膀胱移行细胞癌伴前列腺癌的诊断与治疗

目的　提高膀胱移行细胞癌伴前列腺癌的诊治水平。　方法　对 8例膀胱移行细胞癌伴前列腺癌患者的临床资料进行分析。　结果　 8例术前均经膀胱镜检查及活检病理证实为膀胱移行细胞癌。 7例经直肠前列腺穿刺活检确诊前列腺癌 ,1例为前列腺增生症 ,行膀胱前列腺全切术后病理证实为前列腺癌。 4例行经尿道膀胱肿瘤电切及双侧睾丸切除术 ,术后使用丝裂霉素或BCG等膀胱灌注及氟他胺内分泌治疗。 1例行膀胱前列腺全切加回肠膀胱术。 8例中 2例失访 ,3例因多发性转移 ,术后存活 <1年 ,3例行根治性膀胱前列腺全切术 ,术后随访 1.5～ 4.0年 ,经胸片、CT、同位素和PSA等检查未见肿瘤复发或转移。　结论　血清PSA测定、前列腺直肠指诊、经直肠前列腺B超检查、活检及膀胱镜检查是诊断膀胱移行细胞癌伴前列腺腺癌的主要方法 ,根治性膀胱前列腺切除是影响预后的重要因素     

Importance of early treatment of transitional cell carcinoma of prostatic ducts

Twenty-three men who underwent radical cystoprostatectomy between March 1, 1983, and October 1, 1986, were found to have not only multifocal carcinoma in situ (CIS) of the bladder but also transitional cell carcinoma (TCC) of the prostatic ducts. In 18 patients TCC was limited to the epithelium lining the prostatic ducts (CIS of prostatic ducts), but in 5 patients TCC also invaded the prostatic stroma (invasive TCC of prostatic ducts). During follow-up (mean, 26 months), in 2 of the 18 patients (11%) with CIS of the prostatic ducts metastases developed. By comparison, metastatic TCC developed in 5 of 5 patients (100%) who had invasion into the prostatic stroma. Evidence indicates that patients with multifocal CIS of the bladder should be evaluated very closely for the presence of TCC of the prostatic ducts. When TCC is present in the ducts, radical cystoprostatectomy is necessary to control this lesion before it progresses to invasion. When invasion has occurred, however, radical cystoprostatectomy alone is not sufficient therapy. Since metastatic TCC develops in 100 percent of these patients, we believe that chemotherapy (either adjuvant or neoadjuvant) should be used in addition to radical cystoprostatectomy.     

Atypical metastases from transitional vesical carcinoma

A patient with documented transitional vesical carcinoma also manifested bilateral pulmonary nodules of extraordinary and uncharacteristic dimensions, confirmed as metastatic by transthoracic needle biopsy. A summary of reported uncommon manifestations of metastatic bladder cancer is reported, as well as recommended reactions to pulmonary lesions of indeterminate origin.     

Neurological deficit as the first manifestation of vesical transitional cell carcinoma

Transitional cell carcinoma of urinary bladder (TCCUB) usually presents with hematuria. Cerebral and leptomeningeal metastases as a first manifestation of TCCUB have been occasionally reported in the medical literature. Hence, we report a case of an elderly man who presented with localizing neurological signs and whose magnetic resonance imaging brain showed multifocal cerebral and leptomeningeal lesions suspected to be metastatic deposits. Thorough search for the primary tumor revealed TCCUB.     

Primary transitional cell carcinoma of prostatic periurethral ducts

Primary transitional cell carcinoma of the prostatic periurethral ducts is a distinct histologic variety of prostate carcinoma. Traditional methods of therapy for adenocarcinoma of the prostate are ineffective. A review of the literature suggests that appropriate radical surgical therapy should be considered for early control of this disease.     

Conservative treatment of superficial transitional cell carcinoma of prostatic urethra with intravesical BCG

We reviewed 125 male patients treated with a six-week course of intravesical bacillus Calmette-Guerin (BCG) for superficial transitional cell cancer (TCC) of the bladder that was associated with mucosal involvement of the prostatic urethra in 15 cases. In 13 of these cases, there was a sustained complete response in both the bladder and the prostate. Among the other 110 patients, in 14 TCC developed in the prostate from one to fifty-three (mean 15) months after completion of BCG. Six of these 14 had had complete response in the bladder. Recurrent TCC in the prostate was seen in only 4 percent and 6 percent of patients who had prostatic urethritis on cystoscopy and prostatic granulomas on biopsy, respectively. In contrast, recurrence was observed in 14 percent of those without urethritis and in 44 percent of those without granulomas. Transurethral resection of the prostate (TURP) prior to BCG did not appear to influence tumor recurrence in the prostate. However, after BCG, 3 patients with recurrent TCC in the prostate had complete local response after TURP alone. Further, prostatic urethritis (73%) and prostatic granulomas (60%) were more frequent among patients who had TURP prior to BCG than in those without TURP (33% and 27%, respectively). Superficial TCC of the bladder associated with mucosal involvement of the prostatic urethra can be treated successfully with intravesical BCG. In addition, our results suggest that intravesical BCG has a prophylactic effect on tumor recurrence in the prostate, and that TURP may have an important role by removing present disease and by facilitating the development of an effective biologic response to BCG in the prostate. TCC in the prostate is a significant cause of relapse, and frequent surveillance of the prostatic urethra should be performed in conservatively treated patients with superficial bladder cancer.     

膀胱移行细胞癌伴前列腺癌的诊断与治疗(附5例报告)

目的:提高膀胱移行细胞癌伴前列腺癌的诊治水平。方法:对5例膀胱移行细胞癌伴前列腺癌患者的临床资料进行分析。结果:5例患者平均年龄66.2岁,术前均经膀胱镜检查及活检病理证实为膀胱移行细胞癌(均为II至III级)。1例术前既往诊断为前列腺癌,4例术后病理证实为前列腺癌,前列腺癌Gleason分级4级至6级;2例行膀胱全切,输尿管皮肤造口术。1例行膀胱前列腺全切加回肠膀胱术。1例行径尿道膀胱肿瘤切除术,1例因身体原因仅行姑息性输尿管皮肤造口术。术后随访8个月至26个月。1例术后20个月后死于全身广泛转移;1例随访14个月带瘤存活;余3例经胸片、CT、同位素和PSA等检查未见肿瘤复发或转移。结论:膀胱癌患者,如合并的前列腺癌,如果重视不够容易被漏诊。血清PSA测定、前列腺直肠指诊、经直肠前列腺B超检查、活检及膀胱镜检查是诊断膀胱移行细胞癌伴前列腺腺癌的主要方法,当诊断膀胱癌同时存在局限性前列腺癌时,治疗方案应根据膀胱癌和前列腺癌的分期、分级综合而定。膀胱移行细胞癌伴前列腺癌并不提示预后不良。     

Clinical features of stage D prostatic carcinoma

Sixty seven cases of stage D prostatic carcinoma were analyzed according to age, chief complaints, histopathological types, metastatic sites, and serum acid and alkaline phosphatase levels. In spite of metastasis, which were in 62 cases (92.5%) to bone, in 17 cases (25.4%) to lymph nodes, and in 3 cases (4.5%) to the lung, the most common chief complaints were symptoms related to the primary lesion, such as dysuria and urinary frequency. There was no significant correlation between the incidence of bone metastasis and histopathological type. However, higher incidence of lymph node metastasis was observed in the histological types of moderate and poorly differentiated adenocarcinoma than well differentiated type. When cases were divided into two groups by age, significant differences were observed between younger (64 less than or equal to years old) and older (greater than or equal to 65 years old) groups in the following points: 1) Histopathologically, well differentiated type was not recognized in the younger group, while three histological types of well, moderate and poorly differentiated adenocarcinoma, were equally distributed among the older one. 2) Although there was no significant difference in the incidence or the numbers of metastatic sites to bone between the two groups, the younger patients had less symptoms related to bone metastasis. The prominent symptoms in the younger group were complaints about voiding.     

Adenocarcinoma arising from the prostatic duct mimicking transitional cell carcinoma

A 71-year-old man was first diagnosed with primary transitional cell carcinoma of the prostate with a skip lesion on the distal urethra. The patient received three courses of intra-arterial chemotherapy of cisplatin (CDDP) and pirarubicin (THP-ADM) followed by a radical prostatectomy. Histopathologic examination of the prostatectomy specimen revealed adenocarcinoma invasion along the prostatic duct extending to the peripheral acini, which was diagnosed as ductal adenocarcinoma. The clinical and histopathologic features of this case are entirely different from usual adenocarcinomas of the prostate. This rare histopathologic feature should be recognized as 'ductal carcinoma of the prostate', to distinguish it from papillary adenocarcinoma or adenocarcinoma with endometrioid features. The patient has had no sign of recurrence 14 months after the operation. CDDP-based chemotherapy followed by radical prostatectomy may be one of the promising therapeutic modalities for this rare entity.     

Clinical study of transitional cell carcinoma of the prostate associated with bladder transitional cell carcinoma

BACKGROUND: Transitional cell carcinoma of the prostate in patients with bladder cancer appears to influence the prognosis and affects the decision about therapeutic modality. Therefore, it is important to characterize transitional cell carcinoma associated with bladder cancer. METHODS: From April 1980 to December 1998, 81 male patients underwent total cystoprostatectomies for transitional cell carcinoma of the bladder. The 81 cystoprostatectomy specimens were examined to clarify the characteristics of prostatic involvement by transitional cell carcinoma. The extent, origin, mode of spread and risk factor of prostatic involvement as well as the prognosis were investigated. In 13 of 15 patients with prostatic involvement the prostate was examined by sequential step sections. RESULTS: Prostatic involvement was observed in 15 of 81 patients (18.5%). Prostatic urethral involvement, invasion to prostatic duct/acinus, prostatic stromal invasion and extraprostatic extension and/or seminal vesicle involvement were recognized in 12 (80%), 14 (93.3%), six (40%), and five (33.3%) of the 15 patients, respectively. Twelve of the 15 patients (80%) with prostatic involvement had papillary or non-papillary tumors (i.e. carcinoma in situ) both in the prostatic urethra and prostatic duct. In 10 of these 12 patients (88.3%), there was contiguity between prostatic urethral and ductal tumors. Seven of the 23 patients (30.4%) with carcinoma in situ of the bladder showed prostatic involvement, which increased to 50% in the presence of carcinoma in situ of the trigone or bladder neck. CONCLUSIONS: Eighty per cent of the patients with prostatic involvement showed papillary or non-papillary tumors both in the prostatic urethra and prostatic duct. There was a high level of contiguity between both tumors. Patients with carcinoma in situ of the trigone or bladder neck revealed significantly higher incidence of prostatic involvement.     

膀胱癌合并前列腺增生经尿道同期电切术30例分析

目的　探讨同期行经尿道膀胱肿瘤加前列腺电切术治疗膀胱癌合并前列腺增生症患者的可行性及疗效。方法　回顾分析30例膀胱癌并前列腺增生患者的手术方法。 18例同期行经尿道膀胱肿瘤加前列腺电切术 (A组 ) ;12例单纯行经尿道膀胱肿瘤电切术 (B组 )。结果　随访 4～ 6 0个月 ,A组有 10例术后复发 ,异位复发 6例 (占 6 0 % ) ,无尿道、前列腺窝及膀胱造瘘口的转移或种植。B组 7例复发 ,异位复发 5例 (70 .1% ) ,3例随访期内因前列腺增生症再行经尿道前列腺电切术。结论　膀胱肿瘤合并前列腺增生患者同期行经尿道电切术 ,在切除肿瘤后应用Ellick吸除器吸尽切下膀胱内组织后再切除增生的前列腺组织 ,可以减少膀胱内肿瘤细胞种植机会 ,缩短住院时间 ,提高疗效     

Secondary transitional cell carcinoma and nitrogen mustard treatment

Transitional cell carcinoma (TCC) of the bladder in children is a rare occurrence. Cyclophosphamide is a known risk factor for the development of TCC. Other alkylating agents, such as nitrogen mustard, have not been implicated in the development of secondary adult or pediatric TCC. The role of radiotherapy in the development of secondary malignancies of the bladder remains controversial. We report a case of childhood TCC in a patient in remission from Hodgkin's lymphoma previously treated with non-cyclophosphamide chemotherapy and low-dose nodal radiotherapy.     

Cytology of transitional cell carcinoma in situ of urinary bladder with extensive prostatic involvement.

Cytologic differences in the urine of 6 patients with transitional cell carcinoma in situ (CIS) of the urinary bladder with and without prostatic duct involvement are described. In the former group, there was an admixture of CIS cells along with many bizarre malignant cells which increased with time and showed malignant criteria indicative of changes more than CIS alone.     

Primary transitional carcinoma of the prostatic ductus

Primary prostate transitional cell carcinoma is a very rare tumour originating in the transitional epithelial cells of the intraprostate periurethral ductus. Only 17 of 829 patients diagnosed with prostate carcinoma were found to have the transitional cell variety. Eight (8) of those had pure transitional cell carcinoma and 9 a mixed presentation of acinar adenocarcinoma and transitional cell ductal carcinoma. Bladder origin of the tumour was ruled out in all cases. We report a retrospective study on the clinical behaviour of prostate transitional cell carcinoma. Compared to acinar carcinomas, few differences were found when age, symptoms, physical findings and imaging diagnosis were evaluated. Clinical presentation, DRE, PSA, metastatic spread and presence of supravesical obstructive uropathy where also studied to establish a diagnosis. Radiotherapy was the most frequently used therapeutical approach. Mean survival is 26.6 months (4-60 months) and there has been 11 death up to now. Compared to acinar forms, this tumour shows a hormone-resistant, aggressive biological behaviour with poor prognosis. Early diagnosis and radical surgery are the only options available to increase life expectancy for these patients.     

Changes of phenotypic expression of prostatic antigen in secondary transitional cell carcinoma of the prostate: evidence for induction phenomenon as a mechanism for acquisition of prostatic antigens in prostatic transitional cell carcinoma

BACKGROUND: In vitro and experimental studies of mesenchymal-epithelial interaction for the prostatic stroma have demonstrated that the prostatic stroma is capable of inducing the nonprostatic epithelium to acquire many features of prostatic epithelium. We investigated whether this phenomenon could be observed in vivo in human prostatic stroma. MATERIALS AND METHODS Sixty transitional cell carcinoma (TCC) of the urinary bladder: (a) 20 with glandular lumen; (b) 20 without glandular lumen: (c) 10 mixed TCC-adenocarcinoma (ACA); and (d) 10 with synchronous or metachronous TCC of the prostate; and three primary TCC of the prostate were examined and submitted for immunostaining for prostatic acid phosphatase (PAP) and prostatic specific antigen (PSA). RESULTS: There was a spectrum of immunostaining for PSA ranging from negative reactivity in TCC without glandular lumen of the urinary bladder, to focal and weak reactivity in single cells with varying degrees of nonmucinous glandular differentiation and to strong reactivity in groups of cells in primary and synchronous or metachronous TCC in the prostate. The areas of carcinoma geographically closest to the prostate and with the most extensive nonmucinous glandular differentiation displayed the most frequent and strongest immunoreactivity for PSA. The immunoreactivity for PAP was usually stronger than for PSA. Four cases of TCC and mixed TCC-ACA were immunoreactive only for PAP. Furthermore, there was a change in the phenotype of TCC in the urinary bladder as it spread into the prostate. For 10 TCC in the urinary bladder with synchronous or metachronous tumor in the prostate, all TCC in the urinary bladder were negative for PAP and PSA, whereas six TCC in the prostate were focally positive. CONCLUSIONS: The spectrum of immunoreactivity for PAP and PSA and the change in immunoreactivity of TCC of the urinary bladder as it spreads into the prostate are likely induced by the prostatic stroma through the mechanism of mesenchymal-epithelial interaction. Prostate 47:172-182, 2001.     

A prostatic duct carcinoma difficult to distinguish from transitional cell carcinoma: a case report

A 77-year-old male with a complaint of dysuria and gross hematuria for 3 months visited our hospital. Abdominal ultrasonography, computed tomographic scan and magnetic resonance imaging revealed a prominent tumor from the bladder neck. Serum prostate specific antigen (PSA) level was high (1,130 ng/ml) suggesting prostate cancer, but transitional cell carcinoma (TCC) was detected by transurethral biopsy. Bone scintigraphy revealed multiple bone metastasis. Since gross hematuria requiring bladder tamponade continued, simple cystoprostatectomy and cutaneous ureterostomy were performed. Pathological findings showed prostatic acinar carcinoma and prostatic duct carcinoma mimicking TCC, and PSA immunohistochemically weak positive. The final diagnosis was prostate cancer consisting of acinar and ductal component. Adjuvant hormonal therapy was performed, but was ineffective. The patient died 2.5 months after operation. We reviewed and discussed 66 cases of prostatic duct carcinoma, including our case, in the Japanese literature.     

Cytogenetic analysis of transitional cell carcinoma of the bladder. Clinical implications

Cytogenetic analysis of resected bladder tumors was performed in 30 patients. None of these patients had previous irradiation or chemotherapy. Direct chromosome preparations were made. Of the 30 preparations, 20 had chromosome abnormalities. We have observed a good correlation between the chromosome abnormalities and the stage/grade of the tumors. Patients were followed from 3 to 23 months. During this period, 61% of the patients with noninvasive or submucosal invasive bladder tumors and chromosome abnormalities have had recurrences. The existence of a good correlation between chromosomal abnormalities and the capacity of the neoplasm to recur was confirmed.