Clinical and pathological characteristics of micropapillary transitional cell carcinoma: a highly aggressive variant

PURPOSE

We present preliminary clinical, histochemical and molecular findings for 5 patients with micropapillary transitional cell carcinoma of the bladder, a rare histological variant not widely recognized in the urological literature.

MATERIALS AND METHODS

The 5 patients were prospectively identified. In 3 cases immunohistochemical staining for expression of CD31, p53, E-cadherin, and alpha, beta and gamma-catenin was performed on paraffin embedded tissue. Sequencing was used to identify point mutations in exons 5 to 9 of p53, and exons 1 and 2 of H-ras.

RESULTS

Of the patients 2 died within 1 year of presentation to our institution with rapid local extension along the bladder serosal surface and ureteral sheaths. Another patient had progression to invasive disease within 22 months. In the 3 cases with immunohistochemical staining p53 was negative, despite positive staining of nonmicropapillary transitional cell carcinoma within the same specimen. Stains for the angiotrophic marker CD31 were negative. In all 3 cases normal membrane associated alpha, beta and gamma-catenin expression was present. Examination of p53 sequences revealed a single point mutation in exon 8 of 1 case. In 2 cases different mutations in exon 1 of H-ras were noted.

CONCLUSIONS

Micropapillary transitional cell carcinoma is a rare and highly aggressive variant. Paradoxically, our study demonstrated no significant p53 abnormalities. The lacunar histological pattern did not appear to represent invasion of vascular spaces. Rather, these tumors seemed to have the ability to disrupt and replace the normal stromal matrix to achieve rapid nonendothelial extension. Thus, micropapillary histology may predict a lesser likelihood of surgical cure.

Metastatic merkel cell tumor to bladder presenting as an encroachment tumor with gross hematuria

Merkel cell carcinoma is an uncommon and aggressive tumor of neuroendocrine and epithelial origin. A case of metastatic Merkel cell tumor with hematuria secondary to invasion into the bladder is presented. This is the second reported case of metastatic Merkel cell tumor to the bladder and the first published cystoscopic image of such a lesion.

IFN-α 2B Enhances Th1 Cytokine Responses in Bladder Cancer Patients Receiving Mycobacterium bovis Bacillus Calmette-Guérin Immunotherapy

Combination therapy with intravesical bacillus Calmette-Guérin (BCG) plus IFN-α for superficial bladder cancer has been demonstrated to be more effective than either single agent alone in animal studies and of suggested greater efficacy in clinical studies. However, the mechanism by which IFN-α enhances BCG-mediated antitumor activity is poorly understood. Using PBMCs from bladder cancer patients, IFN-α was found to substantially enhance the efficacy of BCG to induce IFN-γ production. Among 34 patients tested, 80% showed >4-fold increase. This effect of IFN-α was observed in both initial and memory responses to BCG. In addition, IFN-α up-regulated BCG-induced IL-12 and TNF-α and down-regulated BCG-induced IL-10. Neutralizing endogenous IL-10 or adding exogenous IL-12 provided further synergy for IFN-γ production. In clinical practice, intravesical IFN-α 2B (50 million units (MU)/dose) was observed to accelerate urinary IFN-γ production to low-dose BCG (one-tenth or one-third of a full dose) in patients treated with combination therapy compared with BCG alone. These results suggest that IFN-α is a potent BCG enhancer that polarizes the BCG-induced immune response toward the cellular immune pathway by promoting Th1 cytokine expression and reducing Th2 cytokine expression. This study provides an immunological basis for future rational use of IFN-α in conjunction with intravesical BCG for bladder cancer immunotherapy.

IFN-alpha 2B enhances Th1 cytokine responses in bladder cancer patients receiving Mycobacterium bovis bacillus Calmette-Guérin immunotherapy

Combination therapy with intravesical bacillus Calmette-Guérin (BCG) plus IFN-alpha for superficial bladder cancer has been demonstrated to be more effective than either single agent alone in animal studies and of suggested greater efficacy in clinical studies. However, the mechanism by which IFN-alpha enhances BCG-mediated antitumor activity is poorly understood. Using PBMCs from bladder cancer patients, IFN-alpha was found to substantially enhance the efficacy of BCG to induce IFN-gamma production. Among 34 patients tested, 80% showed >4-fold increase. This effect of IFN-alpha was observed in both initial and memory responses to BCG. In addition, IFN-alpha up-regulated BCG-induced IL-12 and TNF-alpha and down-regulated BCG-induced IL-10. Neutralizing endogenous IL-10 or adding exogenous IL-12 provided further synergy for IFN-gamma production. In clinical practice, intravesical IFN-alpha 2B (50 million units (MU)/dose) was observed to accelerate urinary IFN-gamma production to low-dose BCG (one-tenth or one-third of a full dose) in patients treated with combination therapy compared with BCG alone. These results suggest that IFN-alpha is a potent BCG enhancer that polarizes the BCG-induced immune response toward the cellular immune pathway by promoting Th1 cytokine expression and reducing Th2 cytokine expression. This study provides an immunological basis for future rational use of IFN-alpha in conjunction with intravesical BCG for bladder cancer immunotherapy.

p53-mediated germ cell quality control in spermatogenesis

Spontaneous germ cell death is a common cellular process in the mammalian testis, although the function of this process during spermatogenesis is unclear. An investigation was undertaken to determine whether p53 serves as a mechanism in germ cell quality control by causing spontaneous germ cell death. Using an annexin V assay, lower levels of spontaneous apoptosis were found in the testes of p53-/- mice compared to p53+/+ mice. Propidium iodine staining revealed that the greatest reduction in apoptosis and the largest increase in cell numbers occurred in the tetraploid germ cell population of p53-/- mice. Microscopic examination of sperm morphology showed an increased percentage of abnormal forms in p53-/- mice. Furthermore, p53-/- mice sired fewer offspring than p53+/+ mice did when both groups were mated with p53+/+ females. These results suggest that p53 mediates spontaneous testicular germ cell apoptosis and failure to remove defective germ cells by this mechanism results in increased percentages of abnormal sperm and reduced fertility. p53-mediated apoptosis may be an effector of cellular proofreading that acts to maintain the cellular integrity of germ cells during spermatogenesis.

Experimental cryptorchidism induces testicular germ cell apoptosis by p53-dependent and -independent pathways in mice

Cryptorchidism is associated with male infertility: germ cell loss occurs by apoptosis in response to elevated temperature. Since the tumor suppressor p53 is highly expressed in the testis and is known to induce apoptosis, an investigation was undertaken to establish whether heat stress causes p53-mediated germ cell apoptosis. Using a mouse model of experimental unilateral cryptorchidism, it was observed that testicular weight reduction, germ cell loss, and DNA fragmentation all began in the cryptorchid testes on Day 6-7 in wild-type mice. In contrast, these changes were delayed by 3 days in p53-/- mice. These results suggest that abdominal heat stress induces germ cell loss through two apoptotic pathways: a p53-dependent pathway responsible for the initial phase of germ cell apoptosis, and a p53-independent pathway that accounts for subsequent apoptosis.

Immediate sexual rehabilitation by simultaneous placement of penile prosthesis in patients undergoing radical prostatectomy: initial results in 50 patients

OBJECTIVES

To evaluate the results of simultaneous placement of a penile prosthesis with radical prostatectomy.

METHODS

From June 1993 to June 1996, 50 men underwent a combination procedure of non-nerve sparing radical retropubic prostatectomy and placement of a penile prosthesis. We performed a retrospective chart review of these patients, examining patient age, preoperative prostate-specific antigen level, Gleason score, operative time, estimated blood loss, analgesic use, length of hospital stay, time until intercourse, and complications. This group was compared with a group of 72 men undergoing radical prostatectomy alone during the same time interval.

RESULTS

No significant differences were noted in preoperative patient variables. The mean operative time for prosthesis insertion was 82 minutes, and the mean time to sexual intercourse was 12.7 weeks. No prosthesis infections have occurred, with a mean follow-up of 1.7 years. Four men (8%) have required revision of their inflatable penile prosthesis. There were no significant differences between the combination procedure and radical prostatectomy alone with regard to estimated blood loss, length of hospital stay, or analgesic use.

CONCLUSIONS

Simultaneous placement of a penile prosthesis during radical prostatectomy provides early return to sexual function, with no apparent increase in morbidity. Further study will be required to determine the impact of combination surgery on psychosocial adjustment and quality of life.

p53 is associated with the nuclear envelope in mouse testis

p53 has been postulated to play a role in meiosis as well as in the regulation of germ cell numbers by apoptosis. This study investigated the subcellular localization of p53 in the testis, including conditions known to induce germ cell apoptosis. Western blot analysis showed that p53 was enriched in the nuclear envelope fraction, and confocal microscopy confirmed that p53 was associated with the nuclear envelope of germ cells. Exposure of the testis to heat stress induced translocation of p53 into the nucleus. Nuclear envelope binding provides an optimal site for rapid entry of p53 into the nucleus, where it may act as a DNA-binding protein to induce apoptosis or cell cycle arrest in response to appropriate stimuli. The nuclear envelope sequestration of p53 also provides a framework to understand how mitosis and meiosis in the testis may proceed despite high intracellular concentration of p53.

Heat stress causes testicular germ cell apoptosis in adult mice

An investigation was undertaken to determine whether the germ-cell loss associated with exposure of the testis to abdominal temperature occurs by apoptosis. Using an adult-mouse model of experimental unilateral cryptorchidism, it was observed that DNA fragmentation, consistent with apoptosis, was observed on day 6 in the cryptorchid testis, with subsequent loss of testicular weight, histologic evidence of germ-cell loss, and histochemical staining of apoptotic germ cells observed on day 7. Vacuolization of the germinal epithelium and the appearance of multinucleated giant cells was noted synchronously with the onset of germ-cell loss. Histochemical staining for apoptosis was noted most frequently among the primary spermatocytes and round spermatids. These results indicate that the testicular germ-cell loss observed with exposure to abdominal heat stress occurs by apoptosis. Further investigation of the biochemical mechanisms involved in testicular apoptosis may provide strategies to address a variety of male reproductive issues such as contraception and infertility.

Primary lymphoma of the bladder: a unique cystoscopic appearance

Primary lymphoma of the bladder is a rare disorder that occurs in the fifth to seventh decades, with a female preponderance. Although computed tomographic scanning is the best diagnostic imaging study, cystoscopic biopsy and immunoperoxidase staining are needed to make the diagnosis. Primary lymphoma of the bladder has a good prognosis and responds to a variety of therapeutic modalities. Throughout the literature, authors have described primary lymphoma of the bladder as a submucosal tumor, smooth, nonulcerative, edematous, friable, or even hemorrhagic. We present what we believe to be the first photographic image of the cystoscopic appearance of primary lymphoma of the bladder.

Occult prostate cancer in men with low serum testosterone levels

OBJECTIVE

To determine the prevalence of occult prostate cancer in men with low serum total testosterone or free testosterone levels.

DESIGN

Retrospective analysis of a consecutive series of men.

SETTING

Academic teaching hospital.

PATIENTS

Seventy-seven men with low total testosterone or free testosterone levels, with normal results of digital rectal examination and prostate-specific antigen (PSA) levels of 4.0 ng/mL or less. The mean age was 58 years.

INTERVENTIONS

Sextant prostate needle biopsies with ultrasound guidance.

MAIN OUTCOME MEASURES

Results of prostate needle biopsies, transrectal ultrasound, prostate volume, PSA level, PSA density, total and free testosterone levels.

RESULTS

Prostate cancer was identified in 14% (11/77) of the entire group and in 10 men (29%) aged 60 years or older. The median age for men with cancer was 64 years. Histologic examination showed Gleason scores of 6 or 7 for all cancers. No significant differences were noted between the cancer and benign groups with regard to PSA level, PSA density, prostate volume, total testosterone level, or free testosterone level.

CONCLUSIONS

A high prevalence of biopsy-detectable prostate cancer was identified in men with low total or free testosterone levels despite normal PSA levels and results of digital rectal examination. These data suggest that (1) digital rectal examination and PSA levels are insensitive indicators of prostate cancer in men with low total or free testosterone levels, and (2) PSA levels may be altered by naturally occurring reductions in serum androgen levels.

Constitutive expression of high levels of prostate-specific antigen in the absence of prostate carcinoma

OBJECTIVES

To identify distinguishing serologic features in patients with stable marked elevation in prostate-specific antigen (PSA) and multiple negative biopsies.

METHODS

The study population consisted of 7 patients with a stable PSA level of greater than 20 ng/mL (average 27.0), followed for at least 34 months (average 56), and with two or more negative prostatic biopsies including transition zone biopsies. The PSA density (PSAD), rate of change in PSA, reverse transcriptase/polymerase chain reaction (RT/PCR), and free/total PSA were obtained.

RESULTS

Rate of change in PSA level was stable (0.18 +/- 1.2 ng/mL/yr), suggesting that there was no occult cancer; PSAD was high (0.34 +/- 0.5 ng/mL/cc), indicating that prostate size was not the sole cause of the elevation. The RT/PCR was negative in 6 of 7 patients, further decreasing the likelihood of an occult malignancy. Free versus total PSA was not consistent, averaging 16.8%, but with a range of 6% to 34%.

CONCLUSIONS

Novel PSA tests were not found to be useful in this cohort of patients with multiple negative biopsies and PSA elevations greater than 20 ng/mL. Additional studies with larger sample size are required to confirm this finding.

A novel method for monitoring Mycobacterium bovis BCG trafficking with recombinant BCG expressing green fluorescent protein

To better understand intracellular and extracellular trafficking of Mycobacterium bovis bacillus Calmette-Guérin (BCG) when used as an intravesical agent in the treatment of transitional cell carcinoma (TCC) of the bladder, recombinant BCG (rBCG) expressing the jellyfish green fluorescent protein (GFP) was created. When the MB49.1 murine TCC cell line was incubated with GFP-expressing rBCG, internalization of the pathogen could be directly visualized by UV microscopy and quantitated by flow cytometry. The in vitro internalization of the GFP rBCG by the bladder tumor cells was temperature dependent, occurring most readily at 37 degrees C and being severely inhibited at 4 degrees C. Optimum internalization was achieved in vitro at a 10:1 BCG-to-tumor cell ratio over 24 h during which approximately 16% of the tumor cells became infected. Cytochalasin B, a phagocytosis inhibitor, abrogated the ingestion by almost 100% at a concentration of 200 micrograms/ml, indicating that contractile microfilaments likely played an important role in this process. By using mitomycin, a DNA cross-linking reagent, to inhibit proliferation of MB49.1 cells, clearance of about 40% of the green rBCG was achieved by 3 days postinfection. No significant difference between the GFP rBCG and wild-type BCG was observed in the ability to induce the expression of cell membrane proteins of major histocompatibility classes I and II, ICAM-I and -II, B7-1 and -2, of Fas from MB49.1 cells or cytokine production from mouse spleen cells. These results indicate that GFP rBCG may serve as a useful substitute for wild-type BCG in future studies of in vivo trafficking experimental and clinical immunotherapy.

Distinct glycoforms of a tumor specific glycoprotein, gp200, in human testis and testicular tumors

We recently purified a 200 kD peanut agglutinin-binding glycoprotein from the embryonal carcinoma cell line HT-E (833K) that is expressed selectively in nonseminomatous germ cell tumors. We now further characterize gp200 using Western blot analysis to compare normal and malignant testicular germ cells for reactivity to peanut agglutinin, a plant lectin that recognizes terminal D-galactosyl residues, and GCTM-2, a monoclonal antibody that recognizes a 200 kD keratan-sulfate proteoglycan on human embryonal carcinoma. The results indicate that normal germ cells express gp200 as a membrane-bound 230 kD glycoform that expresses terminal galactose residues. This 230 kD glycoprotein is absent on spermatozoa but present on seminomatous germ cell tumors and somatic tissue and does not express terminal galactose on its carbohydrate side chains. In contrast, nonseminomatous germ cell tumors express a heavily sialylated glycoform of gp200 that does express terminal galactose residues. These results describe a glycoprotein that exists in several glycoforms in normal and malignant testicular germ cells. The differential expression of these glycoforms may help in understanding the ontogeny of germ cell tumors.

Bacillus Calmette-Guérin immunotherapy for superficial bladder cancer. New prospects for an old warhorse

The use of live M. bovis BCG to treat superficial bladder cancer has endured its seemingly anachronistic origin in the early days of tumor immunology to emerge as the therapy of choice for superficial bladder cancer. Its superiority over conventional intravesical therapy has been established for tumor prophylaxis and treatment of residual disease and CIS, providing long-term results that have translated into improvements in disease progression and survival. Although its exact mechanism of action remains elusive, extensive studies suggest that this intracellular pathogen stimulates the immune system to produce powerful cytokine mediators and effector cells that act locally to destroy bladder tumors. Although unique toxicities occur by virtue of BCG's use as a live vaccine, this same liability has opened the door for new opportunities through the use of recombinant DNA technology. Exciting prospects include the use of BCG as a cytokine carrier and as a tumor antigen depot. Genetic engineering may also yield varients that are both intrinsically safer and more specific in bladder tumor targeting.

Temperature-dependent expression of a 95 kD protein in rat testis

Testicular tissue from mature male Sprague-Dawley rats was maintained in culture at 33 degrees C or 37 degrees C. Detergent-extracted proteins were separated by polyacrylamide gel electrophoresis (PAGE) followed by staining or fluorography. Unilateral surgical cryptorchidism was performed as an in vivo model for testicular exposure to abdominal temperature. Testes were harvested at various time points, followed by protein analysis as performed for in vitro studies. Tissue incubated in vitro for 48 h at 37 degrees C demonstrated loss of a prominent actively synthesized 95 kD protein (p95) seen at 33 degrees C. No other temperature-dependent protein changes were observed. Liver, kidney, spleen and thymus failed to reveal p95 or any other temperature-sensitive proteins when incubated at 33 degrees C and 37 degrees C. Surgical cryptorchidism resulted in loss of p95 by 1 week in abdominal testes and normal p95 expression in sham-operated scrotal testes. p95 appears to be a temperature-sensitive protein in rat testis, with increased degradation accounting for its loss at abdominal temperature. The failure to identify similar protein changes in other tissues suggests a role for p95 in the temperature-dependent function of the testis.

The effect of testicular nongerm cell tumors on local spermatogenesis

OBJECTIVE

To assess ipsilateral spermatogenesis in men with malignant and benign nongerm cell tumors of the testis.

DESIGN, PATIENTS

Histologic review of radical orchiectomy specimens performed for 20 men with malignant nongerm cell tumors and 15 with benign testicular lesions, including five Leydig cell tumors with benign clinical features.

MAIN OUTCOME MEASURES

Degree of spermatogenesis was determined on a 1 to 10 scale, with 10 representing mature sperm within a seminiferous tubule. For each patient "near" and "far" scores were determined by obtaining the mean score of 50 tubules adjacent (< 3 mm) to the tumor and 50 tubules distant (> 3 mm) from the tumor, respectively.

RESULTS

Total, near, and far scores were all lower for malignant tumors than for benign lesions. Scores for Leydig cell tumors were similar to benign lesions. Malignant tumors demonstrated a gradient effect, with greatest impairment of spermatogenesis occurring adjacent to tumor. In contrast, a distinction between near and far scores was not observed for benign lesions or Leydig cell tumors.

CONCLUSIONS

Malignant nongerm cell tumors of the testis were associated with significant impairment of ipsilateral spermatogenesis, particularly in areas adjacent to tumor. These findings are similar to those observed for testicular germ cell tumors, suggesting a generalized negative influence on ipsilateral spermatogenesis by malignant tumors.

Recombinant Mycobacterium bovis BCG secreting functional interleukin-2 enhances gamma interferon production by splenocytes

Mycobacterium bovis BCG was genetically engineered to express and secrete mouse interleukin-2 (IL-2) and rat IL-2. Genes encoding IL-2 were inserted into an Escherichia coli-BCG shuttle plasmid under the control of the BCG HSP60 promoter. To facilitate study of proteins produced in this system, the IL-2 gene product was expressed (i) alone, (ii) with the mycobacterial alpha-antigen secretion signal sequence at the amino terminus, (iii) with an influenza virus hemagglutinin epitope tag at the amino terminus, and (iv) with both the secretion signal sequence and the epitope tag. When expressed with the alpha-antigen signal sequence, biologically active IL-2 was secreted into the extracellular medium. Western blot (immunoblot) analysis of the intracellular IL-2 and extracellular IL-2 revealed that the secretion signal was appropriately cleaved from the recombinant lymphokine upon secretion. To assess the ability of recombinant BCG to stimulate cytokine production in a splenocyte population, mouse splenocytes were cultured together with wild-type or IL-2-producing BCG. IL-2-secreting BCG clones stimulated substantial increases in gamma interferon production, which could be reproduced by the addition of exogenous IL-2 to BCG. Levels of IL-6, IL-10, tumor necrosis factor alpha, and granulocyte-macrophage colony-stimulating factor were not significantly changed, while IL-4 and IL-5 remained undetectable (less than 50 pg/ml). The enhanced production of gamma interferon in response to IL-2-secreting BCG was strain independent. Recombinant BCG expressing mammalian cytokines provides a novel means to deliver cytokines and may augment the immunostimulatory properties of BCG in immunization and cancer therapy.

A self-expanding prostatic stent for bladder outlet obstruction in high risk patients

We describe the clinical experience with a self-expanding prostatic stent used in patients with bladder outlet obstruction and advanced comorbid medical illness. A Gianturco-Z stent was placed in 25 men, including 21 in urinary retention. Patients were followed clinically and with serial endoscopy. Mean age was 80.5 years (range 54 to 98). Mean followup was 10.1 months, with a longest followup of 24 months. Spontaneous voiding resumed in 20 of 21 patients (95%) with retention, with 16 of 21 (76%) demonstrating long-term success. Two patients failed due to stent migration within 1 month. Other complications were limited to minor stent incrustations in 2 cases, symptomatic urinary infections without fever in 2 and epididymitis occurring 15 months following stent placement in 1. No perioperative cardiovascular complications were encountered. Followup endoscopy revealed partial stent coverage by urothelium in 13 of 16 men at 1 month and greater than 90% coverage in 8 of 13 by 3 months. The high success rate with minimal morbidity observed suggests that prostatic stents may become the first-line therapy for the medically compromised man with bladder outlet obstruction.

Genital swelling secondary to leakage from continuous ambulatory peritoneal dialysis: computerized tomography diagnosis

We report a case of acute genital swelling in a patient receiving continuous ambulatory peritoneal dialysis. Physical examination did not identify or localize any defect. Computerized tomography demonstrated extravasation into the left groin and scrotum. Surgical repair of an inguinal hernia resulted in complete resolution of the genital swelling.

Candida epididymitis: newly recognized opportunistic epididymal infection

Epididymitis is common, yet it is rarely associated with fungal pathogens. We report a case of Candida albicans epididymitis in a diabetic which was ultimately treated by orchiectomy. Opportunistic infections of the genitourinary tract in immunosuppressed patients are becoming more prevalent; examples include fungal infections in patients with acquired immune deficiency syndrome or after organ transplant. The fact that opportunistic organisms can invade the epididymis and produce infection suggests that in cases of persistent epididymitis, which have failed to respond to conventional therapy, more aggressive diagnostic procedures should be considered. Needle aspiration with cultures for fungus and viral organisms should be performed. This is especially true in patients with preexisting chronic illness or an immune compromised state.

Synchronous adenocarcinoma and transitional cell carcinoma of the bladder associated with augmentation: case report and review of the literature

We report a case of synchronous transitional cell carcinoma and adenocarcinoma in an augmented bladder 8 years after cecocystoplasty. We discuss the clinical presentation as well as current clinical and basic research concepts, and suggest that the anastomotic zone in such cases may be at risk for malignant transformation.

Purification of a tumor-specific PNA-binding glycoprotein, gp200, from a human embryonal carcinoma cell line

A 200-kDa peanut agglutinin (PNA)-binding glycoprotein, gp200, has been purified and partially characterized from the human embryonal carcinoma cell line, HT-E (833k). Tissue distribution analysis of this molecule by lectin blotting with PNA of detergent-extracted proteins from human cell lines and tissues demonstrated expression limited to nonseminomatous germ cell tumors. The 200-kDa protein was purified with lectin affinity and gel filtration chromatography. Purification to apparent homogeneity was demonstrated by one- and two-dimensional gel electrophoresis. Characterization of gp200 revealed it to be a surface integral membrane glycoprotein; however, gp200 could also be purified from the culture media of EC cells, suggesting gp200 has an extracellular role. The carbohydrate groups of gp200 are N-linked and partially sialylated and contain terminal galactose residues. These initial studies suggest that the PNA-defined glycoprotein, gp200, is a candidate for a nonseminomatous germ cell tumor marker.

Influence of testicular carcinoma on ipsilateral spermatogenesis

A histological review of radical orchiectomy specimens was performed to assess the impact of testicular cancer on spermatogenesis. Slides from 28 patients with testicular cancer were available for review, consisting of 14 pure seminomas, 12 embryonal carcinomas and 2 mixed tumors. For each specimen tubules adjacent (less than 3 mm.) to the tumor and distant (more than 3 mm.) from the tumor were evaluated. This study indicates that marked impairment of ipsilateral spermatogenesis is associated with testicular carcinoma, particularly in the vicinity of the tumor. The quality of distant spermatogenesis appears to be influenced by tumor type and not by elevation of known serum tumor markers, such as human chorionic gonadotropin and alpha-fetoprotein, nor by the presence of carcinoma in situ.

Rapid high resolution two-dimensional electrophoresis of human sperm proteins

An improved protocol has been developed for two-dimensional gel analysis of human sperm proteins through the application of recent technical advances. Advantages of this protocol consist of increased resolving power, reduced processing time, enhanced reproducibility of staining patterns, and applicability to small quantities of protein. Technical improvements include determination of optimal protein loading (20 micrograms/gel), development of a reliable tube gel casting system, and application of minigel technology. In this study over 500 proteins were resolved with molecular weights ranging from 12,000 to 105,000 and isoelectric points from 5.0 to 8.5. This is a three-fold improvement in resolution over earlier results. A single operator was able to generate two-dimensional gels of multiple samples in less than one day. This rapid high resolution technique should facilitate further investigation of human sperm proteins under normal and pathologic conditions.

Protein differences between normal and oligospermic human sperm demonstrated by two-dimensional gel electrophoresis

Protein expression by sperm obtained from men with normal semen analysis and men with oligospermia were evaluated by two-dimensional gel electrophoresis. Proteins were solubilized in a 9.5 M urea/2% Nonidet-P40 (LKB, Bromma, Sweden) lysis buffer and underwent second dimension separation on 10 to 16% polyacrylamide gradient gels. A set of 36 invariant proteins was identified in all normospermic samples, whereas 8 of 10 evaluable oligospermic samples lacked 1 or more of the invariant proteins. Proteins absent in oligospermic samples may be critical to normal sperm function and may serve as markers for infertility.

Regional loss of chromosome 6 in two urological malignancies

Immunogenetic evidence suggests a genetic association between the major histocompatibility complex and the two genitourinary neoplasms, testicular teratocarcinoma and renal cell carcinoma. In order to develop a possible explanation for these findings, we designed a series of experiments to investigate the existence of a tumor suppressor gene in the region of HLA by looking for loss of germ line heterozygosity in these neoplasms at loci within and centromeric to HLA on chromosome 6. Restriction enzyme-digested DNA, from 15 human teratocarcinoma tumors, and corresponding normal somatic DNA, from peripheral blood mononuclear cells, were hybridized to one of three chromosome 6 probes determined to be polymorphic in this region. Probe 4c11 (6p11-cen) revealed loss of germ line DNA in three of 14 tumors. In contrast, probes pC22A (6p21.3) and p308 (6cen), which hybridize to chromosome 6p sequences, telomeric and centromeric to those sequences recognized by 4c11, did not demonstrate loss or sequence alteration in a total of 14 analyzable tumors. A total of 33 renal cell carcinoma specimens was also analyzed with the informative 4c11 probe with loss demonstrated in six of 33 tumors. In contrast, 23 different samples representing 15 other tumor types were examined with 4c11. Loss of chromosome 6p DNA was demonstrated in only two samples. These data support the hypothesis that there is nonrandom loss of DNA centromeric to HLA on chromosome 6 in both testicular teratocarcinoma and renal cell carcinoma.

Aspiration and tetracycline sclerotherapy of hydroceles

Aspiration and sclerotherapy of hydroceles have been considered an effective outpatient procedure. We report on our experience with modification of this procedure in the treatment of 28 hydroceles. A 10 per cent solution of tetracycline hydrochloride was used as the sclerosant. In this series the mean followup was 15 months and there was an over-all 93 per cent success rate. A single treatment was successful in 75 per cent of the hydroceles. Complications included a hematoma in 2 patients and epididymitis in 1. We consider aspiration and sclerotherapy of hydroceles to be a reasonable alternative to an operation.

Inhibition of ganglioside sialyltransferase activity and stimulation of neutral glycolipid exocytosis by heparin

Heparin treatment of human teratocarcinoma cells in culture has several manifestations. Accumulation of gangliosides is greatly decreased while the content of cellular neutral glycolipids is relatively unaffected. However, synthesis of neutral glycolipids is increased and large amounts of these glycolipids are exported out of the cells into the medium. In addition, sialyltransferase activity of heparin-treated teratocarcinoma cells is significantly inhibited, accounting for the decreased cellular content of gangliosides. These studies are not intended to infer any physiological role of heparin in the regulation of glycolipid biosynthesis. However, results do show that beta-D-galactoside 2,3-sialyltransferase is a heparin-binding protein and that inhibition of the enzyme activity by heparin is linked to an alteration in the secretion of most neutral glycolipid precursors and sialyltransferase acceptors. These data suggest that in addition to its biosynthetic function, this ganglioside transferase may play a regulatory role in glycolipid secretion.

Trophoblastic differentiation of human teratocarcinoma cell line HT-H1

In culture the human teratocarcinoma cell line HT-H generates both adherent monolayer and free-floating aggregates. Some populations of aggregated cells develop further to form cystic bodies. A previous study showed the morphological resemblance of the cystic bodies to cells of blastocyst of preimplantation embryo. In this study, HT-H adherent cells were further separated into two subpopulations, fast adhering and slow adhering cells. Fast adhering cells produce fibronectin, spread well onto substratum, and do not proliferate. In contrast, slow adhering cells do not produce fibronectin. Trophoblastic markers were examined in each morphological stage of HT-H cells and the following results were obtained. Only fast adhering cells produce progesterone. Human chorionic gonadotropin was secreted preferentially by fast adhering cells, about six times less by slow adhering cells, and was not secreted by aggregates or cystic bodies. All stages of HT-H cells express c-fos but only fast adhering cells express c-fms oncogene. Cytokeratin 18 was expressed in all stages of HT-H cells. The level of cytokeratin 18 is modestly decreased from adherent to aggregates further into cystic bodies. These results indicate that HT-H cells share properties with cells in trophoblast, placenta, and extraembryonic endoderm. Spontaneous differentiation of HT-H cultures results in the appearance of fast adhering cells which exhibit biochemical properties expected for syncytiotrophoblast.

Major histocompatibility antigens are not detectable on post-meiotic human testicular germ cells

Neither HLA Class I nor Class II transplantation antigens were detected on human testicular germ cells by immunohistologic or immunoprecipitation techniques. This unusual characteristic of human germ-line cells could help to explain their immunologically privileged status in potentially hostile autologous and allogeneic host environments.

Major histocompatibility antigens are not detectable on post-meiotic human testicular germ cells

Neither HLA Class I nor Class II transplantation antigens were detected on human testicular germ cells by immunohistologic or immunoprecipitation techniques. This unusual characteristic of human germ-line cells could help to explain their immunologically privileged status in potentially hostile autologous and allogeneic host environments.

Immune properties of human teratocarcinoma. I. Human teratocarcinoma targets distinguish between natural killer and activated killer cells

Four human teratocarcinoma (HT) cell lines were studied as a class of targets for natural (NK) and activated (AK) lymphocyte-mediated cytotoxicity. NK cells were found to be ineffective in lysing 51chromium-labeled HT targets. In contrast, alloactivated and mitogen-activated AK cells were highly cytotoxic for HT. The specificity of AK-mediated HT lysis was investigated by cold target competition experiments. The results showed that the target was shared by all HT lines tested but was not MHC related and was not present on lymphoblastoid cells (LBL) or on resting or activated normal lymphocytes. The demonstrated presence of unique fetal antigens on HT may provide an informative model for the study of AK target specificity and its functional relationship to differentiation.

Immune properties of human teratocarcinoma. I. Human teratocarcinoma targets distinguish between natural killer and activated killer cells

Four human teratocarcinoma (HT) cell lines were studied as a class of targets for natural (NK) and activated (AK) lymphocyte-mediated cytotoxicity. NK cells were found to be ineffective in lysing 51chromium-labeled HT targets. In contrast, alloactivated and mitogen-activated AK cells were highly cytotoxic for HT. The specificity of AK-mediated HT lysis was investigated by cold target competition experiments. The results showed that the target was shared by all HT lines tested but was not MHC related and was not present on lymphoblastoid cells (LBL) or on resting or activated normal lymphocytes. The demonstrated presence of unique fetal antigens on HT may provide an informative model for the study of AK target specificity and its functional relationship to differentiation.

Fucosyl-globoside and sialosyl-globoside are new glycolipids isolated from human teratocarcinoma cells

Several novel glycosphingolipids have been isolated from the human teratocarcinoma cell line HT-E (833K). These cells contain two neutral glycolipids which metabolically incorporate radio-labelled fucose. In addition, there are three new gangliosides present, which are all members of the globoside series of glycolipids. One of the fucose containing glycolipids forms globoside when treated with alpha-fucosidase, and one of the gangliosides forms globoside when treated with neuraminidase. On the basis of chromatographic behavior, exoglycosidase treatment and antibody reactivity, the tentative structures of these new glycolipids are: Fuc (alpha 1-?) GalNAc (beta 1-3) Gal (alpha 1-4) Gal (beta 1-4) Glc (beta 1-Cer) and NeuAc (alpha 2-3) GalNAc (beta 1-3) Gal (alpha 1-4) Gal (beta 1-4) Glc (beta 1-Cer)

The effects of irradiation on blood components

The functional properties of formed elements of whole blood were studied following irradiation doses of 500 to 20,000 rads. Irradiated lymphocytes retained only 1.5 per cent of their 3H thymidine uptake after a 5,000-rad exposure and none after 7,500 rads. Red blood cells stored for 21 days and then irradiated with 5,000 rads had the same survival as nonirradiated controls. In contrast, 5,000 rads reduced platelet yields. However, transfused irradiated platelets produced the expected increases in platelet counts and controlled hemostasis in thrombocytopenic patients. After 5,000 rads, granulocytes had normal bacterial killing capacity, chemotactic mobility, and normal superoxide production after high-dose stimulation. Nitroblue tetrazolium reduction and ingestion stimulated by complement opsonized oil droplets were not diminished by 5,000- and 10,000-rad irradiation. The functional qualities of cellular blood components other than lymphocytes are not compromised by 5,000 rads. This irradiation dose may be an effective means of controlling incidence of graft-vs-host disease in immunosuppressed patients.