PURPOSE: The role of MRI in the detection of cholangiocarcinoma of the common hepatic duct has rarely been described. This study was attempted to ascertain characteristic MR features of cholangiocarcinoma. MATERIALS AND METHODS: The T1(500/30, TRs/TEs) and T2 weighted(200/80, TRs/TEs) MR images were obtained from nine patients with cholangiocarcinoma of the common hepatic duct. The common hepatic lesions were detected in seven cases. MR features of cholangiocarcinoma were analysed according to the signal intensity and associated findings. RESULTS: The seven cases showed lower signal intensity than the surrounding normal liver parenchyma on T1 weighted image. On T2 weighted image, the tumor showed isosignal intensity and hyperintensity in four and three patients, respectively. T2 image also revealed diffusely increased signal intensity in some hepatic lobe or segment in four cases, and Intrahepatic periductal high signal intensity in one case. Other associated MR findings were intrahepatic metastasis, and intratumoral hemorrhage, each noted in a different case. CONCLUSION: T2 weighted Image appears to be effective in the detection of cholangiocarcinoma of the common hepatic duct and evaluation of its associated intrahepatic lesions.
Cholangiocarcinoma* ; Hemorrhage ; Hepatic Duct, Common* ; Humans ; Liver ; Magnetic Resonance Imaging ; Neoplasm Metastasis

The currently proposed factors inducing prostatic hyperplasia are the combined effect of androgen and estrogen and the reawakening of the embryonic growth potential of mature prostatic stroma. This experiment was designed to find out any histological or structural differences occurring after compensating sex hormones on the mature prostate and the implanted fetal urogenital sinus (UGS) tissue which possesses a differentiating potential under the same condition. The ventral lobe of the rat prostate with implanted fetal UGS showed 4.4 fold increase in weight compared to the non-implanted contralateral ventral lobe. After the castration, both ventral lobes showed marked atrophy, and no further progress in differentiation occurred in the implanted UGS. Dihydrotestosterone (DHT) compensation after castration revealed a significant increase in weight in the mature prostate but the ventral lobe with the implanted UGS showed relatively low recovery rate in weight than in non-castrated control group. The compensation of estradiol after the castration showed little difference in mature prostate compared to castrated control group, but the UGS implanted ventral lobe revealed a relative stromal hyperplasia. Unlike the single-hormone compensation, the mature prostate displayed the characteristic hyperplasia of epithelium of each acinar lumen, but the UGS dearly showed the formation of new acini with nodular pattern when compensated with both DHT and estradiol. The level of DHT showed a significant correlation with the height of the prostatic acinar cell which differentiated from the UGS, and an inverse correlation with the stroma/epithelium ratio of implanted group. The serum concentration of estradiol showed a significant correlation with the relative volume of juxta-prostatic tissues, such as the coagulating gland and the adjacent stroma. From the above results, it might be assumed that the estrogen may have an important role in the embryonic stroma-mediated initiation of nodular hyperplastic changes of microacini under the influence of DHT and the determination of histologic pattern after initiation might be controlled by the prostatic DHT concentration.
Acinar Cells ; Adult* ; Animals ; Atrophy ; Castration ; Compensation and Redress ; Dihydrotestosterone ; Epithelium ; Estradiol ; Estrogens ; Gonadal Steroid Hormones ; Humans ; Hyperplasia ; Mice* ; Prostate* ; Prostatic Hyperplasia ; Rats

Inadequate effectiveness of anticancer drug in treating renal cell carcinoma has been attributed to the overexpression of multidrug resistance gene (MDR1) and its product, membrane-bound P-glycoprotein. P-glycoprotein is known to actively pump out intracellular drug, which results in low intracellular anticancer drug concentration. Progesterone, which has been used in patients with advanced renal cell carcinoma is found to cause a three to four-fold increase in vinblastine accumulation in the P-glycoprotein-expressing murine macrophage-like cell line.We have studied to evaluate the MDR modulating action of medroxyprogesterone acetate (MPA) in renal cell carcinoma cell lines also with tamoxifen and verapamil. A-498 of a high mdrl expressed cell line and Caki-2 of a low mdrl expressed cell line were each placed in 96 multiwell plates. Vinblastine, in concentration from 0.01 ug/ml to 10 ug/ml was added to each well and verapamil, from 0.1 uM to 10 uM, MPA, from 2.5 uM to 25 uM, or tamoxifen, from 0.1 uM to 10 uM was also added. The in vitro chemosensitivity of two renal cell carcinoma cell lines (Caki-2 and A498) to vinblastine was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazol bromide(MTF) colorimetric assay. Growth of Caki-2 cells is inhibited by low doses of vinblastine(IC50: 0.27 ug/ml), but A-498 cells are highly resistant to the drug, with ICs0 value of 0.47 ug/ml. The chemosensitivity of the A-498 cells is increased in response to 5 uM MPA, 1 uM verapamil and 2 uM tamoxifen, which are known to partially reverse the MDR phenotype in other resistant tumors. The effective concentration of MPA for MDR reversal is in clinically achievable concentration but one of verapamil is not. The chemosensitivity of Caki-2 cells does not change according to MDR modulating agents. .MPA is an effective MDR modulating agents to enhance the cytotoxicity of vinblastine in renal cell carcinoma cell line showing P-glycoprotein expression. It suggests that combination therapy of MPA and vinblastine is better than monotherapy with MPA or vinblastine alone.
Carcinoma, Renal Cell* ; Cell Line* ; Drug Resistance, Multiple ; Genes, MDR ; Humans ; Medroxyprogesterone Acetate* ; Medroxyprogesterone* ; P-Glycoprotein ; Phenotype ; Progesterone ; Tamoxifen ; Verapamil ; Vinblastine*

Inadequate effectiveness of anticancer drug in treating renal cell carcinoma has been attributed to the overexpression of multidrug resistance gene (MDR1) and its product, membrane-bound P-glycoprotein. P-glycoprotein is known to actively pump out intracellular drug, which results in low intracellular anticancer drug concentration. Progesterone, which has been used in patients with advanced renal cell carcinoma is found to cause a three to four-fold increase in vinblastine accumulation in the P-glycoprotein-expressing murine macrophage-like cell line.We have studied to evaluate the MDR modulating action of medroxyprogesterone acetate (MPA) in renal cell carcinoma cell lines also with tamoxifen and verapamil. A-498 of a high mdrl expressed cell line and Caki-2 of a low mdrl expressed cell line were each placed in 96 multiwell plates. Vinblastine, in concentration from 0.01 ug/ml to 10 ug/ml was added to each well and verapamil, from 0.1 uM to 10 uM, MPA, from 2.5 uM to 25 uM, or tamoxifen, from 0.1 uM to 10 uM was also added. The in vitro chemosensitivity of two renal cell carcinoma cell lines (Caki-2 and A498) to vinblastine was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazol bromide(MTF) colorimetric assay. Growth of Caki-2 cells is inhibited by low doses of vinblastine(IC50: 0.27 ug/ml), but A-498 cells are highly resistant to the drug, with ICs0 value of 0.47 ug/ml. The chemosensitivity of the A-498 cells is increased in response to 5 uM MPA, 1 uM verapamil and 2 uM tamoxifen, which are known to partially reverse the MDR phenotype in other resistant tumors. The effective concentration of MPA for MDR reversal is in clinically achievable concentration but one of verapamil is not. The chemosensitivity of Caki-2 cells does not change according to MDR modulating agents. .MPA is an effective MDR modulating agents to enhance the cytotoxicity of vinblastine in renal cell carcinoma cell line showing P-glycoprotein expression. It suggests that combination therapy of MPA and vinblastine is better than monotherapy with MPA or vinblastine alone.
Carcinoma, Renal Cell* ; Cell Line* ; Drug Resistance, Multiple ; Genes, MDR ; Humans ; Medroxyprogesterone Acetate* ; Medroxyprogesterone* ; P-Glycoprotein ; Phenotype ; Progesterone ; Tamoxifen ; Verapamil ; Vinblastine*

Surgical tumor resection, most appropriately together with the affected organ, is the sole form of curative therapy in low-staged renal cell carcinoma. But the fact that about 30% of patients show distant metastases or regional lymph node metastases at the time of diagnosis of renal cell carcinoma indicates the urgent need for the development of an effective treatment modalities. Herein we report the preliminary result of chemo-immuno-hormonal(triple) combination therapy which consists of a-interferon, vinblastine and medroxyprogesterone acetate in 17 patients with metastatic renal cell carcinoma from June 1990 to June 1994. The patients received the treatment with the combination of alpha interferon(a-IFN: 6 million units IM three times a week), vinblastine(VBL: 3 mgN2 IV monthly) and medroxyprogesterone acetate(MPA: 600 mg IM twice a month) at least 6 cycles. Although almost all the patients tolerated the treatment a few patients were stopped the treatment when the general condition of the patient became poor in progressive disease The 5 of 17 patients showed partial response and one patient with lung and liver metastasis was resolved completely. The response rate was 35.3% after treatment and the survival rates for 6 month and 1 year were 70.6% and 47.1%, respectively. So the chemo-immuno-hormonal combination therapymight be an alternative safe modality and be able to prolong the survival duration in patients with advanced renal cell carcinoma.
Carcinoma, Renal Cell* ; Diagnosis ; Drug Therapy ; Humans ; Liver ; Lung ; Lymph Nodes ; Medroxyprogesterone ; Medroxyprogesterone Acetate ; Neoplasm Metastasis ; Survival Rate ; Vinblastine

PURPOSE: The therapeutic dose of cytokine for patients with advanced renal cell carcinoma is very high and leads to toxic side effects and a substantial cost to the patients. Interleukin-2(IL-2) could be released continuously and slowly in the host by genetic engineering of IL-2 genes and increase host immunity with decreasing the a verse effects of the drug. We investigated the IL-2 gene expression, amplification of viral titer, and transduction of IL-2 gene into human renal cell carcinoma cell line with retroviral vectors. MATERIALS AND METHODS: For the production of retroviral vectors with the IL-2 gene, we used PA-317 as a packaging cell and Caki-2 as a renal cell carcinoma cell. Retroviral supernatants were added to culture flask containing Caki-2 cells and after 48 hours, replacement with a media containing G418(Gibco, Grand Island, NY) 800 microgram/m1 was done for selection of transfected colonies. The selected colonies were cultured and then measured the amount of IL-2 production per 1xl0(6) for 24 hours using an ELISA assay kit(BioSource International, USA) for IL-2. RESULTS: Thirteen colonies were selected and the amount of IL-2 production was 143.1 +/-75.3pg/m1/10(6) cells/24hr(range: 51.5-370.7). CONCLUSIONS: The success of transduction of the IL-2 gene into human renal cell carcinoma cell lines with a retroviral vector will give a possibility in gene therapy for advanced renal cell carcinoma and may have promising results
Carcinoma, Renal Cell* ; Cell Line* ; Enzyme-Linked Immunosorbent Assay ; Gene Expression ; Genetic Engineering ; Genetic Therapy ; Humans* ; Interleukin-2* ; Product Packaging ; Zidovudine*

In patients with prostatic adenocarcinoma with bony metastasis, pain palliation is an important point in improving their life quality. It is a known fact that local external irradiation is an effective treatment modality for metastatic bone pain. Because bony metastasis often affects multiple sites in prostatic adenocarcinoma, hemibody irradiation is often necessary. But it has various complications. Strontium-89 was administered in 6 patients with prostatic adenocarcinoma with symptomatic multiple bony metastasis whose pain was not controlled with local external irradiation or antiandrogen therapy. In 2 of 6 patients, pain disappeared and in other 2 of 6 patients, pain decreased to 20% of pretreatment level. Hematologic adverse effect did not appear in any patient. Along with decreasing pain, need of analgesics decreased and life quality of the patients improved. However, the PSA level of the patients did not change. Strontium-89 treatment for patients with prostatic adenocarcinoma with symptomatic bony metastasis is a valuable treatment modality in improving life quality of the patients and time-saving when compared with other treatment modalities. However there are some unsolved questions in Strontium-89 treatment such as when to start the treatment and its indications. A prospective study thould be designed including more cases.
Adenocarcinoma ; Analgesics ; Hemibody Irradiation ; Humans ; Neoplasm Metastasis ; Prostate* ; Prostatic Neoplasms* ; Quality of Life

The prostate specific antigen(PSA) has the most available clinical value in monitoring the disease status and treatment response, especially in patients with advanced metastatic adenocarcinoma of prostate. Between March 1992 and May 1994, 22 patients with newly diagnosed metastatic prostate cancer received gonadotropin-releasing hormone analogue monthly and antiandrogen daily. The 15 patients whose serum PSA levels were normalized within the first 3 months had serum PSA level of 71.3+/-22.7 ng/ml at the time of diagnosis and their Gleason score was 6.2+/-1.3. The other 7 whose serum PSA levels were not normalized even after hormonal treatment, had 75.6+/-39.1 ng/ml of serum PSA level at the time of diagnosis and their Gleason score was 8.71+/-0.98. There was not signifcantly different in PSA levels but in Gleason scores between the two groups at diagnosis. So the serum PSA level of patients with low Gleason score have a tendency to be normalized within 3 months of hormonal treatment. And we suggest that the normalization of serum PSA level after 3 months treatment might be the earliest and most highly correlated predictor of response or prognosis.
Adenocarcinoma ; Diagnosis ; Gonadotropin-Releasing Hormone ; Humans ; Neoplasm Grading* ; Prognosis ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms*

PURPOSE: The Bard Bladder Tumor Antigen(BTA) test is a latex agglutination assay that qualitatively detects the presence of basement membrane degradation complexes in the urine when the bladder tumor cells invade and destruct an extracellular matrix, called basement membrane. We evaluated the clinical significance of BTA test in the diagnosis and follow-up of patients with bladder cancer by comparing it with bladder washing cytology. MATERIALS AND METHODS: The Bard BTA test was compaired to bladder washing cytology in 26 patients with bladder cancer(group l), 18 undergoing surveillance cystoscopy for previous bladder cancer(group ll), and 10 suffering from other urologic diseases except bladder cancer(group lll). RESULTS: Of the group l patients, 84.6% were correctly diagnosed with the Bard BTA test compared to 69.2% with bladder washing cytology, which is statistically significant(p < 0.05). There was no difference in sensitivity according to tumor grade and stage. There was a high positive rate in group ll and lll patients probably due to the degeneration of basement membrane by other conditions such as intravesical BCG or mitomycin instillation, infection, or prostate cancer. CONCLUSIONS: The Bard BTA test is a non-invasive, simple, rapid, inexpensive adjunct to cystoscopy, and superior to bladder washing cytology in sensitivity, but many false positive results were observed. Further clinical evaluation is warranted to determine whether the false positive results are true or the result of inadequate number of patients studied.
Agglutination ; Basement Membrane ; Cystoscopy ; Diagnosis* ; Extracellular Matrix ; Follow-Up Studies* ; Humans ; Latex ; Mitomycin ; Mycobacterium bovis ; Prostatic Neoplasms ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urologic Diseases

Polyamines are non-specific marker of cellular proliferation in many malignant tumors, and it is also increase in certain benign conditions. We measured the urinary polyamines to investigate the possibility as a marker of abnormal prostate growth and the correlation with various clinical parameters. Urinary polyamine concentrations in 27 cases of symptomatic benign prostatic hyperplasia (BPH) were compared with those in 32 cases of age matched normal controls. Urinary concentration of polyamine profiles were quantitatively determined by Gas Chromatography/Nitrogen Phosphorus Detector and they were calculated by the correction of gram creatinine. The concentrations of N-acetyl putrescine, N-acetyl cadaverine, spermidine(spd), N1-acetyl spermidine, N8-acetyl spermidine, and spermine(spm) showed significant increase in BPH compared with normal control(all p<0.05). Level of serum prostate specific antigen(PSA) in BPH patients was negatively correlated with the concentration of urinary spermidine(p=0.049). And the ratio of spm/spd correlated with the level of prostate volume(p=0.046). No significant correlations was found between other clinical parameters such as age, level of hemoglobin or erythrocyte count with polyamine profiles concentration. These data suggested that urinary concentration of polyamines in BPH are elevated compared with those in normal control. Altered regulation of the biosynthesis and metabolism of spermidine and spermine may be involved in BPH.
Cadaverine ; Cell Proliferation ; Creatinine ; Erythrocyte Count ; Humans ; Metabolism ; Phosphorus ; Polyamines ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Putrescine ; Spermidine ; Spermine