Treatment of Stage D Prostatic Carcinoma With Megestrol Acetate

ONCOLOGY AND CHEMOTHERAPY

Structural analogues of trichloroethylene will react with cystine to form halogenated vinyl cysteines. These new vinyl cysteines were found to be nephrotoxic to mice, producing a proximal tubular necrosis within 3 days of exposure, preceded by a transient polyuria. It must now be determined if these conjugates form in animals or in vitro biological systems and if they may, indeed, be the cause of the nephrotoxicity of compounds, such as chlorotrifluoroethylene and chlorodifluoroethylene, a reductive metabolite of the commonly used anesthetic agent, halothane. H.D.P. 6 figures, 15 references

ONCOLOGY AND CHEMOTHERAPY Vasculitis Associated With Renal Oncocytoma

B. R. SUSMAN, F. C. LEVIN, P. BARLAND AND F. FROMOWITZ, Departments of Pathology and Medicine, Montefiore Hospital and Medical Center, Bronx, and Department of Health, City of New York, New York N. Y. State J. Med., 81: 1501-1503 (Sept.) 1981 A 72-year-old physician had progressive myalgias, paresthesias of both feet, fever, diaphoresis, cyanosis of the toes progressing to ischemic necrosis, Raynaud's phenomenon, leukocytosis, mild anemia, markedly elevated sedimentation rate and microhematuria. Excretory urography (IVP), sonography and renal angiography revealed a vascular tumor in the left kidney for which a radical nephrectomy was done. Microscopic examination revealed a uniform population of large cells with eosinophilic granular cytoplasm and tubule formation characteristic of a renal oncocytoma, with some areas of necrosis within the tumor. An active necrotizing vasculitis of the small and medium-sized arteries was seen in the perinephric tissue. There was marked flare in the vasculitis observed immediately after the operation. This flare disappeared within 48 hours and the patient was entirely free of symptoms 16 months later. N onembolic systemic vasculitis may occur in association with malignant tumors but has not been reported with apparently benign tumors. This is the first such case reported. M.G.F. 1 figure, 13 references

Hormone Receptors in Male Breast Carcinoma S.

J.

E. J. KEENAN, H. S. MOSELEY AND Division of Surgical Oncology, Department of Surgery, University of Oregon Health Sciences Center, Portland, Oregon RUFF,

J. E.

BAUER,

W. S. FLETCHER,

J. Surg. Oncol., 18: 55-59, 1981

The specimens of 14 male patients with histologically proved carcinoma of the breast were assayed for hormone receptors. The tumors in all 14 patients contained estrogen receptors. The tumors in 8 of 12 patients also contained progesterone receptors. Nine patients underwent modified radical mastectomy. Two patients had a radical mastectomy and 1 had a simple mastectomy. Two patients with palpable axillary nodes had biopsies only. Twelve patients have had no evidence of disease with a mean followup of <2 years. The 2 patients who had metastasis responded to orchiectomy and subsequent adrenalectomy. These authors suggest that carcinoma of the breast in male patients is highly endocrine sensitive and has an excellent chance for response to endocrine ablation. F. T.A. 2 figures, 18 references

395

Management of Prostate Carcinoma

E. D. WHITEHEAD, Department of Urology, Mount Sinai School of Medicine, City University of New York and Department of Urology, Beth Israel Medical Center, New York, New York N. Y. State J. Med., 81: 1481-1485 (Sept.) 1981 Carcinoma of the prostate is the most common cancer among men >65 years old and is the second most frequent cause of cancer deaths in the United States. The digital rectal examination remains the most important diagnostic procedure. Fifty per cent of the palpable nodules of the prostate are proved carcinoma after biopsy. Unsuspected carcinoma also may be discovered in surgical specimens removed for benign prostatic hyperplasia. Current diagnostic and staging procedures, principles and therapeutic alternatives of management, complications and survival rates are reviewed concisely. 2 tables, 49 references

Abstracter's comment. This is an extensive review of the current controversies regarding treatment modalities. With new imaging equipment computerized tomography should be included among the approaches to staging. M.G.F. Estradiol-3-Dansylate Used as a Fluorescent Histochemical Stain, a Possible Prognostic Aid for Nondisseminating Prostatic Carcinoma J.

P. R. VAN DALEN, Department of Cytology, Rotterdamsch Radio-Therapeutisch Instituut, Rotterdam, The Netherlands

J. Surg. Oncol., 17: 373-378, 1981 The author's initial study did reveal that only half of all prostatic carcinomas from transperineal biopsies were stainable with estradiol-3-dansylate. There was an indication that biopsies from patients with distant metastasis were stained in a lower percentage than from patients without distant metastasis. Approximately a third of the patients with prostatic carcinoma but without distant metastases at diagnosis have a tumor with a positive estradiol-3-dansylate staining and a well to moderate differentiation. They have a low risk for future dissemination. If this correlation could be confirmed in future studies it would mean that about a third of the patients with localized prostatic carcinoma may be indicated by a transperineal biopsy with this method as having a low risk for future metastasis. P.R.R. 2 figures, 4 tables, 3 references

Treatment of Stage D Prostatic Carcinoma With Megestrol Acetate M. BLOCK, P. BONOMI, K. ANDERSON, J. WOLTER, J. SHOWEL, D. PESSIS AND R. SLAYTON, Section of Medical Oncology,

University of Wisconsin, Madison, Wisconsin; Department of Internal Medicine, Section of Medical Oncology, and Departments of Biochemistry and Urology, Rush University, Chicago, Illinois J. Surg. Oncol., 17: 367-371, 1981 Nine patients with symptomatic stage D prostatic carcinoma were treated with 40 mg. megestrol acetate 3 times daily. Of the 9 patients 7 experienced objective stabilization or partial regression lasting >3 to >33 months. In 1 patient with pulmonary metastases 50 per cent regression of the metastases oc-

396

DISEASES OF BLOOD VESSELS, HYPERTENSION AND RENOV ASCULAR SURGERY

curred. A progesterone receptor was found in the cytosol of the excised pulmonary metastasis in this patient. No gastrointestinal toxicity, gynecomastia, fluid retention or thromboembolic complications were observed during treatment. The rate and duration of r€sponse with megestrol acetate are similar to those with diethylstilbestrol. The authors suggest that a randomized, prospective study is needed to compare these treatments. P.R.R. 2 tables, 8 references

Cancer Statistics of Chinese Versus Americans Y.-T. N. LEE, Department of Surgery, University of Southern California School of Medicine and Tumor Surgery Service, Los Angeles County- USC Medical Center, Los Angeles, California J. Surg. Oncol., 17: 355-366, 1981 After comparing cancer rates of Chinese in the United States versus Americans the author indicates that the total mortality from cancer per 100,000 women was similar for Chinese women in Shanghai and in the United States. For men the rates were essentially the same for Chinese and whites in the United States, and were significantly higher than those for men in Shanghai. Bladder cancer has a relatively low mortality rate in China and among Chinese in the United States but the difference in incidence between Shanghai men and United States white men is even more pronounced (3.04 versus 17.8 per 100,000 per year). Cancer of the prostate is a rare neoplasm in men in Shanghai (1.02) compared to United States white men (39.7 per 100,000). In the United States Wilms tumor is twice as common as retinoblastoma. In Canton and Shanghai retinoblastoma is 3 to 4 times as common as Wilms tumor. The cancer incidence among Chinese living in the United States gradually assumes the pattern of American distribution. This is reflected by an increased incidence of cancer of the colorectum and prostate, and decreased cancer of the stomach, liver and nasopharynx. P.R.R. 9 tables, 27 references

DISEASES OF BLOOD VESSELS, HYPERTENSION AND RENOVASCULAR SURGERY Angiotensin Converting Enzyme Activity in Human Serum: Relationship to Enzyme Inhibitor In Vivo and In Vitro B. N.

P. MoJAVERIAN, R. K. P. H. VLASSES AND M. DUDASH, Division of Clinical Pharmacology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania and Merck Sharp and Dahme Research Laboratories, West Point, Pennsylvania SWANSON, M. HICHENS,

FERGUSON,

Res. Comm. Chem. Path. Pharm., 33: 525-536 (Sept.) 1981 Angiotensin converting enzyme inhibitors have been developed. One sv~h inhibitor, captopril, has proved useful in the treatment of hypertension. A newer drug, MK-421 [N-(S-1 carbethoxy-3-phenylpropyl)-S-alanyl-S-proline maleate] also has been shown to lower blood pressure in patients. This drug is hydrolyzed rapidly in vivo to its active diacid metabolite.

Quantitative relationships between angiotensin converting enzyme activity and concentration of the enzyme inhibitor, diacid metabolite, were defined. Dose response curves were generated in vitro by adding diacid metabolite to serum: 10 to 15 per cent of the initial activity was nonsuppressible despite further increases in diacid metabolite concentration. Diacid metabolite and angiotensin converting enzyme activity also were measured in serum from 11 individuals with mild to moderate hypertension who received oral doses of MK-421 daily for up to 28 days. The dose-response curve for serum samples after a single dose of MK-421 was similar to curves generated in vitro, while the curve for samples after chronic therapy suggested a small decrease in inhibitory potency. Monitoring of angiotensin converting enzyme activity will be useful in assessing patient compliance and extent of enzyme inhibition. Preliminary results indicate that angiotensin converting enzyme must be inhibited at least 70 per cent in patients before an antihypertensive effect is observed. Assay of angiotensin converting enzyme as described here is rapid and inexpensive, and may be suitable for routine clinical testing. M.G.F. 4 figures, 21 references

Prevalence of Clinically Unsuspected Pheochromocytoma. Review of a 50-Year Autopsy Series G. ST. JOHN SUTTON, S. G. SHEPS AND J. T. LIE, Division of Cardiovascular Diseases and Internal Medicine and Department of Anatomic Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

M.

Mayo Clin. Proc., 56: 354-360 (June) 1981 Pheochromocytoma occurs in <1 per cent of patients with systemic hypertension. Pheochromocytoma is surgically curable and lethal complications often ensue when the diagnosis is not made. Physical signs other than hypertension are unusual and symptoms are subtle although they may be dramatic when they occur as a spell. Properly selected biochemical tests can establish the diagnosis in >95 per cent of the cases but a high degree of clinical alertness remains a prerequisite for a correct diagnosis. The authors reviewed 54 autopsy proved cases of pheochromocytoma seen at the Mayo Clinic from 1928 to 1977. There were 31 female and 23 male patients, ranging from 40 hours to 92 years old (mean 53 years). Pheochromocytoma was multiple in 10 patients (19 per cent), extra-adrenal in 5 (9 per cent) and malignant in 6 (11 per cent). In 13 patients (24 per cent) pheochrom0cytoma had been diagnosed correctly in life-after the investigation of hypertension in 8 patients, incidentally at laparotomy for unrelated conditions in 4 and in association with the multiple endocrine neoplasia syndrome in 1. Of 41 patients (76 per cent) in whom pheochromocytoma had not been suspected clinically hypertension also was a common finding in 22 (54 per cent). Symptoms such as headache, sweating and palpitations were nonspecific but all occurred more often among the group of patients in whom the diagnosis had been made. For both groups hypertensive or hypotensive crisis precipitated by operation for unrelated conditions was a common cause of death. The prevention of such deaths requires a high degree of clinical alertness and biochemical screening tests for pheochromocytoma in patients with labile or accelerated hypertension. Clinical hints for the diagnosis include unusual lability of blood pressure, symptomatic paroxysms of hypertension and