Stuart M. Bergman

The cell surface antigen A, B or O(H) as an indicator of malignant potential in stage A bladder carcinoma: preliminary report.

The presence or absence of cell surface antigens (A,B and H) on the cell surface of bladder tumors has been studied. The major blood group antigens A, B or O(H) are present on normal bladder epithelium but are not present on some low grade and low stage papillary transitional cell carcinomas of the bladder. We have demonstrated that of 5 stage A bladder tumors that have not recurred in at least 5 years 3 retained the cell surface antigens, while tumors that have recurred locally, invaded or metastasized had lost these cell surface antigens on the original stage A tumor.

The Role of Alphafetoprotein and Human Chorionic Gonadotropin in Seminoma

Abstract: In a prospective study of 60 patients with pure seminoma we have measured the levels of serum human chorionic gonadotropin and alpha-fetoprotein by specific double antibody immunoassays developed originally at the National Cancer Institute, These markers also were localized in different cells using the techniques of immunoperoxidase and immunofluorescence on serial sections of the tumors. Of 60 patients 4 had elevated serum human chorionic gonadotropin, with a range of 2.8 to 428ng./ml. and an average of 109ng./ml. In serial sectioning of the tumor specimens 1 of 4 patients had an element of choriocarcinoma and underwent retroperitoneal lymph node dissection and chemotherapy. The serum human chorionic gonadotropin decreased to normal. Normal levels of alpha-fetoprotein were seen in 59 patients. However, in 1 patient the serum alpha-fetoprotein was 152ng./ml. In serial sectioning an element of embryonal carcinoma was found. This patient has been proved to have metastatic involvement of aortocaval...

The Role of the Radioimmunoassay of Serum Alpha-Fetoprotein and Human Chorionic Gonadotropin in the Intensive Chemotherapy and Surgery of Metastatic Testicular Tumors

Quantitative measurement of serum alpha-fetoprotein and human chorionic gonadotropin by double antibody radioimmunoassays reflects the efficacy of surgical, radiation and/or chemotherapeutic regimens in patients with bulky disseminated testicular tumors. When these therapies are effective they produce an immediate decrease in serum levels of these markers that reflects the decrease in tumor size and could be as rapid as the catabolic decay rate for alpha-fetoprotein or human chorionic gonadotropin. The alpha subunit of human chorionic gonadotropin has a short half-life (20 minutes) and has been used for the first time to localize a recurrent metastatic testicular tumor. Cellular localization of these markers by immunochemical techniques has helped us to understand the natural history of this cancer and the cell types responsible for production of the markers.

Expression of A and B tissue isoantigens in benign and malignant lesions of the breast

AB isoantigens are widely distributed in human tissues and loss of AB isoantigen expression has been shown to be an early marker for carcinomatous transformation in some tissues. We therefore applied the Specific Red Cell Adherence Reaction (SRCA) for detection and localization of AB isoantigens in tissue to the study of benign and malignant proliferative lesions of the breast. Twenty‐nine lesions in 19 patients were studied. AB isoantigen expression in normal breast tissue was found to be largely confined to the mammary duct system. Loss of AB isoantigen expression was a consistent feature of intraductal carcinoma (3 of 3 cases). Proliferative lesions associated with fibrocystic disease also demonstrated varying degrees of isoantigen loss (simple cystic disease, 3 of 8 cases; intraductal hyperplasia, 6 of 7 cases; sclerosing adenosis, 4 of 4 cases; and intraductal papillomatosis, 7 of 7 cases negative for isoantigen). In contrast to other systems, loss of AB isoantigen expression in the breast appears to be a consistent marker of apparently benign proliferative duct lesions associated with fibrocystic disease, as well as duct carcinoma. The early loss of AB isoantigen expression in these histologically benign lesions supports a possible link between fibrocystic disease and mammary carcinoma. In contrast to other tissues, loss of AB isoantigen expression in proliferative breast lesions is not necessarily evidence of malignancy.

Pressure effects of urinary reflux studied with renal autotransplantation and pyelocystostomy.

The pressure effects of urinary reflux on renal structure and function were studied using a canine model in which the kidney was autotransplanted to the iliac fossa and the urine drained through a pyelocystostomy. This provided grade III reflux of urine (distention of the renal pelvis and calyces). A control group of nonrefluxing animals with the ureter and ureterovesical valve intact was studied in an identical fashion, and all animals were observed for one year. The reflux of sterile urine was not associated with any impairment of the inulin clearance or transport maximum of para-aminohippuric acid. There were no histologic abnormalities of glomeruli, tubules, or interstitium noted in the animals exposed to sterile reflux, nor were any differences found between the study and control groups. The transmission of bladder pressures into the renal pelvis and calyces during reflux is considered an unimportant factor in explaining the renal damage noted from sterile reflux of short duration in adults. The pyelocystostomy provides a satisfactory means of urinary drainage, and may be used effectively to study the properties of urinary reflex.

Postoperative Management of Patients with Pheochromocytoma

The optimal preoperative and postoperative management of patients with pheochromocytoma demands a multidisciplinary approach. We report on 5 recent patients to illustrate the large volumes of fluid needed in the early postoperative period. This large fluid requirement is owing to a combination of a change in vascular compliance after excision of a pheochromocytoma, the residual effects of specific preoperative medications (phenoxybenzamine and alpha-methyl-p-tyrosine) and the loss of fluid into the retroperitoneal compartment (third space) produced by extensive dissection. It takes 3 half-lives (36 hours) to dissipate the effects of phenoxybenzamine and alpha-methyl-p-tyrosine, which corresponds to the time in which these patients require large volumes of intravenous fluids.

Correlation of Computed Tomography and Serum Tumor Markers in Metastatic Retroperitoneal Testicular Tumor

Preliminary findings of an apparently good correlation between computed tomography and serum tumor markers—human chorionic gonadotropin and alpha fetoprotein—are presented. These findings are from an ongoing prospective randomized study evaluating the efficacy of intensive chemotherapy and cytoreductive surgery in metastatic retroperitoneal testicular germ cell tumors.

Complication with mechanical stapling device in creation of ileoconduit.

Of 296 patients with pelvic malignancy and ileal urinary conduits, urinary tract calculi developed in 14. Calculi which ordinarily require surgical intervention because of their size may pass spontaneously in patients with ileoconduits because of the presence of a chronically dilated colllecting system and the surgical elimination of three of the four sites of stone impaction (pelvic brim, ureterovesical junction, and ureteral orifice). In 1 patient multiple calculi developed around the surgical staples used to create the proximal end of the ileal conduit. We recommend that autosuture with stapling devices not be used to create the proximal end of an ileal urinary conduit.

The Value of Whole Lung Tomography in the Early Detection of Metastatic Disease in Patients with Renal Cell Carcinoma and Testicular Tumors

The value of whole lung tomography was compared to chest x-rays in patients with renal cell carcinoma and germ cell testicular tumors. We studied 83 patients with testicular tumors and 34 with renal cell carcinoma. At least 1 metastatic lesion was present on whole lung tomography in 11 of 64 patients (17 per cent) with testicular tumors and 2 of 21 (10 per cent) with renal cell carcinoma who had negative chest x-rays. Of the patients with a solitary lesion on the chest x-ray 3 of 10 (30 per cent) with testicular tumor and 5 of 11 (45 per cent) with renal cell carcinoma had multiple metastatic lesions on whole lung tomograms. Falsely positive chest x-rays were noted in 6 of 15 patients (40 per cent) with renal cell carcinoma and 6 of 16 (37 per cent) with testis tumor. These falsely positive results were caused by overlapping shadows, vessels or granulomas.

Abnormal seminiferous tubule cells associated with choriocarcinoma: immunoperoxidase study.

A case is presented of widely metastatic choriocarinoma, associated with an intratubular proliferation of atypical germ cells in the testis and a minute adult cystic teratoma. Immunoperoxidase study of the intratubular germ cells did not confirm their trophoblastic origin. Intratubular proliferation of undifferentiated germ cells may be associated with choriocarcinoma.