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[Cutaneous metastasis of a transitional-cell bladder carcinoma].

Transitional cell of bladder carcinoma metastasizing to the skin is uncommon finding, generally appearing in the final stages such that occurred in our patient that indicated a poor prognosis. A lesion located in the pubic region and internal face of the left lower limb with at erythematous, indurated, and aggregated appearance was found. The histological examination of the specimen after cold biopsy demonstrated cutaneous metastasis from transitional cell carcinoma.

Aged↗

A novel combination of multiple primary carcinomas: urinary bladder transitional cell carcinoma, prostate adenocarcinoma and small cell lung carcinoma--report of a case and review of the literature.

BACKGROUND: The incidence of multiple primary malignant neoplasms increases with age and they are encountered more frequently nowadays than before, the phenomenon is still considered to be rare. CASE PRESENTATION: We report a case of a man in whom urinary bladder transitional cell carcinoma, metachronous prostate adenocarcinoma and small cell lung carcinoma were diagnosed within an eighteen-month period. The only known predisposing factor was that he was heavy smoker (90-100 packets per year). The literature on the phenomenon of multiple primary malignancies in a single patient is reviewed and the data is summarized. CONCLUSION: It is important for the clinicians to keep in mind the possibility of a metachronous (successive) or a synchronous (simultaneous) malignancy in a cancer patient. It is worthy mentioning this case because clustering of three primary malignancies (synchronous and metachronous) is of rare occurrence in a single patient, and, to our knowledge, this is the first report this combination of three carcinomas appearing in the same patient.

Journal Article↗

Orbital metastasis from transitional cell carcinoma of the bladder.

Transitional cell carcinoma (TCC) is a common bladder tumour, 10-15% of which will exhibit invasive behaviour. About 50% of patients with invasive TCC will eventually develop distant metastases, usually to lymph nodes, lung or bones. The case is reported of bladder TCC metastasizing to the orbit.

Aged↗

Keyhole-limpet haemocyanin (KLH) immunotherapy of murine transitional cell carcinoma.

The antigenicity of transitional cell carcinoma of the bladder has stimulated the search for effective immunotherapeutic agents in the treatment of this disease. Non-specific immunotherapy with local (intravesical/intralesional) and systemic Keyhole Limpet Haemocyanin (KLH) in a FANFT induced murine bladder tumor model was studied. Results showed no difference between control or treated groups in either tumor growth or animal survival.

Animals↗

The cytology of transitional cell carcinoma of the urinary bladder.

Urine specimens from 77 patients with transitional cell tumors of the urinary bladder, 15 patients with inflammatory lesions and five normal individuals were analyzed. The two nuclepore slides of all patients with neoplastic disease contained over 100 neoplastic cells and in one-half of the cases over 1,000 tumor cells were present. The percentage of neoplastic cells to atypical and normal cells ranged from 25 per cent for papillary carcinomas, Grade I, to 36 per cent for poorly differenciated carcinomas. There were no significant differences of the cytoplasmic features but the nuclei of malignant cells were slightly more hyperchromatic, contained significantly more nuclei and were characterized by a coarsely rather than finely granular nucleoplasm. The cell size of 5,970 cells and the nuclear size of 8,455 cells was determined by planimetry. Normal transitional cells averaged 341 square microns and were larger than those exfoliated from tumors. The mean nuclear area was 36 square microns for normal cells, 52 square microns for benign atypical cells, 54 square microns for cells from papillary carcinoma, Grade I, 78 square microns for papillary carcinomas, Grade II, and 90 square microns for transitional cell carcinoma, Grades III and IV. The study indicated that significant quantitative differences exist between normal transitional cells and those exfoliated from moderately and poorly differentiated transitional cell carcinomas. The cells exfoliated from papillomas or papillary transitional cell carcinomas, Grade I, closely resemble hyperplastic or atypical transitional cells which in turn can be differentiated from normal urothelial cells.

Adult↗

Incidence and pathology of spontaneous renal pelvis transitional cell carcinomas in rats.

Spontaneous transitional cell carcinoma (TCC) originating from renal pelvis is very rare. Metastasis from this tumor having been reported only once previously. Data from control groups of 17 carcinogenicity studies in Sprague-Dawley and 10 carcinogenicity studies in Fischer 344 (F-344) rats were reviewed and evaluated to determine the incidence and pathology of TCC. Renal pelvis TCC were observed in 1 male and 1 female Sprague-Dawley rat and in 1 male F-344 rat. Metastasis from TCC to the lung was observed in 1 male Sprague-Dawley rat. Detailed histopathological features of this tumor are described and discussed.

Animals↗

Primary transitional cell carcinoma of prostate.

Primary transitional cell carcinoma of the prostate (TCC-P) is a rare tumor for which definitive therapy remains undefined. To establish a basis for therapy, we analyzed 3 new cases and reviewed the literature. The following points were observed: (1) the true diagnosis is often missed at initial pathologic examination; (2) the tumor has a propensity for extensive local invasion; and (3) it commonly presents with obstructive symptoms in relatively young patients. Treatment recommendations based on our review include: maintenance of a high index of suspicion, especially for fifty to sixty-year-old men with prostate tumors or for suspected prostatic adenocarcinoma that is rapidly progressive and/or unresponsive to hormonal therapy; preoperative pelvic irradiation followed by radical cystoprostatourethrectomy is the treatment of choice in low-stage disease, and combined radiation therapy and chemotherapy should be used for disease beyond the prostate.

Adenocarcinoma↗

Gemcitabine and paclitaxel combination therapy in transitional cell carcinoma of the urothelium.

Transitional cell carcinoma (TCC) of the urothelium is considered a chemosensitive malignancy; however, few patients receiving standard therapies achieve long-term disease control. Thus, new treatment approaches using more effective and less toxic agents are needed to improve prognosis in these patients. Two new agents currently being studied are gemcitabine and the taxanes; both of which have produced overall response rates ranging from 22.5 to 28% (gemcitabine), and 7-56% (paclitaxel) when used as single agents in this disease. Both agents have been well tolerated. Results of two phase II studies of gemcitabine combined with paclitaxel have been published. In one, 60% (15/25) of evaluable patients with advanced stage IV TCC responded; in the other, 53% (8/15) of patients with advanced and/or metastatic TCC responded. Several trials evaluating different dosing regimens of gemcitabine plus paclitaxel or docetaxel are ongoing or planned.

Adult↗

Transitional cell carcinoma of the kidney.

Transitional cell carcinoma is an uncommon disease of the renal pelvis, the diagnosis of which depends largely upon radiological investigation. Thirty-eight such tumours in 37 patients have been reviewed to establish the examination of choice. High-dose excretion urography, tailored to the presenting problems, is the primary investigation and the results fall into five main groups. Each presents different differential diagnostic problems. Discrete filling defects within the pyelogram (group I) may be overlooked, but, when seen, can be diagnosed on urography alone. Filling defects with dilated calyces (group II) are easily seen and readily diagnosed. Calyceal obliteration (group III) presents more difficulty in diagnosis and may require retrograde pyelography and selective renal angiography. Hydronephrosis with renal enlargement (group IV) is easily confused with uncomplicated primary pelvic hydronephrosis and will usually require antegrade pyelography for diagnosis. Reduced function without renal enlargement (group V) cannot be diagnosed on excretion urography and requires both retrograde pyeloureterography and selective renal angiography.

Adult↗

[Urinary bladder transitional cell carcinoma with trophoblastic differentiation].

Transitional cell carcinoma (TCC) with trophoblastic differentiation (TD) is a newly recognized variant of urothelial cancer which produces placental proteins, predominantly beta-human chorionic gonadotropin (HCG). It has a poor prognosis. About 210 cases were described, mostly from North America, Europe and Japan. This is the first report of TCC TD in a resident of Israel's upper Galilee. A 69-year-old man whose urinary papillary bladder tumor was established cystoscopically, refused treatment and stopped follow-up. 3.5 years after his last visit, he returned and cytologic examination revealed malignant urothelial cells, while intravenous pyelography disclosed a urinary bladder defect. Cystoscopy showed numerous papillary masses dispersed over the bladder mucosa, which were resected transurethrally. Histopathologic examination revealed TCC grade III, stage A. Tumor cells were immunopositive for beta-HCG and human placental lactogen. 4 transurethral resections of large masses were performed within 2 months. Pulmonary metastases developed and the patient died 4 years after the detection of the urinary bladder tumor.

Aged↗

[Molecular markers for transitional cell carcinoma of bladder].

Superficial transitional cell carcinoma (TCC) has significant rates of recurrence and progression, therefore accurate urinary makers for early diagnosis and follow-up are essential. Urine cytology is the oldest marker, constantly used clinically and considered the "gold standard". In this review we will summarize the properties of different molecular markers for TCC and their yield compared to cytology. Briefly, the older markers--BTA stat, BTA TRAK and NMP22 are more sensitive than cytology, but their specificity is lower, especially in patients with underlying urologic pathologies. FDP (fibrinogen degradation products) analysis is rapid and the test is available clinically. It's sensitivity is higher than cytology for low grade tumors, but specificity is low. Of the newer markers, telomerase has a high sensitivity, and a specificity similar to urine cytology, but also has an increased rate of false positive results. HA-HAase (Hyaluronidase) and CK20 have promising sensitivity and specificity, but are still unavailable for clinical use. CK20 has the additional advantage of being able to detect premalignant conditions as well as predicting recurrence. The role of urinary markers in replacing cystoscopy and urine sediment cytology in the follow-up of TCC and in hematuria work up is still uncertain. It is possible that urinary markers in different panel arrays will have a role in the future for those indications and perhaps in the screening of populations at risk, such as smokers and workers exposed to occupational hazards.

Biomarkers, Tumor↗

Growth-inhibitory effect of quercetin and presence of type II estrogen binding sites in primary human transitional cell carcinomas.

Eight cases of transitional cell carcinoma (TCC) of the bladder were investigated for the presence of estrogen receptors (ER) and Type II estrogen binding sites (Type II EBS). All these tumors specifically expressed type II EBS, while only 3 of 8 cases contained low amounts of ER. All the cases assayed for the presence of both nuclear and cytoplasmic type II EBS revealed the presence of these binding sites in the two compartments. Both cytoplasmic and nuclear receptors were similar to type II EBS described in other tissues relative to their binding specificity for estrogens and quercetin and their sensitivity to reducing agents. Quercetin, 10 microM., was effective in inhibiting in vitro bromodeoxyuridine (BrdUdR) incorporation by TCC cells. Rutin, which bound little if any to type II EBS, did not show any inhibitory effect on in vitro BrdUdR incorporation by tumor cells, suggesting a type II EBS mediated effect of flavonoids. Although the mechanism of the antiproliferative activity of quercetin remains to be fully clarified, the possible therapeutic potential of quercetin and related flavonoids should be considered.

Aged↗

Ciprofloxacin mediated cell growth inhibition, S/G2-M cell cycle arrest, and apoptosis in a human transitional cell carcinoma of the bladder cell line.

The second most prevalent urological malignancy in middle aged and elderly men is bladder cancer, with 90% of the cases being transitional cell carcinomas. The success of current systemic and intravesical therapeutic agents, such as cisplatin, thiotepa, Adriamycin, mitomycin C, and bacillus Calmette-Guerin, is limited with recurrence rates reduced to 17-44%. In addition, most of these agents require instrumentation of the urinary tract and are delivered at a significant cost and potential morbidity to the patient. Fluroquinolone antibiotics such as ciprofloxacin, which can be administered p.o., may have a profound effect in bladder cancer management. This is primarily based on limited in vitro studies on tumor cells derived from transitional cell carcinoma of the bladder that revealed a dose- and time-dependent inhibition of cell growth by ciprofloxacin at concentrations that are easily attainable in the urine of patients. However, the mechanism(s) by which ciprofloxacin elicits its biological effects on bladder cancer cells is not well documented. Our experimental data confirm previous studies showing the in vitro cell growth inhibition of the transitional cell carcinoma of the bladder cell line HTB9 and further showed the induction of cell cycle arrest at the S/G2-M checkpoints. In addition, we found down-regulation of cyclin B, cyclin E, and dephosphorylation of cdk2 in ciprofloxacin-treated bladder tumor cells. There was also an up-regulation of Bax, which altered the Bax:Bcl-2 ratio, which may be responsible for mitochondrial depolarization reported to be involved prior to the induction of apoptosis. The cyclin-dependent kinase inhibitor p21WAF1 level was found to be decreased within 12 h of ciprofloxacin treatment and disappeared completely when HTB9 cells were treated with 200 microg/ml ciprofloxacin for 24 h. The down-regulation of p21WAF1 closely correlated with poly(ADP-ribose) polymerase cleavage and CPP32 activation. Recent studies revealed that p21WAF1 protects cells from apoptosis by arresting them in G1 and further binds to pro-caspase-3, preventing its activation and thus, inhibiting the apoptotic cascade. Hence, the down-regulation of p21WAF1, together with the alterations in Bax and cdk2 as observed in our studies, may define a novel mechanism by which ciprofloxacin inhibits tumor cell growth and induces apoptotic cell death. The results of our current studies provide strong experimental evidence for the use of ciprofloxacin as a potential preventive and/or therapeutic agent for the management of transitional cell carcinoma of the bladder.

Apoptosis↗

[A prostatic duct carcinoma difficult to distinguish from transitional cell carcinoma: a case report].

A 77-year-old male with a complaint of dysuria and gross hematuria for 3 months visited our hospital. Abdominal ultrasonography, computed tomographic scan and magnetic resonance imaging revealed a prominent tumor from the bladder neck. Serum prostate specific antigen (PSA) level was high (1,130 ng/ml) suggesting prostate cancer, but transitional cell carcinoma (TCC) was detected by transurethral biopsy. Bone scintigraphy revealed multiple bone metastasis. Since gross hematuria requiring bladder tamponade continued, simple cystoprostatectomy and cutaneous ureterostomy were performed. Pathological findings showed prostatic acinar carcinoma and prostatic duct carcinoma mimicking TCC, and PSA immunohistochemically weak positive. The final diagnosis was prostate cancer consisting of acinar and ductal component. Adjuvant hormonal therapy was performed, but was ineffective. The patient died 2.5 months after operation. We reviewed and discussed 66 cases of prostatic duct carcinoma, including our case, in the Japanese literature.

Aged↗

Comparison of five histopathologic methods to assess cellular proliferation in transitional cell carcinoma of the urinary bladder.

Transitional cell carcinomas of the urinary bladder vary in their biologic potential, which may be correlated with the grade and stage of the tumor. Cellular proliferation may prove to be another measure of predicting tumor biologic potential. We have compared five different methods to assess proliferation in 26 tumors and correlated these results with tumor grade and stage. A portion of each tumor was incubated in vitro with bromodeoxyuridine (BrdUrd). For each tumor this was compared with at least three of the following four other markers of proliferation: mitotic count, silver-stained nucleolar organizer regions, immunohistochemical staining with Ki67, and proliferating cell nuclear antigen. Statistical correlations were seen between tumor grade and stage and these markers. There were strong correlations between the BrdUrd labeling index (LI) and both the Ki67 LI and proliferating cell nuclear antigen LI. The correlation between the BrdUrd LI and mitotic count was more tenuous; no significant correlation was found between BrdUrd LI and silver-stained nucleolar organizer region count. The correlation between these measurements of proliferation and tumor grade and stage was less strong. Our data suggest that cellular proliferation of transitional cell carcinomas can be reliably assessed with several different markers and that most of these markers can be correlated with tumor grade but not with stage.

Bromodeoxyuridine↗