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The management of transitional cell carcinoma in the prostate.

Transitional cell carcinoma of the prostate is a rare tumour. A review of 318 patients with carcinoma of the prostate presenting to this hospital in the 5 years between April 1974 and April 1979 revealed 7 patients with transitional cell carcinoma arising within the prostate. Two of these had previously been treated for a transitional cell carcinoma of the bladder. These prostatic tumours are usually poorly differentiated and carry a poor prognosis. Early radical surgery, however, achieved a good result in one of our patients. Other forms of treatment were ineffective and a review of the literature revealed that this was also the experience of others. We suggest that cystoprostatectomy should be considered as an early form of treatment.

Aged↗

Is nephroureterectomy necessary in all cases of upper tract transitional cell carcinoma? Long-term results of conservative endourologic management of upper tract transitional cell carcinoma in individuals with a normal contralateral kidney.

OBJECTIVES: To evaluate the endoscopic management of upper urinary tract transitional cell carcinoma (TCC) as a first-line treatment in patients with a normal contralateral kidney. METHODS: During an 11-year period, 21 patients diagnosed with upper tract TCC were treated with conservative endourologic techniques using either neodymium:yttrium-aluminum-garnet laser or electrocautery at our institution. The 21 patients were followed up for a mean of 6.1 years (range 1 to 11.6). RESULTS: A total of 8 renal pelvic tumors and 13 ureteral tumors were found. All tumors were Stage T1 or less and grade 3 or less. All tumors were less than 2 cm in the greatest dimension (range 0.4 to 2). Of the 21 patients, 7 (33%) had one local recurrence and 1 (4.7%) developed two local recurrences. Of the 13 ureteral tumors, 6 (46%) recurred; 1 (12%) of the 8 renal pelvic tumors recurred. No recurrent tumor was shown to have an increase in grade. Of the 21 target renal units, 17 (81%) were preserved; 4 (19%) of 21 patients required nephroureterectomy because of tumor recurrence. Overall, 11 patients in the series died, 10 of non-TCC etiology and 1 secondary to invasive bladder TCC that developed after treatment for upper tract TCC. No patients died as a result of conservative management of their upper tract TCC. CONCLUSIONS: Endourologic techniques and conservative treatment of upper tract TCC is an evolving field; however, in properly selected patients, endoscopic treatment can be safely and effectively used as a first-line treatment for upper tract TCC.

Adult↗

Renal cell carcinoma with renal pelvic extension simulating transitional cell carcinoma: a case report.

A case of renal cell carcinoma (RCC) with unusual extension into renal pelvis is reported. The radiographic findings simulate closely to those of transitional cell carcinoma (TCC) of the renal pelvis. Histopathological study of the extirpated tumor revealed RCC with invasion of renal pelvis. It is emphasized that it is occasionally difficult to distinguish TCC with renal invasion from RCC with renal pelvic extension. In addition, decision of surgical approach should be considered preoperatively in these cases.

Carcinoma, Renal Cell↗

[Biologic behavior of human chorionic gonadotropin hormone (HCGH) in transitional cell carcinomas of the bladder].

Transitional cell carcinoma of the bladder carries a high rate of local recurrence and 15%-30% of the cases progress to advanced stages of the disease. The multiple forms of the tumor make it difficult to find reliable diagnostic elements of tumor evolution and some authors have advocated the use of tumor markers for the diagnosis and follow-up of malignant bladder tumors. This study was conducted to determine the biological behaviour of the HCG beta subunit it transitional cell carcinoma of the bladder. One hundred patients were entered into the study; the control group comprised 30 healthy subjects and the patient group comprised 70 cases of transitional cell carcinoma of the bladder. The results showed the HCG beta subunit increased with the size and degree of tumor infiltration, although the data were not statistically significant. Similarly, analysis of the degree of tumor differentiation/non differentiation provided no statistically significant data.

Biomarkers, Tumor↗

Displaced calcium as a sign of transitional cell carcinoma in analgesic nephropathy.

Transitional cell carcinoma is associated with analgesic nephropathy. Detection of this neoplasm may be delayed because hematuria and colic are the usual symptoms in both conditions. Plain film findings of displacement of the renal calcifications occurring in analgesic nephropathy may be the first sign of transitional cell carcinoma.

Analgesics↗

Clinical outcomes following radical cystectomy for primary nontransitional cell carcinoma of the bladder compared to transitional cell carcinoma of the bladder.

PURPOSE: The effect of bladder cancer histological subtypes other than transitional cell carcinoma (nonTCC) on clinical outcomes remains uncertain. We conducted a multi-institutional retrospective study of patients with bladder cancer treated with radical cystectomy to assess the impact of nonTCC histology on bladder cancer specific outcomes. MATERIALS AND METHODS: A total of 955 consecutive patients underwent radical cystectomy with bilateral pelvic lymphadenectomy for bladder cancer at 3 academic institutions. TCC was present in the radical cystectomy specimen in 888 patients (93%). NonTCC histology was present in 67 patients (7%), including squamous cell carcinoma in 26, adenocarcinoma in 13, small cell carcinoma in 10 and other nonTCC subtypes (ie spindle cell carcinoma, carcinosarcoma and undifferentiated carcinoma) in 18. For patients alive at last followup median followup was 39 and 23 months for patients with TCC and nonTCC histologies, respectively. Bladder cancer specific progression and survival were assessed using Kaplan-Meier and multivariate Cox proportional hazards analyses. RESULTS: Bladder cancer specific progression and mortality did not differ significantly between patients with SCC and TCC histologies. Patients with nonTCC and nonSCC bladder cancer were at significantly increased risk for progression and death compared to patients with TCC or SCC (p <0.001). This association remained statistically significant in patients with organ confined disease (stage pT2 or lower) and patients with nonorgan confined disease (stage pT3 or higher) (p <0.001). In a multivariate analysis nonTCC and nonSCC histology was associated with an increased risk of bladder cancer progression and death (OR 2.272 and 2.585, respectively, p <0.001), even after adjusting for final pathological stage, lymph node status, lymphovascular invasion and neoadjuvant or adjuvant treatments. CONCLUSIONS: NonTCC and nonSCC histological subtype is an independent predictor of bladder cancer progression and mortality in patients undergoing radical cystectomy for bladder cancer. Patients with bladder TCC and SCC share similar stage specific clinical outcomes.

Aged↗

Amyopathic dermatomyositis associated with transitional cell carcinoma of the bladder.

Transitional cell carcinoma of the bladder is the most common tumor of the urinary tract. However, it has only been reported twice in the literature to be associated with the paraneoplastic syndrome dermatomyositis. We report a case of amyopathic dermatomyositis in a patient whose painless gross hematuria was due to transitional cell carcinoma of the bladder as well as review this association.

Aged↗

A renal cell carcinoma extending into the renal pelvis simulating transitional cell carcinoma.

A case of renal cell carcinoma with unusual extension is reported, in which the radiographic findings have a close resemblance to those of transitional cell carcinoma of the renal pelvis. We emphasize that it is occasionally difficult to draw a distinction between transitional cell carcinoma with renal invasion and renal cell carcinoma with renal pelvic extension even by computed tomography (CT) and angiography.

Adult↗

Synchronous ipsilateral conventional renal cell and transitional cell carcinoma.

Simultaneous occurrence of renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) in the same kidney is unusual. We report a 61-year-old man with ipsilateral synchronous renal adenocarcinoma and renal pelvic TCC. He was referred to our department for gross hematuria and right flank pain. CT and MRI studies revealed a 57 x 50 mm irregular and infiltrative upper right kidney mass with necrotic components. A right radical nephrectomy was done. Pathological diagnosis was a high grade tumor originating from just beneath the intact urothelium of renal pelvis and infiltrating through the parenchyma showing solid and occasional tubular growth patterns. A second tumor in close proximity to the first was reported as well differentiated RCC. This is a rare case of combined renal malignancies.

Carcinoma, Renal Cell↗

Transitional cell carcinoma involving the prostate.

Transitional cell carcinoma involving the prostate gland was studied in 27 patients. Three different groups were recognised on the basis of the clinical pattern and histological findings. Each group has a different prognosis and merits a different approach to treatment. Thus, stromal involvement of the prostate by transitional cell carcinoma is a sinister finding that requires radical treatment, whereas ductal involvement by either carcinoma in situ or non-invasive papillary tumours can be managed less aggressively. This study emphasises that the present classification for these tumours is unsatisfactory and that adequate histopathological information is essential for their management.

Carcinoma in Situ↗

[Comparative study of pure epidermoid carcinoma of the bladder and transitional cell carcinoma with squamous or mixed differentiated foci].

INTRODUCTION: The epidermoid bladder carcinoma is an infrequent tumour in our environment accounting for 5-8% of total vesical tumours, but is not so uncommon to find foci of squamous differentiation within a transitional carcinoma. We conducted a comparative study between these two histologic forms and analyzed the pattern of their clinical behaviour. MATERIAL AND METHODS: Retrospective study on a total of 32 cases of epidermoid carcinoma diagnosed between 1986-1996 that following histological confirmation were divided into two groups; plain epidermoid carcinoma (PEC), 11 cases; and transitional carcinoma with foci of squamous differentiation (MEC), 19 cases. After further review 2 cases were excluded. RESULTS: PEC appears in older patients. Both tumoral forms are more frequent in males, the male/female ratio being lower in PEC. Presence of irritative factors is significantly associated to PEC (P < 0.01) and smoking to MEC. Presentation signs are similar in both groups, and haematuria is the most frequent sign. Most usual location in both groups was the trigone, which caused uni/bilateral hydronephrosis in over 50% patients. At the time of diagnosis all PECs were invasive versus only 86% in the MEC group. TREATMENT: PEC group underwent the following procedures: 4 radical cystectomies, 2 cystectomies plus radiotherapy, 3 palliative TUR and 2 TUR with radiotherapy. In the MEC group there were 3 radical cystectomies, 2 cystectomies plus radiotherapy, 1 cystectomy with previous chemotherapy, 8 palliative TUR, 2 TUR with endovesical chemotherapy, 1 TUR with systemic chemotherapy, 1 TUR with radiotherapy and 1 systemic chemotherapy. Mean survival was 12.5 months (0-43) in PEC and 26.55 (0-96) in MEC. Disease-free time in PEC and MEC was 5 months (0-37) and 10.25 (0-70) respectively. Only one patient achieved 5-year survival. CONCLUSION: Epidermoid carcinoma both plain and mixed is an aggressive tumour with poor prognosis and short survival. 100% PECs in our series are invasive at diagnosis, and no statistically significant differences were found in survival and disease-free time between both histological variants. Cystectomy remains the choice therapy.

Adult↗

Expression of CD44 splice variants in human transitional cell carcinoma.

The CD44 cell adhesion molecule is a surface glycoprotein mainly expressed in lymphoid tissues. Recently, abnormal variants of CD44 including alternatively-spliced large molecular variants, have been reported in many neoplastic tissues. We studied the variation in the size of CD44 molecules in 25 transitional cell carcinomas and 11 normal transitional epithelial tissues, using the reverse transcriptase-polymerase chain reaction (RT-PCR) followed by electrophoresis and Southern blot hybridization. Whereas 23 of 25 (92.0%) tumor tissues expressed CD44 splice variants with large molecular size, only 1 of 11 (9.1%) normal tissues expressed the abnormal variants. Urine sediments from 5 of 7 (71.4%) patients also was positive for the CD44 splice variants. CD44 splice variants are increased markedly in human transitional cell carcinoma. In conclusion, detection of CD44 splice variants using the RT-PCR, which is a convenient molecular biological technique, may be useful in combination with other diagnostic methods such as cytology, flow cytometry, and tumor antigens.

Alternative Splicing↗

Bladder cancer as a prognostic factor for upper tract transitional cell carcinoma.

PURPOSE: Upper tract transitional cell carcinoma (UTTCC) is a relatively rare tumor. Overall 5-year disease specific survival is in the range of 16.5% to 95% depending on stage. In this study we evaluated predictors associated with disease recurrence and disease specific survival. MATERIALS AND METHODS: We report on 129 patients with a median age of 68 years who underwent nephroureterectomy for UTTCC between July 1989 and June 2002. A total of 67 patients had primary UTTCC and 62 had previous (52) or synchronous (10) transitional cell carcinoma of the bladder (BTCC). Medical records were reviewed and analyzed for possible prognostic predictors (primary tumor stage, grade, multifocality, carcinoma in situ, symptoms and signs at presentation, sex, and history of smoking). Disease specific survival and freedom from bladder recurrence were assessed with the Kaplan-Meier method, and differences between the groups were compared using the log rank test. The Cox proportional hazards regression model was used to assess the significance of each predictor. RESULTS: Disease specific death was reported for 44 patients. In a multivariate analysis using previous BTCC as a predictor (categorized as superficial, invasive or none), primary disease stage and history of BTCC were associated with disease specific survival (p = 0.001 and p = 0.018). History of BTCC grouped the patients into distinct populations in terms of disease specific survival and freedom from bladder recurrence. CONCLUSIONS: This study demonstrates that a history of BTCC (invasive or superficial) has an adverse effect on the prognosis of patients diagnosed with UTTCC independent of primary tumor stage.

Adult↗

A squamous cell bladder carcinoma with karyotypic abnormalities reminiscent of transitional cell carcinoma.

A squamous cell carcinoma was investigated cytogenetically by means of chromosome banding. The karyotype was complex with many structural and numerical changes, including -9 and del(11p), aberrations that also have been noted in transitional cell carcinoma. Thus, cytogenetic studies may be an important complement to the histological classification of bladder tumors, and may even contribute to our understanding of the etiology and pathogenesis of the 2 main types of bladder cancer.

Aged↗

Allelic losses at chromosome 3p are seen in human papilloma virus 16 associated transitional cell carcinoma of the cervix.

OBJECTIVE: Transitional cell carcinomas (TCCs) of the cervix are rare neoplasms of the female genital tract. Although these tumors display urothelial differentiation, there is controversy regarding their histogenetic relationship to squamous cell carcinomas (SCC) of the cervix versus transitional cell carcinomas of the bladder. METHODS: We performed partial allelotyping of five TCCs of the cervix using 23 polymorphic markers located on chromosomes 3p and 9, which demonstrate frequent and early losses in cervical SCC and urothelial TCC, respectively. Multiplex polymerase chain reaction was used on DNA extracted from archival paraffin-embedded tissue using precise microdissection. Additionally, P53 gene mutation analysis was performed using single-strand confirmation polymorphism (SSCP) and the presence of human papilloma virus (HPV) sequences was analyzed using general and specific (types 16 and 18) primers. RESULTS: General HPV sequences were demonstrated in all cases, but the oncogenic strain HPV 16 was present in only three (60%) of the five tumors; no HPV 18 was detected in any sample. Three of five TCCs, all harboring HPV 16 sequences, demonstrated concurrent allelic losses at several 3p loci (specifically 3p12, 3p14.2 [the FHIT gene locus], 3p21.3, and 3p22-24.2). LOH at a single locus on 9q32-qter was demonstrated in one tumor; no other deletions were seen on chromosome 9. P53 gene mutations in exons 5-8 were absent by SSCP analysis. CONCLUSIONS: The infrequent involvement of chromosome 9 in TCCs of the cervix, along with the concurrent presence of 3p LOH and oncogenic HPV 16 in a subset of tumors, suggests a closer histogenetic relationship of this neoplasm to cervical SCCs rather than urothelial TCCs.

Carcinoma, Squamous Cell↗