Cyclophosphamide-Induced Urinary Bladder Cancer: A Case Report

A case of carcinoma of the bladder developing in a patient whoreceived cyclophosphamide therapy for multiple myeloma over5 yr is presented. Literature reviews and possible mechanismsof urinary bladder carcinogenesis associated with cyclophosphamideare discussed.     

A Primary Epithelioid Angiosarcoma Arising in a Bilharzial Urinary Bladder: A Reappraisal and Case Report

Background: Angiosarcoma (AS) of the urinary bladder is a very rare and aggressive malignancy with a dismal outcome. Case report: Here, we report a primary epithelioid angiosarcoma (EAS) of the urinary bladder in a forty-nine-year-old male patient who presented with severe hematuria. Cystoscopic examination revealed hemorrhagic ulcerated bladder mucosa but no definite mass lesions. Intractable hematuria raised the initial clinical impression of idiopathic hemorrhagic cystitis. Analysis of the cystoscopic biopsy revealed features of old bilharzial cystitis, markedly atypical epithelioid endothelial cells arranged as primitive anastomosing vascular structures and expressing vascular markers. The diagnosis of EAS was established. The patient developed intractable severe hematuria, and a radical cystoprostatectomy was performed. The patient was started on chemotherapy but suddenly developed widespread distant metastasis (liver, lung, suprarenal glands, and lymph nodes) and succumbed to death two months after the surgery. Conclusion: To the best of these authors’ knowledge, we presented the first report of primary EAS arising in a bilharzial bladder. The relevant studies were discussed.     

Right Iliac Metastasis Occurring Eight Years after Resection of Invasive Bladder Cancer: A Case Report

A case of transitional cell carcinoma of the bladder which metastasizedto the right ilium eight years after resection of the originaltumor without recurrence in the urinary tract is reported. Boththe original and metastatic tumors were shown by immunoperoxidasetechnique to contain carcinoembryonic antigen (CEA). The patientreceived a combination of intra-arterial chemotherapy, irradiationand hyperthermia with partial response.     

Neuroendocrine Carcinoma of the Urinary Bladder: Case Report and Review of the Literature

A 63-year-old Japanese man complained of hematuria and pollakisuriafor several months. Computed tomography and cystography disclosedan infiltrative tumor mass in the irregularly thickened apicaland posterior walls of the urinary bladder. Narrowing of thevesical lumen and posterior extension of the tumor into thepelvic cavity were also noted. After palliative ureterocutaneostomy,60 Gy irradiation was given locally. The patient died of cachexiaseven months later. Autopsy revealed neuroendocrine carcinomaof the urinary bladder with extensive invasions and metastasesto the pelvic and peritoneal cavities, liver, lungs, vertebrae,left kidney and retroperitoneal lymph nodes. Histologically,atypical tumor cells with eosinophilic cytoplasm formed solidnests and anastomosing cords with pseudoglandular structures.No other histologic tumor components were included. An intacturachal remnant was found at the vesical apex while featuresof metaplastic cystitis were absent. In addtion to positivecarcinoembryonic antigen and cytokeratin, the argyrophilic cancercells were immunoreactive for neuron-specific enolase, chromograninA, serotonin, neuropeptide Y, glicentin, somatostatin, neurotensinand calcitonin. Ultrastructurally, neurosecretory-type granules,with a mean diameter of 166 nm, were identified in the cytoplasmof the tumor cells. To discuss the histogenesis of the tumor,44 previously reported cases of neuroendocrine carcinoma ofthe urinary bladder were reviewed.     

A Case of Urinary Bladder Urothelial Carcinoma with Squamous,Glandular, and Plasmacytoid Differentiation

We report an extremely rare case of urothelial carcinoma (UC) of the urinary bladder with diverse histological differentiation into squamous, glandular, and plasmacytoid components. A 65-year-old man presented with gross hematuria. Cystoscopy showed a papillary-growing tumor with a wide-based stalk on the left wall of the urinary bladder. Based on the clinical diagnosis of locally invasive bladder cancer, the patient underwent radical cystectomy. Histological examination of the cystectomy specimen revealed UC with histological differentiation into multiple tumor subtypes. The tumor was composed of squamous cell carcinoma with marked keratinization, adenocarcinoma characterized by tall columnar cells with scattered goblet cells, conventional high-grade invasive UC and UC in situ, and plasmacytoid UC composed of discohesive cancer cells with eccentric nuclei and eosinophilic cytoplasm that diffusely infiltrated the bladder wall through the serosal surface. Immunohistochemically, the loss of membranous E-cadherin expression was noted only in the plasmacytoid UC component. The patient developed local recurrences 2 months postoperatively and died of the disease 6 months postoperatively. It is critical to correctly diagnose the histological variants of UC to predict a patient''s prognosis and to determine the optimal treatment.Key words: Bladder cancer, E-cadherin, Histological variant, Immunohistochemistry, p63, Pathological diagnosis, Prognosis     

External Beam Radiotherapy for Focal Lymphoepithelioma-Like Carcinoma in the Urinary Bladder: A Case Report and Literature Review

Lymphoepithelioma is a malignant epithelial tumor in the nasopharynx characterized by prominent lymphoid infiltration. Carcinomas that resemble lymphoepitheliomas have been called lymphoepithelioma-like carcinomas and have been reported in other organs. A tumor in the bladder is categorized by the percentage of the total area occupied by the lymphoepithelioma-like carcinoma pattern, with the prognosis dependent on the percentage. We present an 81-year-old man with stage 3 chronic obstructive pulmonary disease and a history of aortic aneurysm repair. The computed tomography scans indicated thickening and irregularity of the bladder wall, with left external iliac lymph node metastasis. His diagnosis was bladder cancer, and the clinical stage was evaluated as T3N1M0. Transurethral resection of the bladder tumor was performed, and the pathological specimen showed that the tumor was composed of undifferentiated malignant cells with sheets and nests arranged in a syncytial pattern, as well as an urothelial carcinoma lesion. A prominent lymphoid reaction accompanied the tumor. The pathological diagnosis was focal-type lymphoepithelioma-like carcinoma containing a component of urothelial carcinoma G3>G2. His general condition was such that he could not tolerate radical cystectomy or systemic chemotherapy. External beam radiotherapy (total 60 Gy) was given to the bladder, including the lymph node metastatic lesion. No cancer recurrence was detected by regular follow-up computed tomography and cystoscopy. He eventually died of other causes 48 months later. Although treatment for focal lymphoepithelioma-like carcinoma generally requires multifocal therapies, in the present case, the bladder became tumor free. We also summarize previously reported lymphoepithelioma-like carcinoma cases treated with radiotherapy.Key Words: Bladder cancer, Lymphoepithelioma-like carcinoma, External beam radiotherapy     

Inflammatory Myofibroblastic Tumor of the Urinary Bladder with Benign Pelvic Lymph Node Enlargement: A Case Report

Inflammatory myofibroblastic tumors (IMTs) rarely occur in the urinary bladder. It is apparently difficult to distinguish these tumors from other malignant spindle cell proliferations. Herein, we report a case of IMT of the urinary bladder with enlarged pelvic lymph nodes. The definitive pathological diagnosis could not be established by biopsy. Instead, the diagnosis of IMT of the urinary bladder was determined by a positive reaction to anaplastic lymphoma kinase by immunohistochemistry after radical cystectomy. No malignant findings were observed on histopathological evaluations of the enlarged lymph nodes.Key words: Inflammatory myofibroblastic tumor, Urinary bladder, Lymph node swelling     

Malignant Disease of the Urinary Bladder

Of 290 cases registered as cancer of the bladder at the Peter MacCallum Clinic, 28 were discarded as being wrongly registered or diagnosed, or unable to be assessed in any useful way. Two hundred and sixty-two cases were reviewed in detail. Symptomatology, sex and age distribution are in no way different from other published series. Attention is drawn to the influence of smoking in lowering the age of onset, this effect being more marked in women. The lack of concomitant lung cancer is felt to be worthy of comment when 12 patients had other malignancies. The prognosis in relation to sex does not differ, but young patients seem to fare twice as well as old ones. The importance of pre-treatment staging and assessment of the histology is emphasized and a set of guide lines as to management is set out. Survival rates for the overall series show a five-year figure of 4/40 (10%) for unstaged; 8/31 (23%) for T.O; 6/36 (16%) for T.l; 4/22 (18%) for T.2; 2/20 (10%) for T.3; and 2/76 (2–6%) for T.4. The determinate figures at five years for radically treated, assessable cases are T.O 7/15 (43%), T.l 6/16 (35%), T.2 4/12 (33%), T.3 2/5 (40%) and T.4 1/6 (17%). Figures suggest that early total cystectomy is indicated for uncontrollable well differentiated mucosal tumours, while radiation alone–or as an electivepreoperative measure–is preferable for poorly or moderately differentiated tumours. Pure squamous or adenocarcinomas are radio-resistant and seldom operable, but cystectomy is the only treatment likely to be curative. A tendency to squamoid or adenocarcinomatous differentiation, however, is not a sign that radiotherapy will fail. Radiation under hyperbaric oxygenation holds some promise for improving the local clearance of tumour. Cytology may be of some use in selecting follow-up cases for cystoscopy, but its accuracy requires some improvement.     

The Performance of the Xpert Bladder Cancer Monitor Test and Voided Urinary Cytology in the Follow-up of Urinary Bladder Tumors

BackgroundCystoscopy in complement with urinary cytology represents the gold standard for the follow-up of patients with urinary bladder tumours. Xpert Bladder Cancer Monitor Test (XBC) is a novel mRNA-based urine test for bladder cancer surveillance. The aim of the study was to evaluate the performance of the XBC and voided urinary cytology (VUC) in the follow-up of bladder tumours.Patients and methodsThe XBC was performed on stabilized voided urine and VUC was performed on urine samples. The results were compared to cystoscopic findings and histopathological results after transurethral resection of the bladder lesion.ResultsFor the prediction of malignant histopathological result sensitivity, the specificity and negative predictive value were 76.9%, 9 7.5% and 93.0% for the XBC and 38.4%, 9 7.5% and 83.3%, respectively for VUC. For the prediction of suspicious or positive cystoscopic finding sensitivity, the specificity and negative predictive value were 75.0%, 95.2%, and 93.0% respectively for the XBC and 41.7%, 97.6%, and 85.4% for VUC. The sensitivities for papilary urothelial neoplasms of low malignant potential (PUNLMP), low- and high-grade tumours were 0.0%, 66.7% an d 100.0% for the XBC and 0.0%, 66 .7% and 42.9%, respectively for VUC.ConclusionsThe XBC showed significantly higher overall sensitivity and negative predictive value than VUC and could be used to increase the recommended follow-up cystoscopy time intervals. Complementing the XBC and voided urinary cytology does not improve performance in comparison to the XBC alone.Key words: cystoscopy, Xpert BC Monitor Test, urinary bladder neoplasm, voided urinary cytology     

A Clinical Review of Small-Cell Carcinoma of the Urinary Bladder

Small-cell carcinoma of the urinary bladder is a rare and aggressive type of bladder cancer that has a poor prognosis. The incidence has been gradually increasing because of the aging population. Owing to its rarity there are no available treatment guidelines. Several retrospective studies and 1 prospective study have provided some insight into therapy for this disease. A multimodal approach that includes chemotherapy, local radiation therapy, and definitive surgery in resectable cases appears to be an optimal management approach.     

Inverted Papillary Carcinoma of the Urinary Bladder

A 47-year-old man presented with an inverted papillary carcinomaof the urinary bladder. Cystoscopy revealed an approximately2 cm mass, with a small stalk and smooth surface, which wassituated just medial to the right ureteral orifice. Transurethralresection of the tumor was performed on July 25, 1983. Malignantchanges were recognized in the epithelial cords in the resectedspecimen. This is in contrast to the general view that invertedpapilloma of the urinary bladder is benign in nature. The authorsbelieve that careful pathologic examination should be done whenan inverted type tumor of the urinary tracts is found. No recurrencehas been recognized as of September 11, 1987.     

Coexistence of Papillary and Nodular Carcinomas in the Urinary Bladder

Of 203 patients with transitional cell carcinoma of the urinarybladder which had been cystectomized and examined by step-sectioningduring the period between 1969 and 1986, 33 had coexistent papillary,papDlonodular and/or nodular carcinomas in the bladder. Of them,12 (36%) had a history of papillary carcinomas, 26 (79%) hadmultiple rumors and 22 (67%) had a concomitant carcinoma insitu, and/or mucosal dysplasia. Moreover, microscopic papillarystructures were identified in 32 out of the 33 (97%) cases withpapillonodular and/or nodular carcinomas, indicating some ofthe nodular invasive carcinomas in the bladder to have developedfrom papillary carcinomas.     

A Systematic Overview of Radiation Therapy Effects in Urinary Bladder Cancer

A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for urinary bladder cancer is based on data from 3 meta-analyses and 33 randomized trials. The studies include 4 333 patients. The results were compared with those of a similar overview from 1996 including 15 042 patients. The conclusions reached can be summarized as these points: There is moderate evidence for an overall survival benefit with preoperative radiotherapy followed by cystectomy compared to curative radiotherapy based on early studies (1964-1986). Since that time surgical as well as radiation techniques have developed considerably. Therefore, the conclusion may not be relevant to modern treatment of invasive urinary bladder carcinoma.There is only one small study reporting on curative radiotherapy where increased dose per fraction is compared with conventionally fractionated radiotherapy to the same total dose. Thus, no conclusions can be drawn concerning optimal fraction dose.A meta-analysis based on two studies on hyperfractionated radiotherapy gives moderate evidence of a survival benefit at 5 and 10 years and an increased local control rate compared with conventional fractionation.The documentation of local control and overall survival rate after split-course radiation treatment compared to continuous therapy is conflicting. No firm conclusions can be drawn.Four small and early studies have compared radiation treatment using neutrons with photon treatment. The reports favour therapy with photons with respect to overall treatment results. There is moderate evidence for this conclusion.There is fairly strong evidence in early studies that radiation treatment in combination with hyperbaric oxygen does not confer a treatment benefit compared to radiation in normal atmosphere.There is no indication of a treatment benefit with the addition of either hyperthermia or misonidazole.A large number of phase II studies, suggesting an increased possibility for bladder preservation with concomitant chemoradiotherapy compared to radiotherapy alone, have been reviewed in a previous SBU report on chemotherapy. Only one small randomized study has been reported where concomitant chemoradiotherapy with cisplatin is compared to radiation alone. No conclusion on the therapeutic benefit of combined treatment can be drawn. Large randomized studies are needed.There is some evidence that preoperative radiotherapy followed by cystectomy does not confer any significant survival benefit compared to cystectomy alone.There is moderate evidence that palliative radiotherapy of invasive bladder carcinoma can rapidly induce tumour-related symptom relief.There is moderate evidence that palliative hypofractionated radiotherapy, 3 fractions during one week, gives the same relief of symptoms as 10 fractions during 2 weeks.     

Metastatic Small Intestinal Cancer of the Urinary Bladder

We report an extremely rare case of small intestinal cancer metastasized to the urinary bladder, presenting a urologic symptom. A 41-year-old man first presented with nausea, vomiting and abdominal pain. Based on the clinical diagnosis of jejunal cancer, he underwent a partial resection of the jejunum with lymph node dissection. The pathological diagnosis was moderately differentiated adenocarcinoma of the jejunum, pT4N0. Seventeen months after surgery, he presented with a gross hematuria. Computed tomographic scan showed wall thickening of the posterior wall of the urinary bladder. No tumor was found in other organs or lymph nodes. Based on histological and immunohistochemical analysis, the diagnosis of urinary bladder metastasis from jejunal adenocarcinoma was made. This is the first report of urinary bladder metastasis from small intestinal cancer. Although very rare, the possibility of metastatic small intestinal cancer should be considered in differential diagnosis in patients with adenocarcinoma involving the urinary bladder.     

16例膀胱腺癌粘液组化及免疫组化观察

 原发性膀胱腺癌是一种少见的膀胱恶性肿瘤。本组报告16例，男性13例，女性3例。粘液组化结果：膀胱腺癌PAS／AB和HID／AB染色显示类似胃肠道腺癌粘液分泌；免疫组化结果：9例Keratin阳性，13例CEA阳性。提示原发性膀胱腺癌发生于移行上皮的腺上皮肠化生。此外，对于膀胱腺癌预后与病理的关系作了简要讨论。     

膀胱小细胞癌的研究进展

 膀胱小细胞癌（Small—cell carcinoma of the urinary bladder，SCBC），是泌尿系肿瘤中一种比较罕见的恶性肿瘤。但因其在临床和流行病学特征与膀胱移行细胞癌存在着极大的相似性，而生物学行为却呈高度恶性，进展快、转移早、预后差，如今已越来越受到肿瘤科及泌尿外科医生的重视。因此，本文将对膀胱小细胞癌的新近研究做一综述。     

Detection of the c-myc Gene Product in Urinary Bladder Cancer

Expression of the c- myc gene product in urinary bladder cancer was investigated by immunohistochemical staining with anti-c- myc monoclonal antibody (mAb) MYC-1. Positive staining was observed in the cytoplasm, but not in the nucleus in tissues fixed with 10% formalin. On the other hand, positive staining was localized in the nucleus in cryopreserved tissues. Of 34 cryopreserved specimens examined, positive staining with MYC-1 mAb was observed in 1 of 12 (8.3%) of grade 1 (G1), 12 of 15 (80%) of G2 and 6 of 7 (86%) of G3. Positive staining with Ki-67 mAb was observed in 2 of 12 (17%) of G1, 12 of 15 (80%) of G2, and 6 of 7 (86%) of G3. These results suggest that tumors with higher nuclear pleomorphism contain more proliferating cells.     

Diagnostic Role of Survivin in Urinary Bladder Cancer

Background: Early diagnosis of carcinoma of bladder remains a challenge. Survivin, a member of theinhibitor of apoptosis (IAP) protein family, is frequently activated in bladder carcinoma. The objective of thisstudy was to investigate urinary survivin as a marker for diagnosis of urinary bladder. Materials and Methods:We examined urinary survivin concentration in 28 healthy individuals, 46 positive controls and 117 cases ofhistologically proven TCC prior to transurethral resection, using ELISA, and compared values with findings forurinary cytology. Results: Survivin was found to be significantly higher in the cancer group (P<0.05). A cut offvalue of 17.7 pg/ml was proposed, with an approximate sensitivity of 82.9% and specificity of 81.1% (P<0.0001),whereas urine cytology had a sensitivity of 66.7% and a specificity of 96.0%. Conclusions: Urinary survivin canbe used as a non-invasive diagnostic biomarker for TCC bladder, both for primary and recurrent disease.