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Lymphocytes from patients with bladder, renal or prostate carcinomas, or with non-malignant genito-urinary disorders, and from normal individuals, were tested in a microcytotoxicity test against cultured bladder cancer cells (T24) and other target cell types. Effector cells were titrated over a range of concentrations against target cells to achieve a quantitative measure of toxicity. Tests were shown to be reproducible by repeat tests of normal donors. Lymphocytes from patients with bladder cancer were more strongly cytotoxic to T24 than lymphocytes from normal healthy donors or from patients with renal or prostatic carcinomas. Cell-mediated cytotoxicity (CMC) by lymphocytes from bladder-cancer patients, however, was not significantly stronger than CMC by lymphocytes from patients with non-malignant GU disorders. Strength of CMC against T24 by lymphocytes from patients with bladder cancer correlated inversely with the extent of disease. Patients with superficial and locally invasive lesions showed strongest anti-T24 reactivity while patients with disseminated disease had CMC equivalent to normals. In tests against target cells derived from amnion of carcinomas of the breast, cervix and/or colon, CMC by lymphocytes from bladder-cancer patients was not significantly different from that of any other group. Lymphocytes from all donor groups were cytotoxic at some level to cells from cultures derived from bladder cancer and other tissues, although cell lines differed in apparent vulnerability in CMC tests.

Carcinoma of the urinary bladder, which accounts for approximately 2 % of human malignant disease, occurs in men three times as often as in women. It is estimated that the disease will strike 28,000 Americans this year and that more will die from it than from carcinoma of the uterine cervix. The etiology of the disease in individual eases remains obscure even though epidemiologists and others have demonstrated a higher incidence in smokers (59, 94, 97) and coffee drinkers (14, 36) as well as workers associated with aniline dye (69), rubber (10), plastic (70) and cable industries (21). The diagnosis is most frequently suspected in patients presenting with painless hematuria, pyuria or symptoms of lower urinary tract disease and is ordinarily confirmed by cystoscopy and appropriate endoscopic biopsies. Proper management for the disease today requires the knowledge and expertise not only of the surgeon, but also of the pathologist, radiologist, radiotherapist and medical oncologist working closely together as a cohesive team.

The symptoms, physical, radiographic, and pathologic findings, and the survival rate in 40 patients with transitional-cell carcinoma of the renal pelvis and ureter were studied. The incidence of these tumors was found to be increasing, with the peak in the seventh decade. The sex ratio was 2.3:1, male to female. Most of the tumors occurred in the lower third of the ureter. Hematuria was the most common presenting symptom. Diagnosis was evident in 69.5 per cent of patients with ureteral carcinoma and 82 per cent with renal pelvic carcinoma by retrograde ureteropyelography. Total nephroureterectomy with excision of the vesical cuff was the surgical procedure of choice. However, in selected cases a conservative procedure is indicated. The over-all five-year survival rate for all grades of tumor was 48 per cent, 52 per cent for ureteral and 44 per cent for pelvic tumors.

Transitional-cell carcinoma of the bladder has been induced by chronic oral administration of N-[4-(5-nitro-2-furyl)-2-thiazolyl] formamide (FANFT) in C3H/He mice, and successfully transplanted in syngeneic animals. Evaluation of the effectiveness of several chemotherapeutic agents on this tumor indicated that cyclophosphamide and cis-diammine dichloroplatinum (CACP) significantly inhibited tumor growth and prolonged the median survival time of tumor-bearing animals. When administered before formation of palpable tumors, cyclophosphamide completely prevented growth of the implants in 100 per cent of animals; when administered after the growth of larger, palpable tumors, cyclophosphamide inhibited tumor growth in all animals and produced a "cure" in 45 per cent. Combination chemotherapy with cyclophosphamide and CACP was more effective than either drug used as a single agent. Adriamycin, dactinomycin, and mitomycin C administered individually exhibited limited activity while 5-fluorouracil, CCNU (1-2 choloroethyl-3-cyclohexyl-1-nitrosourea), BCNU (1,3-bis [2-chloroethyl]-1-nitrosourea), methrotrexate, and hydroxyurea were ineffective against this tumor. The consistent growth pattern, the histologic similarity to bladder cancer in human beings, and the successful propagation in syngeneic animals, make the FANFT-induced tumor a suitable model for chemotherapy of bladder carcinoma in human beings.

Summary The prognosis in transitional cell carcinomas of the bladder may be assessed by the: (1) clinical assessment of the depth of invasion; (2) pathological evidence of the depth of tumour invasion; (3) the degree of tumour differentiation; (4) the absence of lymph node invasion; (5) the patients age—older patients are more likely to have tumours invading muscle. The choice of surgeon and the treatment regime used did not influence the prognosis.

Partially purified fractions of human tissues have been analyzed by competition radioimmunoassay for the presence of two of the principle structural components of type-C RNA viruses, the major core protein (p27 to p30) and the major envelope glycopeptides (gp69/71). Screening of tissues was carried out by use of a heterologous assay system of 125 I-labeled Rauscher murine virus p30 antigen and anti-RD 114 virus serum which was found to detect a class of interspecies determinants common to murine, feline, and primate viruses. A competitor with the same apparent affinity for antibody binding as that of purified viral core proteins was found in relatively high concentration in tissues from patients with systemic lupus erythematosus, in some neoplastic tissues, and also in normal human tissues. This competitor from a lupus spleen chromatographed on phosphocellulose and showed size fractionation during gel filtration similar to known p27 to p30 viral proteins. An immunologically reactive protein was also demonstrated by immunodiffusion and by immunoprecipitation of 125 I-labeled human protein with anti-RD 114 p28 serum. Analysis of these human competitor proteins with homologous assay systems of viral core proteins and corresponding antisera showed that all, including the normal tissue extracts, appear similar to core proteins of known viruses, especially the RD 114 and woolly monkey species. A hypothesis suggested by these data is that many, if not all, humans harbor at least part of the genome of one or more type-C viruses, the properties of which are similar to those of viruses from other mammalian species, particularly primates.

Bone scans with Technetium-99m (99mTc)-polyphosphate generally visualize the kidneys with reasonably good definition. As a result unsuspected renal abnormalities are not infrequently discovered incidental to the procedure. More attention to this aspect of the scan is warranted.

A case of chondrosarcoma of the kidney associated with papillary transitional-cell carcinoma of the renal pelvis and ureter is reported. Chondrosarcoma of the kidney is rare. A few instances of coexisting chondrosarcoma and transitional-cell carcinoma of the urinary tract have been reported previously. The association of sarcoma with transitional-cell carcinoma in these sites may be the result of a response to a common causative factor, or it may be merely coincidental. The nature of coexistent chondrosarcoma and transitional-cell carcinoma should become clearer as more cases are studied and reported.

Peripheral lymphocytes from patients with urinary bladder carcinoma and controls have been separated on the basis of rosette formation with sheep erythrocytes. The fractions were tested for tumor-specific cytotoxicity. The E rosette-forming cells of purity ⩾ 90% respond well in PHA-induced cytotoxicity but are totally inactive in the tumor assay. The non-E rosette-forming cells (purity ⩾ 91%) give enhanced activity in the tumor-specific cytotoxicity as well as in antibody-mediated target cell lysis in a model system. These data support the notion that the effector cells in cell-mediated immunity to carcinoma of the urinary bladder are members of the nonthymus-derived population of peripheral lymphocytes.

The formation of an artificial bladder has exercised the minds of surgeons for nearly a century. A segment of ileum or colon, the caecum, the rectum, the vagina and part of the stomach have all been used with varying success. An alternative to the present-day accepted method of urinary diversion (ileal conduit or ureterosigmoidostomy) is presented in a series of ten cases, operated on over a five-year period. The clinical details, complications and results of colocystoplastay are analysed. This feasibility study gives the impression that the operation is worth-while and that it probably represents the most physiological replacement of the bladder to date

SUMMARY Carcinoma of the urinary tract in Uganda shows some unusual features. Squamous cell carcinoma is the predominant histological type. This is associated not with urinary schistosomiasis, which only occurs in one small area of the country, but with longstanding posterior urethral strictures of gonococcal origin. This association is found in both bladder and urethral carcinomas, the relative frequency of the latter being unusually high. Possible aetiological factors include dietary overload with tryptophan and increased beta-glucuronidase activity. The presence of a stricture is likely to have an enhancing effect on carcinogenesis and is the major factor in producing a high incidence of squamous cell growths through urinary stasis, infection and metaplasia.

The urine and plasma of 16 patients with carcinoma of the bladder, and 27 normal individudls were studied for the presence of carcinoembryonic antigen (CEA). An attempt was made to determine whether urine CEA-like antigens are filtered by the kidney or shed directly by the bladder tumor itself. There were elevated levels of CEA in the plasma of patients with bladder tumors. The urine of patients with bladder carcinoma had significantly higher levels of CEA-like antigen than the urine of normal individuals. These same bladder tumor patients did not have a positive correlation between their plasma CEA and the urine CEA-like antigen levels. It appears from these findings that urinary carcinoembryonic-like antigen is shed directly into the urine and not filtered by the kidneys.

A series of 50 patients treated with total cystectomy for transitional cell carcinoma is reported. The cases are grouped according to the histologic type and stage of the carcinoma. Forty-three patients had anaplastic carcinomas, of which 32 had invaded more than half of the bladder musculature (Stages P3 and P4). Twelve patients came to operation despite the presence of recognised distant metastases. Nine primary deaths occurred among 38 patients treated with radical surgery. When five years had elapsed, 8 of 29 patients were alive (28 per cent), of whom one had a recurrence in loco. The conclusion is drawn that cystectomy is best suited to tumours which have invaded to a depth of more than half the bladder musculature, or those with perivesical infiltration (Stage P3). However, the results hitherto recorded with supervoltage radiation are somewhat better than those obtained with cystectomy. The problems attached to urinary diversion following total cystectomy are considered briefly. Uretero-ileo-cutaneo...

Neutralizing antibodies to simian virus 40 (SV40) were detected in sera of seven of 182 patients studied at the Roswell Park Memorial Institute. Four of 91 (4.4%) bladder tumor patients, two of 24 (8.3%) patients with prostatic carcinoma, and one of four patients with testicular tumors had antibodies. Neutralizing antibodies were demonstrable in repeated bleedings over a 5–11 month period. T antibodies were not detected in any of the sera. None of the antibody-positive patients gave a history of immunization with (potentially SV40-contaminated) poliovirus vaccines, the only known source of major human exposure to SV40 in the United States. These findings suggest that the seven antibody-positive donors were infected with a virus cross-reacting with SV40 or that infection with SV40 may have occurred in some unknown manner.

SUMMARY Enzootic bovine haematuria of the Darjeeling district of India was identified histologically as “haematuria vesicalis bovis”, with the main lesions occurring in the urinary bladder. The lesion was one of carcinoma of the transitional epithelium. The transitional epithelium was grossly hyperplastic, and solid cords of transitional epithelium invaded and infiltrated into the submucosa producing transition-cell islets or nests, causing tissue reaction in the form of marked fibrosis, hyperplasia of lymph nodes, and proliferation of venules of the lamina propria to resemble haeman-giomatous conditions. Haemorrhage was observed to have occurred from these lesions via lenticular ulcers in the mucosa, and this gave rise to haematuria.

Extract Bovine enzootic haematuria is essentially a neoplastic condition of the urinary bladder which is characterized by the clinical condition of haematuria. The appearance of haematuria which may be persistent or intermittent is followed by anaemia, wasting and usually death. The disease occurs in older animals of both sexes.

A lucent filling defect within the renal pelvis or infundibulum seen during intravenous or retrograde urography presents a well known diagnostic problem for the roentgenologist. Although many lesions may produce a similar appearance on the initial study, several suggestions are offered here to help narrow the differential diagnosis.A combination of repeated urographies, oblique projections, occasional angiography, and careful attention to roentgenographic appearance immediately adjacent to the apparent filling defect will suggest the correct diagnosis in many cases.The cases illustrated and discussed include: the aberrant papilla; multiple papillae draining into a single calyx; a normal papilla with a short minor calyx draining into an infundibulum (seen en face); nonopaque calculus; blood clot; nonobstructing transitional cell carcinoma; cavernous hemangioma; a crossing vessel that impresses only one edge of the pelvis; and a pseudodefect produced by overlap of 2 or more adjacent infundibula.

The management and the radiotherapeutic results of carcinoma of the nasopharynx have been fairly extensively reviewed in the past few years (1–3). It is generally agreed that radiotherapy is the treatment of choice, and surgery, other than a tissue biopsy, has little to offer. When the disease is localized to the nasopharynx (T1 and T1) (4), a cure rate of over 50 per cent has been accomplished. Even in patients with metastatic disease in the neck (N1 and N2) , lout of 3 may survive free of disease for five or more years following irradiation (5–8). That nasopharyngeal carcinoma may recur at the primary site after a long period of freedom from disease and that patients may survive with the disease five or more years (3, 8) following radiotherapy have not been emphasized. The purpose of this report is to present the problems of locally recurrent carcinoma of the nasopharynx and its management by radiation therapy. Thirty-five cases of nasopharyngeal carcinoma recurrent at the primary site were obtained fro...

Malacoplakia appears as dome-shaped yellow nodules which stud the surfaces of the genitourinary tract. Throughout their evolution the overlying epithelium remains intact. In early phases they simulate pyelocystitis cystica, which is usually far more discrete. The malacoplakic nodules grow to 2.5 cm. diameter in bladder and then resemble bullous cystitis, or if single they simulate tumor or endometrioma. Only isolated amyloid nodule of bladder, however, is also yellow.As malacoplakic nodules heal, they do so individually, and have an umbilicated moon-crater appearance which is quite characteristic. Crops of lesions may appear over several years of observation. Final healing is without scarring.The various radiologic features and cystoscopic and pathologic correlations are reviewed from studies on 5 instances.

The ultrastructure of human ureteric epithelium and three ureteric transitional cell carcinoma have been described. Two tumours from the same ureter contained large cytoplasmic bodies (ribonuclear bodies) made of aggregated ribosomes. Abnormality of cytoplasmic fibrils with the formation of perinuclear bands of fibrils was the other characteristic feature in the tumours. The tumours showed several abnormalities of nuclear and organelle structure that are commonly present in malignant cells.

Cloacogenic carcinoma is a relatively rare lesion that arises from the cloacogenic zone of the anorectal junction. This tumor has a very high malignant potential if it is not diagnosed and aggressive therapy is not applied early.Although cloacogenic carcinomas differ in histopathology from the more common adenocarcinomas of the rectum and squamous cell carcinomas of the anus, there are no characteristic clinical signs or symptoms. However, the roentgenologic features are fairly typical and an early diagnosis can be made if these subtle but significant features are recognized in the barium enema examination.Furthermore, metastases of cloacogenic carcinoma to regional lymph nodes can be detected by lymphangiography.Even though the cloacogenic tumor has been a recognized clinicopathologic entity for more than a decade, it is relatively unknown to radiologists; yet, early roentgenologic diagnosis of the tumor as well as detection of regional metastases can be made.This report deals with the roentgenologic dia...

Interviews were conducted with 470 patients with transitional or squamous-cell carcinoma of the lower urinary tract, more than 90 per cent of whom had a bladder tumor. An age-stratified and sex-stratified but otherwise random sample of 500 persons drawn from the population of the entire study area was also interviewed as a control. Among men, cigarette smokers have a relative risk of bladder cancer of 1.89 as compared with nonsmokers, and about 39 per cent of the cases are related to smoking. This amounts to 16.4 cases per year per 100,000 men 20 years of age and over. Among women 20 years of age and over, the comparable figures are 2.00, 29 per cent and 3.9 cases per year per 100,000. For both sexes risk is increased among those who smoked heavily and those who inhaled. None of the excess risk of bladder cancer associated with cigarette smoking is explained by any indirect association with occupational experience. No significant risk is associated with pipe or cigar smoking. The data also sugges...

Renal ischemic changes at the cellular level were studied in difficult renal stone surgery cases requiring renal pedicle occlusion for various time intervals. By correlating these findings with the cl

Highly malignant and distinctive transitional cell tumors of the anorectal area can arise from inconstant and persisting embryologic entodermal cloacal vestiges situated just above the dentate line. These nonkeratinizing lesions are quite similar histologically to the transitional cell tumors found in the cloacogenic portion of the lower genitourinary tract.

In 100 cases of transitional-cell carcinoma of the bladder biopsy specimens were taken from the mucosa away from the tumour where it looked normal viewed through the cystoscope. Histological examination of this mucosa has revealed precancerous abnormalities in over 80% of the cases.