A case of squamous cell carcinoma arising in the urinary bladder diverticulum

A 49-year-old man was admitted to our hospital with the chief compliant of difficulty of urination, lower abdominal pain and macrohematuria. On cystoscopy, a non-papillary tumor was seen in the diverticulum on the right side of the urinary bladder. Having made the diagnosis of urinary bladder cancer, we performed total cystectomy, retroperitoneal node dissection and construction of an ileal neobladder. Histologically, it was squamous cell carcinoma, pT3a, pN0. Seven months after the operation, the patient died of recurrent disease.     

A case of carcinoma of the bladder diverticulum

Carcinoma of the bladder diverticulum is a relatively rare disease. However, its preoperative diagnosis is often difficult. Also, infiltration occurs easily because the diverticulum wall is thin, and prognosis is said to be relatively poor. Histologically, the occurrence rate of squamous cell carcinoma is markedly high. We have experienced a case of squamous cell carcinoma in the bladder diverticulum occurring simultaneously with transitional cell carcinoma of the bladder; and, report this case along with a review of the literature. The patient, a 79-year-old male, had sudden macroscopic hematuria on December 15, 1980, and went to the urology department of a separate hospital. IVU showed distortion of the right ureter, and the patient was referred to our hospital. Cystoscopy revealed a diverticulum in the right wall of the bladder. In the posterior wall of the bladder 2 papillary sessile tumors were also detected. Pathological diagnosis by cold punch biopsy done after the patient was admitted to hospital revealed a grade III transitional cell carcinoma. Total cystectomy + bilateral cutaneous ureterostomy was performed. The diverticulum was in the right wall of the bladder and a papillary sessile tumor with a diameter of 4 cm was found in the diverticulum. A papillary sessile tumor 2 cm in diameter was found in the left bladder wall. Histopathological diagnosis of the tumor in the diverticulum was squamous cell carcinoma ( pG2 , pT3b , ly1, v(-) INF beta) and that of the tumor in the bladder was transitional cell carcinoma ( ( pG3 , pT2 , ly1, v(-), INF gamma).(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

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 report: small cell carcinoma transformed from transitional cell carcinoma of the urinary bladder

A 72-year-old man presented with gross hematuria. Cystoscopy showed a non-papillary tumor at the right side of the posterior wall. Transurethral resection of the bladder tumor (TURBT) was performed. Pathologic findings demonstrated superficial transitional cell carcinoma (TCC). However, recurrent tumors were detected at the same location after 69 months' follow up. TURBT was done for the biopsy and pathologic examination showed muscle-invasive TCC. After two courses of neoadjuvant chemotherapy (MVAC), we performed radical cystectomy with Hautmann's continent reservoir. Pathologic findings revealed small cell carcinoma without any TCC features. Immunohistochemical staining using chromogranin A and synaptophysin was positive in the latest TURBT and the radical cystectomy specimens. We report a case of primary small cell carcinoma transformed from TCC of the urinary bladder.     

A young patient with invasive small cell carcinoma of the urinary bladder: a case report

A 29-year-old woman with gross hematuria was referred to our hospital. Cystoscopy revealed a nonpapillary broad-based tumor on the right lateral wall of the urinary bladder, which a transurethral biopsy identified as transitional cell carcinoma (G2). CT and MRI suggested that the carcinoma invaded beyond the bladder wall. We performed a radical cystectomy with hysterectomy and the construction of an ileal neobladder. Pathological examination of the specimen indicated that it was small-cell undifferentiated carcinoma at the stage of pT2bpN0. For adjuvant chemotherapy, four cycles of CPT-11 and CDDP chemotherapy were performed, which is currently the usual chemotherapy for small-cell lung carcinoma in Japan. The patient is alive without any evidence of tumor recurrence at 12 months after surgery.     

Three cases of small cell carcinoma of the urinary bladder: a case report

We report three cases of small cell carcinoma of the urinary bladder. Case 1: A 69-year-old man showed microscopic hematuria during follow up of prostate cancer of stage D2. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage of pT2N0M0. Complete remission was achieved by three courses of chemotherapy consisting of irinotecan and carboplatin. The patient was died by prostate cancer 16 months after the chemotherapy. Case 2: An 83-year-old woman presented with macroscopic hematuria. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage of pT2N0M0 and partial cystectomy was performed. The patient has been alive without any evidence of tumor recurrence at 6 months after surgery. Case 3: An 84-year-old man presented with macroscopic hematuria. The patient was diagnosed with small cell carcinoma of the urinary bladder at the stage ofcT3bN0M1 with multiple liver metastases. Complete remission was achieved by three courses of chemotherapy consisting of etoposide and carboplatin.     

Case report: a case with small cell carcinoma of the bladder transformed from urothelial carcinoma

A 69 year-old woman visited our hospital with a chief complaint of macrohematuria in April 2004. She was diagnosed with bladder tumor. She underwent transurethral resection ofbladdar tumor three times and right partial ureterectomy for ureteral tumor following primary bladder carcinoma. All pathological findings demonstrated that the tumor was urothelial carcinoma (UC), G1-G2, pT1 including right ureteral tumor. In spite of intravesical instillation of BCG, recurrent invasive bladder tumor was found in June 2006. In July 2006, we performed total cystectomy and construction of ileal conduit. Surgical specimen revealed small cell carcinoma and immunohistochemical staining with NSE and synaptophysin was positive. On day 67 after operation, the patient died of multiple metastases to liver and bone.     

A case of transitional cell carcinoma of the bladder in a juvenile patient

A case of transitional cell carcinoma of the bladder in a 18-year-old female is presented. Cystoscopic examination revealed a papillary tumor on the left lateral wall. Histopathology of the excised tumor showed transitional cell carcinoma, G1 > 2, pT1a. Recurrence has not been observed for about 1 year, after intravesical pirarubicin therapy.     

A case of transitional cell carcinoma of the bladder in a juvenile patient

A 17-year-old male was referred to our hospital with the chief complaint of right back pain. Cystoscopic examination revealed a papillary tumor on the posterior wall following detection on screening ultrasound examination revealed a tumor in the bladder. Transurethral resection of the bladder tumor was performed. Histological examination of the excised tumor revealed transitional cell carcinoma, grade 1, pTa. No recurrence has been observed for about 1 year postoperatively.     

A case of transitional cell carcinoma of the bladder in a juvenile patient

A 15-year-old male was referred to our hospital with the chief complaint of gross hematuria. Cystoscopic examination revealed a papillary tumor on the posterior wall. Transurethral resection of the bladder tumor was performed. Histological examination of the excised tumor showed transitional cell carcinoma, grade 1, pTa. Recurrence has not been observed for about 2 years after the operation. We investigated 54 previously reported Japanese cases of bladder cancer before age twenty including the present case.     

A case of prostatic small cell carcinoma

A 66-year-old man was referred to our hospital with a complaint of lumbago. Digital rectal examination showed an enlarged, irregular prostate with stony hardness. The serum level of prostate specific antigen (PSA) was elevated. Abdominal computed tomography showed enlarged common iliac and paraaortic lymph nodes, and multiple liver metastases. Bone scintigraphy showed multiple bone metastases. Histological and immunohistochemical examinations indicated small cell carcinoma and adenocarcinoma of the prostate. Chemotherapy could not be performed due to acute hepatic failure. The patient died 1 month after his first visit.     

A case of true carcinosarcoma in bladder diverticulum]

We report a case of carcinosarcoma arising from a bladder diverticulum. A 71-year-old male was referred to our hospital for macroscopic hematuria. Two diverticula were identified in the left wall of the urinary bladder, one of which showed a broad-based tumor. The bladder tumor was resected using a transuretheral approach and the tumor was histologically diagnosed as leiomyosarcoma. The patient underwent partial resection of the bladder including the two diverticula and the tumor. Pathological examination revealed that the resected specimen was composed of three elements, transitional cell carcinoma (G3), squamous cell carcinoma, and leiomyosarcoma. Thus, the patient was diagnosed with carcinosarcoma. He died 5 months after surgery to remove the panperitonitis carcinomatosa. This case is the 38th reported case of bladder carcinosarcoma in Japan.     

Three cases of transitional cell carcinoma in bladder diverticulum treated by a bladder-preserving approach

Three cases of transitional cell carcinoma (TCC) in the urinary bladder diverticulum were encountered during a period of 12 years and bladder preserving treatments were performed. Case 1: A 78-year-old man was admitted with a chief complaint of hematuria. Papillary tumors in the diverticulum of the right bladder wall were revealed (TCC, G3, T3N0M0). Intraarterial infusion chemotherapy was performed and complete remission was achieved. When a recurrent bladder tumor appeared 22 months later, transurethral resection was performed and there was no evidence of recurrence for 50 months. Case 2: A 60-year-old man was admitted with a chief complaint of gross hematuria. Cystoscopic examination revealed papillary tumors in a bladder diverticulum near the ureteral left orifice. Transurethral resection revealed TCC G2 and carcinoma in situ. Partial cystectomy, including the bladder diverticulum, and vesicoureteral neostomy was performed. The histological stage of the tumor was pTis and the wall of diverticulum possessed a thin muscle layer histopathologically. Twenty two months later, recurrence in the left bladder wall developed and transurethral resection and bladder instillation therapy were performed. For 21 months he had no evidence of recurrence. Case 3: A 59-year-old man was admitted with a chief complaint of hematuria. A solid tumor in the diverticulum of the bladder left wall was revealed. After 4 courses of intraarterial infusion chemotherapy, 41% remission was achieved and partial cystectomy was performed. Histopathological diagnosis was TCC G3, pT3b, INF-alpha, v (-), ly (-), and no muscle layer was found in the diverticulum. There was no evidence of recurrence 16 months after operation. By using the combination therapy, bladder preserving treatment is possible in the cases of bladder cancer arising in the diverticulum.     

A case of signet-ring cell carcinoma of the urinary bladder

Signet-ring cell carcinoma of the urinary bladder is a rare disease. A 78-year-old man was admitted to our hospital on March 18, 1988 with the complaints of microhematuria and pollakisuria. Cystoscopic examination revealed non-papillary tumor at the dome of the bladder. partial cystectomy was done under epidural anesthesia. Pathological findings revealed signet-ring cell carcinoma. The gastrointestinal, respiratory and genitourinary tracts were examined but no other tumor lesions could be found. The postoperative course was uneventful, and chemotherapy such as biological response modifier was administered. However, the patient died of heart failure on July 14, 1988. This is the sixtieth case reported in the literature.     

A case of small cell carcinoma of the ureter

We report a case of primary undifferentiated small cell carcinoma of the ureter. A 62-year-old man showed gross hematuria. Retrograde pyelography and CT scan revealed a tumor in the left ureter. The light microscopic examination revealed small cell carcinoma and transitional cell carcinoma. To the best of our knowledge, this is the first report of a small cell carcinoma originating in the ureter in Japan.     

A case of small cell carcinoma of the ureter

A 69-year-old man was referred to our hospital with a chief complaint of asymptomatic gross hematuria. After radiological evaluations, left nephroureterectomy with bladder cuff was performed under a clinical diagnosis of a left ureteral tumor (2 cm). Histological examination revealed a small cell carcinoma of the ureter (pT3, pN1). After the operation, adjuvant chemotherapy with irinotecan, etoposide and cisplatin was administered in combination with radiation therapy. At 14 months after the operation, there has been no evidence of recurrence. To our knowledge, this is the 22nd report of a small cell carcinoma originating from the ureter.     

A case of small cell carcinoma of the kidney

A 47-year-old man had a retroperitoneal tumor measuring 18 cm in maximum diameter of the left kidney that was diagnosed with computed tomography (CT)-guided needle biopsy as small cell carcinoma. Microscopically, the tumor cells showed immunohistochemical reaction for neural cell adhesion molecule antibodies. This patient with advanced renal small cell carcinoma and multiple metastatic lesions was treated with the first-line combination chemotherapy of cisplatin, etoposide and ifosphamide, which showed a partial response of primary renal tumor and a complete response of liver metastasis, and with the second-line chemotherapy of cisplatin and irinotecan, which showed a complete response of Virchow's nodal metastasis. Thereafter, in spite of salvage chemotherapy of amurubicin hydrochloride for persistent and refractory renal small cell carcinoma, he died 32 months after the first presentation due to local progression. However, combination chemotherapy of these anticancer agents made his prognosis more favorable than we expected before treatment. The extrapulmonary small cell carcinomas are generally known to be more aggressive and malignant than the lung small cell carcinomas, and small cell carcinoma arising from the kidney is an extremely rare malignant neoplasm, with only 34 cases reported in the English or Japanese literature. The prognosis of renal small cell carcinomas is currently limited as compared with the lung small cell carcinomas, and therefore a cumulative investigation of a larger number of cases treated with multidisciplinary modalities including combination chemotherapy is necessary.