Willet F. Whitmore

Retropubic implantation of iodine 125 in the treatment of prostatic cancer

SummaryA technique of retropubic implantation of 125I seeds in selected patients with prostatic cancer has been presented. The method is technically simple and it has permitted delivery of potentially effective irradiation to the prostate, constituted a 1-step treatment, required a relatively short hospitalization, had no associated mortality and only minimal morbidity, produced only minimal disturbances in urinary, rectal and sexual functions, resulted in more accurate tumor staging and produced an encouraging degree of local regression in clinically evident prostatic lesions during a brief period of followup.

MALIGNANT TUMORS OF THE SPERMATIC CORD

The present study deals with 11 malignant tumors arising from the spermatic cord. Ten of the tumors were of mesoblastic origin and one was a teratoma. Local recurrence appeared to be a common problem and was attributed to inadequate removal of the primary tumor at biopsy. Distant metastasis occurred only in the late stages of disease after local recurrence could not be controlled or when retroperitoneal disease had become extensive. Radical orchiectomy followed by retroperitoneal node dissection was considered the treatment of choice for this disease.

Myosarcomas of the bladder and prostate

Of 32 patients seen in Memorial Center since 1920 with myosarcomas of the bladder or prostate 26 were male and six were female. The tumors arose in the bladder in 20, in the prostate in 11 and in one patient both organs were involved. Sarcomas of the bladder account for two or three of every thousand bladder cancers and for one of every thousand prostate cancers. Seventy‐six patients, or approximately 10% of reported cases, have survived 3 years or more from diagnosis. Forty‐five of those 76 sarcomas were reported as specific myosarcomas, i.e., embryonal rhabdomyosarcoma, adult rhabdomyosarcoma, leiomyosarcoma or combinations of those three. Thirty‐six arose in the bladder, nine arose in the prostate. The most successful methods of treatment have been cystectomy for embryonal rhabdomyosarcoma of the bladder and segmental resection for leiomyosarcoma of the bladder. Rhabdomyosarcoma of the bladder and prostate has seldom been managed successfully, so that no particular treatment can be unconditionally recommended. Embryonal rhabdomyosarcoma of the prostate is as yet an incurable condition.

Embryonal adenocarcinoma in the prepubertal testis. A Clinicopathologic Study of 18 Cases

The clinicopathologic findings in 18 children with embryonal adenocarcinoma of the testis seen at the Memorial and James Ewing Hospitals are reviewed and discussed in the light of current concepts of treatment and histogenesis. the majority of these uncommon tumors occur prior to 4 years of age, but they are occasionally seen in older children and in adults, either in a pure form or in conjunction with other germinal tumor patterns. This series includes 2 cases in which, for the first time, distinct teratomatous elements are seen in association with the embryonal adenocarcinoma in prepubertal testes. Presenting as an asymptomatic testicular mass, this tumor requires careful differential diagnosis from the more common causes of scrotal enlargement. Two unique cases in which maldescent was present are reported; in one of these, bilaterality was suggested. Prophylactic retroperitoneal lymph node dissections were carried out in 8 cases, and, in all cases, the nodes were negative. Factors affecting survival are discussed with particular reference to the occurrence of solitary metastasis. Five of the 18 patients died of their disease. the highly reliable correlation of pathologic stage with clinical stage in these tumors renders questionable the need for retroperitoneal lymph node dissection in children with this tumor, although the small number of cases precludes final resolution of this question. the term “embryonal adenocarcinoma” is preferred for these childhood testis tumors which are felt to represent a single germinal tumor of varying form which differs from the adult émbryonal carcinoma in appearance and behavior although probably not in histogenesis.

Flow cytometry of low stage bladder tumors: Correlation with cytologic and cystoscopic diagnosis

Flow cytometry examinations (FCM) were carried out on 110 bladder irrigation specimens from 84 urologic outpatients who had had prior conservative treatment for low stage bladder tumors. The specimens were easily obtained, and adequately cellular in all cases. Of 60 examinations on patients with no cytoscopic abnormalities, FCM and conventional cytology were both negative in 30 and both positive in 12 instances; there were 18 with positive FCM and negative cytology. Of 15 instances with cystoscopically benign appearing papillary lesions, FCM and cytology were both negative in three and both positive in three cases; FCM was positive and cytology negative in nine. Of 35 instances with suspicious cystoscopic findings, FCM and cytology were both positive in 19 and both negative in four; FCM was positive and cytology negative in 12. There were no examples of positive conventional cytology and negative FCM. These findings indicate that, after conservative treatment of low stage tumors, FCM of bladder irrigation specimens may be a more sensitive measure of cytologic abnormalities than is conventional cytology. Specimen collection is feasible as part of the routine urologic examination in an outpatient clinic.

Carcinoma in-situ of the ureter in patients with bladder carcinoma treated by cystectomy

Ureteral carcinoma in‐situ was found in 17 (8.5%) of 205 patients undergoing cystectomy for bladder carcinoma. The incidence was highest in patients with multifocal tumors and in those with high stage and high grade tumors. The clinical and pathologic significance of this finding are discussed.

Flow Cytometry for Followup Examinations of Conservatively Treated Low Stage Bladder Tumors

A series of 26 conservatively treated patients with low stage bladder tumors was examined later by outpatient cystoscopy, conventional cytology and flow cytometry. Based on those findings the patients were separated into 5 groups. In the 4 patients in group 1 all findings persistently were negative. The 4 patients in group 2 had initially normal cystoscopy with progressively more abnormal flow cytometry and intermittently positive cytology; they subsequently suffered tumors. The 10 patients in group 3 had positive cystoscopy and flow cytometry, and intermittently positive cytology. The 6 patients in group 4 had negative cystoscopy with intermittently positive cytology and persistently positive flow cytometry. In all 6 cases flow cytometry was more sensitive than conventional cytology in detecting early and, sometimes, cystoscopically occult neoplasms. In the 2 patients in group 5 cystoscopically visible papillomas and low grade papillary carcinomas were found with negative flow cytometry and negative or suspicious cytology. The papillary tumors in these 2 patients were believed to be composed principally of benign or atypical epithelium, with too few malignant cells to be detected by present flow cytometry techniques. Our preliminary results suggest that flow cytometry may be a valuable tool for followup of patients who have had conservatively treated low stage bladder tumors and are at risk for development of carcinoma. In addition, the techniques may be used to monitor changes in the proportion of benign and malignant cells and, thus, can be of help in following the course of newly forming papillomas, papillary carcinomas or carcinoma in situ in papillomas or flat epithelium.

Non‐extirpative treatment of myosarcomas of the bladder and prostate

Patients who present initially with locally unresectable or metastatic myosarcoma of the bladder or prostate may be treated by a variety of non‐extirpative methods. The success of these methods in 4 cases reported here suggests that we should consider this approach more often. While chemotherapy and x‐ray therapy are by no means universally effective in myosarcomas of bladder and prostate, we recommend their use definitively and aggressively when surgical extirpation is impossible. In addition, we favor using them preoperatively in more favorable situations. The application of cryotherapy has intriguing possibilities and deserves further exploration.

Obstruction of the rectosigmoid and sigmoid flexure after radical cystectomy for cancer of the bladder

Summary and ConclusionsA previously unreported complication after surgery for cancer of the bladder is discussed. Of approximately 400 patients who underwent total cystectomy, dissection of pelvic lymph nodes, and urinary diversion for cancer of the bladder, partial or complete obstruction of the rectosigmoid and sigmoid flexure developed in eight. Its clinicopathologic characteristics, possible causes, and management have been discussed.