Primary female urethral carcinoma. A retrospective comparison of different treatment techniques.

Between July 1951 and January 1984, 14 female patients (11 black and three white; average age, 58 years) were treated for primary urethral carcinoma. Five patients had radical surgery, six received preoperative radiotherapy (2000 cGy in five fractions) followed by anterior exenteration, and three had definitive radiotherapy (external beam 4000 to 5000 cGy plus 2800 to 3000 cGy interstitial implant). The mean follow-up times were 5.6, 3.9, and 2 years, respectively. In the first two groups, two of 11 patients (18%) are alive and well with no evidence of disease. The rest died of local as well as distant disease. In the third group, two of three patients (67%) are alive and well with no evidence of disease. The third patient died of papillary adenocarcinoma of the uterus 30 months later with no evidence of the primary tumor.

Biochemical nature of the prostate-associated antigen identified by the monoclonal antibody, KR-P8.

The KR-P8 monoclonal antibody identifies an organ-specific antigen that is associated with normal as well as malignant specimens of human prostate tissue. The antigen is secreted by cells of the prostate and is present in samples of seminal plasma. Data presented here describe the biochemical nature of the antigen that is recognized by KR-P8 as it occurs in seminal plasma and in extracts prepared from cells of the prostate tumor line, PC3. Antigen contained in seminal plasma migrated as a broad band on SDS-polyacrylamide gels in the molecular weight range of 48,000-75,000 d. A similar pattern was observed for antigen prepared from detergent extracts of PC3 cells. The antigen was found to be sensitive to treatment with trypsin and chymotrypsin and the contribution of carbohydrate residues to the structure of the molecule was shown by studies that demonstrated binding of the antigen to Concanavalin A and Soybean Agglutinin lectins. Loss of antigenicity subsequent to periodate oxidation suggested that carbohydrate units are involved in the recognition site for KR-P8 on the antigen.

Mitomycin for patients who have failed on thiotepa. The National Bladder Cancer Group.

The National Bladder Cancer Group undertook a study to determine the effectiveness and toxicity of mitomycin in patients who failed on thiotepa. A total of 117 patients with residual superficial transitional cell bladder cancer (Ta, T1, Tis) who had previously failed on intravesical thiotepa were treated with 40 mg of mitomycin instilled intravesically weekly for eight weeks. Four to six weeks after the last treatment, tumor response was evaluated by cystoscopy, biopsy of the site of the index lesion, and cytology. In 57 patients (48.7%), visible tumor had been ablated. Results of cystoscopy, biopsy, and cytology were negative in 32 (27.4%) patients. Eleven patients (9.4%) had no visible tumor and negative cytology unconfirmed by biopsy. In 14 patients (12%) who had complete destruction of the tumor at cystoscopy, and biopsy specimen was negative for tumor, cytology was positive, indicating a partial response. Six patients (5.1%) withdrew from the study before the first evaluation because of local toxicity (cystitis).

Localization of a normal prostatic secretory product using the monoclonal antibody KR-P8.

We previously reported that the monoclonal antibody KR-P8 detects a prostate organ-specific antigen that is distinct from other markers such as prostatic acid phosphatase and prostate specific antigen. In this report we demonstrate that the antigen recognized by KR-P8 is among the secretory products of both normal and malignant prostatic epithelium. Immunoperoxidase staining patterns showed that the antigen was concentrated on the luminal surfaces of the glandular epithelial cells of prostate, and also that the antigen was localized within secretory vacuoles of cells of the prostate tumor line PC3. In addition, using an immunoblotting assay the KR-P8 binding antigen was detected in the growth media of PC3 cells and also found to be present in human urine and seminal plasma. The data suggest that the antigen recognized by KR-P8 may be a useful marker for studying the secretory processes of the prostate gland.

Malignant thymoma: role of radiation therapy in management.

Malignant thymoma is a rare tumor generally seen as an anterior mediastinal mass. Radiation therapy in ten patients with malignant thymoma diagnosed in 1968-1983 was reviewed retrospectively. Surgical therapy consisted of subtotal resection in four patients and biopsy only in six. Megavoltage irradiation in the dose range of 4,600-5,250 cGy was employed. In all symptomatic patients, palliation of presenting symptoms was achieved. In seven patients, a greater than 50% reduction in tumor mass followed radiation therapy. Local control was achieved in six patients. Three patients show no evidence of disease clinically, after a minimum follow-up study of 1 year. Radiation therapy is an important therapeutic modality in the control of malignant thymoma.

Bullous pemphigoid. Occurrence in a patient with mycosis fungoides receiving PUVA and topical nitrogen mustard therapy.

A 57-year-old woman with mycosis fungoides developed blisters within cutaneous plaques while receiving PUVA therapy and topical nitrogen mustard. Direct and indirect immunofluorescence studies showed the findings of bullous pemphigoid. Her bullous disease was controlled after cessation of these therapies and institution of prednisone and methotrexate. During the 5 months following completion of a course of electron-beam therapy, she has been free of the cutaneous manifestations of both diseases. Previous instances of PUVA-related pemphigoid have occurred in psoriatics. The role of ultraviolet light in the induction of pemphigoid is discussed, particularly with regard to its possible interaction with the altered skin of psoriasis or mycosis fungoides. Some of the rare cases of bullous mycosis fungoides might actually have represented ultraviolet-unmasked bullous pemphigoid.

Characterization of a monoclonal antibody, KR-P8, that detects a new prostate-specific marker.

This report characterizes a prostate-specific monoclonal antibody, KP-P8, which was prepared against the human prostate cell line PC3. The antigen detected by KR-P8 was identified on the surfaces of 90% of cells of the PC3 line, as well as on 67% of cells of the Du-145 prostate line, but it was absent from the surfaces of normal peripheral blood leukocytes and cells of a number of lymphoblastoid lines. As judged by immunoperoxidase staining techniques, KR-P8 reacted with the glandular epithelium of all specimens of normal, benign hypertrophic, and malignant prostate glands tested. However, no reactivity was noted with numerous other human tissues including normal bladder, lung, liver, kidney, testis, colon, parotid gland, thyroid gland, and spleen. These results indicate that the antigen detected by KR-P8 is prostate organ-specific. Competitive blocking studies showed that the antibody did not recognize the previously described prostate-specific antigen or the alpha-Pro-3 antigen described by other investigators. The KR-P8 antibody also did not bind to purified prostatic acid phosphatase. The presence of the KR-P8 antigen was demonstrated in cell-free preparations of dilute seminal plasma by radioimmunoassay, indicating that this antigen is secreted by the glandular cells of the prostate gland. The clinical significance of this marker was demonstrated by its ability to identify prostate metastases of the lymph node.

Small-cell carcinoma of the lung: patterns of treatment failure in patients treated primarily by chemotherapy.

Treatment failure patterns in 75 patients with small-cell carcinoma of the lung who were treated primarily by chemotherapy were reviewed. Of 10 patients with localized disease who underwent complete staging work-ups, six had metastases to the chest, four to the central nervous system, four to bone, and one to the lymph nodes. Of 32 patients with disease considered to be localized but who did not undergo complete staging work-ups, 23 had metastasis to the chest, 11 to the central nervous system, four to bone, and two to the lymph nodes. Of 33 patients with documented distant metastasis 23 had metastasis to the chest, 14 to the central nervous system, 15 to bone, and six to the lymph nodes. Median survival times of patients showing complete response to treatment was 17 months; for those showing partial response it was 7 months.

Computed tomography in the management of bladder carcinoma.

Between 1978 and 1980, 30 patients were evaluated by computed tomography (CT). CT differed from clinical stage in 10 of 30 patients (30%). In 9 of the 10 patients the change in stage resulted because of extravesical extension or involvement of the prostate. Seventeen patients underwent pre-operative irradiation, and CT scans done post-irradiation showed a decrease in tumor stage in 5 patients (33%). The accuracy of CT in detecting nodal involvement was limited with an overall accuracy of 65%. CT has limited value in staging of bladder cancer.

Role of computed tomography in the evaluation and management of carcinoma of the prostate.

Between January 1978 to March 1980, 25 patients with biopsy-proven prostate carcinoma were evaluated by computerized tomography (CT). CT differed from clinical stage in 7 of 25 patients (28%). In 6 of the 7 patients, change in stage resulted because of demonstration of extracapsular extension and/or pelvic lymph node involvement. Twelve of the 25 patients (48%) underwent surgery with histological confirmation of CT findings. Ct identified nodal involvement accurately in 10 of 12 patients (83%). We recommend use of CT for initial staging, treatment planning and assessment of response in the management of prostate cancer.

Body computed tomography in the evaluation of pediatric malignancy.

Fifty-eight body CT scans were obtained in 33 children with malignant disease over a 2-year period at the Medical College of Virginia Hospitals. When compared with conventional radiography, excretory urography, nuclear medicine, and ultrasound, CT provided additional information in 26 patients (78%). In 17 patients CT was useful for monitoring response to surgery, radiation therapy, and/or chemotherapy.