Paraneoplastic neurological syndrome in transitional cell carcinoma of the bladder.

Paraneoplastic neurological syndromes are well known sequelae of some malignancies but they have never been reported in transitional cell carcinoma of the bladder. A paraneoplastic neurological syndrome characterized by visual changes, glossal spasm and dysphagia associated with an invasive high grade transitional cell carcinoma of the bladder is reported. Neurological symptoms resolved after extirpation confirming a paraneoplastic condition. Recurrent disease was associated with recurrent neurological symptoms and resolved after a complete response to combination chemotherapy.     

Paraneoplastic leukemoid reaction as marker for transitional cell carcinoma recurrence

A case of a 78-year-old man with transitional cell carcinoma and a paraneoplastic leukemoid reaction. The leukocytosis was present at the diagnosis of carcinoma. It dissipated with complete tumor resection, was absent when a surveillance computed tomography scan showed no evidence of recurrence at 6 months, and had returned with tumor recurrence at 8 months. This case demonstrates that a paraneoplastic leukemoid reaction can be used as a tumor marker in cases of transitional cell carcinoma when a leukemoid reaction is found at presentation.     

Hypercalcemia, leukemoid reaction, and thrombocytosis as paraneoplastic presentation of transitional cell carcinoma of the kidney

The most common etiologies of hypercalcemia are hyperparathyroidism or malignancy, most often of the lung, breast or hematological system, but rarely occur in transitional cell carcinoma. The appearance of this metabolic disorder and other paraneoplastic signs like leukemoid reaction or thrombocytosis is a potential marker for malignant behaviour and poor prognosis in advanced tumours. Simultaneous presentation of that three paraneoplastic signs have only been described in two patients with wellknown bladder carcinoma. Most paraneoplastic syndromes appear only during the late stages of malignancy when the diagnosis has long been established, but sometimes may be an early sign of the malignancy. We describe a case of a previously unknown infiltrating transitional cell carcinoma of the kidney without bony metastasis, that presented itself with hypercalcemia, hyperleukocytosis resembling a leukemoid reaction and thrombocytosis. We think recognizing the paraneoplastic syndrome is very important because it is an alarm sign of malignancy.     

ABCG2在肝细胞癌组织中的表达及临床病理意义

目的 探讨干细胞标记物ABCG2（ATP结合转运蛋白G超家族成员2）在肝细胞癌组织中表达的意义。方法 应用免疫组化SP法检测ABCG2在130例肝细胞癌组织和相应癌旁肝硬化组织中的表达、分布情况。结果 免疫组化显示ABCG2阳性染色定位于癌细胞的胞膜,部分病例胞浆也有表达。ABCG2在肝细胞癌组织和相应癌旁肝硬化组织中的表达阳性率分别为83%（108/130）和17%（22/130）。ABCG2的表达与患者性别、年龄、临床分期、是否有乙肝后肝硬化、肿瘤大小均未显示明显相关性（P＞0.05）。与无脉管癌栓组比较,有脉管癌栓组ABCG2呈高表达,差异有统计学意义（P＜0.05）。结论 ABCG2在肝细胞癌的发生发展过程中可能起着一定的作用,它有可能成为肝癌干细胞标记物之一。     

Extensive cutaneous metastasis of transitional cell carcinoma of the bladder

Cutaneous metastasis of bladder carcinoma is extremely rare. Iatrogenic implantations have been the main cause in the majority of cases of transitional cell carcinoma with cutaneous metastasis. Otherwise, primary cutaneous metastasis is accepted as the late manifestation of systemic spread. The present paper describes a case of relatively early and extensive skin metastasis of transitional cell carcinoma in a 78-year-old man. The patient had a histopathological diagnosis of poorly differentiated (grade III) muscle invasive transitional cell carcinoma with a staging of T2NOMO 6 months prior to presenting. He presented to our outpatient clinic with a 3-month history of skin lesions as multiple, rubbery subcutaneous nodules. Radiological reinvestigation revealed no other metastatic site (including bone and lung), except for a metastatic nodule in the liver. The present paper reports an interesting and rare case of extensive skin metastasis of transitional cell carcinoma as the primary complaint.     

Soft tissue metastases by micropapillary bladder carcinoma. Metastatic disease

Micropapillary transitional cell carcinoma is a rare (incidence of 0.7%) and highly aggressive variant of bladder carcinoma. Morphologically, it is characterized by small tight clusters of neoplastic cell floating in clear spaces resembling lymphatic channels. Its usual presentation is like a high grade and stage carcinoma and most often is associated with a variable component of conventional carcinoma or other variants. The usual sites of bladder cancer metastases are the lymph nodes, lungs, bone and liver. Soft tissues metastases from transitional cell carcinoma of the bladder occur infrequently. We report the cases of a 77-year-old man presenting with an abdominal soft tissue mass a six years after local excision of a micropapillary bladder carcinoma.     

Large cerebellar lesion as original manifestation of transitional cell carcinoma of the bladder

Patients with transitional cell carcinoma of the bladder classically present with irritative voiding symptoms or painless hematuria. Common sites of vascular metastases include the liver (38%), lung (36%), bone (27%), adrenal glands (21%), and intestine (13%). Vascular metastasis to the brain, without a prior history of chemotherapy, is extremely rare. To our knowledge, this is the first report of a patient with bladder transitional cell carcinoma whose original presentation was from a symptomatic, metastatic, cerebellar lesion.     

Antigen(s) on human transitional cell carcinoma detected by a xenogeneic antiserum

Summary In studies concerning human bladder cancer, antisera were raised in rabbits against human tumours, normal tissue, and cell lines derived from human tumours and were analysed by absorption and complement dependent microcytotoxicity tests. No significant selective cytotoxicity was discernible with any unabsorbed antisera. After absorption of A53, (an antiserum against the transitional cell carcinoma derived cell line T24) with peripheral blood cells and normal adult tissues, it was cytotoxic to two bladder cancer cell lines (T24 and J82) but not to four other cell lines. This activity was removed by absorption with each of two specimens of transitional cell carcinoma but not by normal bladder and by absorption with T24 or J82 but not with four other non-bladder cell lines. This functional specificity for transitional cell carcinomas could be due to a tumour associated antigen, a significant quantitative difference between tumour and normal cells, or an embryonic specificity reexpressed on the tumour. Further experiments are necessary to investigate these alternatives.Abbreviations used TAA tumour associated antigen(s) - NRS normal rabbit serum - MEM Eagle's minimal essential medium and additives - LuLiKi mixture of homogenates of human lung, liver and kidney - TCC transitional cell carcinoma - NBI normal bladder     

Lymphocyte antibody interaction in cytotoxicity against human transitional cell carcinoma.

The interaction of antibodies and lymphocytes in their immune reaction against human transitional cell carcinomas was studied using the in vitro microcytotoxicity assay. A non-complement dependent, IgG antibody was detected in the serum of occasional transitional cell carcinoma patients, which induced cytotoxicity against transitional cell carcinoma target cells by lymphocytes from donors with and without transitional cell carcinoma. The observation that lymphocytes from transitional cell carcinoma donors were more sensitive to activation by this anti-transitional cell carcinoma, lymphocyte dependent antibody is compatible with the hypothesis that the surface of lymphocytes from some transitional cell carcinoma donors is coated in vivo with an anti-transitional cell carcinoma lymphocyte dependent antibody and that this antibody may be a significant factor in immunity to transitional cell carcinomas of the urinary tract.     

Peritonitis carcinomatosa in a patient with recurrent "superficial" bladder cancer treated with cystectomy and nephroureterectomy

We report on a 45-year-old woman treated with cystectomy after failure of bacille Calmette-Guérin therapy for superficial transitional cell carcinoma. After 9 months, left-sided nephroureterectomy was performed for recurrence in the left ureter. The pathologic examination revealed carcinoma in situ and no tumor-positive lymph nodes (pTisN0Mx). At 2.5 years later, she complained of abdominal distension and pain. She underwent bilateral removal of the ovaries, infracolic omentectomy, and liver biopsy because of suspicious lesions on the liver. Pathologic examination revealed extensive peritoneal spread of transitional cell carcinoma. The seeding potential of high-grade urothelial cancer is well known; however, we found no clear explanation for the peritoneal spread of tumor cells in this patient that occurred years after the surgical procedures.     

Paraneoplastische Syndrome des Nierenzellkarzinoms

Renal cell carcinoma associated paraneoplastic symptoms include constitutional symptoms as well as specific metabolic and biochemical abnormalities. These are present in up to 40% of patients with renal cell carcinoma during the course of the disease. This report provides information on the most common manifestations and their therapy; some rare variants are also mentioned. The importance of paraneoplasia lies partly in the fact that paraneoplastic symptoms may be the precursor of either primary or recurrent disease. The presence of paraneoplastic manifestations does not necessarily imply a poor prognosis or metastatic disease.     

Prognostic variables in patients with transitional cell carcinoma of the renal pelvis and proximal ureter

Recent technological advances in urological endoscopic surgery of the renal pelvis and proximal ureter via ureteroscopy or percutaneous nephroscopy have made it possible to consider parenchymal-sparing procedures in patients with transitional cell carcinoma. To define the role of these procedures in the management of renal pelvic or proximal ureteral transitional cell carcinoma we analyzed retrospectively 31 patients who underwent nephroureterectomy for transitional cell carcinoma of the renal pelvis and/or proximal ureter. High grade upper urinary tract transitional cell carcinoma and a history of metachronous or synchronous bladder transitional cell carcinoma were independent adverse prognostic factors. However, patients with low grade upper urinary tract transitional cell carcinoma and no evidence of a urothelial field change had a 100 per cent 5-year survival rate. It would appear that parenchymal-sparing endoscopic techniques should be regarded with caution in patients with either high grade transitional cell carcinoma of the renal pelvis and proximal ureter or a history of bladder cancer.     

Immunohistochemical localization of metallothionein in transitional cell carcinoma of the bladder

Metallothionein is a metal binding protein thiol found in high concentrations in the liver and kidney. Recent evidence has linked overexpression of cellular metallothionein with tumor cell resistance to chemotherapeutic drugs, such as alkylating agents and cis-diamminedichloroplatinum (II) (cisplatin). We studied the metallothionein content of 9 human transitional cell carcinomas of the bladder with immunohistochemical methods. All tumors stained positive for metallothionein and the staining was localized almost exclusively to the cytoplasm. Uroepithelium displaying dysplastic changes or carcinoma in situ demonstrated the greatest intensity of staining, while staining in the invasive portions of the tumor was weak and variable. These findings were of interest, since combination chemotherapy of invasive transitional cell carcinoma of the bladder often is ineffective against carcinoma in situ. Normal uroepithelium stained strongly in all 3 patients who experienced disease progression and death, and in only 1 of the 5 who are currently without evidence of disease.     

Ipsilateral synchronous neoplasms of kidney presenting as acute pyelonephritis and bladder metastasis

Ipsilateral multiple synchronous primary renal neoplasms is an uncommon presentation, and only a few cases have been reported in published studies. We report the case of a 57-year-old woman with acute pyelonephritis as the initial presentation, in whom conservative treatment had no effect. Surgical intervention revealed the presence of concomitant renal cell carcinoma, collecting duct carcinoma, and urothelial carcinoma (transitional cell carcinoma) of the kidney. Metastatic renal cell carcinoma to the bladder, liver, and lung subsequently developed. Deceptive inflammatory presentations can occur in aggressive synchronous renal malignancies. Recognition of this rare disease entity could prevent delays in diagnosis and treatment.     

Interleukin-6 in renal cell carcinoma.

We studied interleukin-6 production in 4 human renal cell carcinoma cell lines and measured the serum level in 71 patients with renal cell carcinoma, thus, clarifying a relationship between interleukin-6 secretion and an occurrence of the paraneoplastic syndrome in the carcinoma. Interleukin-6 was produced by 3 cell lines and detected in 25% of the patients. The level of interleukin-6 did not directly correlate with tumor volume and the differentiation grade of the carcinoma. However, the positive rate increased with progression of the stage. The serum level affected the 5-year survival of patients without distant metastasis. When serum interleukin-6 was elevated patients had a significantly higher frequency of unexplained fever and an elevation of acute phase proteins. These results suggest that some renal cell carcinomas can produce interleukin-6 and this cytokine is responsible for several paraneoplastic syndromes in the carcinoma.     

Bilharzial related, organ confined, muscle invasive bladder cancer: prognostic value of apoptosis markers, proliferation markers, p53, E-cadherin, epidermal growth factor receptor and c-erbB-2

PURPOSE: We investigated the association of the apoptosis related proteins Bcl-2, Bcl-x, Bax and Bak, p53, the adhesion molecule E-cadherin, the receptor proteins epidermal growth factor receptor and c-erbB-2, and the proliferation markers proliferating cell nuclear antigen and Ki-67 with the clinical outcome of bilharzial related transitional cell carcinoma and squamous cell carcinoma. MATERIALS AND METHODS: Cystectomy specimens from 109 patients with organ confined, muscle invasive stage, pT2pN0M0, bilharziall positive bladder cancer were examined, including 60 with squamous cell carcinoma and 49 with transitional cell carcinoma. Immunohistochemical results were correlated with tumor progression. RESULTS: In squamous cell carcinoma but not in transitional cell carcinoma the loss of epidermal growth factor receptor, Bax and Bak was significantly associated with higher histological grade (p = 0.02, 0.006 and 0.01, respectively). On univariate analysis patients with transitional cell carcinoma had a poorer prognosis than those with squamous cell carcinoma. p53 Over expression and the loss of Bak positivity were associated with shortened progression-free survival in transitional cell carcinoma (p = 0.006 and 0.04, respectively), and squamous cell carcinoma (p = 0.00001 and 0.04, respectively). In squamous cell carcinoma high tumor grade (p = 0.02) and in transitional cell carcinoma high labeling indexes for MIB-1, Bcl-x expression and c-erbB-2 positivity (p = 0.03, 0.02 and 0.04, respectively) were associated with a poorer prognosis. On multivariate analysis p53 emerged as a significant prognostic factor for each condition. Additional independent prognostic factors were proliferating cell nuclear antigen for squamous cell carcinoma, and MIB-1, Bcl-x and Bax for transitional cell carcinoma. CONCLUSIONS: Bilharzial related transitional cell carcinoma and squamous cell carcinoma of the bladder differ in interims of protein expression and prognosis. Independent prognostic factors were p53, MIB-1, Bcl-x, and Bax in the former disease, and p53 and proliferating cell nuclear antigen in the latter disease.     

Serum concentration of laminin in transitional cell carcinoma

The concentration of laminin in the serum was determined for 45 patients with urinary tract transitional cell carcinoma, and the clinical significance of the findings was considered. The difference between the serum laminin concentrations in the control group and the transitional cell carcinoma patient group was not statistically significant, but the serum laminin level was highest in the transitional cell carcinoma patients with metastatic foci. In many of the patients who had metastatic foci and showed clearly progressive disease, the serum laminin concentration was found to increase with the passage of time. When the transitional cell carcinoma tissues were stained by the fluorescent antibody technique, there was little distribution of laminin in the tumor tissues, contrary to our earlier-reported findings regarding the staining of laminin in renal cell carcinoma tissues. In renal cell carcinoma patients, the serum concentration of laminin had been found to be high even when there were no metastatic foci, and consideration of this fact strongly suggests the possibility that the mechanism for laminin synthesis in urinary tract transitional cell carcinoma is different from that in renal cell carcinoma. It was surmised that the serum laminin concentration has potential for use as a diagnostic indicator of metastasis in patients with urinary tract transitional cell carcinoma.     

浅表性和浸润性膀胱移行细胞癌上皮钙黏素基因启动子C/A单核苷酸多态性的比较

目的 比较浅表性和浸润性膀胱移行细胞癌上皮钙黏素基因启动子近侧-160位点C/A单核苷酸多态性.方法 浅表性和浸润性膀胱移行细胞癌各33例17例.从血液中提取人基因组DNA,PCR扩增包含E-cad基因启动子近侧序列-160位点的DNA片段,长约190 bp.分别用限制性内切酶HphⅠ和AflⅢ将PCR产物消化过夜,行4%琼脂糖凝胶电泳,根据酶切产物的电泳结果判断基因型.结果 浅表膀胱移行细胞癌的CC、CA、AA基因型分别有9、14和10例;浸润膀胱移行细胞癌的CC、CA、AA基因型分别有2、3和12例.浸润性膀胱移行细胞癌A等位基因频率0.79(27/7)高于浅表性膀胱移行细胞癌0.52(34/32),差异有统计学意义(P＜0.05).结论 E-cad基因启动子近侧序列-160位点A等位基因与膀胱移行细胞癌的侵袭能力密切相关.     

Squamous cell carcinoma of the thymus. An analysis of eight cases

Eight cases of squamous cell carcinoma of the anterior mediastinum, most likely derived from the thymus, are presented. Seven were male and one female ranging in age from 39 to 65 years; the average was 55.5 years. There were no cases associated with any paraneoplastic syndromes. They possessed common morphological characteristics. Grossly, the tumors resembled malignant thymoma. Invasion of the lung and metastases to regional lymph nodes were frequent. Often observed microscopically were foci of sharply defined keratinization resembling Hassall's corpuscles, no radial arrangement of tumor cells at the periphery of nests, and broad, fibrotic, or hyalinized stroma. Admixture of a few lymphoid cells and some features transitional to thymoma were also observed in some parts of tumors. However, undoubtedly carcinomatous areas were present in some or large parts of all the tumors, where individual cells possessed a vesicular nucleus and a prominent round nucleolus. These features were distinct from those of bronchogenic squamous cell carcinoma and other thymic tumors, although they appeared to be related to thymoma. Treatment of choice is radical surgery and postoperative radiotherapy, because of relatively high radiosensitivity. Prognosis of patients was relatively good. From analyses of cases it is concluded that squamous cell carcinoma of the thymus should be separated from ordinary thymoma of the epithelial type, and that squamous cell carcinoma involving both the thymus and lungs should be carefully examined for the primary site of growth.     

Is it transitional cell carcinoma or renal cell carcinoma on computed tomography image?

We report on a 58-year-old female patient with renal cell carcinoma simulating transitional cell carcinoma on computed tomography. The computed tomography scan showed an enhancing 2.5-cm left renal pelvic mass without renal parenchymal mass. Urinalysis revealed microscopic hematuria. Cystoscopy and urine cytology was negative for transitional cell carcinoma. Laparoscopic nephroureterectomy was done under the preoperative diagnosis of localized transitional cell carcinoma of the renal pelvis according to the computed tomography findings. The histologic result, however, was a clear cell renal cell carcinoma.