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The carcinomas of the male genitourinary tract--prostate, testicle, bladder, kidney and penis--are discussed with regard to incidence, prognosis and therapeutic possibilities. The results of drug treatment, especially for prostatic and non-seminoma testicular cancers, are presented in detail.
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Our studies indicate that certain urologic tissues demonstrate evidence of proteins which compete with the interspecies antigens of C-type ribonucleic acid viruses for binding sites of the feline and murine oncornavirus antiglobulins. This fact indicates either the association of viral antigens within these tissues or the presence of a protein so similar to the interspecies antigen that it cross reacts. Studies are now underway to localize reacting antigens within these urologic cells, to correlate the immunologic properties with enzymatic properties known to be specific for oncornaviruses and to assay the activity of patient sera with isolated interspecies antigens. Sera from patients with urologic malignancies will be tested to determine whether the sera can effectively absorb reactivity from tissue extracts or compete with reagent rabbit antisera raised against the interspecies component of the viruses. Should either activity be detected in patient sera, clinical screening will be undertaken to determine if this approach is applicable to early detection of urologic malignancies.
Nineteen patients are reported who developed acute myeloblastic leukemia following treatment for a variety of solid tumors, including seminoma (four cases), melanoma (one case), and cancer of the ovary (six cases), colon or rectum (three cases), bladder (two cases), cervix, endometrium, and larynx (one case each). There were nine men and ten women, with a median age of 49.8 years (range 29 to 75). The mean interval between the diagnosis of solid tumors and acute leukemia is 5.8 years. In two patients the two diseases occurred simultaneously or within six months of each other. One patient was treated only surgically. Eight patients were treated with radiotherapy, five with chemotherapy, and five received both chemotherapy and radiotherapy. Pancytopenia was commonly noted prior to the onset of leukemia with chromosomal abnormalities observed in four cases in which a karyotype was performed. Three patients achieved complete hematological remission following antileukemic therapy. One hundred and six additional patients with non-hematopoietic neoplasms and acute leukemia are reviewed. Although acute leukemia may occur in a higher than expected frequency in patients with solid tumors because of a possible increased risk of a second neoplasm, it seems more likely that the acute leukemia is related to the radiotherapy and/or chemotherapy administered to treat the first neoplasm.
Information on metastases from carcinoma of the mammary gland in an autopsy study of 707 cases occurring in white women over a 15-year period are presented and tabulated. Multiple primary cancers occurred in 19% of the cases. Of the 137 cases that exhibit more than one neoplastic malignancy, 31 (23%) were present in the contralateral mammary gland. Seventy patients had no metastasis from the mammary cancer at the time of death, and 55 of these patients had another cancer. Additional information has been added concerning the frequency of metastasis in parathyroid and thymus. When a parathyroid contains a metastasis, extensive metastases were noted in many organs and thus represents a late stage of the cancer.
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The aliphatic nitrosamines dimethylnitrosamine (DMN), diethylnitrosamine (DEN), dipropylnitrosamine (DPN), and dibutylnitrosamine (DBN) reached fetal tissue in quantitatively measurable amounts after subcutaneous administration to pregnant Syrian hamsters. The compounds were present for at least 2 h in maternal blood, placenta, fetus, and amniotic fluid; DBN was still measurable after 6 h. Only a weak or borderline transplacental effect was seen when incidences and latencies of neoplasms in the respiratory and digestive tracts of the F1-generation were compared with those of the P-generation after exposure to a single dose of DMN or DPN. However, some tumor types occurred at relatively high rates in the young, but were seen only occcasionally in their mothers or in this hamster colony in general.
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A mesothelioma of the spermatic cord occurred at the site of multiple hernial repairs. The aggressive biologic behavior of this tumor is exhibited by its early lymph node invasion and extensive metastases to the pleural cavities, lungs, and spleen. These tumor cells contained a large amount of stable of stable glycogen-like carbohydrate insoluble in formalin and tolerating postmortem changes. Electron microscopy revealed features similar to those mesotheliomas arising from body cavities.
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Leiomyomas may originate from any anatomic location of smooth muscle in the genitourinary system but are uncommon neoplasms. Five unusual cases of leiomyomas arising from the renal pelvis, bladder, spermatic cord, and glans penis are presented. The leiomyoma arising from the glans penis in a three-year-old boy is the first case of a leiomyoma in that location noted in the literature. A review of leiomyomas from each genitourinary structure of origin is presented.
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Serum beta-2-microglobulin levels were measured in patients with renal, vesical and prostatic cancer. Measurements were made only on samples with a serum creatinine less than or equal to 105 mumol./l. to eliminate the possibility of elevated beta-2-microglobulin being a result of impaired renal function. This criterion eliminated 28 to 50 per cent of the patients with bladder cancer and 73 per cent of those who had undergone nephrectomy for renal carcinoma, which, obviously, limits the value of beta-2-microglobulin measurement for the surveillance in these cancers. Beta-2-microglobulin values in patients with prostatic cancer were seldom increased to more than 3.0 mg./l. In bladder cancer patients with normal serum creatinine the frequency of an elevated serum beta-2-microglobulin increased with the increase in tumor stage.
Genitourinary tumors account for half of all documented cases of pseudohyperparathyroidism. The treatment of hypercalcemia is directed toward immediate correction of the electrolyte imbalance and long-term control. These goals are accomplished with volume repletion, calcium normalization and removal of the tumor. Effective therapy includes saline infusion and furosemide. Additional control is obtained with phosphates and/or indomethachin. In refractory cases actinomycin-D or mithramycin is helpful. The first reported case of urethral cancer and second reported case of testicular seminoma producing this syndrome are added to the literature.
Carcinoembryonic antigen was measured in the urine and plasma of 108 patients with several types and various stages of genitourinary cancer. The value of the carcinoembryonic antigen assay as an early indicator of neoplastic disease was evaluated and a correlation was made between the extent of disease and the concentration of urinary and plasma carcinoembryonic antigen. Patients were classified according to stage of tumor involvement as follows: no evidence of disease, non-malignant disease, non-invasive disease, no known metastasis, regional metastasis and disseminated metastasis. The urinary carcinoembryonic antigen levels more closely paralleled the extent of disease than did the plasma carcinoembryonic antigen levels in patients with bladder cancer. Neither urinary nor plasma carcinoembryonic antigen levels were useful in assessing the extent of disease in patients with prostatic or testicular cancer. Studies related to microbiological interference in the carcinoembryonic antigen assay indicated that bacterial counts up to 10(5) organisms per ml. did not interfere. Cytological studies indicated that the presence of white blood cells, atypical cells and malignant cells could result in elevated urinary carcinoembryonic antigen levels.
Partially purified extracts from 71 human urothelial tumors and from 75 human urothelial non-tumor tissues were used as competing antigens in competition radioimmunoassay in an effort to detect the presence of 1 of the structural components of type C-ribonucleic and viruses, the p30 core protein. Testing of the tissue extracts was carried out by homologous and heterologous assay systems using 125I-labeled murine (Friend) and feline (Rickard) p30 antigens and anti-feline and anti-murine p30 antisera. The homologous assays were designed to detect the presence of p30 antigens in the human tissue extracts having similar characteristics to the p30 antigens of either the feline or murine type C viruses. The heterologous assay system was designed to detect interspecies antigenic determinants common to murine and feline viruses and also primate viruses. A competing antigen present in 28 per cent of the tissue extracts assayed demonstrated an antigenic protein that competed with the viral p30 protein used in the heterologous radioimmunoassay system and to a lesser extent in the homologous feline radioimmunoassay system. Antigenic competitor proteins were found in tumor and non-tumor tissue. These data suggest that some human urothelial tissues contain at least part of the genome of 1 or more type C viruses. Those tissues that are positive only in the heterologous assay system behave like viral p30 antigens already identified in tissues of several other primates. Those tissues that are positive in the heterologous assay system and the homologous system indicate that the p30 antigenic activity is closely related to that p30 present in feline C-type viruses. Further purification and more detailed characterization of those competing proteins are now under study.