Prediction of response to radiotherapy in invasive bladder cancer.

The original pre-treatment histological sections from 125 patients with invasive (T2/T3) transitional cell bladder cancer treated by radical radiotherapy were studied; 63 tumours responded completely to radiation and 62 did not; 55 of 72 tumours containing areas of squamous metaplasia and 27 of 36 staining for beta-human chorionic gonadotrophin failed to respond to radiotherapy; 26 of 28 tumours showing both squamous metaplasia and beta-human chorionic gonadotrophin did not respond to radiation, whereas 40 of 45 tumours without either of these features responded. The DNA ploidy of 86 tumours in the series was measured by flow cytometry; 11 of 27 aneuploid and 30 of 59 diploid tumours responded to irradiation. Squamous metaplasia and beta-human chorionic gonadotrophin in bladder cancer indicate resistance to radiotherapy but DNA ploidy does not.

Malakoplakia of the pancreas.

We report a case of malakoplakia arising in the pancreas of a 45-year-old woman. Clinical and histological features are described. Malakoplakia was present with chronic pancreatitis and adenocarcinoma. The aetiology of malakoplakia at this site may be due to a stromal response to carcinoma or an abnormal localised histiocytic response to infection or inflammation. This case and previous reported cases suggest that the aetiology and pathogenesis of pancreatic malakoplakia is not the same for all patients.

Findings in lymph nodes of patients with germ cell tumours after chemotherapy and their relation to prognosis.

One hundred and forty six patients with advanced germ cell testicular tumours (38 seminomas and 108 malignant teratomas) treated by combination chemotherapy were studied over 10 years. Most of the improvement seen was in patients with malignant teratoma undifferentiated. In the most recently treated patients (1984-1987) 75% of drug resistant cases were malignant teratoma intermediate compared with 26% in the series treated between 1978-1983. The microscopic features of 52 primary testicular tumours were compared with features seen in excised retroperitoneal lymph nodes after completion of chemotherapy. Primary malignant teratoma intermediate had a higher incidence of viable malignancy in the excised tissue than malignant teratoma undifferentiated. Mature teratoma or fibronecrotic tissue within resected tissue was associated with a good prognosis. If resection was complete patients with drug resistant malignant teratoma intermediate had a more favourable prognosis than drug resistant malignant teratoma undifferentiated. It is advised that retroperitoneal node dissection should be considered in the management of patients with advanced germ cell testicular tumours, and that as complete a resection as possible be attempted to avoid the danger of missing residual disease.

Clinical importance of squamous metaplasia in invasive transitional cell carcinoma of the bladder.

One hundred cases of transitional cell carcinoma of the bladder were studied to determine whether squamous metaplasia and other histological features within the bladder can be of value in predicting outcome of treatment with radiotherapy. Sixty cases showed the changes of squamous metaplasia, and of this group 46 (78%) failed to respond to radiotherapy. A significant response rate of 90% was seen in the 40 tumours without squamous metaplasia. It is concluded that transitional cell carcinomas of the bladder showing squamous metaplasia are mainly resistant to radiotherapy and alternative treatment methods should be sought.

Squamous cell carcinoma in a duplicate large intestine. A case report.

A case report of a squamous cell carcinoma arising in a closed duplication of the large intestine is presented. The aetiology of squamous cell carcinoma in this site is discussed. It is quite possible the epithelial changes described in this case are similar to those associated with squamous cell carcinoma in other anatomical sites. The unusual environment within the lumen of a closed duplication may be carcinogenic.

The immunocytochemical demonstration of basement membrane deposition in transitional cell carcinoma of bladder.

We assessed the staining characteristics of the basement membrane of transitional cell carcinoma of bladder using a monoclonal antibody to type IV collagen. Basement membranes were clearly stained at the stromal/carcinoma interface. As transitional cell carcinoma became less well differentiated and the depth of invasion increased interruptions to basement membrane staining became more extensive and these findings are comparable to those described in similar series of transitional cell carcinoma using polyclonal antibodies to type IV collagen. The defects in basement membrane staining may be related to the degree and direction of tumour cell differentiation or may be explained by increased degradation compared to synthesis of basement membrane components. Demonstration of the basement membrane may be of value in diagnostic histopathology as a marker of the biological behaviour of transitional cell carcinoma of bladder.

Human chorionic gonadotrophin expression and histological findings as predictors of response to radiotherapy in carcinoma of the bladder.

A retrospective analysis of the prognostic value of pretreatment histology and expression of human chorionic gonadotrophin (B-hCG) was carried out in 100 invasive (T2/T3) transitional cell carcinomas of the bladder treated in a uniform manner. After transurethral resection of the tumour, all patients received a course of radical radiotherapy, with salvage cystectomy for those who failed to respond. Forty-nine of 100 patients responded to radiation; thus 51 did not. Forty-seven of 60 (78%) patients whose tumours contained areas of squamous differentiation and 22 of 29 (76%) of tumours staining positively for HCG failed to respond to radiotherapy. Twenty-two of 23 (96%) patients with tumours that had both these features did not respond to radiotherapy. The other histological features studied (grade of tumour, necrosis, inflammation, vascular invasion, and growth pattern) appeared unrelated to each other or to clinical outcome.

Clinicopathological importance of primary dysplasia of bladder.

A retrospective study of 15 patients with primary dysplasia of bladder urothelium was performed in an attempt to clarify some of the clinical and histopathological features. The lesion occurs predominantly in middle aged men who present with irritative bladder symptoms with or without haematuria and show no evidence of bacteriological urinary tract infection. Appearances at cystoscopy are non-specific. Thirteen patients showed no progression to carcinoma in situ after a long period of follow up, but primary dysplasia cannot be regarded as an entirely innocuous condition as the remaining two patients did develop carcinoma in situ. The grade of dysplasia on presentation bears no relation to the final outcome. Regular cytological analysis of urine seems to be the best means of follow up, and more active treatment does not seem to be justified.

Aortic occlusion in systemic lupus erythematosus associated with antiphospholipid antibodies.

The patient, a Caucasian woman of 22 years, developed malignant hypertension at the age of 16 years. An abdominal bruit was found on routine examination. She had two spontaneous abortions and systemic lupus erythematosus was diagnosed at age 21 years. She was found to have a persistently low positive VDRL and antibodies to mitochondria were also present on repeated examinations, to a titre of 1/160. Because of angiographic findings, demonstrating an occlusion of the aorta, an endarterectomy of the descending thoracic and upper abdominal aorta was performed. This showed mainly intimal thickening and the presence of thrombus. She then had four further spontaneous abortions (with good blood pressure control). The lupus anticoagulant and antibodies to cardiolipin were found to be positive at this time.