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PubMed2001

Cystitis glandularis mimics bladder cancer--three case reports and literature review.

Cystitis glandularis is an uncommon proliferative disorder of the mucus-producing glands within the mucosa and submucosa of urinary bladder epithelium. We report three cases with gross hematuria on first presentation. Both sonography and computer tomography revealing bladder tumor and transurethral resection was performed in all three cases. Cystitis glandularis was confirmed by pathology. Short-term follow-up of sonography and cystoscopy showed good results.

Adult↗

PubMed2001

Granular cell tumor of the urinary bladder.

A case of granular cell tumor of the urinary bladder is reported. A 48-year-old Japanese man with a bladder tumor underwent transurethral resection of the tumor and microscopic examination showed a granular cell tumor. Immunohistochemical staining for neuron specific enolase and S100 protein was positive, and it was suggested that the granular cell tumor was derived from Schwann cells.

Granular Cell Tumor↗

PubMed2003

Hepatoid adenocarcinoma of the urinary bladder.

Hepatoid adenocarcinoma is rare in the urinary bladder with only three well-illustrated previously reported cases. Pathological diagnosis is based on a combination of histological features resembling hepatocellular carcinoma and the positive immunostaining for alpha-fetoprotein. We present the clinicopathological features of four additional cases. The patients were males 66, 85, 61 and 68 years old. Hematuria was the initial symptom in all four patients. Two cases were treated by cystoprostatectomy and the remaining two by transurethral resection of the bladder. On histology, the cases showed a mixture of cells growing in a solid fashion and sheets or anastomosing trabeculae of hepatoid cells merging focally with a secondary glandular pattern of adenocarcinoma. Intracytoplasmic hyaline globules in all and bile production in three of the cases also supported the impression of hepatocytic differentiation. Immunoreactivity for alpha-fetoprotein, low molecular weight cytokeratin, alpha-1-antitrypsin, albumin, epithelial membrane antigen and a striking canalicular pattern when stained against polyclonal carcinoembryonic antigen (CEA), all indicate hepatocellular differentiation. The hepatic nature of the cells was further assessed by detecting the recently incorporated marker hepatocyte paraffin 1, by means of immunohistochemistry and albumin gene mRNA non-isotopic in situ hybridization, both of which had positive signals in all four cases. Three patients died 12, 14 and 19 months after diagnosis. The fourth patient was alive with disease at 26 months of follow-up. In conclusion, hepatoid adenocarcinoma seems to be an aggressive malignant neoplasm that is rare in the bladder whose correct diagnosis may need appropriate immunohistochemical and in situ hybridization means in addition to a complete patient clinical and pathological evaluation. The exact histogenesis and classification of these tumors remains to be established.

Adenocarcinoma↗

PubMed2006

Laparoscopic partial cystectomy for a vesical leiomyoma.

A 47-year-old woman presented with gross hematuria and urinary frequency for 6 months. The tumor located at the dome of bladder was resected by transurethral resectoscope. The pathology revealed leiomyoma; however, her symptoms did not improve after the endoscopic procedure. We performed transurethral mucosal incision for circumscribing the margin of tumor and transperitoneoscopic partial cystectomy to treat the patient successfully.

Cystectomy↗

PubMed2004

Treatment of invasive bladder cancer: lessons from the past and perspective for the future.

Radical cystectomy with lymphadenectomy is the gold standard for treatment of invasive bladder cancer. However, the treatment alone does not always provide a satisfactory result for the disease extending outside the bladder. In this review we discuss several clinical issues in the diagnosis and treatment of this invasive disease. Although the quality of diagnostic imaging modalities has improved, they are still not sensitive enough for the staging of the disease, especially for early invasive disease. In addition, lack of serum markers hinders appropriate monitoring of patients with the disease. Regarding the surgical aspect of lymphadenectomy, the area of its dissection, the standard number of nodes retrieved and the method of pathological examination should be established so that the clinical benefits of surgery can be more clearly defined. Neoadjuvant chemotherapy for invasive disease is promising for improvement of survival of patients. A chemotherapy regimen as effective as, but less toxic than, MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) has been reported and several phase III clinical trials have been launched to determine the benefits of adjuvant or neoadjuvant chemotherapy with newly developed agents. However, we still lack a chemotherapy regimen more effective than MVAC, which is the most crucial issue in the treatment of this invasive disease. An alternative option for such disease may be bladder preservation with transurethral resection of tumor followed by chemoradiotherapy. However, patients who are indicated for this treatment may be limited to those with early invasive disease having certain favorable clinical and pathological features.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1992

Intravenous urography in patients with transitional cell carcinoma of the bladder. The incidence and implications of ureteral obstruction.

In order to study the value of excretory urography in the diagnosis of transitional cell carcinoma of the bladder, and also the incidence and implications of ureteral obstruction, 100 consecutive patients were studied. Of 73 patients with superficial tumours (stages Tis, Ta, T1) only 1 (1,4%) had hydronephrosis as a result of the bladder tumour. However, 2 further patients had hydronephrosis secondary to synchronous ureteral tumours. Of the 27 patients with muscle-invasive tumours, 10 (37%) had hydronephrosis at the time of diagnosis. Four patients who had normal upper tracts initially, developed hydronephrosis during follow-up: 1 due to progression of a superficial tumour to stage T3, 1 due to the development of an ureteral tumour, and 2 due to fibrosis of the intramural ureter after transurethral resection of superficial tumours. The presence of ureteral obstruction at the time of diagnosis most often implies a muscle-invasive tumour, but the possibility of a synchronous ureteral tumour must also be considered. Fibrous strictures of the distal ureter can occur after transurethral resection of superficial bladder tumours.

Carcinoma, Transitional Cell↗

PubMed2001

Radiotherapy for carcinoma of the bladder: a review.

Carcinoma of the bladder (CaB) is a common and important tumor in North America and Western Europe. There has been a steady increase in the incidence of CaB during the past 25 years in both of these regions with a simultaneous decrease in the mortality rates. The decrease in mortality is primarily due to an earlier diagnosis and the availability of more effective therapeutic interventions resulting from major advances in surgery and a wide use of multimodality bladder preservation therapy.The use of radiotherapy in the management of muscle-invasive CaB has undergone a major evolution. External beam radiotherapy alone is used infrequently in carefully selected patients. The same applies to the use of preoperative irradiation. Brachytherapy alone or combined with external beam radiotherapy has been used successfully in Europe but is used infrequently in North America. External beam radiotherapy is an essential component of a multimodality therapy consisting of cytoreductive surgery via transurethral resection of a bladder tumor followed by a planned combination of radiotherapy and chemotherapy. The outcomes of this bladder preservation therapy are similar to those reported in a like patient population treated with radical cystectomy. The main benefit of conservatively treated patients is functioning bladder in about 50% of those receiving conservative therapy. Radiotherapy alone or in a combination with chemotherapy remains an important and effective palliative therapy for patients with recurrent and/or metastatic CaB. Current research efforts are directed toward a better identification of important pretreatment risk factors predicting failure thus helping in a more optimal selection of patients who would benefit most from radical cystectomy or from the application of bladder preservation therapy.

Brachytherapy↗

PubMed1994

Radical external beam radiotherapy of urinary bladder carcinoma. An analysis of results in 500 patients.

Between 1970 and 1985, 500 patients with urinary bladder carcinoma received external beam radiotherapy with curative intent at the Centre of Oncology in Kraków. The 5-year survival without evidence of cancer for T1 patients was 100% (5/5), for T2 48.7% (19/39), for T3 32% (128/400), and for T4 7.1% (4/56). In our patients the clinical T category was the only pretherapeutic prognostic parameter of statistical significance confirmed in uni- and multivariate analysis. The tolerance of therapy was poorer in patients who had partial transurethral resection of the bladder tumour performed prior to radiation therapy, and in those whose bladder volume was less than 200 ml. The additional irradiation of regional (pelvic) lymph nodes seemed to improve survival of patients with T3 bladder carcinoma.

Aged↗

PubMed1986

The effects of intravesical and intradermal application of a new B.C.G. on the dog bladder.

Intravesical and intradermal application of B.C.G. (Bacillus Calmette Guérin) has proven to be effective in the prophylaxis of recurrence of superficial bladder carcinoma after transurethral resection and in the treatment of carcinoma in situ (C.I.S.) in man. Different strains of B.C.G. have been used for this purpose. In this article a new strain of B.C.G. (B.C.G.-R.I.V.M.) has been tested to assess its toxicity. The effects of intravesical and intradermal application of B.C.G.-R.I.V.M. were studied on normal and on coagulated canine urothelium. In this study no general side effects of B.C.G.-R.I.V.M. were seen. Only minor local changes occurred in the bladder wall. Small granulomas were found in the suburothelial tissue. No granulomas or signs of active inflammation were observed in the pelvic lymphnodes, spleen and liver. Because B.C.G.-R.I.V.M. seemed to be a safe agent in the dog we have started to use it for prophylaxis in superficial bladder cancer in man.

Administration, Intravesical↗

PubMed1992

Intravesical instillation of beta-interferon in the treatment of bladder cancer.

A total of 36 patients with single superficial bladder cancer TNM stage Ta-T1/G2 was studied over a 24-month period before entering the study to evaluate the efficacy and tolerance of high doses of beta-interferon (beta-INF); 24 patients had a primary tumour (group 1) and 12 had had more than 3 recurrences (group 2). They received 8 intravesical doses of beta-INF, 50,000,000 IU in 50 ml sterile water, at weekly intervals, 15 days after transurethral resection of the bladder (TURB). Efficacy was estimated by simple recurrence rate and by the person-years method. The recurrence rate was 25% in group 1 with a mean follow-up of 21.6 months. Comparison with the recurrence rate of a historical control group treated only by TUR showed that there was a slight statistically significant difference. Group 2 had a recurrence rate of 100% in the period before beta-INF (follow-up 24 months) and 91% after INF administration (mean follow-up 20.5 months). Patients were questioned about side effects before and after each treatment; tolerance of the drug was excellent. The results suggest that beta-interferon could be safely used as a prophylactic agent against the recurrence of primary superficial bladder cancer. Its efficacy seems comparable to that obtained with other current chemoprophylactic agents.

Administration, Intravesical↗

PubMedDate not supplied

The use of the marker tumor concept in Ta, T1 bladder cancer: is it justified?

Adjuvant instillations with chemo- or immunotherapy agents after transurethral resection of Ta, T1 bladder tumors are administered on non-measurable non-visible disease. To know whether adjuvant therapies are efficacious the marker tumor concept has been developed. The use of marker lesions has been questioned by many as dangerous and/or unethical because a deliberately left-behind tumor might be invasive or become invasive if the adjuvant therapy is not effective. However, 4 EORTC, 2 British, and one Japanese study using different drugs have shown that it is safe and ethically justified to use the marker tumor concept in clinical phase II studies. Data from six trials indicate the the risk of leaving an invasive tumor behind or that a tumor might progress while being treated with instillations is 0.8% (3/383). Marker lesion studies should be limited to intermediate risk patients. Expensive and inefficient long term phase III trials may be avoided by marker tumor trials. Exposing patients to ineffective drugs in prophylactic trials also jeopardizes the patient with regard to recurrence and/or progression of their bladder tumors.

Biomarkers, Tumor↗

PubMed1988

Treatment schedule of intravesical chemotherapy with mitomycin C in superficial bladder cancer: short-term courses or maintenance therapy.

Intravesical chemotherapy using mitomycin C in patients with superficial bladder cancer after transurethral resection (TUR) has proved to be highly effective in preventing tumor recurrences and/or progression. No consensus has been reached on the appropriate dose and treatment schedule. This and other variable factors such as different criteria for entry and follow-up in the reported studies so far make it impossible to compare the results. There are indications that long-term mitomycin C instillation therapy improves recurrence rate, progression rate, and survival. Considering prognostic factors in patients with superficial bladder tumors, it is justified and necessary to investigate this regimen in future protocols.

Administration, Intravesical↗

PubMed1995

[Primary amyloidosis localized in the bladder].

OBJECTIVE: We report a case of localized amyloidosis of the urinary bladder in an 80-year-old female whose main presenting symptom was massive hematuria. METHODS: Cystoscopic examination revealed a tumor on the trigone and bladder neck. A transurethral resection of the tumor was performed and the fragments were processed for histopathological study with hematoxylin-eosin and Congo red staining and ultrastructural study. RESULTS: The histopathological analyses disclosed large eosinophilic deposits in the submucosa with birefringence under polarized light in Congo red staining. Electron microscopy revealed a meshwork of filaments typical of amyloid. The patient had no symptoms or signs of systemic disease and remains symptom-free four years later. CONCLUSIONS: Primary localized amyloidosis of the urinary bladder is a rare condition that can be successfully treated surgically and has an excellent prognosis.

Aged↗

PubMed1984

Cobalt therapy prophylaxis of recurrence of T1 bladder cancer.

Eighteen patients with T1 transitional cell carcinoma of the urinary bladder were submitted to transurethral resection of the tumor, followed by Cobalt therapy (5,500 rads to the pelvis and 6,500 rads to the bladder in six weeks). The recurrence rate at three years follow-up was 33% (6/18). Recurrence of transitional cell carcinoma of the urinary bladder is a well known condition in stage O and A, even when low grade is present. Recurrence rates at one year as high as 84% (Loening et al., 1983) are reported in the current literature. In recent years many studies have been performed which were oriented to the use of intravesical chemotherapy in order to reduce the recurrence rate (Adolphs and Bastian, 1983; Huland, 1983; Loening et al., 1983; National Bladder Cancer Collaborative Group A, 1977; Rodriguez and Caserta, 1983; Zincke et al., 1983) of this tumor. We started a protocol on treatment of the transitional cell carcinoma of the urinary bladder in 1963. The protocol calls for transurethral resection of the tumor followed by Cobalt therapy. This is an interim report on stage T1 (stage A) with such a treatment.

Adult↗

PubMed1996

[Cavernous hemangioma of urinary bladder: a case report and review of the literature].

We report a case of cavernous hemangioma of the urinary bladder treated with transurethral resection (TUR). A 58-year-old woman was admitted to our department with the chief complaint of macroscopic hematuria. Cystoscopy revealed a red sessile tumor 2 cm in diameter, at the internal urethral orifice. The tumor had a mostly low signal intensity, partly high signal intensity, on T1-weighted, coronal magnetic resonance (MR) images. Computed tomography and T2-weighted MR images did not delineate the tumor. TUR was performed, and the specimen was pathologically diagnosed as cavernous hemangioma of the urinary bladder. A brief description of the case is provided and the literature is reviewed.

Female↗

PubMed1996

The ileal neobladder--updated experience with 306 patients.

From April 1986 through May 1995, 306 men with primary urothelial carcinoma underwent radical cystoprostatectomy and orthotopic bladder substitution via the ileal neobladder. Altogether, 7.5% of the patients suffered general early complications, including thrombosis, embolism, wound infection, and pneumonia. Specific early complications directly related to formation of the neobladder and requiring surgery included ileus (4%), abscess drainage (2%), and leakage of the ileal anastomosis (0.5%). The early reoperation rate was 6.5%. Early complications that required temporary percutaneous drainage were lymphocele formation (3%) or ureteral obstruction (6%). In all, 9% of our patients required prolonged catheter drainage for leakage of the ileouretheral anastomosis. Late complications requiring reoperation were ileus (2%), abscess drainage (1%), neobladder fistula to the colon (1.5%), ureteral reimplantation because of obstruction (3.6%), and nephrectomy for hydronephrosis (1%). A transurethral incision of the ileouretheral anastomosis was necessary in 7% of cases. Continence was separately addressed by sending each patient and his home physician a detailed questionnaire: Using our criteria (no diapers, no awakenings) the night and day continence rate increased from 67% at 6 months, to 72% at 1 year to 85% at 2 years, finally reacting 90% after 4 years. In part II of this presentation we address the question as to whether the option of orthotopic bladder replacement has any impact on the patient's and physician's decision toward earlier cystectomy. We compared our ileal neobladder cohort with a group of 137 patients that had been operated on during the same time span by the same group of surgeons. There was no negative selection with regard of the tumor stage of our patients. However, as compared with the conduit group, the neobladder cohort had a significantly improved survival rate. This phenomenon is explainable by the significantly lower number of previous transurethral resections of the bladder (TUR-Bs) performed in the neobladder group. The time span between primary diagnosis and cystectomy was 10 months in the neobladder group as compared with 18 months in the conduit patients. These data reinforce our belief that orthotopic bladder replacement using the ileal neobladder yields an extraordinary functional result that can be accomplished with a high degree of patient satisfaction and minimal complication. The availability of orthotopic bladder replacement does indeed stimulate the physicians and patients decision toward earlier cystectomy.

Aged↗

PubMed2002

Optimal timing of radical cystectomy for patients with invasive transitional cell carcinoma of the bladder.

OBJECTIVE: To determine whether the timing of radical cystectomy affects the survival of patients with invasive transitional cell carcinoma (TCC) of the bladder. METHODS: Between January 1985 and June 2000, 167 patients underwent radical cystectomy in our institution. Among them, 50 patients who did not receive any perioperative therapies, including chemotherapy and radiotherapy, were divided into two groups, viz. 28 patients who underwent radical cystectomy within 3 months after the primary diagnosis of invasive bladder cancer (group A) and 22 who underwent radical cystectomy more than 3 months after the primary diagnosis (group B), and we then compared several clinicopathological factors and the survival between these two groups. RESULTS: No significant difference was observed in the patients' clinicopathological characteristics except for age between these two groups. The median follow-up periods for groups A and B were 53 and 48 months, respectively. In groups A and B, an average of 1.2 (range 1-2) and 1.4 (range 1-3) transurethral resections (TURs) of bladder cancer were performed, respectively (p = 0.83). Twenty of 28 patients in group A underwent orthotopic neobladder replacement, whereas only four of 22 underwent neobladder creation (p = 0.001). The recurrence-free, cause-specific and overall survival rates in group A were significantly higher than those in group B (p < 0.05, p < 0.05 and p < 0.05, respectively). Final pathological analysis revealed that the distributions of pathological stage, tumor grade and lymph node metastasis were similar between groups A and B; however, the incidence of vascular involvement in group B was significantly higher than that in group A (p < 0.05), despite the lack of a significant difference in the incidence of vascular involvement in TUR specimens between these two groups. CONCLUSIONS: These findings suggest that radical cystectomy in the early disease process, especially before the occurrence of vascular involvement, may result in the improvement of survival of patients with invasive TCC of the bladder.

Aged↗

PubMed1995

A phase I study of intravesical continuous perfusion of recombinant interleukin-2 in patients with superficial bladder cancer.

A Phase I study was started to evaluate the locoregional and/or systemic toxic effects of the continuous perfusion of recombinant interleukin-2 (rIL-2) in superficial bladder cancer. Three different dose levels were used: 3 x 10(6) IU/day (3 patients), 9 x 10(6) IU/day (3 patients) and 27 x 10(6) IU/day (3 patients). Two patients (one treated with 3 x 10(6) and another with 27 x 10(6) IU/day of rIL-2) had hematuria after the end of the treatment, one patient had fever (grade I) and 7 of 9 patients experienced hypotension (grade I-II). All effects were not dose related. Routine laboratory tests indicated that no significant variations of biochemical parameters occurred. A phenotypic analysis of white blood cells detectable in the bladder, showed an evident locoregional activation of lymphoid cells. In particular, T lymphocytes expressed activation antigens (such as CD25 and HLA-DR) following treatment with rIL-2. A 6- to 12-month clinical follow-up, showed that all patients but one (which recurred after 5 months) are alive and disease-free. This therefore indicates that the locoregional perfusion of rIL-2 is safe and gives clinical results similar to those obtained using Calmette-Guérin bacillus locoregional instillation, in patients who underwent a transurethral resection of superficial bladder cancer.

Administration, Intravesical↗