Biomedical subjects
Publications and source records attributed to N Javadpour.
In two patients with renal cell carcinoma, late metastases to the remaining kidney were found. The metastases were histologically identical to the primary tumor, and more than one nodule recurred in both cases. Advanced surgical techniques allowing removal of metastases from the sole kidney make diagnosis of these lesions clinically important.
To clarify the mechanism for the coexistence of ovarian and testicular tissue in the 46,XX true hermaphrodite, we studied a 20-year-old phenotypic male with gynecomastia and elevated serum concentrations of estradiol in whom an ovotestis was discovered upon scrotal exploration. Y chromosomal material could not be detected by fluorescent Y-body analysis or Giemsa-banding technics in cells cultured from peripheral blood, breast or forearm skin or the ovarian or testicular portions of the ovotestis. However, serologic testing, using the sperm cytotoxicity assay, revealed that cells cultured from the testicular portion of the ovotestis were H-Y antigen positive whereas cells cultured from the ovarian portion were H-Y antigen negative. These observations indicate that the ovotestis arises from an H-Y+/H-Y- mosaic primordium.
Certain in vivo and in vitro immunologic features of carcinogen-induced murine bladder cancer have been studied. The consistency of tumor induction, its natural history, and immunogenicity both in vivo and in vitro render this syngeneic murine bladder tumor a suitable model for immunologic studies. Pre-immunization of strain C3H/Hen mice with mid-gestational fetal cells did not protect the animals from tumor challenge. Sera of mice immunized with mid-gestational fetal cells were not cytotoxic to cultured tumor cells in a microcytotoxicity assay indicative of dissimilarity between the tumor associated antigen and the syngeneic mid-gestational fetal antigen.
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.
The evolution of malignant testicular tumor to mature teratoma has been studied in 4 patients. Computed tomography has been helpful in early diagnosis of this biologic phenomenon in these patients receiving intensive chemotherapy for disseminated non-seminomatous testicular cancer. Although the potential significance of this conversion in terms of survival is not known its early recognition by computed tomography has been useful in selecting and monitoring the therapy of these patients.
We examined 76 bladder tumors of various stages and grades for the presence of the ABO (H) cell surface antigen, using the specific red cell adherence technique. Of the grade I lesions studied 70 per cent were positive for the cell surface antigen and none of the 26 grade III tumors retained the antigens. When correlated with clinical stage the tumors showed no antigens for those of stages B1 to D, while 12 of 16 stage A lesions were positive for the antigen. When stage A lesions were studied and the findings were correlated with recurrence and metastasis/invasion rates the cell surface antigen was present on the initial tumor in only 1 lesion that recurred at an invasive stage. The findings of this study show that the specific red cell adherence technique may be valuable for predicting malignant potential in low grade, low stage cancer of the bladder. If supported by further investigation this technique may offer the capability of selecting low grade, low stage bladder tumors that are destined to invade or metastasize while they are at curable stages.
A case is presented of a 2 cm. renal angiomyolipoma. Computerized tomography demonstrated a region of low attenuation coefficient within this tumor, while B-mode ultrasound visualizes the tumor as a cluster of high amplitude echoes. The diagnosis of a renal angiomylipoma may be suspected preoperatively when this combination of findings is present with computerized tomography and ultrasound.
During the past several years the development of radioimmunoassay and immunocytochemical techniques to detect small amounts of marker in the sera and cancer cells of cancer patients has made a significant impact on the diagnosis and management of certain cancers. Among these markers alpha-fetoprotein, human chorionic gonadotropin, and pregnancy specific beta-1 glycoprotein have been useful in the staging, detection of recurrence, prognosis, and management of testicular cancer. In this article the recent developments and future perspectives concerning these and other newer markers are discussed.
Computed tomography (CT) was used to evaluate 26 patients with a variety of adrenal lesions. Surgical proof was available in 22 patients and clinical confirmation with a variety of other studies in the other four patients. Nine patients ahd aldosterone-producing adrenal adenomas and CT correctly identified seven. Four patients had cortisol-producing adenomas and five patients had cortisol-producing carcinomas; CT identified each of these tumors. Prominent but normal shaped glands were seen in each of the four patients with adrenal hyperplasia. Adrenal metastases from malignant melanoma in two patients were identified. Only one of two pheochromocytomas in two patients could be seen on CT. CT is a noninvasive method of localizing adrenal tumors and may be helpful in distinguishing adenomas from adrenal hyperplasia.
Schwangerschafts (pregnancy) protein No. 1 (SP1), a recently identified beta1-glycoprotein that occurs during pregnancy, was assayed in the sera of 97 men with germ cell tumors of the testis. SP1 was elevated at 11-440 ng/ml in 3 of 6 men with choriocarcinomas, in 5 of 17 men with teratomas or "teratocarcinomas" (embryonal carcinomas and teratomas), and in 5 of 50 men with embryonal carcinomas; the highest value in 143 patients with nonmalignant diseases was 9.1 ng/ml. None of 24 sera from men with seminomas and none of 5 sera from men with orchitis had elevated SP1. In the 1 patient examined, testicular choriocarcinoma SP1 had immunochemical and gel chromatographic properties similar to those of highly purified SP1 of placental origin.
Inbred Sewall Wright strain 2 male guinea pigs with established intradermal tumors and microscopic lymph node metastases were treated either by local excision, cryosurgery, or intralesional injection of BCG. Cryosurgery and local excision were effective in eliminating growth of the primary tumor but failed to prevent growth of lymph node metastases. In contrast, intralesional injection of BCG caused regression of primary tumors and prevented growth of lymph node metastases.
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The HCG and AFP have been quantitated in the sera of 130 patients with the diagnosis of testicular seminoma utilizing a specific double antibody radioimmunoassay. These tumor markers also were localized in tumor cells of some of these patients utilizing an indirect immunoperoxidase technique. 11 of 130 patients had elevated serum levels of HCG. The HCG molecules have been localized in the syncytiotrophoblastic giant cell (STGC) that is occasionally observed in seminomas. None of the patients with pure seminoma had an elevated level of serum AFP. We have concluded that in patients with pure seminoma the level of serum HCG can be elevated (10 of 130 or 7.6%), but we have not observed elevated serum levels of AFP in these patients.
In vivo and in vitro immunologic cross reactivity between SV40 virus transformed prostatic tissue and fetal antigens of LVG/LAK strain hamsters has been studied. The hamsters immunized with fetal antigens demonstrated significant resistance to tumor growth. Complement-dependent humoral cytotoxicity of target SV40 tumor cells in microtest plates was used to demonstrate the presence of significant antibody titer in fetal-immunized hamsters. When the immune sera were absorbed with SV40 transformed prostatic tissue, cytotoxicity indices were markedly lower than with the unabsorbed immune sera. The transformed prostatic tissue was found to have an elevated tartrate inhibited acid phosphatase indicative of the presence of epithelial components in the transformed tissue. These experiments demonstrate in vivo and in vitro cross reactviity between fetal antigens and tumor associated antigens of transformed prostatic tissue. This study suggests a similarity between fetal antigens and antigens of a specific organ tissue (prostate) transformed by a DNA oncogenic virus.
The role of biologic markers in the management of testicular and bladder cancer has been described. alpha--fetoprotein (AFP) and human chorionic gonadotropin when used together have been extremely helpful in detecting recurrence, staging, and monitoring of testicular cancer. The cellular localization of these markers by immunoperoxidase has also been an aid in understanding the natural history of these tumors. The cell surface antigens in bladder cancer have been useful predictors as to whether or not Stage A bladder cancer will develop into more invasive cancer when compared with the conventional histopathologic examination of the bladder tumor. In the last six years we have prospectively utilized these markers in the management of testicular and bladder cancer. The clinical and laboratory findings of these prospective studies are reviewed.
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.
A technique utilizing a combined thoracoabdominal-median sternotomy approach is described for stimulatenous resection of a large adrenal cancer occluding the inferior vena cava and extending into the left hepatic vein. This technique is useful in removint an extensive extension of a renal or adrenal cancer into the inferior vena cava.