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Cyclophosphamide is used both in the treatment of malignant and non-malignant diseases. Urinary neoplasms secondary to its use have been described. We discuss the case of a patient with panarteritis nodosa treated with cyclophosphamide during 63 months, with a total dose of 210 grams, and that showed a bladder neoplasm 8 years after beginning of the treatment. In patients receiving a total dose of cyclophosphamide over 85 grams, a follow-up of ten years minimum should be performed aimed to the early detection of secondary neoplasms.
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Large numbers of female BALB/c mice were exposed to low levels of 2-acetylaminofluorene (2-AAF) in the diet. The dose response for urinary bladder neoplasms exhibited a shallow trend to low doses which increased sharply at the higher doses. The dose response over the entire dosage range gave the impression of a "threshold" type response below the mid-doses. Since the tumor incidence at the lower doses was less than 1.0 percent, relatively few urinary bladder tumors occurred. Thus, it was deemed advisable to re-examine noninvasive or early invasive bladder carcinomas and to study the dose response for only the "unequivocal" urinary bladder tumors. Examination of the dose response curves for "unequivocal" urinary bladder tumors showed a positive trend over the low end of the dose range. As a further check, an analysis was conducted on only invasive or metastasizing bladder carcinomas. In this case, there was no significant low dose trend. Thus, the shape of the low dose response curve for bladder carcinomas remains uncertain.
OBJECTIVES: To determine what practitioners could reasonably expect from urinary cytology (UC) consultations by analyzing their role in our clinical practice. METHODS: Reports of 227 consecutive interpretations on 130 patients collected during a 13-month period were correlated with all available follow-up information. RESULTS: In our practice, UC consultations can predict the presence of bladder carcinoma in nearly 90% of patients, the major mitigating factor being the absence of tumor cells in specimens from patients harboring bladder neoplasms. High-grade neoplasms are most reliably detected with UC. Very low grade neoplasms are difficult to detect, primarily because the cells of these lesions lack features of carcinoma. Significant interobserver variation did not occur. CONCLUSIONS: Pathology consultations based on UC can be associated with high diagnostic yields provided that certain factors are understood. These include that (a) the clinical import of diagnostic terms may vary among observers and should be mutually understood in individual practice settings; (b) UC specimens may not contain tumor cells even when patients have bladder cancer; (c) correlative information may be difficult to obtain and thus seem to inflate calculations for false-positive results; (d) interobserver variation can be reduced if cytopathologists use limited and uniform diagnostic terms; and (e) a high level of diagnostic expertise from cytopathologists should be expected.
A case of spontaneous remission of bladder cancer in an 85-year-old man is reported. The clinicopathological features are presented and the literature reviewed.
OBJECTIVE: To determine if CT cystography and virtual cystoscopy have a role in the assessment of neoplasms of the urinary bladder. MATERIAL AND METHODS: Twenty five adults suspected of having bladder tumours underwent CT cystography. Twenty three had subsequent virtual cystoscopic reconstructions from the axial data. The examinations were reviewed by two radiologists and the findings were correlated with those at conventional cystoscopy. RESULTS: Seventeen masses larger than 0.5 cm were identified by CT cystography in 16 patients. Two patients had normal CT cystography, but one had small recurrent neoplasms on conventional examination. Seven patients had nodular mucosal irregularities which were subsequently shown to be neoplastic in three. Accuracy for diagnosis of neoplasm in all patients was 88%. CONCLUSION: CT cystography is very accurate at identifying masses larger than 0.5 cm and can show mucosal abnormalities as small as 2 mm. It is minimally invasive and can be diagnostic when conventional cystoscopy is inconclusive. It can indicate appropriate areas for assessment and biopsy at conventional examination. Virtual cystoscopy gave comparable views to conventional cystoscopy, but did not add diagnostic information. It is not likely to replace conventional cystoscopy, but may be helpful in occasional circumstances where the latter is inconclusive, or can not be performed.
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Fifty-six patients with bladder carcinoma were studied with MR imaging for the assessment of the local stage, using the inversion recovery pulse sequence with fat suppression (STIR) with air in the bladder. With this technique images of the inner and the outer parts of the bladder wall were obtained, showing high contrast between the latter and the tumor (tumor/muscle contrast 89.9%). Four tumor stages were recognized: superficial neoplasms (Tis, Ta, and T1), partial wall infiltrating neoplasms (T2); total wall infiltrating neoplasms (T3a, T3b), and neoplasms involving other pelvic organs (T4). MR imaging was compared with histopathologic diagnosis obtained at transurethral resection or cystectomy. True-positive diagnosis was obtained in 80.4%; false-positive in 14.3% of cases; false-negative in 5.3%. Despite the relatively high incidence of overstaged neoplasms, STIR technique combined with air in the bladder allowed a good accuracy in local staging.
Quantification of the argyrophilic nucleolar organizer regions (AgNORs), using a one-step silver colloid method, was made in proliferative urothelial lesions including neoplasm of the rat urinary bladder induced by 0.05% N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) and of the human urinary bladder. The mean numbers of AgNORs in various experimental lesions in rats given BBN for 5-30 weeks in drinking water were: nontreated urothelium (n = 6), 1.26 +/- 0.09; urothelium outside focal lesions (n = 10), 1.75 +/- 0.10; simple hyperplasia (n = 10), 2.01 +/- 0.15; papillary or nodular (PN) hyperplasia (n = 10), 2.15 +/- 0.19; papilloma (n = 5), 2.37 +/- 0.12; and transitional cell carcinoma (TCC) (n = 5), 3.52 +/- 0.23. There was a significant difference in the mean number of AgNORs between any two groups (p less than 0.05), except for simple hyperplasia vs PN hyperplasia (p = 0.085). In various proliferative lesions of human biopsy and resected samples, the mean numbers of AgNORs were normal urothelium (n = 8), 1.71 +/- 0.08; proliferative cystitis (n = 14), 1.79 +/- 0.18; hyperplasia (n = 8), 1.76 +/- 0.23; mild dysplasia (n = 5), 2.15 +/- 0.36; moderate dysplasia (n = 13), 2.61 +/- 0.27; severe dysplasia (n = 6), 3.46 +/- 0.57; G0 of TCC (n = 9), 1.95 +/- 0.17; G1 of TCC (n = 16), 2.39 +/- 0.20; G2 of TCC (n = 21), 3.33 +/- 0.31; G3 of TCC (n = 15), 4.68 +/- 0.51; and carcinoma in situ of TCC (n = 10), 3.61 +/- 0.52.(ABSTRACT TRUNCATED AT 250 WORDS)
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Within one year 38 patients with bladder tumors--most malignant--were treated by argon-laserbeam (6 Watt and 15 Watt). We now survey altogether 45 endoscopic operations. To bring the laserbeam into the waterfilled bladder, we use a special light-conductor and a normal operation-cystoscope. Laser therapy takes place after conventional electro-resection (TUR) by coagulation of the tumor ground or independently by destroying small relapses of tumors. We have observed some advantages of argon-laser treatment compared to electro-surgery: 1. No convulsions of bladder muscle with the danger of perforation, sometimes produced by current impulses. 2. Painlessness. Laser treatment is possible without anesthesia. 3. More therapeutic range. 4. Cases of absence of recidivation. We hope that the new therapy will be able to reduce the recidivation of bladder tumors and to improve the poor results of operative treatment.
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