No abstract

One hundred fifteen patients underwent surgical treatment of renal cell carcinoma. Survival time was analyzed by statistical regression methods in order to determine the joint significance of stage, using both the Robson and TNM classifications, histologic grade, cell type, and demographic features of the patient sample. Grade and cell type were essentially interchangeable with respect to predicting survival in patients with and without metastatic disease. The strong association between these two factors explains and supports this result. The presence of metastases dramatically altered survival. Local extent of the tumor was an important indicator of survival in the nonmetastatic group of patients, but was not a statistically significant factor in those patients presenting with widespread disease. Venous involvement was not found to be of prognostic significance in either group. Age and weight loss contributed to predicting survival in the nonmetastatic patient group in addition to the measures of disease extent already discussed. Sex and race were not significant indicators of length of survival. In the group of patients with metastatic disease, no difference in survival was observed between soft tissue and bony metastases.

Using a modification of the histologic grading system of the NSABP, we observed a trend towards higher levels of estrogen (E2R) and progesterone receptor (PR) content in well (grade I) and moderately (grade II) differentiated mammary carcinomas. This relationship between receptor content and histologic grade is enhanced by considering estrogen and progesterone receptor simultaneously. The rank correlation between the quantitative levels of E2R and PR was 0.74 among histologic grade I tumors and 0.64 among histologic grade II tumors. Among the grade III carcinomas, the majority of tumors displayed either a paucity of measurable receptor or a divergence between levels of estrogen versus progesterone receptor (r = 0.19). The use of ultrastructural evaluation of features of differentiation is discussed in the evaluation of grade III tumors and in the evaluation of specific histologic types of mammary carcinoma.

A patient with clinical hypercortisolism and an infiltrating ductal carcinoma of the right mammary gland is presented. Provocative testing of adrenal function demonstrated the pattern of ectopic adrenocorticotropic hormone (ACTH) production. Ultrastructural analysis of the tumor revealed 150-200 nm electron-dense granules that when primarily fixed in Os04 appeared as membrane-bound, centrally dense cored granules. ACTH was extracted from the tumor tissue and immunocytochemically localized in the tumor cell cytoplasm. A clinically significant level of estrogen receptor protein was present in the tumor tissue (120 fmoUmg protein). This case confirms the ability of mammary carcinoma to produce the ectopic ACTH syndrome. Table 1) and ACTH levels were measured. Biopsies were done of the subcutaneous tumor nodules, which were studied by tissue extraction for ACTH (Table 2), immunocytochemistry ( Fig. IB), transmission electron microscopy ( Fig. 21, and estrogen binding protein assay. This supported the carcinoma as the source of ACTH. A bilateral adrenalectomy (left 24 g. right 26 g) was performed. Following adrenal ablation, the chest wall tumor masses reduced in size. A recrudescence of tumor growth was noted at eight months, and she expired 22 months after adrenalectomy. Metastases to bone marrow, lung, cranium, liver, and chest wall were present at the time of her death with no other apparent source of tumor other than the initial breast carcinoma.

No abstract

Tumors of ceruminous gland origin in the external auditory canal are rare in man. A case is described in which such a tumor presented as an invasive vascular temporal bone neoplasm, mimicking a glomus jugulare tumor. Light and electron microscopic study of this tumor confirmed a diagnosis of ceruminous gland adenocarcinoma. Tumors of ceruminous gland origin appear to have a distinctive clinical behavior by virtue of their unique anatomical location in the external auditory canal. Our experience with this case establishes another clinical picture characterizing the histologic type of ceruminoma designated as a ceruminous gland adenocarcinoma. We feel that the generic term "ceruminoma," with its implied histologic subgroups, is useful to the clinician when he encounters a tumor arising from the modified sweat glands of the external auditory canal.

Three histochemical techniques for estrogen binding localization in tissue sections were compared to sucrose density gradient analyses for estrogen receptor in 186 breast carcinomas. Apparent localization to epithelial elements was noted using 6-BSA-Fluor-CMO-17 beta-estradiol, 17-BSA-Fluor-TSC-estrogen, and polyestradiol phosphate/anti-estradiol antibody methods. The correlation between the histochemical methods and standard sucrose density gradient techniques was poor for the polyestradiol antibody method and the 6-BSA-fluor-CMO-17 beta-estradiol techniques. While an improved correlation was observed with the 17-BSA-Fluor-TSC-estrogen compound, the compound's binding was not effectively blocked by preincubation with diethylstilbestrol. This failure to show convincing saturability of binding, combined with problems of extraction of soluble receptor proteins in the aqueous incubation media and washed from cells rendered permeable by cryostat sectioning, indicates that several areas will require clarification before histochemical techniques can begin to be considered as a method for estrogen ""receptor" analyses in the clinical evaluation of breast neoplasms.

There are few established human prostatic adenocarcinoma cell lines in existence. Most established lines are nonfunctional and hormonally insensitive. A human prostate adenocarcinoma (9479) has been serially transplanted for more than 4 years in athymic nude mice. The tumor is estrogen and androgen insensitive, is transplantable between mice with a high rate of success. The tumor does not produce enzymatically measurable acid phosphatase, but does produce immunologically identifiable acid phosphatase. Not only has the tumor retained its original morphology, it also appears to produce a factor producing hypophosphatemia. Current studies in regards to the endocrinological aspects of this tumor are in progress. We propose that acid phosphatase is produced, but in an altered form.