Surgical management of bladder transitional cell carcinoma in a vesicular diverticulum: case report

We report a case of primary transitional cell carcinoma (TCC) of a bladder diverticum along with a literature review. A 55-year-old male presented with painless gross hematuria. A histological diagnosis of TCC within a bladder diverticulum was made following cystoscopical examination. Initially transurethral resection of bladder tumour with subsequent intravesical chemotherapy followed. As a result of recurrence and in view of bladder-sparing therapy, a distal partial cystectomy was performed. This report demonstrates that conservative bladder-sparing treatment can be achieved and subsequently followed by vigilant cystoscopy.     

A case of transitional cell carcinoma in a pyelocaliceal diverticulum

A 63-year-old man visited our hospital because of painless macrohematuria. Drip infusion pyelography and retrograde pyelography revealed a space-occupying lesion with extravasation of contrast medium to upper caliceal system. A computed tomographic study revealed an intrarenal solid moiety and further more, arteriography showed the arterial encasement and fine neovascularity of the lesion. On gross section of the extirpated kidney, a cystic cavity measuring 3 by 3 cm existed at the upper pole and apparently channeled to the upper caliceal system. Small stones were found in the cystic cavity. Histopathologically, the wall of the cavity was covered with layered squamous cells and a part of the wall developed metaplasic transitional cell carcinoma proliferation which invaded into the renal parenchyma and renal pelvis, as well.     

Ten cases of transitional cell carcinoma of bladder causing ureteric obstruction

A review was carried out on 10 patients with superficial transitional cell carcinoma of the bladder (Ta lesions) that were causing ureteric obstruction. Evidence of upper tract obstruction did not necessarily indicate deep invasion.     

膀胱移行细胞癌微血管分型及意义

为探讨膀胱移行细胞癌组织中肿瘤微血管不同类型与浸润和转移的关系，应用免疫组织化学ＳＰ法在６１例膀胱移行细胞癌组织中对第Ⅷ因子相关抗原进行表达并计数，根据肿瘤组织中微血管（ＭＶ）的分布特点及其与肿瘤组织的关系，将ＭＶ分为两型：Ⅰ型为肿瘤组织内ＭＶ，位于癌组织内，血管迂曲，扩张，变形；Ⅱ型为肿瘤旁ＭＶ，位于肿瘤边缘，血管分布不均。结果显示浸润性癌组的Ⅱ型ＭＶ数显著高于Ⅰ型ＭＶ数（Ｐ＜００５），在浅表性癌组中Ⅰ，Ⅱ型ＭＶ数之间无显著性差异（Ｐ＞００５），伴淋巴结转移的癌组织Ⅱ型ＭＶ数显著高于Ⅰ型ＭＶ数（Ｐ＜００５）。认为肿瘤血管的生长有很大的异质性，肿瘤边缘的微血管与肿瘤的浸润有密切关系。     

Plasmacytoid transitional cell carcinoma of urinary bladder: a clinicopathologic study of 9 cases

In this report, we summarized the clinicopathologic features of 9 cases of plasmacytoid transitional cell carcinoma (TCC) of the urinary bladder, a rare variant of TCC. All 9 patients were men with a mean of age 64.3 years (range, 46 to 81 y). All but 1 patient presented with gross hematuria; the remaining patient had urgency and microscopic hematuria. Cystoscopic findings revealed a dominant solid mass with surrounding multiple papillary lesions in 6 cases and multiple masslike lesions in 3 other cases. The initial diagnosis of plasmacytoid TCC was made on transurethral resection in 8 cases and cystoscopic biopsy in 1. One patient had TNM stage I disease, 2 had stage II disease, 3 had stage III disease, and 3 had stage IV disease. Four patients were treated by radical cystectomy with chemotherapy, 2 by radical cystectomy alone, 1 each by chemotherapy or intravesical bacillus Calmette-Guerin infusion alone, and 1 did not receive any further therapy. Microscopically, all tumors contained plasmacytoid cells, which composed 30% to 100% of the entire tumor. Eight of 9 cases were associated with high-grade TCC, and transitional cell carcinoma in situ was present in 4 cases. The plasmacytoid tumor cells were characterized by eccentrically located nuclei and abundant eosinophilic cytoplasm. Interestingly, plasmacytoid transitional cell carcinoma in situ was noted in 1 case. Immunohistochemical staining demonstrated that both plasmacytoid and conventional TCC components were positive for cytokeratins 7 and 20. The mean Ki-67 labeling index was 30% (range, 10% to 50%), and p53 expression in the majority of cases was low (5% to 10%), except for in 2 cases (70% and 80%). The mean follow-up in 8 patients was 24.5 months (range, 5 to 47 mo); the other patient was lost to follow-up. Five patients died of disease from 5 to 36 months, 2 patients were alive with disease at 30 and 47 months, and 1 patient was alive and well at 36 months with no evidence of disease. In summary, plasmacytoid TCC tends to present at an advanced stage and to have a poor prognosis. Morphologic recognition and distinction from other plasmacytoid malignant neoplasms is critical for its clinical management and immunohistochemical studies may be required for differential diagnosis.     

Case report: transitional cell carcinoma in situ within a urethral diverticulum

A 56-year-old female smoker presented after long diagnostic delay with high-grade transitional cell carcinoma in situ within a urethral diverticulum. This is the third report of this type in the literature. Preoperative investigations, including urine cytology and magnetic resonance imaging (MRI), were not helpful.     

膀胱移行细胞癌肿瘤血管生成的研究

为探讨肿瘤微血管与膀胱移行细胞癌浸润和转移的关系，应用免疫组织化学技术在６４例膀胱移行细胞癌组织中对第Ⅷ因子相关抗原进行表达，并计数肿瘤的微血管（ＭＶ）。结果发现，术后复发者ＭＶ数明显高于未复发者（Ｐ＜００１），浸润性癌的ＭＶ数明显高于浅表性癌（Ｐ＜００１），组织学Ⅲ级高于Ⅰ、Ⅱ级（Ｐ＜００５），伴淋巴结转移的ＭＶ数显著高于未转移者（Ｐ＜００５）。结果提示以ＭＶ为标记的肿瘤血管与膀胱移行细胞癌的分期、分级及预后密切相关，肿瘤的增长和转移有赖于肿瘤血管的生成。     

一氧化氮合成酶在膀胱癌中的表达及意义

目的　了解三种类型一氧化氮合成酶 (NOS)在膀胱癌中的表达情况 ,探讨其与肿瘤发生发展的关系。　方法　对 2 5例开放手术切除的膀胱癌组织标本进行三种NOS免疫组织化学染色 ,自动图像分析仪对染色程度分级 ;6例肾移植供体正常膀胱组织标本作为对照。　结果　诱导型NOS(iNOS)在肿瘤上皮细胞呈阳性表达 ,在正常膀胱移行细胞不表达或仅微弱表达 (P <0 .0 5)。内皮细胞型NOS (eNOS)在肿瘤基质毛细血管内皮细胞中的表达阳性率 1 0 0 % ,高于对照组中的 67%。两组标本中神经型NOS(nNOS)表达部位及强度相似。统计学分析显示iNOS和eNOS表达与肿瘤分级、分期无明显相关性 ,P均 >0 .0 5。　结论　iNOS及eNOS在膀胱癌的高表达可能与肿瘤的发生发展有关。     

Squamous cell carcinoma and transitional cell carcinoma arising in bladder augmentations

Tumours arising in bowel-augmented bladders are rare. Usually these tumours are adenocarcinomas that occur along the anastomotic line. We present two unusual tumours, squamous cell carcinoma and transitional cell carcinoma, that occurred in bladder augmentations. We also emphasize the need for regular cystoscopic surveillance.     

Two cases of primary carcinoma developed in a vesical diverticulum treated with ileal neobladder for total bladder replacement

Two cases of carcinoma developed in vesical diverticulum were encountered. Both these males, the first, 66-year-old and the second case, 68-year-old gentleman, visited our clinic with a complaint of asymptomatic gross hematuria. Total cystectomy was performed, and an ileal neobladder was constructed for total bladder replacement in both two cases. Pathological examination of the first case revealed transitional cell carcinoma, and the second case showed adenocarcinoma mixed with transitional cell carcinoma. Although primary carcinoma developed in vesical diverticulum was initially reported by Williams in 1883, adenocarcinoma is very rare. The diagnosis is often challenging and the prognosis is dire. Both our cases were successfully treated with total cystectomy and an ileal neobladder was constructed for total bladder replacement. Careful management and aggressive therapy for such patients may make even cure possible.     

Orbital metastasis,by transitional cell carcinoma of the bladder

We report a new case of a patient with transitional cell carcinoma of the urinary bladder and a solitary metastasis to the orbita. A review of the literature shows two cases described previously. This case is interesting for the clinical features and evolution.     

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.     

Whole bladder photodynamic therapy for transitional cell carcinoma of bladder

Our preliminary studies indicate that the bulb-tip technique for whole bladder photodynamic therapy (PDT) illuminates the entire bladder mucosa and is applicable to the management of superficial transitional cell carcinoma of the bladder. This treatment modality may be an option to patients who are failures to other standard treatments. A randomized clinical study is needed to decide on PDT as a primary treatment of choice for transitional cell carcinoma of the bladder.     

A case of small cell carcinoma in a diverticulum of the bladder

We report a case of small cell carcinoma in a diverticulum of the bladder. A 64-year-old Japanese man visited our hospital with the chief complaint of urinary retention. Cystoscopy revealed a papillary tumor arising in a diverticulum on the right lateral wall of the bladder. Partial cystectomy was performed under the diagnosis of bladder cancer in the diverticulum. The histopathological diagnosis was a combination of small cell carcinoma and urothelial carcinoma, of which the former was dominant. It is often difficult to detect tumors in the bladder diverticula and its early penetration is not rare because of the thin wall. Therefore, the prognosis of the bladder cancer in the diverticulum is believed to be generally poor. On the other hand, small cell carcinoma originating in the urinary bladder is also characterized by its extreme rareness and poor prognosis. To our knowledge, this is the second case report of the small cell carcinoma arising in a diverticulum of the urinary bladder in the Japanese literature.     

Primary carcinoma in a diverticulum of the bladder: a report of two cases

Two cases of carcinoma in a diverticulum of the bladder were experienced. The first case was of a 50-year-old male who presented in February, 1981, complaining of asymptomatic microhematuria. The excretory urogram revealed a diverticulum in the left lateral aspect of the bladder which was causing shift of the lower ureter to the median side. The cytology report of voided urine was class III. Diverticulectomy was performed and pathologic findings was a transitional cell carcinoma, grade 1, stage 0. The patient has been free of recurrence for the past 54 months. The second case was of a 67-year-old male with the chief complaint of pollakiuria. Non-papillary tumor in a diverticulum of the bladder was found by cystoscopy and computed tomography. Tumor biopsy and urinary diversion by ileal conduit were performed in the usual manner. The pathologic finding was transitional cell carcinoma of grade 11 malignancy. The patient died of intestinal obstruction on January, 19, 1984, about 15 months after the surgery. The 117 cases of carcinoma in a diverticulum of the bladder we found in the Japanese literature are reviewed briefly.     

Late recurrence of transitional cell carcinoma of bladder

The case is presented of a patient with local recurrence of transitional cell carcinoma eleven years after preoperative irradiation and cystourethrectomy.     

膀胱移行细胞癌的微卫星不稳定性研究

目的了解膀胱移行细胞癌（ＴＣＣ）组织中微卫星不稳定（ＭＳＩ）的情况及其与膀胱癌生物学行为的关系。方法选择４个阳性率较高的微卫星位点，应用ＰＣＲＭＩＡ分析２３例ＴＣＣ病人的ＭＳＩ及其与临床分期和病理分级的关系。结果ＭＳＩ在ＴＣＣ患者中以扩增表达为主，２３例ＴＣＣ病人中有９例出现ＭＳＩ，占３９％，其中３例同时有２个位点出现ＭＳＩ。病理分级和临床分期较高者，ＭＳＩ的阳性率明显增高（Ｐ＜００２５及Ｐ＜０００５）。结论ＴＣＣ患者的肿瘤组织中存在ＭＳＩ，且ＭＳＩ预示着ＴＣＣ的恶性程度较高。