Lenore S. Englander

Evaluation of Bladder Washings and Urine Cytology in the Diagnosis of Bladder Cancer and Its Correlation with Selected Biopsies of the Bladder Mucosa

We report a prospective study of 136 patients with biopsy proved bladder tumor who underwent 311 evaluations with cystoscopy, urinary cytology, bladder washing and, when indicated, bladder biopsies. Cytology results from bladder washings were superior to routine urinary cytology studies in detecting abnormal cells. Also, there was a significant increase in the number of positive cytology studies in bladder washings from patients with no evidence of tumor by cystoscopy but who had biopsy proved dysplasia. Multiple selective bladder biopsies showed a higher incidence of mucosal abnormalities if the primary tumor was of a higher grade.

Prognostic factors in localized prostatic carcinoma

Serial histological sections were performed in 54 radical prostatectomy specimens in an attempt to identify prognostic factors responsible for dissemination of prostatic cancer. Factors considered in the study included clinical versus pathological staging, histological grading of the biopsy specimen compared to the final pathological result, intraprostatic tumor distribution and deoxyribonucleic acid analysis of the tumor by flow cytometry in the last 33 cases. In patients with clinical stages A2 and B1 disease pathological findings were in accord in 78 per cent (11 of 14). However, only 3 of 40 patients with clinical stage B2 tumor had pathological stage B2 disease. Histologically, 72 per cent of the tumors were bilateral. Microscopic involvement of the capsule per se did not appear to influence lymph node invasion, since only 1 of 27 patients with microscopic capsular involvement had pelvic lymph node metastasis. However, 9 of 13 patients with seminal vesicle involvement had pelvic lymph node metastasis. The addition of flow cytometry to the Gleason score improves the predictive value of histological grade in higher stage lesions.

Estrogen and progestin receptors in human prostatic carcinoma.

Cytosol receptors for estrogens (ER) and progestins (PR) were assayed in human prostatic carcinoma (CaP) and benign prostatic hyperplasia (BPH). Specimens were obtained from either the peripheral or the periurethral zone of the prostate. Stringent criteria were used to identify and measure 7‐8S specific receptor using sucrose gradient analysis in a vertical tube rotor. Progesterone receptor was found in 14 BPH samples assayed and in 12 of 13 prostate cancers. In contrast, the 7‐8S estrogen receptor was found in none of the nine benign samples assayed and in all prostate cancers. BPH samples were taken from either peripheral or periurethral zones and gave similar results. The histology of individual specimens did not correlate with either the ER or PR present, and, in the cancers, there was no correlation between the pathologic stage or the Gleason score and receptor content.

Primary mediastinal germ cell tumors histologic patterns of treatment failures at autopsy

Twenty‐five patients presented with primary mediastinal germ cell tumors at Roswell Park Memorial Institute between 1959 and 1984. All patients were treated by surgery and chemotherapy with or without radiotherapy. Four patients are still alive, and 21 patients died of mediastinal germ cell tumor and its sequelae. Two patients were found to have testicular scars and were dropped from the study. Nongerm cell malignant transformation of a teratoma occurred in five of the remaining 17 patients (29%), resulting in three adenocarcinomas and two sarcomas. Another patient developed leukemia. Metastatic disease most commonly involved the lungs, mediastinal lymph nodes, liver, bone, retroperitoneum, and heart. Respiratory failure was the cause of death in 12 patients. Of the possible mechanisms of germ cell transformation into malignant nongerm cell tumors discussed, this study suggests that chemotherapy alone is unlikely to induce stem cell differentiation. The presence of mature, differentiated teratoma within the primary lesion may be indicative of a poorer prognosis.

Experimental Photodynamic Treatment of Canine Bladder

In urology, important limiting factors in the application of hematoporphyrin derivative and photodynamic therapy appear to be the problems of standardization of dosimetry and the technique of transurethral photoradiation. Experimental photodynamic therapy on canine bladder with normal and altered epithelium was performed using an argon laser as an energy source. A 630 nanometer wavelength of light was delivered through a quartz-optical fiber with either a regular flat end for focal illumination or a bulb-type end which produced an isotropic light pattern. It was demonstrated that normal canine bladder was resistant to photodynamic therapy and that the bulb tip produced whole bladder illumination. With a moderate light dose of 18 to 30 Joules/cm.2 the effect following whole bladder illumination on the bladder was generalized and superficial. This approach appears to be ideal for treating superficial transitional cell carcinoma of the bladder. Additional work is needed in selecting appropriate energy doses.

Severely Contracted Bladder Following Intravesical Mitomycin C Therapy

Most superficial bladder tumors are best treated by transurethral resection. However, because of their multifocal origin and high rate of recurrence they often present challenging therapeutic problems. Intravesical chemotherapy often is used in such cases in the treatment and prevention of recurrent transitional cell carcinoma of the bladder. Recently, mitomycin C intravesical chemotherapy was shown to be effective in the treatment of superficial bladder tumors. No systemic toxicities were described but bladder irritation and drug-related palmar desquamation were noted. We report a case of a severely contracted bladder requiring urinary diversion following intravesical chemotherapy with mitomycin C. A possible relationship of this complication to the mitomycin C treatment is suggested.

Bleomycin-induced nodular pulmonary fibrosis masquerading as metastatic testicular cancer.

Bleomycin has become an important component of combination chemotherapy, particularly in the treatment of metastatic testis carcinoma. Pulmonary toxicity is a major risk and irreversible pulmonary fibrosis or even death may result from its use. Rarely diffuse fibrosis may lead to discrete nodularity mimicking pulmonary metastasis. We report such a case, and discuss the various clinical, radiographic and histopathological forms of bleomycin-induced pulmonary toxicity.

The effect of nitrofurantoin on bladder tumor cell lines: in vitro growth and implantation in the cauterized mouse bladder.

Nitrofurans compounds and derivatives demonstrate antineoplastic activity in vitro as well as in vivo. Nitrofurantoin caused in vitro growth inhibition of a FANFT-induced murine bladder tumor (MBT2) and a human transitional cell carcinoma cell line (GIBB) in concentrations of 125 microM, 250 microM and 500 microM. The implantation and growth of MBT2 in the cauterized mouse bladder was inhibited by 250 microM nitrofurantoin. The bladder mucosa of two groups of C3Hf/HeHa female mice was electrically cauterized. In group I, 1 X 10(6) MBT2 cells were injected into the bladders of 42 mice, while in group II 1 X 10(6) MBT2 cells in 250 microM nitrofurantoin solution were injected into the bladders of 51 mice. Positive tumor implantation was seen in 25 bladders (59.5 per cent) of group I as compared to 15 bladders (29.5 per cent) of group II. All tumors in group I were large, occupying more than 50 per cent of bladder cross sectional area with 24 per cent showing extravesical extention. Sixty-six per cent of tumors in groups II were less than 25 per cent of bladder cross sectional area and 13.4 per cent had extravesical extention.

Histological Patterns of Treatment Failures in Testicular Neoplasms

We reviewed 77 consecutive autopsies performed between 1965 and 1982 on patients who had been treated for germ cell tumors of the testis at our institute. Identifiable germ cell tumor was present at autopsy in 64 cases. On review, a single pattern was seen at autopsy in the majority of the cases (69.7 per cent) compared to the primary tumors, in which single patterns were seen in only 45 per cent. The occurrence of yolk sac tumor as the sole element in 6 of 29 autopsy specimens of nonseminomatous tumors after the introduction of the current standard 3-drug therapy and only once in 32 autopsies before 1976 appears significant. A possible explanation for this finding is that the yolk sac element was obscured by more aggressive and rapidly growing varieties of tumor in the earlier years but proved less responsive to chemotherapy.