[Tumor classification according to the TNM system in the region of the urogenital tract. 4. Testicular neoplasms, penile neoplasms].
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Sixty-three patients with squamous cell carcinoma of the penis have been reviewed. The 3 year survival was 77%, and the 5 year survival was 59%. Prognosis was related to both clinical staging and histological grading. Stage I and II carcinomas were best treated by surgery alone. Stage III and IV carcinomas were best treated by local amputation of the penis combined with radiotherapy to the inguinal nodes. Surgery as a primary treatment for clinically positive nodes was successful in less than half the cases treated, and in this series was always followed by wound infection and lymphoedema. Tender, enlarged inguinal lymph nodes should be observed for up to 3 months following primary treatment, as a large percentage of these nodes are inflammatory and subside spontaneously.
The development of microscopically controlled surgery, the use of the fixed-tissue technique for advanced, complicated carcinomas and for malignant melanomas, the use of the fresh-tissue technique for less advanced carcinomas, the five-year results, and plans for the future of the method are discussed.
Published figures from veterinary schools indicate that tumours may account for about 1 to 3 per cent of surgical cases. In this paper an account is given of clinical and pathological aspects of the tumours that are most likely to be encountered in practice, either as visibly or palpably detectable masses of tissue, or as internal tumours responsible for clinical signs. Amongst the common and important tumours dealt with, the most prominent are "equine sarcoid", squamous-cell carcinoma (of eye region and of glans penis), granulosa-cell tumours and melanomas. Well over a hundred references provide entry to the relevant literature. The need for further pathological and clinical studies of equine tumours is stressed.
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Seven cases with secondary skin carcinomas are described. The primary tumor was located at the tongue, the larynx, the thyroid, the abdomen, the ovaries, the collum uteri and the rectum. From the literature 60 other patients with secundary skin carcinomas and 100 primary carcinomas were evaluated. Clinical evidences for a secundary skin carcinoma are: unusual localization, multiple occurrence and an even surface. It was examined whether the localization of the secundary skin tumor refers to the localization of the primary tumor.
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3000 IgE serum concentrations were determine d radioimmunologically in a large group of 1616 tumor patients and a group of 308 controls. Because of a wide scattering the individual IgE levels do not give a diagnostic indication. On the other hand we have found a highly significant difference (p less than 0.001) between the IgE levels of male and female tumor patient-groups, which does not exist among the controls. Female patients tend to lower, male patients to higher levels. In patients with carcinoma of the testis three times higher IgE levels were found. Their relation to a coincidence with high HCG levels is discussed. Furthermore IgE follow up-studies are described. They correlate close by with the clinical picture. Consequently IgE follow up-studies are applicable to tumor prognosis and possibly to tumor therapy.
With respect to the primary tumor there is no difference between the proposal of the UICC and the Heidelberg version for TNM classification of the penis carcinoma. Clinically the Heidelberg scheme seems more practical, but there were no statistical differences between them. With respect to the prognosis for the patient, the size and localization of the primary tumor are of secondary importance. What is important is the degree of tumor spreading in the lymph system. From this point of view, one needs only to differentiate between T1 (tumor restricted to the penis) and T2 (tumor extending the bounds of the penis). On the other hand, size, localization, and degree of infiltration of penis carcinoma do have different therapeutic consequences, so from this point of view the differentiation of the primary tumor from T1 up to T4 should be retained. With respect to the classification of the state of the corresponding lymph system it is our opinion that the UICC proposal is too differentiated and has little meaning. In its stead, the Heidelberg scheme is clear and simple. Any examiner can complete it. With the help of life tables extending beyond 10 years after diagnosis we were able to determine that 5 years is not a sufficiently long time to clsoe a case of penis cancer. Even with proper treatment, the patient may suffer up to 10 years or more from the disease. In patients aged between 50 and 59 years of age the cancer seems to grow faster; in spite of proper and intensive treatment those patients had a clearly limited life expectancy. In patients aged 60-69 and more so in those between 70 and 79 years of age the tumor seemed to grow slowly and often had no effect on the survival rate.
A case of adenocarcinoma of the prostate with metastases to the prepuce and glans penis is described. This is the second case reported. The various routes of tumor spread to the penis are discussed briefly, and the possibility of direct spread is postulated as the cause of "kissing" foreskin and glandular lesions.
Single cell suspensions have been prepared, by enzyme digestion, from the mouse preputial gland tumor and separated by flotation centrifugation into populations of different buoyant densities. These populations of cells have been shown by morphological, chemical and biochemical criteria to be in different stages of maturation. Some properties of the separated cells are described.
Two cases of primary malignant melanoma of the penis are reported and 35 cases from the world literature are reviewed. The tumour most commonly started in the glans penis and less frequently from the prepuce. The microscopic appearances were identical with those of tumours arising elsewhere in the skin. A comparison is made between the incidence of melanoma of the penis and melanoma occurring elsewhere on the body surface. Evaluation of the best treatment was difficult because the total number of cases was small and the methods of treatment and results so variable. It would seem that the prognosis of malignant melanoma of the penis is generally poor, although there are sufficient examples of long-term survival after total amputation in Stage I disease to suggest that this radical treatment is justified.
Sixty-five cases referred to one hospital between 1964 and 1977 were studied. Forty-one presented in Stages 1 or 2 and when treated by the Iridium mould technique gave a 12/13 (92.3%) crude 5-year survival rate, an improvement over the results of previous methods of treatment, including partial amputation. In Stage 3 radical amputation gave an 89% 5-year survival rate. Node dissection was reserved for inguinal nodes in Stages 1, 2 and 3 which failed to resolve after treating the primary tumour. Undifferentiated tumours and those with the microscopic "cord" pattern of growth did badly.
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