choriocarcinoma of the bladder. The initial biopsy of the bladder tumor showed co-existence of choriocarcinoma and transitional cell carcinoma, while the cystectomized bladder tumor and metastatic tumors were composed only of choriocarcinoma. The diagnosis of choriocarcinoma was confirmed morphologically and by the demonstration of hCG in the tumor and in the serum.
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A deletion of the long arm of the Y chromosome (46,XYq-) was found in two cases with normal male habitus but with azoospermia. The first case was of a 28-year-old married man, an office worker, complaining of infertility. His height was 153 cm, weight 57 kg and distance of extended hand 152 cm. Both testes were 13 ml in size. The second case was a 32-year-old married man, a fireman, complaining of infertility. His height was 160 cm, weight 64 kg and distance of extended hand 161 cm. Both testes were 10 ml in size. In each case, the external genitalia showed a normal male type, but azoospermia was identified in semen analysis. The testicular biopsy specimens revealed spermatogenic arrest with thickening of basement membrane. Chromosomal analysis showed 46,XYq- karyotype. Basal serum levels of luteinizing hormone and follicle-stimulating hormone were slightly elevated and the serum testosterone level was within normal limits. Eight cases of 46,XYq- karyotype in the Japanese literature including our cases were reviewed.
Iopamidol (Iopamiron 370) was examined for use in intravenous urography in 37 patients who previously developed adverse reactions to conventional ionic contrast media or had a history of allergy. The patients were divided into three groups (group A1:22 patients with previous adverse reactions to contrast media, but without history of allergy, group A2:8 patients with previous adverse reactions to contrast media and with history of allergy, group B:7 patients with a history of allergy, but without experience of using contrast media. Adverse reactions to iopamidol were observed in 6 patients (one in group A1, four in group A2, one in group B) and there were no serious adverse reactions. In conclusion, iopamidol seems to be a safe contrast medium for the patients without history of allergy, but we should examine it carefully as in the case of conventional ionic contrast media.
Two cases of advanced adenocarcinoma treated with attenuated vaccinia virus AS strain are reported. One was a primary lung adenocarcinoma with metastatic lesions in brain, right kidney, and rib. The other was a left renal adenocarcinoma with multiple lung and vertebral metastases. In both patients, good antitumor effects against lung and bone lesions were obtained, respectively, and no adverse reactions were noted. Therefore, treatment of patients with AS vaccinia virus appears to suppress the growth of tumor cells without adverse effects on normal human cells. This is the first report to describe the effects of attenuated vaccinia virus AS strain on human cancer.
We attempted to determine the efficacy of basic fetoprotein as a marker in testicular cancer. The levels of serum basic fetoprotein were studied in 58 patients (31 with seminoma and 27 with nonseminoma). Elevated levels were observed in 22 seminoma (71 per cent) and 15 nonseminoma (56 per cent) patients, while the levels of other markers (beta-subunit of human chorionic gonadotropin, alpha-fetoprotein and lactic dehydrogenase) remained normal in 6 seminoma (19 per cent) and 2 nonseminoma (7 per cent) patients. The levels of basic fetoprotein changed in relation to the clinical courses and they elevated again in 3 of 4 patients with recurrence. The concentration of basic fetoprotein in testicular cancer tissue was significantly higher than in the normal testis. Histological localization of basic fetoprotein in testicular cancer tissue was demonstrated immunohistochemically. Thus, basic fetoprotein was considered to be a useful serum marker for testicular cancer.
Primary neuroblastoma of the kidney in adults is an extremely rare neoplasm that had not been described in the literature until 1986. The diagnosis can be made by histopathological examination only. We report 2 unusual cases of neuroblastoma of the kidney in adults. In both patients right nephrectomy was performed after the diagnosis of right renal cell carcinoma was made. Histological examination revealed the tumors to be primary neuroblastomas of the right kidney. In the first patient cobalt therapy was administered to the tumor bed and para-aortic area. Followup at 5 years revealed no sign of tumor recurrence. Progressive disseminated disease has been documented in the second patient despite postoperative adjuvant chemotherapy with combined cis-platinum and epipodophyllotoxin, and combined vincristine, cyclophosphamide, doxorubicin and dimethyl-tri-azeno imidazole carboxamine.
The inhibitory effect of human-recombinant tumor necrosis factor (Hu-rec-TNF) alone or in combination with human recombinant gamma-interferon (rec gamma-IFN), doxorubicin (ADM) or cis-platinum (CDDP) was studied for two human renal cell carcinoma lines (KO-RCC-1 and RCC-nu-1 cells). Hu-rec-TNF inhibited the cell growth of KO-RCC-1 cells in a dose- and time-dependent manner. The inhibitory effect was seen 48 hours after the treatment with Hu-rec-TNF alone. The effect of Hu-rec-TNF was cytotoxic in our experiment. On the other hand, Hu-rec-TNF did not inhibit the cell growth of RCC-nu-1 cells. There were sensitive and resistant cells in renal cell carcinoma. In KO-RCC-1 cells, Hu-rec-TNF enhanced the inhibitory effect of rec gamma-IFN, ADM or CDDP. On the other hand, Hu-rec-TNF did not enhance the inhibitory effect of rec gamma-IFN, ADM or CDDP in RCC-nu-1 cells. In our experiment, the combined treatment with Hu-rec-TNF and rec gamma-IFN, ADM or CDDP was useful in human renal cell carcinoma which was sensitive for Hu-rec-TNF.
A case of asynchronous bilateral renal cell carcinoma is reported. A 52-year-old man with the chief complaint of asymptomatic gross hematuria visited our hospital on November 16, 1981. Intravesicular pyelography showed poor secretion of the left kidney, compression of its pelvis and calyces and normal visualization of the right kidney. On computer tomographic (CT) scanning, abdominal aortogram and left selective renal angiogram, a round tumor lesion on the left kidney was recognized. Under the diagnosis of left renal tumor, radical left nephrectomy was performed in December, 1981. Histological diagnosis was clear cell carcinoma of the left kidney. He was administered medroxyprogesterone acetate. In December, 1985, CT showed a space-occupying lesion laterally on the right kidney and another suspected tumorous lesion. On the right selective renal angiogram, a round hypervascular lesion about 3 cm in diameter was found on the upper portion of the right kidney. On February 10, 1986 simple surgical enucleation of the 2 renal tumors was performed. Histological diagnosis was the same as that of the left kidney. Postoperative course was uneventful. He is well without recurrence or metastasis 8 months after operation.
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We report a case of bladder tumor with multiple metastases including the brain. Bladder tumor is the most common malignancy in uroepithelial tumor, but brain metastasis from bladder tumor is extremely rare. Since 1970 only 8 cases have been reported in Japan. The literature was reviewed.
Leiomyosarcoma of the left kidney seen in a 58-year-old man is reported. On April 10, 1982, he complained of left flank pain. He visited our hospital and left solitary renal cyst was suspected. He had been treated as an outpatient, but left flank pain became exacervated. On May 18, he was admitted to our hospital. On June 7, radical nephrectomy was done under the diagnosis of left renal cell carcinoma. At operation, the tumor invased directory to the psoas muscle and abdominal wall, and could not be completely resected. Pathological diagnosis was renal cell carcinoma with sarcomatoid change. On July 1, he was discharged from the hospital. In December, left flank distention appeared and back pain became exacervated. On February 8, 1983, he was readmitted to our hospital. Low density area was found in left psoas muscle by CT scanning and recurrence of renal cell carcinoma was suspected. alpha-Interferon therapy had been done, but tumor increased remarkably and caused ileus. He died on June 14, 1983. The autopsy revealed a child head-sized cystic tumor in the upper retroperitoneal space, a 5 X 5 X 5 cm metastasis of the left lobe of the liver, a 3 X 3 X 4 cm tumor to the left upper lobe with cavity formation and direct invasion into the spleen, diaphragma and gastric serosa. These metastatic lesions were leiomyosarcoma. Retrospectively, the primary tumor of kidney revealed primary leiomyosarcoma of kidney.
A case of a 19-year-old male with leiomyosarcoma of the prostate is reported. He visited our hospital with the chief complaint of urinary retention in December, 1983. Following overall examination, needle biopsy of the prostate gland was performed with the suspicion of sarcoma. Histology of the prostate revealed leiomyosarcoma. Two courses of combined chemotherapy were given, but the tumor continued to enlarge. The patient died in April, 1984, 5 months after the appearance of the first symptom.
A case of pure choriocarcinoma of the testis in a 62-year-old male is reported. The patient consulted his family physician with an enlarged but painless right scrotal containment in November, 1980. Initial diagnosis was right hydrocele testis and chronic epididymitis, and he was treated with antibiotics. However, the tumor continued to enlarge. Right high orchiectomy was performed on March, 15, 1981 under the diagnosis of suspected right testicular tumor. The resected specimen was 10 X 7 X 6 cm and elastic hard. The cut surface was dark reddish with hemorrhagic foci. Serial sections of the entire testis were made and their histopathological examinations revealed the tumor to be a classical pure choriocarcinoma of the testis. The plasma beta-HCG level was remarkably elevated, but the alpha-fetoprotein level was normal. Anticancer chemotherapy (CDDP 125 mg, MTX 20 mg, ADM 50 mg, and EDX 500 mg) was performed in eight courses after the operation. Multiple metastatic foci were present in both lungs during the treatment, and his condition gradually deteriorated. Therefore, he was transferred to our hospital. Aggressive anticancer treatment could not be given because of his poor general condition, and he died on May, 16, 1982 of carcinomatosis. The autopsy revealed multiple nodular metastasis of the tumor to bilateral lungs, bilateral adrenal glands and right kidney. There was no metastasis to the lymph nodes. The metastatic lesions, macrospically dark reddish with hemorrhagic foci, were histopathologically pure choriocarcinoma.
A case of prostatic papillary adenocarcinoma is reported. A 70-year-old male was admitted with the complaint of urinary retention. Suprapubic prostatectomy was performed on July 17, 1984 under the diagnosis of benign prostatic hypertrophy. The bilobes of prostate were 4 X 3 X 3 cm in size and 60 gm in weight. They were very soft and yellow-red. The histopathological examination revealed papillary adenocarcinoma of prostate. Glands were lined by a single or two layers of cuboidal cells with dark cytoplasm and a clear nucleolus. It seemed to arise from the prostatic duct, since serum level of prostatic acid phosphatase was elevated. But it was thought that prostatic carcinoma of acini grew in the papillary pattern, too. Therefore, it was difficult to identify the origin. Only hormone therapy (Honvan) was performed as postoperative anticancer therapy. During the follow up at the clinic, there have been no abnormal findings.
From 1978 to 1982 bilateral ureterorectostomy and end-to-side sigmoidorectostomy were done following cystectomy for carcinoma of the bladder in 7 patients. No patient had recurrent pyelonephritis or ureterointestinal obstruction. Rectography showed the absence of rectoureteral reflux of contrast medium but rectosigmoid reflux appeared after injection of more than 150 ml. opaque solution. Adequate alkali therapy was performed in 2 patients with hyperchloremic acidosis. While there were some problems concerning the quality of urinary and fecal control achieved in our patients they were no worse than those of ordinary ureterosigmoidostomy. This operation might be recommended for patients in whom a collection appliance is unacceptable. However, before this surgical procedure can be performed the fact that the end result in terms of fecal urinary continence is unpredictable must be explained thoroughly to the patient.
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There is a need for chemosensitivity tests of human tumors to become simpler and to have a better correspondence with their therapeutical record. We examined and compared two chemosensitivity tests in vitro. One was a clonogenic assay performed using a double agar system and the other was a novel dye exclusion method that was a modification of the traditional dye exclusion method of Weisenthal. Cultured cells and surgical speciners of urogenital tumors were used for the present experiments. Comparison of chemosensitivity between the clonogenic assay and the novel dye exclusion test resulted in a similar dose response for each, and both tests were suitable not only for cultured cells but also surgical speciners. Among surgical speciners, 17 of 25 cases (68%) tested by clonogenic assay and 8 of 11 cases (73%) tested by novel dye exclusion test were successful in detecting drug sensitivity. Renal cell carcinomas had higher plating efficiency and showed a higher success rate in the clonogenic assay than any other urogenital tumors. On the other hand, the novel dye exclusion method depended on tumor cell growth in suspension culture. Among 11 cases on which both the clonogenic assay and the novel dye exclusion method were performed, only in one case was there failure to estimate drug sensitivity. Therefore, more successful results in examining the chemosensitivity of urogenital tumors might be expected by using both the clonogenic assay and the novel dye exclusion method.