Delayed cutaneous hypersensitivity and human renal allotransplantation.

A group of 154 patients on chronic dialysis has been evaluated by DNCB reactivity. Viewed as a group, these patients exhibit a highly significant decrease in immunologic responsiveness in comparison to normal individuals. However, 19% of patients had an immunologic response to DNCB and 12% an irritant response. This pretransplant DNCB responsiveness correlated significantly with subsequent allograft rejection in 71 renal allotransplant recipients. For example, at 1 year after transplantation graft survival was strikingly different: DNCB- patients, 78%; DNCB+ patients, 29%; and DNCB-IR patients; 20%. Pretransplant recall-antigen testing results in 32 patients did not correlate significantly with subsequent transplant results. Serial posttransplant delayed cutaneous hypersensitivity responses in patients with a positive response to a skin test antigen in the pretransplant period suggest possible usefulness of this technique for detecting rejection in the posttransplant period. DNCB skin testing should be performed in all transplant candidates to evaluate host responsiveness and should aid in future patient management.     

Delayed cutaneous hypersensitivity reactions to melanoma antigen.

Soluble melanoma antigens were prepared by 3M KCl extraction. These antigens were tested by delayed cutaneous hypersensitivity reactions (DCHR) in 52 patients. Maximum reactivity was noted at 24 hours. DCHR was greater than or equal to 10 mm. of induration in 20 of 34 melanoma patients whereas only three reacted to an autologous muscle extract. Five of 18 patients with other tumors reacted to this antigen. The availability of soluble tumor antigens now permits further purification, chemical characterization, and clinical evaluation of these antigens.     

Delayed cutaneous hypersensitivity reaction: complication of lymphangiography

An unusual delayed hypersensitivity skin reaction developed after lymphangiography to stage the patient's adenocarcinoma of the prostate.     

Delayed hypersensitivity reaction in patients with bone and soft tissue sarcoma.

In patients with sarcoma of the extremity, the tuberculin and dinitrochlorobenzene (DNCB) skin test were performed to correlate the results with the extent and prognosis of disease. Of the tumor-bearing patients, 60.0 per cent gave a positive tuberculin test and 48.9 per cent a positive DNCB test, with a significant difference from the control group with regard to the incidence of positive results in the later test (P less than 0.03). There was no difference between the different stages in the incidence of positive reactions to tuberculin but a marked difference in that to DNCB (78.6%, 40.7% and 0%). Between survivors and those who died, there was no difference in the incidence of a positive tuberculin test but a significant difference was present in that of a positive DNCB test (P less than 0.04), a difference which may be considered to reflect that in stage of disease process at the time of first examination.     

Impact of pelvic lymphadenectomy in patients with prostatic adenocarcinoma

The clinical course of 75 males subjected to radical prostatectomy after pelvic lymphadenectomy were compared with that of 29 males receiving radical prostatectomy without lymphadenectomy. The adverse survival impact of positive pelvic nodes and the impact of pelvic lymphadenectomy are discussed.     

Intravenous hyperalimentation. Effect on delayed cutaneous hypersensitivity in cancer patients

Effects of nutritional repletion with intravenous hyperalimentation (IVH) on sequential skin test reactivity were evaluated in 160 malnourished cancer patients undergoing chemotherapy (76 patients), surgery (49 patients), radiation therapy (20 patients) and supportive care (15 patients). In the chemotherapy group, 45 patients had negative reactions initially, and 25 patients (55%) had at least one skin test convert to positive in an average period of 19 days of IVH. In the surgery group, 23 patients (46%) were initially positive and remained positive, 13 patients (24%) converted from negative to positive, and 13 patients (30%) remained negative or converted to negative. Postoperative complications occurred in 25% of positive reactors, compared with 69% (p < 0.01) of negative reactors. In the radiation therapy group, the skin tests of six patients (30%) remained positive, three patients (15%) converted from negative to positive and the skin tests of nine patients (45%) remained negative. In the supportive care group, the skin tests of 73% of the patients either remained positive or converted to positive with IVH within an average period of 11 days of treatment. Nutritional therapy with IVH was associated with restored skin test reactivity in 51% of malnourished cancer patients undergoing oncologic therapy. Radiation therapy was generally immunosuppressive despite adequate nutritional repletion. In surgical patients, positive skin test reactivity correlated directly with a favorable response to operative therapy.     

Double primary prostatic adenocarcinoma.

Two cases of double primary prostatic adenocarcinoma are described. A periurethral papillary adenocarcinoma coexisted with the common acinar type of cancer, which tends to arise deep in the corpus of the gland. We are of the opinion that the patterns observed in these tumors are not mere variations of one neoplasm, but rather two dissimilar growths of diverse cell origin, varried histology, and possibly also of disparate biologic potential.     

Endocrine effects of oestrogen withdrawal in long-term treated patients with prostatic adenocarcinoma

Eighteen patients with prostatic adenocarcinoma, treated with oestrogen for 45 months or more, were followed-up after withdrawal of oestrogen treatment. Serum concentrations of testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), oestradiol-17 beta, testosterone-oestradiol-binding globulin (TeBg) and prolactin were measured at different intervals between 3 and 42 months after cessation of treatment. Serum testosterone concentrations after cessation of oestrogen treatment were low (range 71.4 +/- 6.3 to 120.8 +/- 23.7 nmol/100ml), whereas the concentrations of LH (range 21.8 +/- 3.6 to 32.6 +/- 9.1 U/1) and FSH (range 31.2 +/- 5.5 to 54.7 +/- 9.5 U/1) were within or higher than the reference range. Prolactin (range 6.0 +/- 85.3 to 7.9 +/- 68.2 micrograms/1) was within the reference range. No significant changes in serum concentrations of testosterone, LH, FSH and prolactin occurred during the follow-up period. The serum concentrations of both oestradiol-17 beta and TeBg, found between 13 and 36 months after oestrogen cessation (range 43.8 +/- 4.6 to 46.2 +/- 5.9 and 64.0 +/- 2.5 to 86.0 +/- 10.0, respectively) were significantly lower than the concentrations found between 3 and 12 months (range 71.9 +/- 10.4 to 99.8 +/- 12.9 and 124.1 +/- 15.5 to 140.2 +/- 13.7, respectively). It is concluded that in patients with prostatic adenocarcinoma, long-term oestrogen treatment causes an irreversible impairment of Leydig cell function and consequently a reduced testosterone secretion after cessation of oestrogen treatment.     

Delayed hypersensitivity reactions in patients with squamous cell cancer of the head and neck

Sixty-three patients with squamous cell cancer of the head and neck were evaluated, correlating TNM class with delayed hypersensitivity reactions. These cell-mediated immune responses were impaired early in the course of the disease. Eight of twenty-four patients with T₁ or T₂ N₀ lesions were DNCB-negative. With more advanced lesions, reactivity was further impaired. Only one of six patients with T₃ or T₄ N₀ lesions was DNCB-positive. There is an impaired response not only to newly encountered antigens but also to previously encountered antigens.There was a correlation between DNCB reactivity, recurrence, and survival in patients with localized disease. There was also similar correlation of PPD reactivity and survival at the one year level. In the presence of cervical node metastases, there was no apparent difference in recurrence or survival related to DNCB reactivity.Skin test reactivity to DNCB in patients with head and neck cancer has apparent prognostic implications and may be of use in patient management.     

Delayed hypersensitivity skin testing does not influence the management of surgical patients.

Delayed hypersensitivity skin testing was performed at weekly intervals on 95 patients with major surgical illness. Patients with abnormal reactions on initial skin testing had a higher mortality than those who were normal initially (p less than 0.01), but this was not due to a greater rate of major septic complications. Significantly higher rates of sepsis (p less than 0.001) and mortality (p less than 0.001) were found in patients with abnormal reactions at any stage of their illness compared with patients who remained normal throughout. However, careful study of the temporal relationship between skin reactions and clinical events in individual patients suggested that these differences were not of value in clinical practice. Abnormal reactions usually followed obvious complications, such as sepsis or secondary hemorrhage, rather than predicted them. Deterioration of skin reactions from normal to abnormal was observed on 32 occasions in 25 patients but preceded the development of sepsis in only four patients.     

Laparoscopic pelvic lymphadenectomy for prostatic adenocarcinoma.

Endoscopic lymphadenectomy of the iliac and obturator nodes is feasible, and the morbidity to date has been acceptable. Further studies are needed to evaluate the procedure's efficacy and to delineate the clinical situations wherein it is most useful. The technique demands a significant training commitment from surgeons and may become obsolete with the evolution of more sophisticated approaches.     

Delayed-type cutaneous hypersensitivity to Thomsen-Friedenreich (T) antigen in patients with pancreatic cancer

The delayed-type hypersensitivity skin reaction to human erythrocyte-derived Thomsen-Friedenreich (T) antigen was studied in 40 patients with pancreatic disease and in 158 control subjects and its sensitivity and specificity were compared with the carcinoembryonic antigen (CEA) blood levels. The skin reaction to T was positive in 22 of 25 patients with biopsy-proven adenocarcinoma of the pancreas (sensitivity, 88%). In these patients, the CEA levels were elevated above 3.5 ng/ml in 12 of 23 (52%). The skin test to T antigen was negative in 11 of 12 patients with chronic pancreatitis (specificity, 92%), but CEA levels were normal in only five of nine with pancreatitis (56%). Two of the patients with pancreatic carcinoma and one of those with pancreatitis were anergic to mumps and dermatophytin antigens and had thus an invalid skin test. The positive response rate to T antigen was significantly greater (P less than 0.005) in the cancer group than the group with pancreatitis; the CEA response was not significantly different. There were no positive responses to T in 82 healthy volunteers. Among 76 patients with chronic disease including six with malignant tumors of the mesoderm and central nervous system, there were four positive responses: two in heavy smokers and two in patients with chronic lung infection. The specificity of the test overall in 158 controls was thus 97.5%.     

Flow cytometry in prostatic adenocarcinoma

Summary We have examined the reproducibility of DNA histograms produced by flow cytometry in two strains of the Dunning R3327 rat prostatic tumor model, determining the extent of variability between tumors in the same animal, from animal to animal within the same strain and from strain to strain. We have also investigated the ability of flow cytometry to monitor changes in DNA histograms produced by tumor age and hormonal manipulation. We have found that there is a considerable difference in aneuploidy in tumors from the two strains, and also much variability in its extent within each strain. While orchiectomy (ORCH) tended to decrease the extent of aneuploidy, this could only be reliably detected if each tumor acted as its own control, with sampling being done pre- and post-ORCH.     

Pure prostatic papillary adenocarcinoma with ductal features

Papillary adenocarcinoma resembling ductal carcinoma and arising in the peripheral zone is extremely rare. We report a case of prostatic papillary adenocarcinoma with ductal features. The patient was a 68-year-old man who initially presented with dysuria and sensation of residual urine after voiding. Prostatic needle biopsy findings supported pathological diagnosis of prostatitis. The symptoms were improved by medication for prostatitis, and prostate-specific antigen (PSA) level of 22.6 ng/ml descreased to 9.9 ng/ml. It remained between 7.2 ng/ml and 9.9 ng/ml for 2 years. However, it gradually increased to 11.9 ng/ml. Transrectal digital examination, T2-weighted magnetic resonance imaging (MRI) of the prostate and transrecral ultrasound showed a mass in the enlarged right side of the prostate. Transrectal needle biopsy of the mass was performed, and papillary adenocarcinoma was suspected by histological examination. Radical prostatectomy was performed. Histological and immunohistochemical examination of the prostatectomy specimen revealed pure prostatic papillary adenocarcinoma with ductal features.