Skeletal muscle metastases from urothelial cell carcinoma

Hematogenous metastasis to skeletal muscle from urothelial carcinoma is extremely rare and metastatic disease to skeletal muscle tends to be found in people with advanced-stage neoplasm. We report in this paper a case of left sartorius muscle metastasis from urothelial cell carcinoma. A left nephroureterectomy with bladder cuff excision was performed and revealed a high-grade papillary transitional cell carcinoma (TCC) of the pelvis. And 6 month later, recurrent bladder cancer was found regular cystoscopy and then treated with transurethral resection of the bladder. After 6 times resection of bladder, an invasion into the bladder muscle layer was found. We recommended additional radical cystectomy to prevent the disease from advancing. However, the patient refused additional surgery. 6 month later, the patient complained of left thigh pain, so ultrasonography-guided biopsy of the nodular mass lesion in the left sartorius muscle was performed. The pathological analysis of the biopsy specimen revealed poorly differentiated metastatic urothelial carcinoma.     

膀胱癌患者手术前后机体氧化应激改变及意义

目的探讨膀胱癌患者手术前后机体氧化应激变化及临床意义。方法 173例膀胱癌患者入选研究,其中移行上皮癌163例,腺癌5例,鳞癌4例,肉瘤1例;非肌层浸润性膀胱癌121例,肌层浸润性膀胱癌52例。分别检测手术前后患者血清VitC、VitE、超氧化物歧化酶（SOD）、谷胱苷肽过氧化物酶（GPx）、丙二醛（MDA）、总抗氧化活性（AOA）等。结果非肌层浸润性膀胱癌患者血清VitC、VitE、SOD、GPx均明显低于肌层浸润性膀胱癌,P〈0.05,MDA含量高于肌层浸润性膀胱癌,P〈0.05。手术后患者血清VitC、VitE、SOD、GPx、AOA均明显高于手术前（P〈0.05）,但MDA含量明显低于手术前（P〈0.05）。结论膀胱癌患者机体氧化应激随其恶性程度升高而升高,手术治疗后机体氧化应激水平降低。     

Can bladder preservation therapy come to the center stage?

Decision‐making in urological cancer care requires a multidisciplinary approach for refinement, but its impact on urothelial carcinoma of the bladder has not been fully addressed for the past three decades, except for the latest immunological checkpoint inhibitor approved by the U.S. Food and Drug Administration for metastatic muscle‐invasive bladder cancer that is resistant to platinum‐based chemotherapy. For the time being, radical cystectomy is the gold standard of curative therapy for muscle‐invasive bladder cancer. Trimodal therapy that combines chemotherapy for the purpose of radiation sensitization, external beam radiotherapy and transurethral resection of bladder tumor has emerged as a potential alternative treatment option that preserves the bladder. In lack of randomized studies for bladder preservation therapy compared with surgery, the principles of management of urothelial carcinoma of the bladder have evolved in recent times, with an emphasis on bladder preservation. A number of bladder preservation techniques are available to the surgeon; however, appropriately selected patients with muscle‐invasive bladder cancer should be offered the opportunity to discuss various treatment options, including organ‐sparing trimodal therapy. The aim of the present study was to compare the primary outcomes of the available treatment methods and identify the sources of variance among studies. A review of various bladder preservation techniques in vogue for the management of urothelial carcinoma of the bladder is discussed.     

Ectopic adrenocorticotropic hormone syndrome in a case of small cell carcinoma of the bladder manifesting as severe muscle weakness

Ectopic adrenocorticotropic hormone syndrome is a paraneoplastic syndrome associated with small cell carcinoma. However, ectopic adrenocorticotropic hormone syndrome is rare in association with small cell carcinoma of the bladder. We report what we believe to be the first case of ectopic adrenocorticotropic hormone syndrome associated with small cell carcinoma of the bladder that manifested as severe muscle weakness due to hypokalemia. An early diagnosis and aggressive potassium replacement is essential for retaining muscle strength. The patient died of pneumonia less than 2 months after the diagnosis. Severe immunosuppression by excess cortisol production was suspected. Control of cortisol levels before chemotherapy might be beneficial in preventing infective complications.     

Role of magnetic resonance imaging in tumor staging and follow-up for bladder cancer

Urothelial carcinoma of the bladder is a common urologic malignancy. Complex factors, such as local stage, tumor grade, biologic potential, and various conditions, can affect the treatment strategy for bladder cancer. However, the local stage—in particular, the presence or absence of muscle invasion—significantly influences decisions regarding treatment strategy. The role of cystoscopy for screening, diagnosis, and transurethral resection cannot be overlooked. The importance of local staging with magnetic resonance imaging is increasing; magnetic resonance imaging of the bladder is considered a useful staging modality. Moreover, a radiologic reporting system for evaluating and scoring muscle invasion of bladder cancer was recently released. This system is based on multiparametric magnetic resonance imaging and is also expected to be feasible for post-treatment follow-up of bladder cancer. In this review, we discuss the role of magnetic resonance imaging in the local staging of urothelial carcinoma of the urinary bladder and post-treatment imaging. In addition, several technical aspects for obtaining appropriate quality magnetic resonance images of the bladder will be discussed.     

再次经尿道电切术治疗非肌层浸润性膀胱癌

目的 总结再次经尿道电切术(Re-TUR)治疗非肌层浸润性膀胱癌的疗效.方法 2004年3月至2008年8月共收治462例非肌层浸润性膀胱癌,男性350例,女性112例,年龄35～83岁.在初次经尿道电切术后根据肿瘤分期和分级,以及标本有无肌层组织进行评估,有125例患者在术后4～6周行Re-TUR,其中Ta期49例,T1期76例;低级别癌58例,高级别癌67例;T1期肿瘤标本内未见肌层组织30例.结果 125例非肌层浸润性膀胱癌患者行Re-TUR,34.4%(43/125)发现有肿瘤残留,其中35例肿瘤未侵犯肌层,Ta期15例,T1期20例;8例肿瘤侵犯肌层.高级别癌的肿瘤残留率较低级别癌高(P<0.05);初次电切标本中无肌层的肿瘤残留率较有肌层的高(P<0.05).12例(9.6%)患者在初次电切术时肿瘤分期被低估.Re-TUR术中发生膀胱穿孔6例,膀胱出血7例.随访3～56个月;Re-TUR发现肿瘤残留的患者,37.2%(16/43)复发,高于Re-TUR未发现肿瘤残留的患者(12.2%,P<0.05).结论 T1期、高级别或初次电切标本无肌层的非肌层浸润性膀胱癌患者术后4～6周应行Re-TUR.Re-TUR能提高分期的准确性.     

Tibial Metastasis from Muscle Invasive Bladder Carcinoma: An Unusual Site

We report a case of a 61-year-old gentleman who presented with frank hematuria with associated weight loss and on-going left knee pain. Subsequent investigation revealed a muscle invasive bladder carcinoma with a related unusual bone metastasis. Though bone metastases form bladder carcinoma are common, frequent deposition sites include the spinal column and pelvis. This case report is to the best of our knowledge the first reported case of a tibial metastasis for relevant bladder carcinoma. Furthermore, we reviewed the literature, relevant diagnostic and management surrounding such occurrences.Key Words: Bladder neoplasm, Carcinoma, Bone metastasis     

Clinico-pathological features of bladder carcinoma: Experience from a tertiary care hospital of Pakistan

Bladder carcinoma is most common urological malignancy in Pakistan. The objective of the study was to determine the clinico-pathological characteristics of histologically confirmed bladder carcinoma at a tertiary care hospital of South Punjab, Pakistan. Methods: In two hundreds and twenty one patients (172 male and 49 female) bladder carcinoma was diagnosed from Jan 1998 to June 2005. All patients were evaluated with regards to clinical presentation, cystoscopic findings and histo-pathological data. Results: Male female ratio was 3.5:1. The median age was 58 years (range 18–87 years). 65% men had history of cigarette smoking while 51% women had long history of smokeless tobacco (nasal snuff or chewable) use. Most patients presented with painless hematuria. Primary transitional cell carcinoma was the most common (i.e. 96%) histological variety of bladder carcinoma. 63% patients had muscle invasive disease at the time of presentation. Even in superficial bladder carcinoma, most patients had invasion of lamina propria (pT1 disease). Conclusion: More than 90% of primary bladder carcinoma are of transitional cell variety and over 60% having muscle invasive disease at the time of diagnosis. Even in patients with superficial disease, majority (i.e. 98%) have invasion of lamina propria.     

二次经尿道双极等离子电切治疗非肌层浸润性膀胱癌

目的 探讨二次经尿道双极等离子电切术(Re-TURBt)治疗非肌层浸润性膀胱癌的疗效.方法 2005年12月至2010年10月共收治231例非肌层浸润性膀胱癌,男性175例,女性56例,年龄28～85岁.在初次经尿道双极等离子电切术后根据肿瘤分期和分级以及标本有无肌层组织进行评估,有63例患者在术后4～6周行Be-TU...     

A case of micropapillary bladder carcinoma

A case of urothelial carcinoma containing micropapillary variant in the urinary bladder is reported. The micropapillary bladder carcinoma isa rare variant of urothelial carcinoma and has an aggressive clinical course. A 45-year-old man complained of hematuria in October, 2009. He visited a hospital and was diagnosed with a bladder tumor. Transurethral resection of the bladder tumor was performed at the hospital. The transurethral resection demonstrated poorly differentiated adenocarcinoma invading the bladder muscle layer. Then he consulted our hospital. Our pathologist diagnosed the case as micropapillary variant of urothelial carcinoma in the urinary bladder. Accordingly, radical cystectomy and pelvic lymph nodes dissection were performed. After the operation, he received three courses of gemcitabine and cisplatin as adjuvant chemotherapy. The patient remains free of tumor recurrence and metastasis for 28 months after the cystectomy.     

Bladder cancer in spinal cord injury patients

A total of 8 cases of bladder cancer in spinal cord injury men (4 quadriplegics and 4 paraplegics) was seen at 3 medical centers since 1985. All 8 men had a hyperreflexic bladder and 3 of them had associated detrusor-sphincter dyssynergia. Upper tract changes were noted in 4 patients: 2 with distal ureterectasis and 2 with mild hydronephrosis. Only 1 of these men did not have historical films with which to compare results. Histology was transitional cell carcinoma in 6 men and squamous cell carcinoma in 2. Four patients presented with muscle invasion and 1 presented with diffuse carcinoma in situ involving the penile urethra. Three patients presented with superficial transitional cell carcinoma and 2 of them had progression to muscle invasion within 6 and 11 months. All but 2 of the patients with invasive disease underwent a radical operation and urinary diversion. Although followup is short (range 6 to 17 months), 5 patients are well with no evidence of disease and of the 3 who died 2 had no evidence of disease. We found a lower incidence of bladder cancer and a decreased percentage of squamous cell carcinoma than in previous reports, which may reflect an improvement in the lower tract management of these patients. Survival with appropriate bladder cancer treatment appears to correlate well with that of the ambulatory population.     

Micropapillary carcinoma of the urinary bladder: a case report and review of the literature

Micropapillary carcinoma is an uncommon variant of urothelial carcinoma with high metastatic potential. The presence of micropapillary carcinoma component in bladder biopsies should alert urologists to its aggressive behaviour. We report the case of a 70-year-old man who presented with macroscopic hematuria lasting 2 weeks. Magnetic resonance imaging revealed a bladder tumour in the dome area extended to perivascular adipose. The transurethral biopsy showed a high-grade micropapillary carcinoma with muscle invasion. Radical cystectomy with lymph node dissection was then performed. The pathological examination revealed a high-grade purely micropapillary carcinoma invading the perivesical adipose. No tumour recurrence or metastasis were reported at the 6-month follow-up.     

A model of orthotopic transplantation in mice using MBT-2

We attempted to produce a malignant urinary bladder carcinoma in mice by transplanting MBT-2 cells. MBT-2 carcinoma about 3.0 x 10(3) cells/0.02 ml were successfully transplanted into the bladder wall with an incidence of 80% (20/25) after three experimental weeks. Inoculated tumor cells grew expansively into the bladder cavity from the bladder submucosa, and invaded the muscle layer. We observed that tumors caused gross hematuria and bilateral hydronephrosis. This malignant tumor model in which a tumor is implanted into its original organs seems to be useful for predicting clinical effectiveness in experimental cancer therapy.     

Photodynamic treatment of bladder cancer. Report of 117 cases]

The clinical data on photodynamic treatment of bladder carcinoma in 117 patients confirmed that the treatment of bladder carcinoma of 1 cm to 2 cm in diameter may obtain better results. Carcinoma of 2-4 cm in diameter should be treated with increasing energy density and repeated exposure. If the carcinoma is larger than 4 cm in diameter or is involving the deep muscle and the cervix of the bladder, the treatment would be unsatisfactory. The tumor free rate in the 117 patients was 94%. The total recurrence rate was 30.1% after 8 years' follow-up. Finally, the indications for photodynamic treatment and the causes of recurrence were discussed.     

Atypical leiomyoma of the urinary bladder--a rare tumor occurring in a young female with concurrent breast carcinoma--an influence of sex steroid hormone?

Smooth muscle tumors are uncommon in the urinary bladder, and atypical leiomyoma of the urinary bladder is extremely rare. We report a case of atypical leiomyoma with a concurrent breast carcinoma and discuss the pathologic features, the possible etiology and clinical outcome of the tumor.     

A case of synchronous triple primary carcinomas of the kidney,bladder and prostate

A case of synchronous triple carcinomas arising in the kidney, bladder and prostate is reported. An 82-year-old man had gross hematuria. Urine cytology was positive and intravenous pyelography showed right hydronephrosis with a filling defect in the bladder. Computed tomography revealed a 4 cm mass in the bladder, enlarged prostate and 6 cm renal mass at the left kidney. Cystoscopy demonstrated a papillary broadbased tumor with some small satellite tumors in the bladder, and magnetic resonance imaging revealed muscle invasion of the bladder tumor. This patient underwent left radical nephrectomy and total cystoprostatectomy with ileal conduit urinary diversion as radical treatment. Histological diagnosis was renal cell carcinoma, transitional cell carcinoma of the bladder. Furthermore, well-differentiated adenocarcinoma was found incidentally in the prostate. Immunohistochemical staining with anti-p53 antibody for the three tumors showed positive staining only for the bladder cancer.     

Solitary skin metastasis from a bladder carcinoma

Cutaneous metastases from urothelial carcinomas of the bladder are very rare. They are related to advanced stages of the disease and have poor prognosis with low survival rates. We report one case of cutaneous metastasis appearing after urological manipulation in a patient with bladder muscle invasive carcinoma, with other metastatic sites and poor response to treatment. The case is discussed and literature is reviewed.     

The molecular detection of circulating tumor cells in bladder cancer using telomerase activity.

PURPOSE: The detection of circulating tumor cells and micrometastases may have important prognostic and therapeutic implications. We investigated telomerase activity as a molecular marker for detecting bladder carcinoma cells in blood. MATERIALS AND METHODS: Peripheral blood mononuclear cells were isolated from whole blood using Ficoll/Hypaque. Immuno-magnetic beads labeled with an epithelial specific antibody were used to harvest epithelial cells from peripheral blood mononuclear cells. Telomerase activity was detected in this select population using the telomerase-polymerase chain reaction-enzyme-linked immunosorbent assay test based on the telomerase repeat amplification protocol method. The clinical applicability of this technique was explored by evaluating 30 patients with muscle invasive or metastatic bladder carcinoma and 17 healthy volunteers. RESULTS: Telomerase expression was detected in 27 of the 30 patients (90%) with high grade, muscle invasive or metastatic bladder cancer but in none of the 17 healthy controls. CONCLUSIONS: This test is a minimally invasive and specific approach for detecting circulating epithelial cells in patients with bladder cancer. This method may have great value for monitoring cancer progression.     

膀胱肉瘤样癌的诊断与治疗（附2例报告）

目的 提高对膀胱肉瘤样癌的认识和诊治水平。方法 分析2例膀胱肉瘤样癌患者的临床资料并结合文献进行讨论。2例患者均有肉眼血尿或伴有膀胱刺激症，膀胱镜检查为实体瘤，表面有坏死组织；病理表现，肿瘤主要由移行上皮癌细胞和恶性间叶细胞（梭形或多形性细胞）组成，之间可见移行过渡；免疫组化CK（＋）、CEA（＋）、SMA（＋）。结果 2例Ⅰ期治疗均行经尿道膀胱肿瘤电切，术后常规膀胱灌注，1例术后5个月死于肿瘤复发及多处转移；1例半年后复发改行部分膀胱切除，至今健在。结论 膀胱肉瘤样癌是一种高度恶性、预后差的肿瘤。确诊需依赖病理和免疫组织化学检查，早期诊断和采用膀胱部分切除或根治性切除，是改善预后的关键。     

Complications of whole bladder dihematoporphyrin ether photodynamic therapy

Photodynamic therapy with dihematoporphyrin ether was used to treat superficial bladder tumors in 7 patients with a followup of at least 1 year. Each patient received treatment to the whole bladder and those with papillary lesions received additional focal treatment. At 3 months 4 of the 5 patients with papillary tumors (stages Ta and T1) and 1 of the 2 with diffuse carcinoma in situ (Tis) were free of disease. However, at 1 year only 3 patients remained free of disease. Of 5 patients with an increase in irritative bladder symptoms 4 had a contracted bladder, hydroureteronephrosis and vesicoureteral reflux. Deep bladder biopsies showed replacement of smooth muscle by fibrous tissue. Six patients had mild to moderate skin phototoxicity. We conclude that although photodynamic therapy is an attractive and exciting method to treat cancer, its use with dihematoporphyrin ether in cases of bladder carcinoma can be associated with significant complications. The correct treatment parameters for safe, effective therapy are not known to date.