Successful long-term management of hepatic and lymph nodes metastases of ureteral cancer by multimodal treatment including radiofrequency ablation

A 56-year-old man presented with asymptomatic gross hematuria. Computed tomography (CT) scan revealed right hydronephrosis and a slightly enhanced invasive tumor in the right lower ureter, providing a diagnosis of ureteral cancer stage cT3NOM0. The patient underwent minimum incision endoscopic nephrouretectomy, and pathological examination of the resected specimen revealed urothelial carcinoma and squamous cell carcinoma with metastases to right obturator lymph nodes (pT3pN2). Ten months later, CT scan of the abdomen revealed two hepatic metastases. After three courses of combination chemotherapy consisting of gemcitabine and cisplatin (GC), one tumor completely disappeared and another achieved a partial response. The patient underwent radiofrequency ablation (RFA) for the residual followed by GC chemotherapy. However, eighteen months later, CT scan of the abdomen revealed two metastatic foci in other hepatic lesion. The patient underwent RFA again followed by GC chemotherapy and then all hepatic metastases have not revealed enlargement. More than three years after surgery, the patient has achieved a high quality of life.     

A collision cancer between urothelial carcinoma and malignant lymphoma of the urinary bladder: a case report

A man in his 70's visited the Department of Internal Medicine due to lumbago that had first appeared two months previously. Abdominal computed tomography showed a low-density area in the liver and swelling of lymph nodes surrounding the abdominal aorta. Four months later, he was hospitalized on an emergency basis in a urology ward in order to control bladder tamponade. Cystoscopy revealed massive blood clots and a papillary tumor at the left wall of the urinary bladder. He underwent transurethral resection of a bladder tumor, and the pathological diagnosis was a collision tumor between urothelial carcinoma (G2, pTa) and malignant lymphoma (B cell type). He underwent a liver biopsy soon thereafter, and the pathological diagnosis was malignant lymphoma (as for the one found in the urinary bladder). Bladder tamponade was repeated, which was relieved after one course of chemotherapy for malignant lymphoma. He underwent six courses of chemotherapy (THP-CO), and he was well without recurrence of either malignant lymphoma or urothelial carcinoma with 3 years' follow-up. To our knowledge, this is the 14th reported case of a collision tumor in the urinary tract.     

膀胱小细胞癌1例报告并文献复习

目的 探讨膀胱小细胞癌的临床诊断、病理特征、治疗及预后,提高对该病的认识和诊治水平.方法 回顾性分析1例膀胱小细胞癌患者的临床资料,并复习相关文献,综合分析膀胱小细胞癌的诊断及治疗状况.结果 该患者行膀胱部分切除术,术后病理证实为膀胱小细胞神经内分泌癌,免疫组化染色显示肿瘤细胞表达神经内分泌标志物神经元特异性烯醇化酶（NSE）、突触素（Syn）、嗜铬颗粒蛋白A（CgA）.术后接受了4个疗程的化疗,死于癌复发和肺转移,术后生存时间为13个月.结论 膀胱小细胞癌罕见,恶性程度高,早期易发生转移,预后差,行根治性切除术加联合化疗或放疗可提高治愈率.     

Small cell carcinoma of the urinary bladder with synchronous esophageal cancer and incidental lung cancer: a case report]

We present a case of triple primary cancers occurring synchronously in the urinary bladder, esophagus, and incidentally in the lung. A 65-year-old man with a chief complaint of gross hematuria was admitted to our hospital. Cystoscopy, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a non-papillary broad-based bladder tumor. Histological diagnosis was transitional cell carcinoma of the urinary bladder and he underwent one course of neoadjuvant chemotherapy (M-VAC) with the preoperative diagnosis of T3bN0M0. After one course of chemotherapy, chest CT, lymph node biopsy and esophagoscopy revealed squamous cell carcinoma of the esophagus. He first underwent radiochemotherapy (total 70 Gy, CDDP 5 mg x 41, 5-FU 250 mg x 24) for esophageal cancer and achieved complete remission. Then, he underwent radiotherapy for a total of 60 Gy for bladder cancer. However, his general condition gradually became worse and he died from metastatic cancer. The autopsy proved that he died from multiple metastases of small cell carcinoma of the urinary bladder and incidentally squamous cell carcinoma of the lung was identified.     

A case of retroperitoneal Castleman's disease associated with bladder tumor and a review of 59 cases in Japan]

We present a case of retroperitoneal Castleman's disease associated with bladder tumor. The patient was a 62-year-old man, who underwent partial cystectomy under a diagnosis of bladder tumor in 1989. Subsequently, recurrent bladder tumor was detected and he consulted the outpatient clinic at our University Hospital in November, 1990, at which time computerized tomography (CT) revealed a retroperitoneal tumor. From February, 1991 four courses of combined chemotherapy (methotrexate, vinblastine, pirarubicin, cisplatin) were administered for the tumor. The tumor reduction rate after the chemotherapy was 60% on CT, and retroperitoneal lymph node dissection and left nephroureterectomy were performed in July, 1991. Histological examination revealed Castleman's disease, hyaline-vascular type. Fifty-nine reported cases of retroperitoneal Castleman's disease in Japan are reviewed.     

Intraarterial neoadjuvant chemotherapy with cisplatin effective against neuroendocrine carcinoma of the urinary bladder: a case report

A 68-year-old male was admitted to our hospital with a complaint of asymptomatic gross hematuria. On physical examination, a huge mass was palpable in the lower abdomen. Computed tomography revealed a huge mass, 12 x 10 cm in size, in the urinary bladder and no metastatic lesions. The value of serum neuron specific enolase (NSE) was 32 ng/ml (normal range: 0-10 ng/ml). Histopathological and histochemical studies revealed neuroendocrine carcinoma which was positive for NSE, chromogranin A, S-100 and cytokeratin. He underwent neoadjuvant ballon occluded arterial infusion (BOAI) chemotherapy with cisplatin (CDDP). Total cystectomy and ileal conduit formation were performed at the preoperative diagnosis of T3N0M0. Examination of the resected specimen indicated a pathologically complete response and he was discharged. The patient is still alive with no evidence of any recurrence at 3 months after the operation. This case suggests that treatment with combined total cystectomy and neoadjuvant BOAI chemotherapy is effective against neuroendocrine carcinoma of the urinary bladder.     

Advanced adenocarcinoma of the urinary bladder successfully treated by the combination of cisplatinum, mitomycin-C, etoposide and tegafur-uracil chemotherapy

Primary adenocarcinoma of the urinary bladder has shown an extremely poor response to radiation or chemotherapy. Therefore, radical surgery is the only therapeutic treatment for it. A case report is presented of a primary advanced adenocarcinoma of the urinary bladder invaded into the uterus with distant metastases which responded completely to systemic combination chemotherapy including tegafur-uracil. The patient was a 53-year-old woman with a history of asymptomatic macrohematuria. She was treated with the combination of cisplatinum, mitomycin-C, etoposide and tegafur-uracil chemotherapy. After four courses of the chemotherapy, computed tomography showed marked regression of the primary tumor of the urinary bladder and the complete disappearance of the distant metastases in the liver, lung and para-aortic lymph node. Subsequently, she underwent radical cystectomy and cutaneous ureterostomy. Pathologically, no viable cancer cells were detected. Three years after the operation, she has no evidence of disease recurrence. Treatment of advanced adenocarcinoma of the urinary bladder by this combination chemotherapy is of benefit.     

膀胱小细胞癌的病理组织学特点及其诊治

目的:探讨膀胱小细胞癌病理组织学特点及其诊断与治疗。方法:回顾分析6例膀胱小细胞癌患者的临床和病理资料,6例患者行经尿道膀胱肿瘤电切术2例,膀胱部分切除术1例,行膀胱全切术2例,单纯化疗1例。5例患者接受2～6疗程化疗。结果:6例随访3个月～3年,1例患者术后生存2年至今,5例均因肿瘤转移死亡,平均生存时间14.8个月。结论:膀胱小细胞癌分化程度低、恶性程度高、易早期转移、预后差,主要依靠病理组织学检查确诊,现有治疗方法不足以将其治愈,手术联合化疗是目前主要的治疗方法,分子靶向治疗是未来治疗的主要手段。     

Primary metastatic neuroendocrine small cell bladder cancer: a case report and literature review

Small cell carcinoma of the urinary bladder (SCCUB) is a rare variant of neuroendocrine nonepithelial tumor. Clinically, SCCUB appears like a flat or ulcerated lesion and microscopically can cause microvascular invasion and necrosis. Small cell cancer, rarely found in the urogenital tract in a primitive form, usually coexists with urothelial bladder cancers. It has an incidence of 0.35-0.7% of all bladder neoplasms and survival at 5 years is estimated to be around 8%. A 60-year-old man who was a smoker was referred to our department with episodes of gross hematuria and pain in the lumbar region. After an extensive transurethral resection of the bladder, including of the muscular layer, the diagnosis of small cell carcinoma of the bladder was made. The neoplastic cells were positive with immunohistochemical staining for chromogranin A, paranuclear reactivity to cytokeratin and neuron-specific enolase. A total-body CT scan revealed lymph node involvement and hepatic, adrenal and lung metastases. Because of the advanced stage it was decided to avoid radical cystectomy and perform chemotherapy. The patient underwent two different cycles of cisplatin chemotherapy following international recommendations, but unfortunately without any response. After palliative therapy, the patient died in January 2010.     

Bladder cancer with skin metastasis: a case report

Bladder carcinoma with skin metastasis is extremely rare. We herein report a case of a bladder tumor with skin metastasis. A 68-year-old man was referred to our hospital with macroscopic hematuria. Cystoscopy revealed a trigone papillary tumor. Transurethral resection of bladder tumor (TURBT) was performed and the pathological diagnosis was transitional cell carcinoma (TCC), pT1, G3. Thereafter, he received several courses of TURBT, intravesical chemotherapy (pirarubicin, bacillus Calmette-Guerin and mitomycin C) and intra-arterial chemotherapy because of recurrence. Thirteen years later, he underwent total cystoprostatectomy with neobladder formation. Histological examination revealed muscle-invasive bladder cancer with a staging of T3bNOM0. Two years and three months later, multiple firm nodules with eruptions appeared on the skin in several regions; they were resected and the histological findings revealed TCC. This indicated metastatic spread from the primary bladder TCC. He received only supportive treatment during this period due to renal dysfunction. He died four months after the manifestation of the skin metastasis due to multiple metastases.     

Choriocarcinoma of the renal pelvis: a case report

A 68-year-old male presented to our hospital complaining of gross hematuria. Intravenous pyelography subsequently demonstrated a left non-visualized kidney, and he was admitted for further evaluation. Cystoscopy revealed a bladder tumor around the left ureteral orifice and retrograde pyelography showed a filling defect in the left renal pelvis. The urinary cytology from the left renal pelvis indicated class IV, and the microscopic findings of a bladder biopsy demonstrated grade 1 transitional cell carcinoma. We performed transurethral resection of bladder tumor (TUR-BT) followed by left nephroureterectomy with bladder cuff. The pathological diagnosis was high grade transitional cell carcinoma with choriocarcinomatous component. After the operation, the serum human chorionic gonadotropin-beta (hCG-beta) level was slightly elevated, and the combination chemotherapy with methotrexate, vinblastine and cisplatin (MVC) was administered. Although the serum hCG-beta level fell to 0.1 ng/ml, after two courses of MVC chemotherapy, bilateral pulmonary metastases appeared in the chest X-ray with increasing hCG-beta levels. Salvage chemotherapy with cisplatin, etoposide and bleomycin (PEB) was performed. After two courses of PEB chemotherapy, the serum hCG-beta level fell to within the normal range and all pulmonary metastases disappeared.     

Primary large cell neuroendocrine carcinoma of the urinary bladder

Large cell neuroendocrine carcinoma (LCNEC) of the urinary bladder is rare. It is a type of neuroendocrine carcinoma morphologically distinct from small cell carcinoma. We report here a case of primary LCNEC of the urinary bladder. We observed a very large invasive tumor, which was not able to be detected three months previously by cystoscopy or computed tomography. The tumor cells morphologically and immunohistochemically resembled that of pulmonary LCNEC. With prompt cystoprostatectomy and chemotherapy, the patient is free of disease 16 months after diagnosis. Although LCNEC is usually very aggressive, it may be controlled by early diagnosis and treatment.     

Combined treatment with CDDP and radiation effective against neuroendocrine carcinoma of the urinary bladder: a case report]

A case of neuroendocrine carcinoma (small cell carcinoma) of the urinary bladder is presented. A 76-year-old man complaining of dysuria visited our clinic on October 31, 1997. On physical examination, a huge mass was palpable in the lower abdomen. Abdominal and pelvic computed tomographic (CT) scan revealed a huge mass, 6.7 x 6.0 cm in size, with extravesical extension in the anterior wall of the urinary bladder and no metastatic lesions. Percutaneous biopsy of the tumor revealed undifferentiated neuroendocrine carcinoma. The value of serum neuron specific enolase (NSE) was 220 ng/ml (normal range: 0-10 ng/ml). Twenty days after the first CT scan, the tumor had grown to be 12.5 x 11.0 cm in size. He was treated with combination therapy of systemic cisplatin and external pelvic radiation and then achieved complete remission on CT scan and biopsy. The value of serum NSE was normalized. Four months later, abdominal CT scan revealed a huge metastastic lesion in the paraaortic and parahepatic regions, but, no local recurrence in the bladder. The value of serum NSE was 240 ng/ml. He was treated with 4 cycles of systemic combination therapy of cisplatin and etoposide. He achieved partial remission (regression rate: 77%) on CT scan after completion of the first 2 cycles, but the tumor showed rapid re-growth and he died of cancer 1 month later despite another 2 cycles. These combination therapies were effective against neuroendocrine carcinoma of the urinary bladder, although, the duration of the effect was short.     

Small cell carcinoma of the bladder: a case report

A 61-year-old man was referred to our hospital with a complaint of gross hematuria and lower abdominal discomfort. Ultrasonography, magnetic resonance imaging and cystoscopy revealed a nodular invasive tumor in urinary bladder. The histopathological findings of transurethral-biopsy specimen was the small cell carcinoma and transitional cell carcinoma of the bladder infiltrating into smooth muscle layer. Total cystectomy with ileal conduit was performed following 1 course of neoadjuvant chemotherapy (M-VAC). Computed tomography (CT) before adjuvant chemotherapy revealed tiny lung metastasis in left peripheral lung area. As postoperative adjuvant therapy, 4 courses of chemotherapy (etoposide and calboplatin) were performed with 50 Gy of extra beam radiotherapy to the lung metastasis. Follow up CT revealed disapperance of lung metastasis, and the patient has been free from disease for one year after chemotherapy.     

Two cases of thymic carcinoma effectively treated by preoperative chemotherapy

A 67-year-old man was admitted with left pleural effusion on chest X-ray film. Chest CT scans showed an anterior mediastinal tumor, left pleural dissemination and pleural effusion. Percutaneous needle biopsy yielded a diagnosis of epitherial carcinoma. The patient underwent 3 courses of systemic chemotherapy (CDDP + ADM + VCR + CPA). At achievement of partial response, the tumor was completely resected. Examination of the resected tumor revealed partial response to chemotherapy. A 49-year-old woman was admitted our hospital with supraclavicular lymph nodes swelling. Chest CT scans showed an large mediastinal tumor. Percutaneous needle biopsy yielded a diagnosis of squamous cell carcinoma of thymus. The patient underwent 3 courses of systemic chemotherapy. At achievement of partial response, the tumor was completely resected. Examination of the resected tumor revealed partial response to chemotherapy. These cases indicate the usefulness of preoperative chemotherapy for advanced thymic carcinoma to reduce tumor size and to control local invasion, distant metastasis before operation.     

Clinical efficacy of modified M-VAC chemotherapy for advanced urothelial carcinoma and influence of squamous cell carcinoma-associated antigen on efficacy of the chemotherapy

The efficacy of modified M-VAC chemotherapy was evaluated in twenty-two patients with advanced urothelial carcinoma (18 cases of transitional cell carcinoma, 3 of transitional cell associated with squamous cell carcinoma and 1 of squamous cell carcinoma). Among the 22 patients, 14 underwent two or more courses of modified M-VAC chemotherapy and had lesions suitable for the evaluation. Three of the 14 patients achieved complete response and 6 partial response, resulting in a 64.3% response rate. With regard to the direct effect according to the site of the lesion, the response rate was 75% for the urinary bladder, 100% for lung, 100% for subcutaneous tissues, and 75% for lymph nodes metastasis, whereas the chemotherapy was ineffective for metastasis in the bone and muscle. With this neoadjuvant chemotherapy the primary tumor of the urinary bladder was downstaged from T2 to T0 in one patient who showed complete response. In 4 of 5 patients achieving partial response, the primary tumors were downstaged from T2 to T1. Of 9 patients given this chemotherapy for metastatic lesions, 2 achieved complete response and are alive, whereas all 3 without response died of cancer within the 1 year following the chemotherapy. Since most of the cases associated with the squamous cells carcinoma component showed no response to the therapy, it seems that the level of serum squamous cell carcinoma-associated antigen may be helpful for predicting the efficacy of modified M-VAC chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of regionally metastatic pure squamous cell carcinoma of the urinary bladder successfully treated with radical chemoradiotherapy

We report a case of regionally metastatic pure squamous cell carcinoma of the urinary bladder successfully treated with combined radiation and chemotherapy in a 46-year-old man. Clinical staging was T3bN2M0. The patient received 50 Gy external radiation combined with intraarterial and systemic chemotherapy. Pathological complete response was found both in bladder and regional lymph nodes when he underwent radical cystectomy and lymph node dissection. The patient has been alive without evidence of disease for two years postoperatively.     

泌尿系统肉瘤样癌和癌肉瘤八例报告并文献复习

目的 探讨泌尿系统肉瘤样癌和癌肉瘤的组织学特点、临床表现、治疗和预后.方法 泌尿系统肉瘤样癌和癌肉瘤8例.其中膀胱肉瘤样癌4例,男3例,女1例,年龄58、63、78、79岁,均因无痛性肉眼血尿就诊,肿瘤直径平均4.5(1.5～6.7)cm,为不规则、广基的浸润性肿物.行膀胱部分切除术2例,TURBt 1例,膀胱癌根治术1例.肾肉瘤样癌1例,男,64岁,因肉眼血尿就诊,伴同侧肾上腺和胰腺转移,行肾癌根治术和胰腺体尾切除术.转移性右肾上腺肉瘤样癌1例,男,47岁,原发灶为左肺肉瘤样癌,行左肺下叶和右肾上腺切除术.肾盂癌肉瘤1例,女,64岁,表现为无痛性肉眼血尿,行左肾、输尿管及部分膀胱切除术.膀胱癌肉瘤1例,男,77岁,无痛性肉眼血尿,肿瘤直径2.5～3.0 cm,行TURBt术.8例均经病理检查确诊.8例均获随访,随访时间36～96个月.结果 膀胱肉瘤样癌4例中:1例G_3、T_(2a)者行TURBt,术后行丝裂霉素膀胱灌注化疗,随访96个月无瘤生存;1例63岁女性先行TURBt,术后病理为肉瘤样癌、T_1伴有原位癌(T_m),1个月后行膀胱癌根治切除术.随访36个月无瘤生存;1例T3a者行膀胱部分切除术,术后辅以放疗,随访36个月无瘤生存;1例T4a者行姑息性膀胱部分切除术,术后病理切缘阳性,术后2个月死于肿瘤多脏器转移.肾肉瘤样癌患者术后2个月开始化疗(盐酸吉西他滨加卡铂),又出现肝、肺转移,术后5个月死亡.转移性右肾上腺肉瘤样癌患者术后在外院行3个疗程化疗(顺铂加依托泊苷),5个月后出现左肾上腺转移,术后7个月死亡.肾盂癌肉瘤患者的肿瘤以软骨肉瘤为主,伴少许鳞状细胞癌及未分化癌,随访60个月无瘤生存.膀胱癌肉瘤患者肿瘤病理分期为T2a,主要是平滑肌肉瘤,伴有鳞状细胞痛和腺癌,术后予以全身化疗(盐酸吉西他滨加卡铂),随访12个月死于慢性阻塞性肺气肿、肺部感染.结论 泌尿系统肉瘤样癌和癌肉瘤少见,多见于老年男性,恶性程度高,浸润性强,预后差.肿瘤的病理分期和治疗是影响预后的因素,早期诊断和积极的综合治疗可望获得较好的治疗结果、延长患者生存期.     

A bulky mass non-Hodgkin's lymphoma with dysuria in the rectovesical space

A case of non-Hodgkin's lymphoma is reported. A 71-year-old man presented with complaint of dysuria and urinary frequency. Rectal examination and CT scan revealed a bulky mass in the rectovesical space. Transperineal needle biopsy of the tumor revealed non-Hodgkin's lymphoma, large cell type, diffuse. The patient received combination chemotherapy of adriamycin, cyclophosphamide, vincristine, prednisolone and pepleomycin. After two days the tumor was marvelously reduced in size, and partial response (PR) by CT was achieved after two months. PR was sustained for two months with cyclophosphamide, vincristine and prednisolone. However, the tumor progressed gradually, and he died five months after the first treatment and two additional courses of chemotherapy. Autopsy showed a 1,700 g bulky mass in the rectovesical space. The mass was covered with peritoneum and had a fistula from rectum to central necrosis of the tumor. Nine cases of the non-Hodgkin's lymphoma with complaint of dysuria have been reported in Japan before our case, which seemed to arise from the submucosal tissue of anterior rectal wall, prostate or lymphatic tissue of rectovesical space.     

Urothelial carcinoma of ureter with neuroendocrine differentiation: a case report

A 73-year-old woman complained of gross hematuria. Urine cytology showed small cell carcinoma (SmCC) cells mixed with urothelial carcinoma (UC) cells. Cystoscopy revealed a bladder tumor around the right ureteral orifice. Abdominal CT demonstrated severe right hydronephrosis. Pelvic MRI showed a mass (approximately phi5 cm) in the urinary bladder wall that protruded into the lumen. TUR biopsy of the bladder tumor was SmCC. With laparoscopic nephrectomy/open ureterectomy, distal end (approximately 10 cm) of the right ureter was tumorous and obstructed. The tumor invaded into the urinary bladder/peritoneum and was unresectable. The tumor of lower-end of ureter tumor was SmCC, showing neuroendocrine differentiation such as pseudo-rosette, positive Grimelius stain, and chromogranin A/NCAM/synaptophysin immunostaining. Proximal to this tumor, non-invasive UC spread superficially over entire length of the ureter to the renal pelvis. Abrupt transition from invasive SmCC to non-invasive UC was observed in the middle of the ureter. Post-operative adjuvant chemotherapy was discouraged due to senile dementia of the patient. The patient died nine months after the operation because of systemic progression of cancer.