In response to the questions relating to the lung tumor, the Institute expressed the following opinion: and atrophy or possibly hydronephrosis secondary to radiation-induced ureteral fibrosis. There is no evidence of any of these changes in the two urologic examinations performed, namely November 1965 and October 1966. The rapid clinical We can find no basis for relating the lung tumor to the treatment which the veteran received for possible residuals of the testicular tumor. Although roentgen radiation has been directly responsible for sume tumors (e€.g., skin cancer) we know of no evidence that roentgen therapy, even in large doses, has been a direct cause of carcinoma of lung. And, although it is theoretically possible that roentgen therapy involving the lungs may be indirectly responsible for the development of carcinoma of lung on the basis of radiation pneumonitis with fibrosis (in the nature of so-called scar cancer), there is no evidence of radiation changes in the slides of the resected lower lobe of the teft lung or in the slides of the left hilar lymph nodes. Neither, according to the records response to [the Doctor’s] therapy and the later demonstration of normal kidney function (October 1966) rule out either radiation-induced fibrosis-atrophy or hydronephrosis secondary to ureteral obstruction. 4) Fibrosis of the bladder neck causing (fibrous contracture) could conceivably result from radiation therapy, but: a. For fibrosis in this region to be secondary to the radiation therapy it would be necessary to prove the radiation therapy was indeed given to this region. submitted, were there at any time foltowing the radiation to the chest the clinical symptoms or pulmonary roentgenographic findings assuci- b. A clearer documentation of this clinical impression is ated with radiation pneumonitis. The testicular tumor for which right orchidectomy was done in service (31 May 1944)(slides not submitted) is recorded in the records as “Embryonal carcinoma with lymphoid stroma (Seminoma)” and as ‘“Seminoma (Malignant teratoma).” Although late metastasis is known to necessary. I. What were the cystoscopic findings at (Dr..... ] made this diagnosis? the time 2. What were his impressions as to the etiology of the occur from seminoma, the tumor removed with the lower lobe of the process? tumor. contracture that no evidence of it existed at the subsequent examination in October 1966? Fibrous contracture implied left tung, 17-1/2 years after the orchidectomy bears no resemblance whatever to a seminoma and must be considered an independent primary In response to the question relating to the genitourinary disorders, the Institute stated: a. There is no known or proven relationship between radiation therapy and prostatic hypertrophy. No documented examples of radiation therapy causing hypertrophy have been reported. b. Prostatitis, pyelonephritis and fibrous contracture of the bladder neck could conceivably result from radiation therapy, but: 1) Inflammation induced by radiation is generally acute, occurring at the time of administration of the radiation therapy. Chronic inflammation may occur in the healing stages following tadiation therapy but it is unlikely that chronic inflammation, radiation induced, would persist for 20 years. 2) The chronic prostatitis diagnosed in October 1966 was considered by the examining physician to be secondary to prostate hypertrophy. In addition, no evidence of chronic prostatitis was found at the time of prior urologic examinationin November 1965. The available evidence favors absence of correlation between radiation therapy and chronic prostatitis. 3. What therapy was employed that would so relieve the fibrosis which could only be relieved by surgical deiatation. The Institute of Pathology, therefore, concluded that (1) there was no basis for relating the lung tumor to the roentgen therapy the veteran received for possible residuals to the testicular tumor; and (2) no cause and effect relationship between radiation therapy and the clinical diagnosis of pyelonephritis, prostatic hypertrophy or chronic prostatitis could be established in this case. And, although a cause and effect relationship between radiation therapy and fibrous contracture of the bladder neck (clinical diagnosis) was theoretically possible, it was unlikely in this case due to the long interval between the time the radiation therapy was given and the time the clinical symptoms said to be due to fibrous contracture of the bladder neck appeared. 7 I Findings of the BVA and Basis for Decision: {n denying service connection the Board said in pertinent part: ....The medical reasoning set forth in the report of the Armed Forces Institute of Pathology is Jucid and unequivocal, and reflects the views of this Board. The Board, therefore, concurs in the medical findings and conclusionsof the Institute of Pathology. 3) Pyelonephritis occurring this long after radiation would of necessity be associated with late radiation changes such as fibrosis 34 35