Primary choriocarcinoma of the urinary bladder: a case report.

We present a 37-year-old patient with primary choriocarcinoma arising in the urinary bladder, who received 5 months of intensive chemotherapy with a very good response. He died of a pulmonary embolus before his treatment could be completed. A post-mortem examination revealed extensive necrotic nodules in the lungs and brain. There was only one small focus of viable tumour in the brain. There was no residual tumour in the bladder, and no testicular tumours or scars fulfilling the criteria for a true extragonadal teratoma. It is likely that the origin of the bladder choriocarcinomas is from metaplasia/de-differentiation of a transitional cell carcinoma to the level of trophoblast. Lesser degrees of differentiation producing functional changes in the carcinoma cells with secretion of beta hCG without structural changes are much more common.

Are moving junctions in craniospinal irradiation for medulloblastoma really necessary?

The case notes of 35 patients treated for medulloblastoma using a standard technique of craniospinal irradiation (CSI) from 1978 to 1992 were reviewed. Two large opposed lateral fields to the whole brain and an orthogonal posterior spinal field were used. The position of the junction between the fields was constant throughout treatment with no feathering and no gap. We present our results, review the literature and discuss the need for feathering. The junction between the cranial and spinal fields produces an area of dose inhomogeneity but the clinical significance of this and the effect of feathering is uncertain.

Uterine sarcomas: a review of the Edinburgh experience from 1974 to 1992.

A retrospective review of patients treated for a uterine sarcoma in Edinburgh from 1974 to 1992 has been performed. Clinical details at presentation, tumour pathology, treatment and the outcome of treatment were all recorded. 82 patients' case notes were reviewed. 54 patients had died and 28 were alive (mean follow-up period 80.3 months). 39 patients had a malignant mixed mesodermal tumour, 12 patients had an endometrial stromal sarcoma, and 27 had a leiomyosarcoma. Using a modified FIGO staging retrospectively, 41 patients had Stage 1 disease, two patients had Stage 2, 16 patients had Stage 3, and 13 patients had Stage 4 disease. Definitive treatment of total abdominal hysterectomy and bilateral salpingo-oophorectomy was used in 69 patients, with 35 of these patients also receiving post-operative radiotherapy to the pelvis. 13 patients did not undergo surgery. Five of these patients received radical radiotherapy, three patients received palliative radiotherapy, and five patients were not treated. The overall median survival is 15 months and the 5-year actuarial survival is 31%. 25 of the 26 surviving patients had Stage 1 disease at presentation. Post-operative pelvic radiotherapy did not influence either survival or local tumour control. 51 of the 54 patients who relapsed had evidence of distant metastases. We conclude that total abdominal hysterectomy and bilateral salpingo-oophorectomy remains the treatment of choice for uterine sarcomas.

Sexual morbidity following radiotherapy for germ cell tumours of the testis.

An anonymous questionnaire study was designed to assess sexual function after orchidectomy and radiotherapy for testicular cancer. Questionnaires were sent to: (1) 237 patients treated with orchidectomy and abdominal radiotherapy in Edinburgh from 1974 to 1988; (2) 32 patients under "surveillance" following orchidectomy alone; (3) 402 "normal" age-matched controls. All were asked questions concerning sexual function over the preceding 6 months. All the patients were also asked the same questions with reference to the first 6 months after completion of treatment. Completed questionnaires were returned from 137 (62%) radiotherapy patients, 18 (56%) surveillance patients and 121 (35%) controls. There was a significant difference between the radiotherapy patients and the controls in almost all the parameters looked at including erection, ejaculation and libido with the treated group performing less well. In addition, almost 24% of the radiotherapy patients felt disabled or disfigured by the treatment, most commonly because of the presence of only one testicle. A deterioration in sexual function was observed with increasing age. In the radiotherapy group of patients there was no difference in response between the two time periods or in any of the treatment variables. The clinical significance of these observations are unclear but together with the increasing information on other toxicities emerging following this therapy the role of radiation for early stage seminoma is being brought into question. This study also confirms the morbidity of orchidectomy. We suggest that testicular implants should be offered more widely.