Fine Needle Aspiration Biopsy of the Penis: Transitional Cell Carcinoma of the Urinary Bladder with Mucinous Differentiation

We report a case of transitional cell carcinoma of the urinary bladder metastatic to the penis. The diagnosis was established by fine needle aspiration biopsy (FNAB). Malignant cells showed mucinous differentiation. Ancillary studies carried out in the FNA material as well as in the primary bladder carcinoma suggested transitional cell carcinoma with mucinous differentiation. FNAB proved to be effective in diagnosing a secondary neoplasm to the penis. Mucoid differentiation of urothelial cells can be seen in FNAB specimens and might pose a problem in differential diagnosis.     

膀胱内翻性乳头状瘤的诊治

目的：探讨膀胱内翻性乳头状瘤的临床特点、病因、病理和诊断治疗。方法：回顾性分析50例膀胱内翻性乳头状瘤的临床资料,复习相关文献,并随访患者。结果：所有患者均接受经尿道膀胱肿瘤电切术（TURBT）治疗;术后病理证实均为膀胱内翻性乳头状瘤,其中29例合并膀胱移行细胞癌;术后42例行膀胱灌注治疗,随访3个月～5年,1例患者肿瘤复发。结论：膀胱内翻性乳头状瘤是泌尿系少见的良性肿瘤,易合并移行细胞癌,很少复发,预后良好。确诊需行内镜检查及活检。TURBT是其标准治疗方法。术后予膀胱灌注有利于防治复发。     

Antitumor Killer Lymphocytes in the Peripheral Blood of a Patient with Transitional Cell Carcinoma of the Bladder

Background: Peripheral blood lymphocytes (PBL) from patients with bladder cancer also contain cells possessing cytotoxic activity against autologous tumor cells. These cells are phenotypically heterogenous and include natural killer (NK) and cytotoxic T cells. This study investigated the role of cytotoxic lymphocytes directed against autologous bladder cancer cells.
Methods: PBL were obtained at intervals before and after surgery and analyzed for cytotoxic activity against autologous bladder cancer cells in 4-hour⁵¹ Cr release assay. PBL stimulated with autologous tumor cells were also transformed with human T-lymphotropic virus type-1, establishing a cell line (KB31) which was analyzed for phenotype and cytotoxic activity against the autologous tumor cells.
Results: PBL preoperative cytotoxic activity was low, but increased after surgery. Cytotoxic activity was found not only against autologous bladder cancer cells, but also against heterologous bladder cancer (KK-47) and myeloid leukemia (K562) cells, with the highest activity against the heterologous cell lines. The cytotoxic activity of KB31 was 40|X% against autologous tumor cells 6 weeks after initiation of the cell line, but decreased to 5|X% by 6 months. This activity was lower than that against the other cell lines, and was similar to that of PBL in short-term culture. Fluorescence-activated cell sorter (FACS) analysis demonstrated that in KB31 cells at 6 weeks, CD8+ cells were dominant, but CD56+ cells predominated at 6 months.
Conclusion: These results suggest that the presence of cytotoxic activity in the peripheral blood of the patient was due to both cytotoxic T cells and NK cells. The cytotoxic activity was lowest prior to surgery and increased postoperatively.     

Tumor recurrence in the remnant urothelium of females undergoing radical cystectomy for transitional cell carcinoma of the bladder: long-term results from a single center

PURPOSE: We analyzed the risk factors and incidence of secondary TCC of the remnant urothelium in women following radical cystectomy for TCC of the bladder. MATERIALS AND METHODS: A total of 85 women with a mean age of 64.5 years with clinically localized TCC of the bladder underwent radical cystectomy between 1992 and 2004. Orthotopic bladder substitution was performed in 46 females, while 39 underwent nonorthotopic urinary diversion. Of the entire cohort 22 (26%) patients underwent cystectomy for multifocal or recurrent TCC. Followup examinations were performed at 6-month intervals. RESULTS: Mean followup in the entire cohort was 49.8 months (median 42). Intraoperative frozen sections obtained from the urethra and distal ureters were negative for TCC and CIS in all patients. Four women (4.7%) had TCC in the remnant urothelium at a mean of 56 months postoperatively. These patients had undergone cystectomy for multifocal or recurrent TCC (4 of 22 or 18%). No secondary TCC was seen in the 63 patients with solitary invasive or nonrecurrent bladder cancer (p <0.05). Urethral recurrence was found in 2 patients (4.3%) 65 and 36 months after orthotopic neobladder surgery, respectively. In the orthotopic group 1 patient (2.1%) had an upper urinary tract tumor 76 months after surgery, while in the nonorthotopic group 1 (2.5%) was found to have an upper urinary tract tumor 48 months postoperatively. CONCLUSIONS: Recurrent or multifocal TCC may represent a risk factor for secondary TCC of the remnant urothelium after cystectomy. In our series all recurrent tumors were late recurrences (more than 36 months postoperatively). Because the rate of urethral recurrence in the current series corresponds to that reported in men (2% to 6%), urethra sparing cystectomy with orthotopic bladder replacement does not appear to compromise the oncological outcome in women.     

Bulky Transitional Cell Carcinoma of Bladder with Inverted Proliferation

Two women, aged 51 and 62 years, had unusual transitional cell carcinomas of the urinary bladder which were > 5 cm and had a structural resemblance to inverted papilloma or Brunn's nest. They were treated by bladder-preserving surgery with no evidence of recurrence after 30 and 1 03 months follow-up, respectively. Our cases show some hitherto unrecognized aspects of transitional cell carcinoma with inverted proliferation because the tumors are usually found in males and tend to be aggressive.     

Changing patterns of bladder cancer in the USA: evidence of heterogeneous disease

Study Type – Disease prevalence (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? The incidence of bladder cancer has shown a slightly decreasing trend during the past several decades. All published epidemiological studies have trended papillary transitional cell carcinoma (PTCC) and non‐papillary transitional cell carcinoma (NPTCC) as one single disease called transitional cell carcinoma (TCC). This study for the first time examined the time trends by PTCC and NPTCC and found that these two histological subtypes presented different temporal trends. The study results support the hypothesis that bladder cancer is a heterogeneous disease and taking disease’s heterogeneity into consideration in future epidemiological studies is essential.

OBJECTIVE

? To test the hypothesis that bladder cancer is a heterogeneous disease.

PATIENTS AND METHODS

? We examined the temporal trends of bladder cancer by histological subtype and by disease stage and grade using the National Cancer Institute’s Surveillance, Epidemiology, and End Results data collected in 1973–2007.

RESULTS

? The age‐adjusted incidence rates of bladder cancer showed a slight decrease from 1973 to 2007 (annual percentage change [APC]=?0.4, P < 0.05). ? Although the age‐adjusted incidence rates of non‐papillary transitional cell carcinoma decreased by about 53% from 7.9 per 100 000 in 1973 to 3.7 per 100 000 in 2007 (APC =?2.2, P < 0.05), the age‐adjusted incidence rates of papillary transitional cell carcinoma increased by about 56% from 6.8 per 100 000 in 1973 to 10.6 per 100 000 in 2007 (APC = 0.5, P < 0.05). ? Among other rare histological subtypes, except for small cell carcinoma which showed a slightly rising trend, squamous cell carcinoma, adenocarcinoma and others all presented a decreasing trend. ? Similar patterns were found for different stages (localized, regional and distant), but a dramatic increasing trend of grade IV was found between 1998 and 2007 when a corresponding decreasing trend was shown for grades I, II and III.

CONCLUSION

? The results support the hypothesis that bladder cancer is a heterogeneous disease and taking disease heterogeneity into consideration in future epidemiological studies is essential.     

Nephrotic Syndrome as a Complication of Intravesical BCG Treatment of Transitional Cell Carcinoma of Urinary Bladder

Nephrotic syndrome can be associated with various neoplasms, especially solid tumors and lymphomas. This patient presented with painless hematuria of transitional cell carcinoma of urinary bladder, underwent transurethral resection, but developed recurrence 16 months later. Repeat resection was done and intravesical Bacillus Calmette-Guerin (BCG) injections were started. After six months, the patient developed hypertension and nephrotic syndrome with a biopsy revealing membranous glomerulonephritis, though there was no radiological evidence of tumor. This is the first case of nephrotic syndrome with intravesical BCG instillation in a bladder carcinoma patient.     

趋化因子受体CXCR4在膀胱移行细胞癌中的表达

目的：研究趋化因子受体CXCR4在膀胱移行细胞癌（BTCC）组织中的表达及其临床意义。方法：运用免疫组化技术，检测42例膀胱移行细胞癌组织、5例腺性膀胱炎组织、5例移行细胞乳头状瘤及10例正常膀胱黏膜上皮CXCR4的表达，染色结果采用免疫反应积分（IRS）和积分光密度值（IOD）分别进行评分。结果：42例BTcc组织中，4｜D例cxcR4表达阳性（95.2％）。随着肿瘤细胞病理分级、临床分期的增加，CXCR4的表达强度升高（P〈0.05）。正常膀胱组织和各阳性对照组中CXCR4的表达呈阴性。结论：CXCR4的表达与BTCC的分级分期有相关性；CXCR4的异常表达与BTCC的复发、转移有关，并有可能成为一种新的预后判断指标。     

BRMS1mRNA在膀胱移行细胞癌组织中的表达及临床意义

目的：探讨膀胱移行细胞癌组织中乳腺癌转移抑制基因（breast cancer metastasis suppressor1,BRMSl）mRNA表达水平与膀胱移行细胞癌的发生和转移的关系。方法：以β-actin为内参照,用荧光RT—PCR方法分别检测正常膀胱、未转移膀胱癌、转移膀胱癌三组标本组织中BRMSlmRNA的表达。结果：未转移膀胱癌和转移性膀胱癌BRMslmRNA表达水平显著低于正常膀胱组织（P〈0．01）,转移膀胱细胞癌BRMSlmRNA水表达平显著低于未转移膀胱细胞癌（P〈0．01）。结论：BRMSlmRNA在膀胱癌组织中的表达水平与膀胱癌的发生和淋巴结转移呈负相关;BRMSlmRNA表达的下降可能促进了膀胱癌的转移。     

膀胱小细胞神经内分泌癌1例报告并文献复习

目的：探讨膀胱小细胞神经内分泌癌的病理及临床特征,提高对该病的认识和诊洽水平。方法：介绍1例94岁高龄膀胱小细胞神经内分泌癌患者的诊治情况及病理特点,并复习有关文献,分析该肿瘤的组织来源、病理和免疫组化特征、诊治及预后情况。结果：本例行经尿道膀胱肿瘤电切术,术后病理诊断为小细胞神经内分泌癌。免疫组化染色示肿瘤细胞表达神经内分泌标记物NSE和CgA,肿瘤标志物Ki-67、C-erB-2、P53表达阳性,PSA、Syn表达阴性。患者术后1个月死亡。结论：膀胱小细胞神经内分泌癌是一种比较少见的高度恶性肿瘤,主要依靠病理及免疫组化诊断,早期膀胱镜检查及活检有助于诊断。     

Patients with bladder and lung cancer: a long-term outcome analysis

OBJECTIVES: To report on patient characteristics, stage of disease and long-term outcome and prognosis of patients with dual bladder and lung cancers, as there is an established increased risk of smoking-related second primary cancers, especially lung cancer, developing in patients with bladder cancer. PATIENTS AND METHODS: We reviewed our hospital tumour registry database from 1990 to 2002, and identified 27 patients who had both bladder and lung cancers among 1038 with bladder cancer and 2427 with lung cancer. Seventeen patients had bladder cancer detected before lung cancer (group 1), and the remaining 10 had lung cancer diagnosed first (group 2). RESULTS: Group 1 and 2 were comparable in terms of patients' characteristics, mean interval between cancer detection and their use of tobacco. Group 1 patients had a tendency towards more invasive lung cancer at diagnosis than had group 2 patients (11/17 vs 2/10 stage >/= IIB, respectively; P = 0.082). The mean follow-up was 49.8 and 64.5 months for groups 1 and 2, respectively (not significant). The mean (sd) interval to death from the date of diagnosis of lung cancer was 18 (17) months for group 1 and 65 (42) months for group 2 (P < 0.05). CONCLUSIONS: Patients with bladder and lung cancer who have lung cancer detected first have a lower lung cancer stage and higher overall survival rate than patients diagnosed with bladder cancer first.     

Bladder cancer after managing upper urinary tract transitional cell carcinoma: predictive factors and pathology

OBJECTIVE: To evaluate patients with a history of transitional cell carcinoma (TCC) of the upper urinary tract (UUT) to determine the incidence, pathological distribution, and risk factors for developing subsequent bladder tumours. PATIENTS AND METHODS: Between 1993 and 2003, 103 patients were treated at our institution for UUT-TCC. We reviewed demographic, clinical, surgical, and pathological data from these patients at a median follow-up of 38.7 months, and used univariate and multivariate analyses with logistic regression modelling to determine prognostic variables for bladder recurrences. RESULTS: In all, 51 (49.5%) patients developed bladder tumours after treatment for UUT-TCC, at a mean interval of 13.2 months. Patient age (P = 0.01), UUT tumour size (P = 0.03), UUT tumour multifocality (P = 0.05), a history of bladder tumours (P = 0.03), and the number of previous bladder tumours (P = 0.05) predicted the development of bladder recurrences on univariate analysis. On multivariate analysis, only a previous history of bladder tumours (odds ratio 2.6, P = 0.05) remained significant. Over 90% of the recurrent bladder tumours were superficial, with two-thirds of these being low to moderate grade. Six patients had muscle-invasive disease, and five had a cystectomy. CONCLUSION: Bladder tumours occurred in half the patients after treatment for UUT-TCC; > 60% of these subsequent bladder tumours were superficial, low- to moderate-grade lesions. Neither the pathology of the UUT tumours nor the method of treatment for the UUT disease was associated with recurrent bladder tumours. Only a history of bladder cancer predicted the development of subsequent bladder tumours.