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PubMed2005

[A case report of inflammatory pseudotumor of the urinary bladder due to diverticulitis of the sigmoid colon].

A 65-year-old female presented to our hospital with a 6-month history of pollakuria, low-grade fever and urgent incontinence. Cystoscopy revealed a nonpapillary bladder tumor that was 50 mm in diameter in the trigon. Computed tomography showed the abscess between the urinary bladder and sigmoid colon. Transurethral resection was performed and the histology consisted of inflammatory lesions with inflammatory cell infiltration, which was diagnosed as an inflammatory pseudotumor due to diverticulitis of the sigmoid colon. Sigmoidectomy was subsequently performed. A fistula between the urinary bladder and the sigmoid colon was not detected. Cystoscopy 2 months after the operation revealed no signs of a bladder tumor.

Aged↗

PubMed1995

Carcinosarcoma of the urinary bladder--case report and literature review.

We describe a patient who presented with gross haematuria and dysuria. Investigations confirmed a bladder tumour, for which transurethral resection was done. The histology showed a carcinosarcoma, which was muscle invasive but organ-confined. The patient refused radical surgery and underwent a course of radical radiotherapy. He died 14 months later. Carcinosarcoma of the urinary bladder is a rare, mixed malignant tumour, composed of mesenchymal and epithelial elements. It is commoner in elderly men. It is an aggressive tumour with a short clinical course, and must be distinguished from collision tumours and spindle cell tumours. Immunohistochemical stains are useful in its diagnosis. It is probably best managed by radical surgery with or without adjuvant therapy, but because of the small number of incidences reported, there is no universal agreement on its therapy.

Aged↗

PubMed2006

Noninvasive squamous lesions in the urinary bladder: a clinicopathologic analysis of 29 cases.

Noninvasive squamous lesions are distinctively uncommon in biopsies of the urinary bladder with the exception of nonkeratinizing squamous metaplasia. The clinical significance of these squamous lesions in the bladder remains to be explored. A total of 29 cases of transurethral biopsies and resections of the bladder containing noninvasive squamous lesions (excluding nonkeratinizing metaplasia) were studied from the consult files of one of the authors. These cases included keratinizing squamous metaplasia (5), verrucous squamous hyperplasia (5), squamous papilloma (5), condyloma acuminatum (3), and squamous cell carcinoma in situ (CIS) (11). Immunohistochemistry for epithelial growth factor receptor (EGFR) and in situ hybridization for wide-range human papillomavirus was performed on 23 cases. The follow-up period ranged from 2 months to 3 years with an average of 1.5 years. After the initial diagnoses in biopsies of the bladder, 10 patients received cystectomies, and 7 patients received repeat tissue sampling of the bladder. Of the 5 patients with keratinizing squamous metaplasia, 2 patients had invasive urothelial carcinoma with squamous features in their cystectomy specimens at intervals of 3 and 14 months, respectively, 1 had persistent keratinizing squamous metaplasia on rebiopsy. Of the 5 patients with verrucous squamous hyperplasia, 1 patient had invasive squamous cell carcinoma at cystectomy at an interval of 14 months, 1 had squamous cell CIS on rebiopsy, 1 had persistent verrucous squamous hyperplasia on rebiopsy, and 2 had no evidence of disease at 6 and 24 months. Of the 5 patients with squamous papilloma, 1 patient had low-grade urothelial carcinoma at cystectomy at an interval of 21 months (h/o low-grade urothelial carcinoma preceding papilloma diagnosis), 2 were free of lesions at rebiopsy. Of the 3 patients with condyloma acuminatum, 1 had squamous CIS at cystectomy at an interval of 3 months, 1 had invasive squamous cell carcinoma at 20 months. Of the 11 patients with squamous cell carcinoma in situ (CIS), 3 patients had invasive squamous cell carcinoma at intervals of 2, 3, and 4 months, respectively, 1 had invasive urothelial carcinoma with squamous features in cystectomies at an interval of 12 months, 1 had squamous cell CIS at 10 months, 1 had high-grade urothelial carcinoma (not otherwise specified) at rebiopsy at an interval of 6 months, and 1 had no evidence of disease at 8 months. Among the 9 patients with invasive carcinoma, 4 patients died in the period of 0.5 to 3 years after the diagnoses. Immunohistochemical study with EGFR demonstrated strong signals in 20 cases and no signals in 2 cases. Wide-range human papillomavirus DNA signal was detected in 1 case of condyloma acuminatum and 1 case of squamous cell CIS. Keratinizing squamous metaplasia, verrucous squamous hyperplasia, and condyloma acuminatum in the urinary bladder can be associated with subsequent or concurrent in situ, or invasive squamous carcinoma and should be closely followed. Squamous cell CIS in the urinary bladder is often associated with subsequent or concurrent invasive carcinoma with squamous differentiation. Enhanced expression of EGFR in these bladder squamous lesions suggests that EGFR may represent a logic therapeutic target in those squamous lesions that are difficult to manage clinically.

Adult↗

PubMed1998

Comparative analysis of MiB1 and p53 expression in human bladder tumors and their correlation with cancer progression.

Expression of p53 and MiB1, markers of tumor proliferation, was evaluated in human bladder tumors, and correlated with ploidy and cancer progression in 83 consecutive patients. Transurethral resection of a newly diagnosed bladder tumor was performed in 73 cases, and systematic bladder biopsies were performed in 10 cases after bacillus Calmette-Guerin (BCG) treatment. p53 and MiB1 expression were performed by an immunohistochemical technique and the ploidy was determined on a frozen fragment of the tumor. p53 expression was correlated in relation to grade, stage and combination of grade and stage. MiB1 expression was correlated with cytological grade, and a significant difference was demonstrated between pT0 and pTa, pTa, and pT1, pTa and pT2 tumors but not between pT1 and > or = pT2 tumors. A discordance was observed for the comparison of p53 and MiB1 values, stage by stage, suggesting that these two techniques are independent of each other. A larger proportion of aneuploid tumors were positive for p53 and MiB1 (64.8 vs. 86.5%, respectively), but p53 and MiB1 immunostaining were not better indicators than ploidy alone to predict cancer progression.

Antibodies, Monoclonal↗

PubMed2001

p53 mutation and bcl-2 expression in transitional cell carcinoma of the urinary bladder.

BACKGROUND: The purpose of our study was to examine the frequency of p53 mutation and bcl-2 expression in transitional cell carcinoma of the urinary bladder and their clinicopathologic correlates. METHODS: A total of 137 patients who underwent transurethral resection for primary transitional cell bladder carcinomas were enrolled. The paraffin-embedded tissue blocks were recut and stained by monoclonal anti-p53 (DO7) and anti-bcl-2 (124) antibodies. The bcl-2 and p53 immunoreactivity was correlated to tumor grade and pathological stage. RESULTS: p53 mutation was identified in 102 patients (78.5%). The mutation was most common in grade 3 tumors (95%) as compared to grade 2 (74%) and grade 1 (80%) tumors, but the difference was not statistically significant (p = 0.289). Stage pT2 tumors had higher incidence of p53 mutation (97%) as compared to pTa-1 tumors (71%, p = 0.0003). Only 17 tumors (13%) expressed bcl-2; the grade 3 tumors had significantly higher incidence of bcl-2 expression (p = 0.04). The bcl-2 expression was not related to pathological stage (p = 0.083). There was no interrelation between p53 mutation and bcl-2 expression (p = 0.97). Grade 3 tumors correlated well with invasive disease (p < 0.00001). When grade 2 tumors were evaluated separately, p53 mutation was positively correlated with disease invasion (p = 0.001). CONCLUSIONS: Grade 3 tumor was the most important variable associated with tumor invasion in transitional cell carcinoma of the urinary bladder. p53 mutation was positively correlated with invasive disease. Grade 2 tumors with p53 mutation had greater probability of disease invasion. Expression of bcl-2 positively correlated with tumor grade but not pathological stage.

Adult↗

PubMed1983

Mitomycin instillation to prevent recurrence of superficial bladder carcinoma. Results of a controlled, prospective study in 58 patients.

In a prospective randomized study, 58 patients with superficial bladder carcinoma received, after transurethral resection (TUR), either no further therapy (30 patients) or mitomycin at 20 mg/20 ml instilled every 2 weeks for the first year and every 4 weeks for the second year starting 3-4 weeks after TUR (28 patients). Bladder tumors recurred in only 2 patients in the treatment group; 15 patients in the control group had recurrences, with increases in grade in 4 patients and in stage in 6 patients. 3 patients in the control group developed metastases, including 1 who died of his tumor; there were no tumor-related deaths in the mitomycin group.

Clinical Trials as Topic↗

PubMed1998

Extravesical tumor relapse in patients with superficial bladder tumors.

PURPOSE: To define the incidence of extravesical urothelial tumors among patients with high-risk superficial bladder tumors. PATIENTS AND METHODS: Three hundred seven patients with multiple recurrent papillary and in situ carcinomas of the bladder were treated with transurethral resection and intravesical bacillus Calmette Guérin (BCG) therapy and monitored for a median of 12 years (range, 10 to 18). Extravesical tumors were detected during investigation of a positive urine cytology after no tumor was found in the bladder. RESULTS: Among 307 patients, 78 (25%) developed tumors in the upper urinary tract (UTT). Of 251 men, 61 (24%) had tumors detected in the prostatic urethra or ducts (T4p). The median times to detection of an UTT or prostatic epithelial tumor were 56 months and 11 months, respectively, and 32% of the UTT and 44% of the T4p relapses were lethal. CONCLUSION: Patients with high-risk superficial bladder tumors who are treated successfully by a bladder-sparing strategy are at increased risk for tumor relapse that involves extravesical mucosa.

BCG Vaccine↗

PubMed1998

Metastatic transitional cell carcinoma of the ovary from superficial bladder tumour.

A 60-year-old female underwent transurethral resection of superficial grade 2 transitional cell carcinoma (TCC) of the urinary bladder. Six months later, intravesical Mitomycin C instillation was given following two superficial recurrences. A further recurrence of TCC grade I was resected transurethrally 39 months later. Forty-eight months after the original diagnosis the patient developed an abdominal mass, which turned out to be TCC grade 3 involving the left ovary. She underwent laparotomy which showed a left ovarian mass. Total abdominal hysterectomy, bilateral oophorectomy and partial omentectomy were carried out. She developed pelvic metastases 3 months later and died.

Carcinoma, Transitional Cell↗

PubMed1990

Interstitial cystitis: bladder mucosa lymphocyte immunophenotyping and peripheral blood flow cytometry analysis.

Interstitial cystitis is a chronic bladder disorder of unknown etiology that primarily afflicts women and is characterized by urgency and pain. Although immune mechanisms have been implicated in the disease process, little is known about the local or peripheral blood immune responses. Cryostat sections of snap-frozen bladder biopsies obtained by transurethral resection from 43 patients (24 with classical and 9 with nonulcerative or early interstitial cystitis, and 10 controls) were analyzed using a panel of monoclonal antibodies with an avidin-biotin immunoperoxidase technique to characterize the local immune response of bladder mucosa. Simultaneously obtained heparinized peripheral blood (10 cc) was analyzed by flow cytometry in 24 patients (9 with classical and 5 with nonulcerative early interstitial cystitis, and 10 controls) using the same panel of antibodies. The control group biopsies (median age 44 years, range 27 to 52 years) had no ulcers, few lymphoid cells (predominately T-helper cells), rare T cell nodules and no B cells. The nonulcer group (median age 39 years, range 29 to 44 years) had rare mucosal ruptures but no ulcers, slightly increased lymphoid cells (predominately T-helper), occasional T cell aggregates, no B cell nodules and rare plasma cells. No statistically significant difference between control and nonulcerative interstitial cystitis patients was identified. In contrast, the classical interstitial cystitis group (median age 68 years, range 47 to 73 years) had ulcers, intense inflammation with focal sheets of plasma cells, aggregates of T cells, B cell nodules including germinal centers, a decreased or normal helper-to-suppressor cell ratio and suppressor cytotoxic cells in germinal centers. Flow cytometry analysis of peripheral blood lymphocyte subsets showed normal patterns in controls, increased numbers of secretory Ig positive B cells and activated lymphocytes in the nonulcerative group, and increased numbers of secretory Ig positive B cells with mildly abnormal kappa-to-lambda ratios and activated lymphocytes in the classical group. We conclude that an immune mechanism has at least a partial role in the pathophysiology of interstitial cystitis. A parallel between interstitial cystitis and inflammatory bowel disease is evident. Further studies are indicated.

Adult↗

PubMed2002

Morphology and therapeutic strategies for neuroendocrine tumors of the genitourinary tract.

BACKGROUND: Although many articles have been published regarding neuroendocrine tumors (NET) and neuroendocrine carcinomas of both low- and high-grade malignancy (NEC) of the genitourinary tract, the histologic diagnosis and therapeutic strategies for treating these entities remains difficult. In the current study the author discusses the significant differences between NET and NEC of the urinary bladder and the prostate, including therapeutic consequences. METHODS: Four hundred eighty neoplasms of the urinary bladder and prostate with a small cell pattern were analyzed not only on slides stained with hematoxylin and eosin but also by means of immunohistochemical stains demonstrating a neuroendocrine origin. The avidin-biotin complex method was used with the following markers: MIB-1, chromogranin A (Chr A), synaptophysin (SNP), cytokeratin (CK) 34betaE12, CK20, androgen receptor (AR), and prostate specific antigen (PSA). RESULTS: Twenty tumors of the urinary bladder and 26 of the prostate demonstrated a diffuse neuroendocrine pattern. Only two patients were found to have a low-grade NEC of the prostate with a low proliferative index but strong expression of neuroendocrine markers. All other patients with small cell neuroendocrine carcinomas of the bladder and prostate demonstrated extremely high proliferation activity (>80%) and expressed Chr A and SNP. CK34betaE12, 20, PSA, and AR were not found to be expressed. The mean survival time was 6.9 months. Fourteen of 20 patients with NEC of the urinary bladder died of the disease and 19 of 24 patients with prostatic NEC died. The therapy for urinary bladder NEC was repeated transurethral resection and antiandrogen therapy was given for NEC of the prostate. Only one patient was treated with chemotherapy, which to the author's knowledge currently is the only treatment for NECs of the genitourinary tract. CONCLUSIONS: Undifferentiated carcinomas of the urinary bladder and prostate should be analyzed not only by means of hematoxylin and eosin but also by immunohistochemical staining for Chr A and SNP to demonstrate a neuroendocrine origin. Because the prognosis of small cell NECs is very poor, pathologists should indicate in their final report the peculiarities of small cell NECs of the prostate and the urinary bladder with special emphasis on different therapeutic strategies.

Aged↗

PubMed1987

[Adenomatous polyps with prostatic type epithelium: a report of two cases].

Two cases of adenomatous polyps with prostatic type epithelium are reported. The first case was of a 62-year-old male suffering from asymptomatic hematuria. Cystoscopic findings showed an urethral tumor in the prostatic urethra. He was treated by transurethral resection of the prostate. The second case was of a 47-year-old male with complaints of hematuria and doubtful findings in urinary cytology. Cystoscopic findings showed that he had an urethral tumor in the prostatic urethra as well as bladder tumor. Both were resected transurethrally. Histological examination revealed that both urethral tumors were papillary adenoma of the prostatic urethra, corresponding to the adenomatous polyps with prostatic type epithelium in the classification of AFIP. The peroxidase-antiperoxidase complex method was performed using the anti-prostatic acid phosphatase antibody and anti-prostatic-specific antigen antibody, and positive reactions were obtained which confirmed that the tumors originated in the prostatic tissue. Benign urethral tumor in males is not common and description of adenomatous polyps with prostatic type epithelium is very rare. We could find only 11 cases in the Japanese literature.

Humans↗

PubMed2002

Inhibition of bladder carcinoma cell adhesion by oligopeptide combinations in vitro and in vivo.

PURPOSE: A presumed reason for the high recurrence rate of superficial bladder cancer after transurethral tumor resection is the reimplantation of tumor cells. Because tumor cell adhesion to the extracellular matrix is mediated by integrin molecules, we tested specific integrin receptor blocking oligopeptides to prevent this mechanism. MATERIALS AND METHODS: An in vitro cell adherence assay with various bladder cancer cell lines and extracellular matrices, including fibronectin, collagen type I, laminin and combinations, was used to analyze the inhibition of tumor cell adhesion by the matrix specific oligopeptides GRGDS, DGEA and EILDV. In therapeutic in vivo experiments the orthotopic murine bladder tumor model MB49 was used. The ability of oligopeptides to interfere with tumor cell adhesion and consecutive tumor outgrowth was evaluated and compared with that of nonspecific peptides, commercially available irrigation fluid and single dose epirubicin chemotherapy. RESULTS: In vitro fibronectin specific oligopeptides showed a concentration dependent inhibition of tumor cell adherence to fibronectin, whereas adhesion to laminin, collagen and combined matrices was not inhibited. In contrast, combinations of integrin receptor blocking oligopeptides were highly active. In vivo local tumor take was not affected by irrigation fluid, nonspecific peptides or monospecific oligopeptides alone, whereas the combination of the 3 oligopeptides effectively inhibited tumor outgrowth. CONCLUSIONS: Combining oligopeptides with various specificities significantly inhibited tumor cell adhesion and tumor outgrowth. Application of this principle in a clinical setting may be an effective method for reducing the recurrence rate of superficial bladder cancer.

Animals↗

PubMed2003

[Cystectomy in superficial bladder tumours. Analysis of criterion include and prediction factors].

INTRODUCTION: Though usually the treatment of a superficial bladder tumour consists in transurethral resection, exceptionally because of several clinical conditions, in this kind of patients a radical cystectomy may be suitable. PATIENTS AND METHOD: From june 1986 through december 2001, 127 radical cystectomies were performed. A series of 25 patients with a radical cystectomy performed in superficial bladder tumours were analysed. Indications, anatomo-pathological correlation and clinical evolution with survival curves are analysed. RESULTS: The mean time of follow-up was 47 months. Extensive GIIIpT1 tumours (40%) were the chief indication. The remaining of the series consisted in carcinoma uncontrollable by endoscopy and refractory to chemotherapy. Anatomo-pathological correlation coincided in 48% of patients, existing supra and understaging in 25% and 28% respectively. A period of 54 months was without relapse. Seven patients died during the evolution (28%), and 18 patients are alive without disease. 128,48 months were the mean actuarial survival. CONCLUSIONS: GIIIpT1 tumours were the chief indication of our series. The significant percentage of understaging, poor morbidity and good survival curves are emphasized. Because of these results we consider that radical cystectomies are a viable choice for selected patients with superficial vesical tumour.

Aged↗

PubMed2004

Transitional cell carcinoma of the bladder in four patients on maintenance hemodialysis.

We report four patients on maintenance hemodialysis (HD) with transitional cell carcinoma (TCC) of the bladder. Three patients underwent transurethral resection (TUR) of their tumors, which were grade 2 or 3, stage pT1 TCC. Among them, one patient underwent repeat TUR for recurrent superficial TCC. The remaining one patient underwent total cystectomy for grade 3, stage pT4 TCC and squamous cell carcinoma of the bladder. Subsequently, he died suddenly without evidence of local recurrence or systemic metastasis. We discuss the relationship between the duration of HD and the tumor grade and stage of primary bladder TCC in maintenance HD patients.

Aged↗

PubMed1992

[An exceptional complication of bladder cancer: intestinal metastases with obstruction of the small intestine].

Intestinal metastases from bladder cancers are extremely rare and all of the cases reported in the international literature have concerned patients in whom the tumour was resected by open surgery. The authors report a unique case of obstructive intestinal metastases from a bladder cancer resected via the transurethral route and regularly followed by endoscopy and systematic biopsies.

Carcinoma, Transitional Cell↗

PubMed2006

Reducing recurrence and costs in superficial bladder cancer: preclinical evaluation of osmotic cytolysis by distilled water vs. mitomycin.

Transurethral resection followed by instillation of chemotherapeutic agents such as mitomycin is considered as standard therapy in recurrent superficial bladder cancer. However, incidence of bladder cancer is increasing, and contrariwise resources to finance the health care systems are decreasing. Therefore, effective alternatives to expensive chemotherapeutics are necessary. Recurrence of bladder cancer after transurethral resection is mostly promoted by reimplantation of dissolved tumour cells which are therapeutical purpose of any intravesically instillated agent. Monolayer cultures of human RT112, RT4, T24 and TCC SUP bladder cancer cells were incubated and exposed to mitomycin or distilled water. Cell survival was determined by microculture tetrazolium assay. Distilled water led to significant cytolysis in all tumour cells. This effect was comparable to exposition to mitomycin. Distilled water and mitomycin have comparable in vitro effects in bladder cancer cells. These findings have to be substantiated by an animal model emphasising the aspect of larger tumour cell compounds or possible damage to healthy bladder tissue.

Antibiotics, Antineoplastic↗

PubMed1993

Nuclear overexpression of p53 protein in transitional cell bladder carcinoma: a marker for disease progression.

BACKGROUND: Approximately one third of the patients with superficially infiltrative transitional cell (T1-TNM pathological staging system) bladder carcinoma who are treated with transurethral resection alone have disease progression. Despite precise pathologic staging and grading, clinical outcome in these patients is not predictable. Recent reports reveal that mutations of the p53 tumor suppressor gene (also known as TP53) occur commonly in bladder cancers. PURPOSE: The aim of this study was to investigate the hypothesis that altered patterns of expression of the protein product(s) of the mutated p53 tumor suppressor gene are associated with tumor progression in patients with T1 bladder cancer. METHODS: We examined deparaffinized tumor tissue specimens from transurethral resection in 43 patients with T1 bladder cancer who had not received adjuvant therapy. Nuclear overexpression of p53 protein was detected by immunohistochemical analysis using the mouse monoclonal antibody PAb1801, which stains both wild-type and mutant p53 proteins. The data were then correlated with the following conventional prognostic variables: age, sex, histologic presence of associated carcinoma in situ, and vascular invasion of tumor. Disease progression rates per 100 person-years were calculated. RESULTS: Median follow-up was 119 months. None of the urothelial and stromal cells from normal bladder specimens showed nuclear overexpression of p53 protein, but patients with T1 bladder tumors could be stratified into two groups with different patterns of staining for p53 protein. Eighteen patients (42%) had no more than 20% tumor cells with positive nuclear staining (group A), while the remaining 25 patients (58%) had 20% or more tumor cells with nuclear immunoreactivity (group B). Patients in group B had a significantly lower progression-free interval (P < .001). Disease progression rates were 20.5% per year for group B and 2.5% for group A. CONCLUSION: These results suggest that T1 bladder cancers exhibiting nuclear overexpression of p53 protein have a higher probability of disease progression. This study also suggests that p53 overexpression is an important prognostic factor in these patients and may be useful in selecting appropriate therapy. IMPLICATIONS: Large prospective studies are needed to confirm these results and to evaluate nuclear overexpression of p53 protein as a prognostic marker in bladder cancer.

Adult↗

PubMed2002

Long term follow-up of superficial invasive bladder carcinoma with or without concomitant epithelial atypia--recurrence and progression.

OBJECTIVE: To examine the significance of concomitant epithelial atypia on late recurrence and progression by long-term follow-up of superficial invasive bladder tumours (stage T1). MATERIAL AND METHODS: Seventy consecutive, unselected patients with newly diagnosed transurethral resection (TURB)-treated stage T1 bladder tumour, and at least 1 year progression-free survival. Preselected site biopsies (PSB) were obtained prospectively to evaluate the significance of concomitant urothelial atypia. Followed for up to 17.6 years. RESULTS: The cumulative probability of recurrence (overall) was 85%, and for new stage T1 tumour 70% after 10 years. Forty per cent of those who survived 5 years without recurrence, were readmitted with often invasive recurrence later. Positive PSB significantly (p < 0.0001) predicted new T1 tumour. Progression (T2+ or metastases) occurred in 27 cases (39%) after the first year. The cumulative probability was 60% (15 years), with a mean progression-free interval of 64 months. Positive PSB, size >3 cm and early recurrence were significant predictive factors in multivariate analysis. CONCLUSION: T1-tumours are at high risk for late invasive recurrence and progression, especially if associated with urothelial atypia elsewhere in the bladder.

Adult↗