A rare case of adenocarcinoma of bladder following augmentation enterocystoplasty

This is a report of a case of poorly differentiated adenocarcinoma found 20 years after bladder augmentation ileoplasty. The origin of this tumor was proved to be the ileal part of bladder augmentation. Autopsy revealed metastatic lesions in the stoma (sigmoid conduit), lungs, liver, left femur, adrenal glands and lymph nodes. A review of the literature revealed only one other such case. This is a rare case of adenocarcinoma in the ileal part of bladder augmentation.     

A case of sigmoid colon cancer that spread to the urinary bladder via the ureter

A 69-year-old male was admitted to the hospital with the chief complaint of left hydronephrosis and diagnosed. A year ago, he underwent sidmoidectomy to cure sigmoid colon cancer diagnosed as stage IV. Ultrasonography (US) and computed tomography (CT) detected the compression of the ureter at its middle left due to the enlargement of the left iliac lymph node and hydronephrosis and hydroureter at the proximal to the compressed part. Then, a ureteral tumor was suspected and urinary cytology was class V. Cystoscopy detected a papillary tumor projecting from the left ureteral orifice. Because the histopathological manifestation by transurethral resection of bladder tumor and that by the sidmoidectomy were consistent, it was considered that sigmoid colon cancer spread to the urinary bladder via the left ureter. There have been only 4 reported cases of adenocarcinoma that multiplied in the ureter, and this is the fifth case report.     

Metastatic intrapelvic tumor from esophageal cancer: a case report

We report a case of a metastatic intrapelvic tumor arising from esophageal cancer. The patient, a 74-year-old man, visited our hospital with the chief complaint of gross hematuria. Magnetic resonance imaging and cystoscopy revealed a huge intrapelvic tumor which invaded the bladder, rectum, sigmoid colon and left ilium. The patient underwent total pelvic evisceration with ileal conduit and colostomy. Pathologic diagnosis of the intrapelvic tumor was moderately differentiated squamous cell carcinoma. Preoperatively, gastrointestinal fiberscopy revealed an esophageal tumor, and biopsy showed moderately differentiated squamous cell carcinoma. Finally, the intrapelvic tumor was diagnosed as metastatic tumor from esophageal cancer.     

Neoadjuvant therapy and bladder substitute for invasive bladder cancer: 20 years experience at Tohoku University

BACKGROUND: Neobladder, using the intestine, was performed after neoadjuvant therapy and total cystectomy as a treatment for invasive bladder cancer. METHODS: Between January 1977 and April 1997, an ileocecal neobladder was used for 23 patients and a sigmoid neobladder was chosen for use in 32 patients. For the diagnosis of invasive bladder cancer and the evaluation of neoadjuvant therapy, we used whole-layer core biopsy (WLCB) of the bladder tumor and fine needle aspiration biopsy (FNAB) of pelvic lymph nodes after bipedal lymphography. For neoadjuvant therapy, two to four courses of internal iliac arterial infusion chemotherapy (IIA) were undertaken in 32 patients. Five patients were treated with IIA combined with 40 Gy irradiation to the pelvic space. RESULTS: Pretreatment WLCB revealed a tumor of stage T2b or greater in 10 patients. After neoadjuvant therapy, three patients were down-staged to pT0. In five patients, pretreatment FNAB revealed pelvic lymph node metastases that were not detected by computed tomography or magnetic resonance imaging. Fine needle aspiration biopsy post-neoadjuvant therapy revealed tumor stage N0 in all patients and lymph node dissection revealed pN0 in four patients. Of the five patients who received 40 Gy irradiation, none had any postoperative complications, such as intestinal fistula or urinary leakage. Four male patients (10%) had urethral recurrence, but all were successfully treated by transurethral resection. Two patients treated prior to 1985 experienced local recurrence. Neither was treated by neoadjuvant therapy. Eight patients who died after 1985 had metastatic cancer, but none had local recurrence. None of the patients who received a sigmoid neobladder required clean intermittent catheterization or had bilateral vesico-ureteral reflux. CONCLUSIONS: Neoadjuvant therapy seems to reduce local recurrence in invasive bladder cancer. The sigmoid colon may be suitable for neobladder.     

A case of fistula between the urinary bladder and an ovarian dermoid cyst

A 20-year-old woman was referred to our hospital for further evaluation on persistent pyuria. Physical examination showed a tender solid suprapubic mass. Computed tomography showed a right ovarian multilocular cystic tumor just above the urinary bladder. Cystoscopy showed pus leakage from an orifice in a hemisphere protrusion of the bladder wall. A small catheter could be inserted into the orifice. It revealed a fistula 4 cm in length between the right ovarian tumor and the vesical cavity. The tumor and the adjacent thickened bladder wall with an abscess and fistula were resected en bloc. Also a small left ovarian cyst was enucleated. Histopathological examination showed bilateral ovarian dermoid cysts, abscess formation, and marked inflammatory change around the fistula in the vesical wall. The fistula was thought to be the consequence of infection of the ovarian cyst.     

A case report of inflammatory pseudotumor of the urinary bladder due to diverticulitis of the sigmoid colon

A 65-year-old female presented to our hospital with a 6-month history of pollakuria, low-grade fever and urgent incontinence. Cystoscopy revealed a nonpapillary bladder tumor that was 50 mm in diameter in the trigon. Computed tomography showed the abscess between the urinary bladder and sigmoid colon. Transurethral resection was performed and the histology consisted of inflammatory lesions with inflammatory cell infiltration, which was diagnosed as an inflammatory pseudotumor due to diverticulitis of the sigmoid colon. Sigmoidectomy was subsequently performed. A fistula between the urinary bladder and the sigmoid colon was not detected. Cystoscopy 2 months after the operation revealed no signs of a bladder tumor.     

Invasive bladder cancer recurrenced 5 years after complete response status by chemotherapy and radiotherapy: a case report

A 72-year-old man had undergone trasucethral resection of bladder tumor (TUR-Bt) three times from 1990 to 1991 and he had been lost to follow with no recurrence from 1996, came to our hospital complaining of asymptomatic macrohematuria in May 1999. A bladder tumor existed around the right ureteral orifice with right hydronephrosis. MRI and TUR-Bt revealed that the cancer was transitional cell carcinoma (TCC) > small cell carcinoma, G3, pT3b. Because the patient insisted on bladder preservation, intra arterial chemotherapy with cisplatinum (CDDP) and epirubicin (EPI-adr) followed by radiotherapy with CDDP was performed. The treatment resulted in a clinical complete response (CR), and the bladder was preserved. In January 2004, an invasive bladder cancer recurred at the left lateral wall. This time, neoadjuvant intra-arterial chemotherapy with CDDP and EPI-adr, followed by radical cystectomy was performed. Histologically, the recurrent bladder cancer was TCC, G3, pT3b.     

Metachronous urothelial cancer in bilateral upper urinary tracts and bladder associated with hereditary nonpolyposis colorectal cancer

A 40-year-old man had undergone right hemicolectomy and sigmoidectomy under the diagnosis of ascending and sigmoid colon cancer and right nephroureterectomy under the diagnosis of right ureteral cancer, in 1997 and in 2002, respectively. In 2007, He visited our hospital with a complaint of bloody stool and hematuria. Colon fiberscopy, ureteropelvicscopy and cystoscopy demonstrated colon cancer, left renal pelvis cancer and bladder cancer, respectively, as diagnosed by biopsies, followed by restative colectomy, left nephroureterectomy and cystectomy. The final histopathological examination showed well differentiated adenocarcinoma (pSM) in the colon, and urothelial carcinoma in the left renal pelvis (pT2) and the bladder (pT1). Since his uncle and elder brother had suffered from stomach cancer and colon cancer, respectively, he was diagnosed with hereditary nonpolyposis colorectal cancer (HNPCC : Lynch syndrome). He has been well doing without recurrence for 3 years after the surgery.     

Primary intestinal type adenocarcinoma of the urinary bladder: a case report]

A 43-year-old man was referred to our hospital with complaints of macroscopic hematuria, micturition pain, and pollakisuria. Cystoscopy revealed a papillary broad-based tumor of 4 cm in diameter at the posterior wall and trigone of the urinary bladder. A punch biopsy specimen was diagnosed histopathologically as adenocarcinoma mimicking colorectal cancer. Computed tomographic (CT) scan demonstrated a large tumor involving both the urinary bladder and the rectum. Total cystoprostatectomy and low anterior resection following colorectal anastomosis, double barreled colostomy, and ileal conduit urinary diversion were performed. The tumor was diagnosed histopathologically as primary intestinal type adenocarcinoma of the urinary bladder infiltrating the sigmoid colon and the small intestine. The patient died 12 months after the operation due to peritonitis carcinomatosa.     

Bladder carcinoma metastases presenting as intraperitoneal dissemination without local recurrence: a case report

A 76-year-old woman presented with gross hematuria and was referred to our OPD. Cystoscopy showed broad-based papillary tumors on the left bladder wall. TUR-BT was performed and pathological diagnosis was grade 3 transitional cell carcinoma of pT1a. Although no intravesical tumor recurrence had been observed, a solid palpable mass was noted in the lower abdomen nine months after TUR-BT, and computed tomography suggested a large ovarian tumor. Subsequently performed was the operation at Gynecology, which revealed a large tumor involving the whole major omentum. Frozen sections of the tumor were diagnosed as transitional cell carcinoma metastases of the bladder cancer, and the final pathological report was the same. Although receiving 4 courses of M-VAC systemic chemotherapy after the operation, she died 14 months later. Autopsy disclosed intraperitoneal cancer dissemination and metastases without any intravesical nor left perivesical tumor recurrence, and it was suggested that the bladder tumor metastases occurred not by direct invasion but by either lymphatic or vascular mechanism in this case.     

Adenocarcinoma of the ileal segment with transitional cell carcinoma of the bladder following ileocytoplasty: a case report

A 67 year-old woman visited our hospital complaining of pollakisuria. She had undergone left nephrectomy and augmentation ileocystoplasty for tuberculous bladder atrophy 40 years previously. She underwent a total cystectomy and tubeless ureterocutaneostomy with a preoperative diagnosis of muscle-invading transitional cell carcinoma of the bladder. The pathological diagnosis was adenocarcinoma of the ileal segment and transitional cell carcinoma of the original bladder. This is the first case report of adenocarcinoma of the ileal segment and transitional cell carcinoma of the original bladder among 22 patients suffering from bladder cancer after ileocystoplasty.     

Late relapse and urothelial carcinoma of residual ureter 16 years after radical nephrectomy: a case report

A 66-year-old male was referred to our hospital for evaluation of tumors in his left residual ureter and the lung. He had a history of left nephrectomy due to "malignant renal tumor", performed by a general surgeon at another hospital 16 years ago. Since a definitive diagnosis of the kidney was uncertain, we speculated that the original renal disease was a renal pelvic cancer and had metastasized in the residual ureter and the lung. We performed systemic chemotherapy followed by resection of residual ureter with bladder cuff Pathological examination revealed urothelial carcinoma. However, the lung tumors did not respond to salvage chemotherapy and slowly progressed. Bronchoscopic biopsy was performed 2 years later and histological finding showed clear cell type renal cell carcinoma.     

Abdominal Actinomycosis Misdiagnosed as a Secondary Bladder Tumor: A Case Report

A 46-year-old woman presented with a hypogastric mass. The preoperative diagnosis was a malignant ovarian tumor involving multiple organs, including the urinary bladder. Surgical exploration was performed with wide resection of the right ovary and uterus, including the affected ileum, sigmoid colon, and omentum. An intraoperative histopathological examination of the paravesical tissue revealed abdominal actinomycosis. Consequently, bladder resection was not done. The cause of abdominal actinomycosis in this patient was probably due to implantation of an intrauterine device 3 years previously.     

Primary adenocarcinoma of renal pelvis and ureter suspected as metastatic tumor: a case report

A 58-year-old man, who had undergone sigmoidectomy for sigmoid colon adenocarcinoma 3 years earlier, was referred to our clinic because of left ureteral tumor incidentally found by computed tomography (CT). Under the diagnosis of left ureteral carcinoma, retroperitoneoscopic left nephroureterectomy was performed. Pathological examination revealed adenocarcinoma of the left renal pelvis and ureter. Subtype of the adenocarcinoma was 'enteric type'. Five months later, urine cytology was positive and multiple non-papillary tumors were found on cystoscopy. By the transurethral resection of the tumors, bladder tumors appeared to be adenocarcinoma. Carefully considering the pathological findings and clinical course, we concluded that the tumor was not metastatic but primary adenocarcinoma followed by intravesical recurrence.     

Experience with demucosalized ileum for bladder augmentation

OBJECTIVE: To assess the use of demucosalized ileum for bladder augmentation, following the same principles previously used with the sigmoid colon. PATIENTS AND METHODS: Eleven patients with bladder exstrophy or a neurogenic bladder had their bladders augmented with demucosalized ileum instead of the sigmoid colon, but following the same technique. The use of a Foley catheter with an inflated balloon greatly facilitated the dissection of the mucosa from the muscle. A silicone model, inserted in the bladder, was used to avoid shrinkage of the patch. An animal model was also used for total bladder replacement following the same principle. RESULTS: The mean (range) follow-up was 15.4 (2-25) months. There was a significant increase in bladder compliance in all patients. A bladder of good shape and compliance was obtained in the animal model, with epithelial growth detected in all cases. CONCLUSIONS: Demucosalized ileum can be used safely for bladder augmentation in the same way as with the sigmoid colon. The distension of the isolated patch greatly facilitates dissection between the mucosa and muscle. The animal model supported this method of bladder replacement.     

Nephrogenic Adenoma in a Patient with Transitional Cell Carcinoma of the Bladder Receiving Intravesical Bacillus Calmette-Guérin

A 76-year-old-man was admitted to our hospital for a recurrent bladder tumor. He had received intravesical bacillus Calmette-Guérin (BCG) treatment for a transitional cell carcinoma of the bladder. A follow-up cystoscopy revealed a solitary papillary tumor in the left bladder wall. A transurethral cold cup biopsy revealed a nephrogenic adenoma without any evidence of malignant cells. We discuss the pathogenesis of nephrogenic adenoma and suggest that prolonged cystitis caused by intravesical BCG may play an etiological role.     

A case of bladder transitional cell carcinoma with sigmoidovesical fistula due to diverticulitis

We present a case of bladder transitional cell carcinoma with sigmoidovesical fistula due to diverticulitis. The patient was a 65-year-old male who had been suffering from recurrent abdominal pain with high fever for the past 6 months. He noticed pneumaturia and cloudy urine several times. He visited a doctor complaining of macroscopic hematuria and high fever, and was treated under the diagnosis of acute prostatitis. In our University Hospital cystoscopy showed a papillary bladder tumor. Pathological study of the tumor revealed transitional cell carcinoma, grade II, noninvasive type. Multiple diverticulosis of sigmoid colon was identified with barium enema examination. We performed transurethral resection of the bladder tumor. Three weeks later, the sigmoidovesical fistula was treated by primary resection of the sigmoid colon and wedge resection of the bladder including fistula.     

Triple cancer in the urinary system: a case report

A 74-year-old male was referred to our hospital due to microhematuria that was pointed out at his health check-up. Cystoscopy showed many papillary bladder tumors under 5 mm in size. Intravenous pyelography also showed deformity of the right kidney and shadow defects in the left renal pelvis. Abdominal computed tomography revealed an 8 cm tumor invading the renal vein in the right kidney, and a 3 cm tumor in the left renal pelvis. Prostate biopsy was performed with PSA 3.4 ng/ml, and he was also diagnosed with prostate carcinoma. First, he received right radical nephrectomy, and secondly left nephroureterectomy and cystectomy. Our case should be called triple cancer because bladder cancer was thought to be daughter tumor of renal pelvic tumor. This is, to our knowledge, the 11th case report that occurred in the urinary tact, and the first case that needed total resection of urinary tract.     

A case of synchronous ipsilateral renal cell carcinoma and transitional cell carcinoma]

A case of synchronous ipsilateral renal cell carcinoma with renal pelvic and ureteral transitional cell carcinoma is reported. A 80-year-old man, who had had transurethral resection of bladder tumor three times, was admitted on August, 1989 for recurrence of bladder tumor. Excretory pyelography revealed a filling defect of left renal pelvis. Findings of retrograde pyelography and computed tomography were in accord with those of the excretory urograms. Under a diagnosis of the left renal pelvic and ureteral tumor associated with the bladder tumor, left nephroureterectomy with bladder cuff resection was performed. Pathological diagnosis was renal pelvic and ureteral transitional cell carcinoma with renal cell carcinoma, which existed incidentally in the same kidney. Double unrelated primary carcinoma in urinary tract, especially, double dissimilar primary carcinoma in the same kidney, is rare. To our knowledge, this case is the 20th double cancer in upper urinary tract reported in Japan.     

Mucosa-associated lymphoma of the bladder with relapse in the stomach after successful local treatment

A 64-year-old woman was referred to our hospital for management of an ovarian tumor. Abdominal computed tomography and magnetic resonance imaging revealed a dermatoid cyst of the ovary and a bladder tumor. Transurethral resection of the bladder tumor was performed. Histopathological examination of the tumor revealed non-Hodgkin's lymphoma of the mucosa-associated lymphoid tissue MALT type. The patient received radiotherapy for the bladder and had a complete response. Nineteen months later, gastrointestinal endosopy revealed the presence of a mass lesion in the stomach. Histopathological examination of biopsy specimens from this tumor indicated the same tumor as that in the bladder as they showed identical IgH gene rearrangement. Because of the detection of evidence of Helicobacter pylori (HP) infection in the gastric mucosal biopsy specimens, the patient was administered HP eradication therapy, but, the tumor persisted. After radiotherapy, the stomach tumor disappeared. Since then she remains without evidence of local recurrence or relapse.