Multifocal transitional cell carcinoma associated with renal cell carcinoma in a patient on long-term haemodialysis.
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BACKGROUND: Peripheral blood lymphocytes (PBL) from patients with bladder cancer also contain cells possessing cytotoxic activity against autologous tumor cells. These cells are phenotypically heterogenous and include natural killer (NK) and cytotoxic T cells. This study investigated the role of cytotoxic lymphocytes directed against autologous bladder cancer cells. METHODS: PBL were obtained at intervals before and after surgery and analyzed for cytotoxic activity against autologous bladder cancer cells in 4-hour 51Cr release assay. PBL stimulated with autologous tumor cells were also transformed with human T-lymphotropic virus type-1, establishing a cell line (KB31) which was analyzed for phenotype and cytotoxic activity against the autologous tumor cells. RESULTS: PBL preoperative cytotoxic activity was low, but increased after surgery. Cytotoxic activity was found not only against autologous bladder cancer cells, but also against heterologous bladder cancer (KK-47) and myeloid leukemia (K562) cells, with the highest activity against the heterologous cell lines. The cytotoxic activity of KB31 was 40% against autologous tumor cells 6 weeks after initiation of the cell line, but decreased to 5% by 6 months. This activity was lower than that against the other cell lines, and was similar to that of PBL in short-term culture. Fluorescence-activated cell sorter (FACS) analysis demonstrated that in KB31 cells at 6 weeks, CD8+ cells were dominant, but CD56+ cells predominated at 6 months. CONCLUSION: These results suggest that the presence of cytotoxic activity in the peripheral blood of the patient was due to both cytotoxic T cells and NK cells. The cytotoxic activity was lowest prior to surgery and increased postoperatively.
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We have established a series of serially-transplantable xenografts of human bladder cancer which encompass the broad range of histological subtypes of this disease. Substantial heterogeneity has been demonstrated with respect to the ultrastructural and functional characteristics of these lines. We have used this model to explore the histogenesis of the different subtypes of bladder cancer as well as for preliminary studies of novel anti-cancer drugs for this disease. Future studies will characterise further the differences between superficial and invasive tumours and may reveal predictors of their natural history and metastatic potential.
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Prostatic involvement with transitional cell carcinoma of the bladder is common. Surveillance for prostatic invasion consists primarily of cystoscopic examination of the urethra. Unfortunately, transitional cell carcinoma may involve other regions of the prostate that are inaccessible by cystoscopy. A total of 58 men with transitional cell carcinoma of the bladder underwent transrectal ultrasound before cystoprostatectomy or, in some cases, ultrasound-guided prostate biopsies and subsequent cystoprostatectomy. Prostatic involvement was found in 20 patients (34.5%). Of those patients 10 (50%) demonstrated prostatic urethra invasion, 7 (35%) stromal invasion, 4 (20%) ejaculatory duct and seminal vesicle invasion, and 3 (15%) involvement of the periprostatic tissues. Invasion of the prostatic urethra was not detected by transrectal ultrasound but 5 of the 7 stromal lesions exhibited hypoechogenicity. All cancer-laden ejaculatory ducts were hypoechoic on ultrasound examination. All cases of periprostatic involvement were also detectable by corresponding areas of hypoechogenicity. Transrectal ultrasound may enhance the surveillance of men with transitional cell carcinoma.
A case of ipsilateral pelvic transitional cell carcinoma and renal cell carcinoma (RCC), in an 82-year-old male is presented. We diagnosed this case as pelvic tumor preoperatively with retrograde pyelography and computed tomography. Operatively renal tumor was found and diagnosed as RCC. We thought it difficult to diagnose as RCC preoperatively. To date, this case is the 13th reported case diagnosed clinically.
We report the development of a clonogenic assay for progenitor cells in transitional cell carcinoma of the bladder. Colony growth has been demonstrated from cells obtained both from surgical biopsies and from bladder barbotages. Electron microscopic and karyotypic evidence supports the contention that these progenitors represent a part of the population maintaining the tumor in vivo. Colony growth occurred in 9 of 11 surgical biopsy samples and in 6 of 6 bladder barbotage samples. Plating efficiency ranged up to 0.7%, and colony size was in some instances greater than 1000 cells. The assay appears potentially useful for analysis of the biology of human transitional cell carcinoma.
Histologic variants of prostatic carcinoma are readily recognized. In this report, we describe a rare variant, adenoid cystic carcinoma, in a 75-year-old man previously diagnosed to have transitional cell carcinoma of the urinary bladder. The diagnosis of adenoid cystic carcinoma was made by the characteristic microscopic features of the tumor morphologically and immunohistochemically. Two months later he was found to have metastatic disease. The patient's treatment consisted of chemotherapy in combination with prednisone and hormonal therapy. Five and a half months after diagnosis, he died with metastatic disease. Making this case unique is the asynchronous occurrence of this variant with transitional cell carcinoma of the urinary bladder, which has never been reported in the literature. We discussed the histopathologic and immunohistochemical features of adenoid cystic carcinoma of the prostate with review of literature.
The presence of squamous differentiation in transitional cell carcinomas has been variably related to prognosis and response to radiotherapy. This study sought to establish whether cytokeratin (CK) 14, normally expressed in the basal cells of squamous epithelium, could be used as a reliable marker of the emergence of a squamous phenotype in transitional cell carcinomas. In a series of 42 tumours, CK14 was expressed in areas of squamous morphology, whereas CK20 identified continuing urothelial differentiation. Furthermore, focal positivity for CK14 was present in a proportion of tumours with no morphological evidence of squamous differentiation, suggesting that it is a more sensitive marker of phenotypic switch. Investigation of CK subtypes may be more powerful than morphology alone in clinical studies of transitional cell carcinomas as CK expression profiles have been related to treatment response in other tumour types.
PURPOSE: Although transitional cell carcinoma of the bladder (TCC) metastasizes frequently with devastating consequences, no marker has been available to monitor this process. Uroplakins are a group of specific markers for normal urothelium and are continuously expressed by the majority of TCCs. Detection of uroplakin-positive cells in the circulation would be a strong indication of hematogenous dissemination of tumor cells in patients with TCC. MATERIALS AND METHODS: Total RNAs were extracted from peripheral blood of 60 patients with TCC (50 non-metastatic and 10 metastatic) and 10 healthy controls, reverse-transcribed and subjected to polymerase chain reaction amplification (RT-PCR) using oligonucleotide primers of human uroplakin II gene. A uroplakin-expressing human bladder cancer cell line (RT4) was used as a positive control to establish the sensitivity of the RT-PCR assay. RESULTS: We showed that the PCR-amplification of the mRNA encoding uroplakin II (UPII), a 15-kDa urothelium-specific marker, constitutes a highly sensitive and specific assay for detecting 100% of transitional cell carcinoma tissue, and that this assay can detect a single bladder cancer cell in a 5-ml. blood sample. UPII mRNA was detected in the blood samples of 2 patients with metastatic bladder cancer without chemotherapy and 1 out of 8 such patients with chemotherapy, but not in those of 50 non-metastatic patients or normal controls. CONCLUSIONS: Uroplakin II is a highly specific marker for human TCC and the detection of uroplakin II in the peripheral blood is associated with metastatic spread of bladder cancer cells. The specific and sensitive detection of uroplakin II provides a useful adjunct for detecting bladder cancer metastasis, staging, and monitoring chemotherapeutic response.