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Muellerianosis of the urinary bladder, endocervicosis type: a case report.

This case reports muellerianosis of the urinary bladder, showing glandular lesions made up of endocervical type glands, in a 36-yr-old woman. The patient presented with lower abdominal discomfort and pain on voiding. The patient had undergone two Cesarean sections 5 yr and 3 yr earlier. On a pelvic ultrasonography, a well-circumscribed mass, 2.2x0.8 cm in dimension, was found with luminal polypoid projection in the posterior wall of the urinary bladder. The patient had a transurethral resection of the bladder mass. Histologically, the tumor was composed of irregularly shaped glands lined by endocervical mucous epithelium in the muscularis propria of the urinary bladder. Some glands exhibited cystic dilatation and contained mucinous secretions. The glands elicited no desmoplastic tissue reaction. The intraluminal mucin often contained polymorphonuclear leukocytes. The glands were mostly lined by tall columnar and bland looking mucous cells with mucin secretion. The ciliated cells were rarely observed. No endometrial component is noted. It would be appropriate to designate this lesion as "Muellerianosis of the urinary bladder, endocervicosis type". Awareness of the lesion and attention to its typical histologic features should facilitate its crucial distinction from adenocarcinoma.

Adult↗

[Surgical treatment of urinary bladder cancer].

Ultrasonic transabdominal and transrectal investigations, computed tomography, endoscopic photodynamic studies, polyfocal biopsy of the urinary bladder were used in examination of 1238 patients which were diagnosed to have urinary bladder cancer. 894 patients underwent transurethral resection of the bladder. Morphologically, cancer of the urinary bladder has an inductory effect on intact parts of the bladder mucosa. This means that even most radical resection does not eliminate grounds for a new tumor growth. Radical cystectomy was performed in diffuse papillomatosis, multiple stage T2 tumors of high-grade malignancy, tumors at stage T3, T4, Nx, MO, in rapid recurrent tumors after conservative or operative treatment.

Cystectomy↗

[Inflammatory pseudotumor of the bladder: etiopathologic and clinical features].

The Authors present a case of inflammatory pseudotumour (IPT) of the urinary bladder occurring in a 57-year-old female patient, who was referred to our department with haematuria, stranguria and hypogastric pain. Ultrasonographic, radiological and endoscopic examinations showed a sessile, ulcerated, easily bleeding bladder formation; urinary cytology revealed no atypical transitional cells. Abdomino-pelvic computed tomography analysis showed thickening of the bladder walls and infiltration of the perivesical fat. Histopathologically, the formation was indicated as an inflammatory pseudotumour (IPT) of the bladder. The patient underwent TURB (transurethral resection of the bladder) and was discharged clinically healed on postoperative day 4. A one-year follow up revealed no evidence of recurrence. On the basis of their experience and a thorough review of the literature review, the Authors discuss the clinico-pathological features of IPT of the bladder and the possible factors involved in the malignant transformation of IPT. In conclusion, the benign nature of the lesion is stressed.

Female↗

Low dose Pasteur bacillus Calmette-Guerin regimen in stage T1, grade 3 bladder cancer therapy.

PURPOSE: We assessed the effectiveness of intravesical bacillus Calmette-Guerin (BCG) for high risk transitional cell carcinoma of the bladder. MATERIALS AND METHODS: A total of 51 patients with stage T1, grade 3 disease was treated with weekly instillations of 75 mg. Pasteur strain BCG for 6 weeks after transurethral resection for bladder cancer. An additional induction course was given to patients with relapse. Tumor-free patients followed a maintenance course with monthly instillations for 12 months. RESULTS: After the initial induction course 37 of 51 patients (72.5%) remained tumor-free. A second induction course was necessary in 13 patients. After 1 or 2 induction courses 44 of 51 patients (86.3%) were tumor-free. The maintenance course was administered to 44 patients, with 41 remaining tumor-free. After a median followup of 33 months (range 3 to 63) 28 patients (54.9%) were disease-free, 12 (23.5%) had recurrent tumors and 7 (13.7%) had progression. The risk of treatment failure was significantly greater for solid than papillary tumors (p = 0.0006), recurrent than primary tumors (p = 0.0052) and coexisting carcinoma in situ (p = 0.124) in multivariate analysis, and for early recurrence (p = 0.0001) in univariate analysis only. The drug was well tolerated with few side effects. CONCLUSIONS: Our data suggest that this low dose Pasteur BCG regimen is effective in the treatment of high risk superficial bladder cancer. Some tumor characteristics, such as solid appearance, coexisting carcinoma in situ, history of superficial transitional cell carcinoma and early relapse after the initial induction course, seem to be negative prognostic factors.

Adjuvants, Immunologic↗

Eosinophilic cystitis: eight cases report and literature review.

Historically, eosinophilic cystitis is a rare disorder of bladder inflammation with eosinophils infiltration diagnosed by pathologic examination. The etiology is unclear despite the past identification of many factors contributing to this disease. Eight patients with eosinophilic cystitis were reported. The intact history, clinical manifestation, radiological examination and response to therapy were all evaluated. The results showed that 7 patients developed hematuria, 6 patients were with dysuria, 4 patients with frequency and 4 patients with urine retention. Seven patients had abnormal urinalysis but no positive finding in culture. Radiological findings revealed that one patient had bladder mass lesions and upper urinary tract dilation. Cystoscopic examination was performed in every patient and showed mass-like, edematous, ulcerative or hyperemic mucosa lesions. Cold-cup biopsy or transurethral resection of bladder lesions were all performed and could be the first priority to be considered. However, partial or total cystectomy should be taken into consideration when simple treatment failed to resolve this problem. Additionally, antihistamines, steroids or antibiotics are given to control the clinical symptoms. The results of these treatments were good except for one case who suffered from recurrence but recovered after simple operation and oral therapy. Although good results were found concerning treatment, long-term follow-up is necessary.

Adult↗

Mutual neoplastic promotion by instillation of mitomycin C and cauterization on rat bladder urothelium.

The authors studied the effect of bladder instillation of mitomycin C (MMC), a potential carcinogen, on the duration and severity of the hyperplasia induced by transurethral fulguration. This experimental system may simulate closely the intravesical chemoprophylaxis of MMC after transurethral resection of bladder cancer. Physiologic saline or MMC was instilled into the rat bladder once on the day of, or 3 or 7 days after cauterization. In all groups instilled with physiologic saline the changes were reversed by day 14. On the other hand, five of nine MMC-instilled rats developed papillary lesions, and three of these had mild dysplastic epithelium on day 84. Under the scanning electron microscope, the animals of these groups showed pleomorphic microvilli on the luminal surface of the regenerative cells on days 10 and 14 after cauterization. These results may indicate the mutual neoplastic promotion by instillation of MMC and cauterization to a certain extent.

Animals↗

Epidermal growth factor in urine from the patients with urothelial tumors.

Epidermal growth factor (EGF) concentration in urine was measured with a radioimmunoassay in 40 untreated patients with urothelial tumors and a comparable control group of 25 normals. The concentration of EGF in urine from the patients with bladder, renal pelvic or ureter tumors was lower than normal (p less than 0.05). Patients with T4 tumors had lower concentrations of EGF compared with those of other stages. EGF concentrations after transurethral resection of bladder tumors were significantly elevated compared with the values before operation. These findings suggest that urothelial tumors are related to a low concentration of EGF and that a decrease of EGF is associated with invasion of tumors.

Carcinoma, Transitional Cell↗

[Intravesical bacillus Calmette-Guerin in the treatment of recurrent superficial bladder tumors].

Seven patients with recurrent superficial bladder tumors were treated by vesical and intradermal administration of BCG. All of these patients have had recurrence more than 2 times. BCG instillation was performed every weeks for 6 weeks after transurethral resection of bladder tumor. A suspension containing 120 mg BCG in 40 ml normal saline was instilled intravesically. BCG was administered into alternate upper thighs using a multiple puncture apparatus. Statistical analysis of bladder tumor in our hospital revealed the second recurrence rate to be 73.2%. The reduction of tumor recurrence rate of BCG treated patients was 43.0%. The reduction of tumor recurrence by BCG treatment was statistically significant, compared to other treatments. It seemed that patients with severe side effects such as bladder tenesmus and urinary infection, have a long tumor-free period. Therefore, we suggest that the reactive inflammation in bladder during BCG treatment plays an important role.

Administration, Intravesical↗

uCyt+ test: alternative to cystoscopy for less-invasive follow-up of patients with low risk of urothelial carcinoma.

OBJECTIVES: To assess the utility of ImmunoCyt/uCyt+ in combination with cytology to reduce the number and cost of cystoscopies in the follow-up of patients with urothelial cancer of the bladder. METHODS: A total of 216 patients under follow-up after transurethral resection of the bladder for urothelial cancer were enrolled in the present study. The mean follow-up time was 26 months (range 3 to 96). Patients were tested for bladder cancer with ImmunoCyt/uCyt+, urinary cytology, and cystoscopy every 3 months. All patients with positive cystoscopy results for recurrence or suspect areas underwent transurethral resection of the bladder. Cystoscopy was considered the reference standard to establish the bladder tumor diagnosis. The patients were divided into low, intermediate, and high risk groups for progression according to the European Association of Urology criteria. RESULTS: A total of 195 patients were suitable for evaluation. The urine samples from 21 patients were considered not evaluable for ImmunoCyt/uCyt+, and those patients were excluded from the study. Of all the control patients, 69.7% had negative cystoscopy findings. In the low-risk group, 84 patients underwent 131 cystoscopies, which diagnosed 30 Stage pTaG1 recurrences but no progression. Cytology and ImmunoCyt/uCyt+ together had a sensitivity of 86.6% and a negative predictive value of 95.2%. CONCLUSIONS: Of the cystoscopies performed during the 26 months of follow-up, 69.7% were negative. In the low-risk group, 30 Stage pTaG1 tumors and no progression was detected at a total cost of 14,672 Euros (USD 17,606). ImmunoCyt/uCyt+ and cytology every 6 months combined with annual cystoscopy reduced the morbidity and cost of follow-up in this group.

Antibodies, Monoclonal↗

Expression of the epidermal growth factor receptor and Her-2 are predictors of favorable outcome and reduced complete response rates, respectively, in patients with muscle-invading bladder cancers treated by concurrent radiation and cisplatin-based chemotherapy: a report from the Radiation Therapy Oncology Group.

PURPOSE: Erb-1 (epidermal growth factor receptor, EGFR) and Erb-2 (Her-2) are two of the best characterized members in the EGFR pathway. In many tumor types, overexpression of these proteins is associated with enhanced malignant potential. Our objective in this study was to investigate the clinical relevance of EGFR and Her-2 expression in bladder cancer cases from four prospective Radiation Therapy Oncology Group (RTOG) bladder preservation trials using cisplatin-containing chemoradiation (RTOG 8802, 8903, 9506, and 9706). METHODS AND MATERIALS: Tumors from 73 cases from patients with muscle-invading T2-T4a bladder cancers had slides interpretable for EGFR staining; 55 cases had slides interpretable for Her-2 staining. Additionally, the respective prognostic values of p53, pRB, and p16 immunostaining were concomitantly examined. Staining and interpretation of staining were done in a blinded manner, without knowledge of clinical outcome. Staining was judged as positive or negative. Subsequently, staining was correlated with clinical outcome. RESULTS: On univariate analysis, EGFR positivity was significantly associated with improved overall survival (p = 0.044); disease-specific survival (DSS) (p = 0.042); and DSS with intact bladder (p = 0.021). There was also a trend for association between EGFR expression and reduced frequency of distant metastasis (p = 0.06). On multivariate analysis adding tumor stage, tumor grade, whether a visibly complete transurethral resection of bladder tumor (TURBT) was done or not, and patient age to the model, EGFR positivity was significantly associated with improved DSS. On univariate analysis, Her-2 positivity was significantly associated with reduced complete response (CR) rates (50% vs. 81%, p = 0.026) after chemoradiation which remained significant on multivariate analysis. The other markers examined in this study were not found to have any prognostic value in this setting. CONCLUSION: Epidermal growth factor receptor expression appears to correlate significantly with improved outcome in bladder cancer, whereas Her-2 expression is significantly associated only with reduced CR rates after chemoradiation. Further investigations are warranted into how EGFR family members regulate response to chemoradiation in bladder cancer and their potential therapeutic implications.

Analysis of Variance↗

[A case of secondary malignant lymphoma of the urinary bladder].

A 56-year-old man was admitted to our hospital for salvage chemotherapy of recurrent diffuse large B cell malignant lymphoma at clinical stage IIIb and which had been treated with 6 cycles of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). Computed tomography showed multiple tumors in the bladder after a cycle of ifosfamide, etoposide and mitoxantrone (MINE), but cystoscopy after the second cycle revealed a single non-papillary tumor about 1cm in diameter. After 3 cycles of MINE therapy, transurethral resection of bladder tumor was performed. At the time of the operation, the protruded lesion disappeared and there remained only a scar. Biopsy of the scar revealed malignant lymphoma infiltrated into the submucosal layer. Although the rate of the bladder involvement of malignant lymphoma reaches 3-20% in autopsy cases, it is very rare for a secondary malignant lymphoma of the urinary bladder to be diagnosed clinically. The prognosis of the secondary bladder lymphoma is much poorer than that of the primary one, because of the widespread dissemination of the disease at the time of diagnosis.

Antineoplastic Combined Chemotherapy Protocols↗

Evaluation of urine CYFRA 21-1 for the detection of primary and recurrent bladder carcinoma.

BACKGROUND: The urinary concentration of soluble cytokeratin 19 fragments, measured by the CYFRA 21-1 assay, may be used for the noninvasive, early detection of bladder carcinoma. METHODS: This prospective study examined urine samples from 325 patients. The authors included 152 patients who presented with hematuria or irritative voiding symptoms (Group 1), 107 patients who were under surveillance after undergoing transurethral resection of bladder carcinoma (Group 2), 46 patients with urinary tract pathology other than bladder carcinoma (Group 3), and 20 healthy participants (Group 4). The urine concentration of CYFRA 21-1 was measured by an immunoradiometric assay. The patients in Groups 1 and 2 underwent cytoscopy and urine cytopathology. Biopsies were obtained if a tumor was seen on cytoscopy or if there was a suspicion of carcinoma in situ (CIS). RESULTS: The optimal cut-off concentration for the detection of primary bladder tumors, 4.9 microg/L, resulted in a sensitivity of 79.3% and a specificity of 88.6%. The optimal threshold for the detection of recurrent bladder tumors (excluding patients who had been treated with intravesical bacillus Calmette-Guerin [BCG]), 4.04 microg/L, resulted in a sensitivity of 76.2% and a specificity of 84.2%. There was no significant advantage for centrifugation of the urine samples or for determination of the creatinine concentration in the urine samples. The CYFRA 21-1 assay of urine samples provided a three-fold greater sensitivity compared with the sensitivity of cytology for detecting Grade 1 transitional cell tumors. CYFRA 21-1 detected 91.9% of Grade 3 tumors, 100% of CIS, and 92.8% of invasive bladder tumors (T2 or higher classification). The CYFRA 21-1 assay detected all tumors that had positive cytology with the exception of only one tumor. Conversely, the assay identified 71% of primary tumors and 65% of recurrent tumors that were missed by cytopathology. Urinary stones, infection, and previous intravesical BCG immunotherapy caused many false positive results. CONCLUSIONS: The urinary CYFRA 21-1 assay is a useful test for the noninvasive detection of bladder carcinoma and for surveillance of patients who were not treated previously with BCG. It may be used in combination with urine cytology and bladder ultrasound. Multi-institutional trials are required to compare the accuracy as well as the cost of this combination of tests with cystoscopy.

Adolescent↗

Cellular fibronectin in patients with transitional cell carcinoma of the bladder.

Various tumor markers for transitional cell carcinoma (TCC) of the bladder have been described, but none of them are used in clinical routine. Fibronectin, a glycoprotein, seems to play a very important role in both the progression and invasion of cancer. The aim of this study was to evaluate cellular fibronectin (cFN) in the urine and blood of patients with TCC of the bladder and to determine its possible role as a tumor marker and prognostic factor. Morning urine samples and blood were collected from 20 patients (8 women, 12 men, mean age 69.9 years) before they underwent transurethral resection of bladder tumors (TURB). Twenty patients (10 women, 10 men, mean age 63.4 years) with nonmalignant urological disorders were recruited as the control group. Determination of cFN in plasma and urine was performed by using a newly developed time-resolved fluorescence immunoassay (TRFIA). Patients with nonmalignant diseases had mean cFN plasma levels of 404 ng/ml (range 181-746 ng/ml). Patients with TCC of the bladder showed significantly higher cFN plasma levels of 686 ng/ml (range 274-1999 ng/ml, p<0.05). Subdivided according to the TNM system, muscle-invasive bladder tumors (n=5) demonstrated higher cFN plasma levels (mean 944 ng/ml) than superficial bladder tumors (n=15, mean 463 ng/ml). There were no differences of plasma cFN concentrations concerning tumor grade and also no differences in urine levels between the different groups. We found a significant difference (p<0.04) of cFN plasma levels between patients with TCC of the bladder and the control group. The difference in cFN plasma levels between pTa/pT1 and >or=pT2 tumors indicates a clinically useful potential of this tumor marker for preoperative staging and postoperative follow-up. Our data underline the important but still unclear role of cFN as a tumor marker in TCC, and this will be the focus of future studies.

Aged↗

Sustained prophylactic effect of intravesical bacille Calmette-Guérin for superficial bladder cancer: a smoothed hazard analysis in a randomized prospective study.

OBJECTIVES: A previous meta-analysis had revealed that intravesical chemotherapy was effective in reducing the recurrence of superficial bladder cancer only in the early phase, the phase thought to be caused by tumor cell implantation and/or residual tumor cells. To ascertain the sustained prophylactic effect of intravesical bacille Calmette-Guérin (BCG) after transurethral resection of bladder tumor (TURBT), we compared the estimation of the duration of the effect with that of doxorubicin. METHODS: Eighty eligible patients with superficial bladder cancer (Stage Ta or T1, grade 1 or 2) were included. Patients were randomly allocated into two groups: the BCG group (six weekly instillations of 80 mg BCG [Tokyo 172 strain]) and the doxorubicin group (17 instillations of 20 mg doxorubicin). A comparison between the smoothed hazards of tumor recurrence was performed using a kernel function method. RESULTS: All 80 patients (40 each in the BCG and doxorubicin groups) were compared. The median follow-up period was 667 days (range 64 to 1607). The risk of recurrence was significantly lower in the BCG group than in the doxorubicin group (P = 0.017, log-rank test). A smoothed hazard curve depicting the reduced risk of recurrence in the BCG group suggested that BCG is not only efficacious in the early phase of recurrence (up to 500 days after TURBT), but also in the late phase, and the latter is thought to include second primary tumors (new tumors). CONCLUSIONS: BCG instillation may prevent tumor recurrence caused by both tumor cell implantation and second primary tumors.

Adjuvants, Immunologic↗

A case of renal cell carcinoma associated with synchronous contralateral renal pelvic cancer and bladder tumor.

We report a case of renal cell carcinoma associated with synchronous contralateral renal pelvic cancer and bladder tumor. The patient underwent total nephroureterectomy for the left renal pelvic cancer with transurethral resection of the bladder tumor. After 2 courses of combination chemotherapy, we performed surgical enucleation of the right renal cell carcinoma. Although transurethral resection of the recurrent bladder tumors was undergone 17 months after the last operation, the patient retains normal renal function.

Carcinoma, Renal Cell↗

[Recurrent and up-grading bladder cancer in a young female: a case report].

We report a case of superficial bladder cancer in a young female, with grade-up tumor after frequent recurrences. A 29-year-old woman complained of gross hematuria on April 25, 1991. Cystoscopic examination revealed a papillary pedunculated tumor and transurethral resection of bladder tumor (TUR-BT) was performed. Pathological examination showed transitional cell carcinoma (TCC) pT1 grade 1. In spite of prophylactic therapy, such as intravesical instillation of anticancer drugs and radiochemohyperthermia, she suffered frequent recurrences. At the 6th recurrence, the tumor deteriorated to grade 3 on September 2, 1992. Total cystectomy was done on February 15, 1993 because of uncontrollable bleeding from bladder cancer. Convalescence was uneventful, and no evidence of recurrence was present 2.8 years postoperatively.

Adult↗

Triple primary cancers involving kidney, urinary bladder, and liver in a dye worker.

A case of triple primary cancers (renal cell carcinoma of the kidney, transitional cell carcinoma of the bladder, and hepatocellular carcinoma of the liver) was reported at autopsy. A 53-year-old man, who had a history of exposure to benzidine, underwent nephrectomy for a left renal cell carcinoma and 10 years later, transurethral resection of bladder tumor (TUR-Bt) for a transitional cell carcinoma of the bladder. At the age of 65, he was diagnosed as having multiple hepatic tumors. Histological examination of biopsy specimens showed these lesions to be undifferentiated carcinomas. Immunohistological examination of both biopsy and autopsy specimens revealed that multiple hepatic tumors were hepatocellular carcinomas, not metastatic tumors from kidney or urinary bladder: tumor cells of hepatic tumors were positive for alpha-fetoprotein, although renal cell carcinomas and transitional cell carcinomas of urinary bladder were positive for Ber-EP4 and keratin, respectively. These findings suggest not only that immunohistological examination is helpful for the diagnosis of multiple primary cancers but also that benzidine may be hepatocarcinogenic in addition to those cancers that are known to be associated with benzidine exposure, i.e., renal cell carcinomas and transitional cell carcinomas in urinary bladder.

Aged↗

Transurethral resection and intravesical therapy of superficial bladder tumors.

The treatment of superficial bladder cancer is aimed at eradicating existing disease, inhibiting tumor recurrence, and preventing progression to invasion or metastasis. Transurethral resection is the primary modality, with intravesical therapy used in some cases to kill residual overt or occult carcinoma and premalignant lesions. Among the agents tested extensively, BCG appears to be more effective than mitomycin C, doxorubicin, or thiotepa, especially against carcinoma in situ. A number of questions remain to be answered about the management of this disease.

Administration, Intravesical↗