Involvement of the anterior urethra in male patients with transitional cell-carcinoma of the bladder undergoing radical cystectomy with simultaneous urethrectomy

Histological tumor extension into the prostate, urethra and ureters was examined in 52 specimens obtained by cystourethrectomy for transitional cell carcinoma of the bladder with one or more risk factors for urethral involvement. In four (21.1%) of 19 patients with diffuse carcinoma in situ in the bladder extending to the internal urethral orifice and prostatic urethra, the anterior urethra was affected by transitional cell carcinoma, including one specimen with invasion into the corpus spongiosum. However, none of 33 patients without these findings had synchronous anterior urethral transitional cell carcinoma involvement. It is recommended that patients with diffuse carcinoma in situ extending into the prostatic urethra undergo careful preoperative assessment of the anterior urethra before cystectomy. In other cases, the anterior urethra can be preserved and used for orthotopic neobladder replacement.      

Indications for urethrectomy

This review article addresses the pertinent issues regarding management of the urethra in the setting of transitional cell carcinoma of the bladder. This topic is often a subject of considerable confusion among urologic surgeons and is timely in this era of routine orthotopic diversion. The risk of urethral recurrence in the retained urethra is approximately 10%. Of the potential risk factors that may predispose the retained anterior urethra to metachronous transitional cell carcinoma, involvement of the prostatic urethra, glands, or stroma is the most significant. In this circumstance, if a cutaneous diversion is performed, urethrectomy is indicated. Conversely, for orthotopic diversion, involvement of the prostatic urethra with transitional cell carcinoma is not a contraindication to proceeding. Orthotopic diversion should be aborted, and cutaneous diversion and urethrectomy should be performed, only if intraoperative frozen section of the prostatic urethra margin is positive. In a woman, en bloc urethrectomy should be included with cystectomy if cutaneous diversion is planned. Although tumor involvement of the female bladder neck is a risk factor for urethral disease, prospective studies suggest that intraoperative frozen section evaluation of the proximal urethra is more accurate and can be used to exclude orthotopic diversion at cystectomy. Using these and other guidelines, management of the urethra should be straightforward and less concerning for the urologic surgeon.     

Carcinoma of the female urethra

From 1962 to 1980, 24 patients with primary urethral carcinoma and 1 vulval cancer involving the urethra were treated in our hospital. In this series, the mean age was 52 years. 23 lesions in the distal (anterior) urethra were all diagnosed preoperatively. Pathological classification were as follows: squamous cell carcinoma 16, adenocarcinoma 3, transitional cell carcinoma and undifferentiated carcinoma 4. The chief method of treatment were resection of the tumor and reconstruction of a new urethra, using bladder flap in two forms: abdominal urethra and reconstructed urethra in the original position. Preoperative or postoperative irradiation was given in one third of the patients. 17 patients have shown satisfactory results in the follow-up. The 7 and 10 year survival rates are 36% and 18% among 11 patients who are living and well.     

女性原发性尿道癌8例报告

 本文报告女性原发性尿道癌8例,年龄在41-63岁,平均年龄(?)3岁,与文献报告的基本一致。前尿道癌7例,后尿道癌1例。腺癌5例,鳞癌2例,移行细胞癌1例。行单纯放疗3例,其中2例分别生存18、11个月,1例失访;肿瘤加部份尿道切除,术后放疗1例,现已15个月健在;全尿道切除加膀胱壁瓣尿道重建术3例,均获满意近期疗效;1例未治。笔者认为,本病以手术治疗为主,全尿道切除加膀胱壁瓣尿道重建术是目前最理想的治疗方法。     

A case of signet ring cell carcinoma of the urinary bladder

A rare vesical carcinoma, arising in a 47-year-old male, is described. The tumor developed from the left ureteral orifice and posterior urethra, showing a nonpapillary appearance with a wide stalk. By light microscopy, the carcinoma was found to be mainly composed of signet ring cells and associated with small foci of transitional cell carcinoma. The previously reported cases of signet ring cell carcinoma of the urinary bladder were reviewed with a special reference to the manifold potentiality of the urothelium.     

Urethral involvement in female patients with bladder cancer. A study of 22 cystectomy specimens

The cystectomy specimens of 22 female patients with various types of bladder cancer were studied for evidence of urethral involvement. The bladder showed high-grade invasive transitional cell carcinoma in 18 patients, in 14 cases in association with flat carcinoma in situ (multifocal in 11 cases and unifocal in three). Three patients had multifocal carcinoma in situ of the bladder without evidence of invasion, and one patient had multifocal high-grade noninvasive papillary carcinoma. Urethral carcinoma in situ was observed in four of 14 patients (29%) with multifocal carcinoma in situ of the bladder, in three cases extending into the periurethral glands. This frequent concurrence of carcinoma in situ of the bladder with urethral and periurethral gland involvement, analogous to the carcinomatous involvement of the prostatic urethra and ducts in male patients, warrants caution in the intravesical therapy of female patients with superficial bladder cancer. The urethra showed invasive carcinoma in three of 18 patients (17%) with invasive bladder cancer (stromal invasion in two cases and vascular invasion in one). This finding reconfirms the use of routine urethrectomy in conjunction with cystectomy in female patients with invasive bladder cancer. An incidental finding was the presence of condylomatous changes in the urethra in five cases (23%).     

Long-term follow-up of intravesical bacillus Calmette-Guérin treatment for superficial transitional-cell carcinoma of the bladder involving the prostatic urethra

BACKGROUND: Intravesical bacillus Calmette-Guérin (BCG) is a treatment option for superficial (5-year follow-up. PATIENTS AND METHODS: Twenty-eight patients with high-risk superficial bladder cancer and prostatic urethral involvement were treated with once-weekly BCG for 6 weeks. Patients with prostatic stromal involvement were excluded. Maintenance was not used before 1995. Currently, we use maintenance BCG after induction. Patients were followed by cystoscopy/cytology and repeat biopsy to detect persistent and/or progressive disease. RESULTS: After 1 or 2 courses of once-weekly BCG for 6 weeks, 64.3% (18 of 28 of patients) exhibited a complete response in the bladder and prostate at their 6-month followup. Of those obtaining a complete response, 55.6% (10 of 18) experienced recurrence. Three recurrences were in the prostate: 1 isolated and 2 associated with multifocal bladder involvement. Twenty-eight percent (8 of 28 patients) underwent cystectomy because of failure of treatment to eradicate superficial disease or disease progression. Disease-specific survival was 89% (25 of 28 patients) at a median follow-up of 7.5 years. CONCLUSION: Our long-term data support the durability of intravesical BCG in select patients with superficial bladder transitional cell carcinoma with prostatic urethral involvement. Follow-up biopsy of the prostatic urethra is mandatory and, if positive, cystectomy is indicated. One third of patients will require cystectomy for persistent or progressive disease; therefore, careful surveillance is critical.     

尿路移行细胞癌患者黏膜组织中内皮素-1的表达及意义

目的探讨内皮素(ET)-1在尿路移行细胞癌(肾盂、输尿管、膀胱癌)患者中的表达及其临床意义.方法应用免疫组化SP法对30例尿路移行细胞癌及20例正常肾盂、输尿管、膀胱组织石蜡切片中ET-1的表达进行检测,结合临床资料进行分析.结果 ET-1在肿瘤组织中的表达阳性率为40.5%,明显高于正常组(P＜0.05).ET-1表达与尿路移行细胞癌组织学分级、临床分期相关(P＜0.05).结论 ET-1表达异常提示其可能参与尿路移行细胞癌的发生、发展与浸润,有望成为治疗人类尿路移行细胞癌的作用靶点.     

Urethra-sparing cystectomy and orthotopic urinary diversion in women with malignant pelvic tumors.

BACKGROUND: To the authors' knowledge, few data exist regarding the functional and oncologic outcome of pelvic tumors in women with urethra-sparing cystectomy and orthotopic urinary diversion to the urethra. PATIENTS AND METHODS: The combined data of 102 women age 28-79 (mean, 59 yrs) years who underwent a urethra-sparing cystectomy and orthotopic urinary diversion for either primary bladder cancer (96 patients), carcinoma of the uterine cervix (2 patients), carcinoma of the vagina (1 patient), primary fallopian tube carcinoma (1 patient), uterine sarcoma (1 patient), or rectal carcinoma (1 patient) were reviewed. The histology of the 96 primary bladder tumors was 81 transitional cell carcinomas (TCC), 8 adenocarcinomas, 5 squamous cell carcinomas, 1 small cell carcinoma, and 1 unclassified. Follow-up ranged from 1.5-100 months (mean, 26 mos; median, 24 mos). In all patients, the bladder neck and up to 1 cm in length of the adjacent urethra were removed with the bladder. An ileal orthotopic neobladder procedure was performed if staging biopsies of the bladder neck and intraoperative frozen section of the urethral margin revealed no tumor. RESULTS: There was no perioperative mortality, and an early and late complication rate requiring secondary intervention in 5 (5%) and 12 (12%) patients. With 88 of 102 patients alive and 83 of 102 patients disease free, a disease-specific survival of 74% and a disease-free survival of 63% was estimated at 5 years. No pelvic recurrence was seen in 81 patients with TCC. Three pelvic recurrences occurred, two tumors of the inner genitalia and one adenocarcinoma of the bladder, none of them in the area of the urethra or its supplying autonomic nerves. Daytime continence was 82%; nocturnal continence was 72%. Twelve (12%) patients were unable to empty their bladders completely and needed some form of catheterization. CONCLUSIONS: The functional and oncologic outcome of female patients with an orthotopic urinary diversion to a remnant urethra was found to be comparable to that found in large studies on males. An orthotopic neobladder proved to be an oncologically safe option for women with pelvic tumors and was found to provide quality of life when there was adherence to previously defined selection criteria.     

Primary clear-cell adenocarcinoma of the proximal female urethra: case report and review of the literature

Primary carcinoma of the female urethra is a rare entity. Adenocarcinomas account for only 10% of cases. Clear cell adenocarcinoma (CCA) of the urethra is more common among women than men.1 We report a case of primary CCA of the urethra and review the literature concerning the histogenesis, management, and outcome of this uncommon tumor.     

RT-PCR法检测尿脱落细胞中XIAP的表达在膀胱癌诊断中的价值

目的：比较膀胱癌患者尿液脱落细胞中XIAP表达的RT-PCR检测法和常规尿脱落细胞病理学检测在膀胱癌诊断中的临床价值。方法：采用逆转录聚合酶链反应技术（RT-PCR）检测51例膀胱尿路上皮癌患者尿液脱落细胞中XIAP-mRNA的表达,同时行常规尿脱落细胞病理学检测,20例非肿瘤人员作为对照组。结果：实验组51例尿脱落细胞XIAP-mRNA RT-PCR检测阳性27例（53%）,尿脱落细胞学病理学检测阳性12例（24%）,对照组20例尿脱落细胞XIAP-mRNA检测阳性1例（5.0%）,对照组尿脱落细胞病理学检测阳性0例（0%）。实验组RT-PCR检测膀胱尿路上皮癌患者尿脱落细胞中XIAP表达的敏感性高于尿脱落细胞病理学检测,差异有极显著统计学意义（P〈0.01）,实验组RT-PCR检测膀胱尿路上皮癌患者尿中XIAP表达的敏感性显著高于非肿瘤对照组,差异有极显著统计学意义（P〈0.01）。结论：膀胱尿路上皮癌患者尿脱落细胞中XIAP表达的RT-PCR检测法较常规尿脱落细胞病理学检测更敏感,临床上作为膀胱癌的筛选方法,有一定的临床价值。     

A new method of implanting orthotopic rat bladder tumor for experimental therapies

We developed a model of orthotopic transplantation of bladder tumor cells in female Fischer rats using a new reproducible technique. After first performing the mechanical abrasion of a portion of the bladder urothelium with an Abrader inserted transurethrally via a catheter, we administered a suspension of 5-40 x 10(6) viable AY-27 tumor cells in sterile phosphate-buffered saline to the bladder cavity. This rapidly led to a tumor growth incidence of approximately 100%. The induced bladder tumors grew expansively into the bladder cavity from the surface (mucosa) and gradually invaded the submucosa, muscles, serosa and surrounding tissue (high-stage invasive transitional cell carcinoma). Size and staging were related to the quantity of tumor cells instilled into the bladder cavity. This model matches the characteristics of human bladder tumor more closely than other bladder cancer models induced with tumor cells. Moreover, it presents many advantages: the method is reproducible, tumors grow rapidly, they are directly attached to the bladder surface and they are always located on the bladder wall, in line with the urethra. This proves especially helpful for evaluating chemotherapeutic agents by different means such as in vivo fluorescence spectroscopy, a noninvasive method used in photodynamic therapy, or other methods designed to detect and treat transitional cell carcinoma.     

Urethral carcinoma in women: results of treatment with primary radiotherapy.

BACKGROUND AND PURPOSE: Urethral carcinoma in women is uncommon. This study was undertaken to evaluate the role of radiotherapy in the treatment of these tumors. MATERIALS AND METHODS: The hospital records of 34 women with primary urethral carcinoma were retrospectively reviewed. There were 15 squamous cell carcinomas, 13 transitional cell carcinomas, and six adenocarcinomas. The primary tumor was >4cm in size in eight patients, involved the proximal urethra in 19 and extended to adjacent organs in 22. Inguinal or iliac lymphadenopathy was present in nine patients. There were eight TNM stage I/II tumors, 11 stage III tumors and 15 stage IV tumors. Radiotherapy was administered only to the primary tumor in 15 patients, and to the primary tumor and regional lymph nodes in the remaining 19 patients. Brachytherapy with or without external radiation was used to treat the primary tumor in 20 patients. RESULTS: Tumor recurred in 21 patients. The 7-year actuarial overall and cause-specific survivals were 41 and 45%, respectively. Large primary tumor bulk and treatment with external beam radiation alone (no brachytherapy) were independent adverse prognostic factors for local tumor recurrence. Brachytherapy reduced the risk of local recurrence by a factor of 4.2. The beneficial effect of brachytherapy was most prominently seen in patients with bulky primary disease. Large tumor size was the only independent adverse predictor of overall disease recurrence and death from cancer. CONCLUSIONS: Radiotherapy is an effective treatment for carcinoma of the female urethra and preserves normal anatomy and function. Brachytherapy improves local tumor control, possibly as a result of the higher radiation dose that can safely be delivered.     

Synchronously diagnosed and treated triple cancer (rectum-ureter-prostate)

A 63-year-old man was admitted for examination of a rectal tumor. A stony hard nodule was palpated in his swollen prostate by rectal examination. The biopsies proved rectal and prostate carcinoma. Transabdominal echogram and DIP showed left hydronephrosis. Left ureteral cancer was suggested by the typical "goblet sign" with retrograde ureterography. Rectal lower anterior resection, left total nephroureterectomy with partial cystectomy, castration and pelvic lymphadenectomy were undertaken synchronously. The pathohistological diagnosis was triple cancer consisting of rectal mucotubular adenocarcinoma, prostatic carcinoma and ureteral transitional cell carcinoma. The diagnosis and treatment of the triple cancer were discussed.     

NMP22肿瘤标志物诊断尿路上皮癌的初步评价

目的：探讨基质蛋白（ＮＭＰ２２）对尿路上皮癌临床诊断的价值。方法：应用酶联免疫法检测２８例尿路上皮癌及４例非尿路上皮肿瘤术前尿液的ＮＭＰ２２的含量。结果：尿路上皮癌ＮＭＰ２２的阳性率为７１．４％，其与病理分级、分期无明显相关性，而尿细胞学阳性率为３２．１％，４例非尿路上皮癌患者尿ＮＭＰ２２含量检测结果的为阴性。结论：尿液ＮＭＰ２２含量的测定有助于尿路上皮癌的诊断，且快速方便。     

Epidemiological characteristics of squamous cell carcinoma and adenocarcinoma of the bladder

Recent incidence data from the United States indicate that transitional cell carcinoma accounts for the vast majority (95%) of bladder tumors in this country, with squamous cell carcinoma (less than 3%) and adenocarcinoma (less than 2%) comprising nearly all the remaining cases. Rates of squamous cell carcinoma and adenocarcinoma were higher in blacks compared to whites, while the reverse was true for transitional cell carcinoma. All three tumors predominated in males, especially transitional cell carcinoma. A population-based case-control study of bladder cancer conducted in 10 geographical areas of the United States identified 43 patients with squamous cell carcinoma and 32 with adenocarcinoma to permit an examination of risk factors. Cigarette smoking was significantly associated with risk of squamous cell carcinoma, with the relative risk rising to 6.1 among smokers of 40 or more cigarettes/day. Significantly elevated risks of squamous cell carcinoma were also associated with a history of 3 or more urinary tract infections (relative risk = 5.7) and with employment as welders and cooks. Risk factors were generally less conspicuous for adenocarcinoma, except for a significant trend with the amount of coffee drinking; however, this finding is based on small numbers and should be interpreted cautiously.     

Transitional Cell Carcinoma presenting as a solitary brain lesion: A case report and review of the world literature

Transitional cell carcinoma of the urinary tract will account for roughly 50,000 new cases of cancer in the US this year. Metastatic involvement to the brain is uncommon with this malignancy. When it does occur, it is usually in the setting of widespread metastatic disease. A rare case of transitional cell carcinoma of the bladder presenting as a solitary brain lesion is reported. In addition, we reviewed the world literature regarding transitional cell carcinoma metastatic to the central nervous system. Our review suggests that metastatic transitional cell carcinoma of the central nervous system has become increasingly common as more effective chemotherapeutic regimens have been developed to control the primary disease. The recent literature also suggests that, much like other metastatic disease to the brain, outcome and survival in patients without widespread disease is improved by aggressive surgical and oncological management.     

肺耐药蛋白在膀胱移行细胞癌中的表达及临床意义

目的 :研究膀胱移行细胞癌的多药耐药性。方法 :应用免疫组化方法检测 65例膀胱移行细胞癌和 12例正常膀胱黏膜组织中LRP的表达。结果 :65例膀胱移行细胞癌组织LRP阳性表达率为76 92 % ,明显高于正常膀胱黏膜组织 ;LRP在中、低分化肿瘤 (G2 +G3)阳性表达率明显高于高分化肿瘤 (G1)。结论 :LRP可能是引起膀胱移行细胞癌原发性耐药的原因之一     

尿液核基质蛋白22在膀胱移行上皮癌筛检中的价值

目的：评价尿核基质蛋白22(NMP22)在膀胱移行上皮癌筛检中的意义。方法：采用酶联免疫法检测28例膀胱移行上皮癌、25例泌尿系良性疾病和10例泌尿系非移行上皮癌患者尿NMP22水平，并与尿脱落细胞学检查进行比较。结果：膀胱移行上皮癌患者尿NMP,,中位值为66．5u／ml，明显高于泌尿系良性疾病和非移行上皮癌，与肿瘤分期、分级、数目无关，以10u／ml为临界，诊断膀胱癌敏感性为85．7％，特异性为60％，尿脱落细胞学检查敏感性为32．1％，特异性为100％。结论：尿NMP22检测膀胱移行上皮癌敏感性、特异性均较高，可用于膀胱移行上皮癌的筛选和术后随访。     

热休克蛋白70在膀胱移行细胞癌中的表达

目的　研究HSP70在膀胱移行细胞癌中的表达。方法　采用免疫组织化学S -P染色法 ,检测 6 3例膀胱移行细胞癌组织中HSP70的表达。结果　HSP70在膀胱移行细胞癌中的阳性表达率为 4 7 6 2 % (30 /6 3)。HSP70的表达与膀胱移行细胞癌的分级和分期呈正相关 (P <0 0 5 )。结论　HSP70在膀胱移行细胞癌中的表达与癌组织的分级和分期有关。检测膀胱移行细胞癌中HSP70表达可为临床判断预后提供依据。