Development of Multiple Transitional Cell Carcinomas in the Urinary Tract

Abstract

The multiplicity of transitional cell carcinomas in the renal pelvis, ureter and bladder was analyzed in terms of (1) tumor configuration, i.e., papillary, nodular cancers, (2) associated mucosal changes such as carcinoma in situ (CIS) and dysplasia and (3) the possible involvement of human papillomavirus (HPV) in the development of multiple papillary cancers in the bladder. The incidences of concurrent or subsequent bladder cancer in renal pelvic cancer and/or ureteral cancer cases were 7/31 (22%) for renal pelvic cancer, 17/28 (60%) for ureteral cancer and 10/15 (67%) for renal pelvic and ureteral cancer. In 33 cases of renal pelvic and/or ureteral cancer occurring since 1978, 67% of the papillary and 13% of the nodular cancers in the upper tract exhibited a simultaneous or later development of bladder cancer. In 211 cases of bladder cancer for which cystectomy was performed, 77% of the papillary cancers arose in multiple form, 57% being associated with CIS and/or dysplasia, whereas 72% of the nodular cancers developed singly, 55% being associated with CIS and/or dysplasia. No positive signals hybridizing to HPV types 1, 5, 6, 11, 16, 17, 18, 20, 33 and 38 were detected in any of 19 papillary bladder cancers and 13 specimens of normal bladder mucosa under conditions of low stringency, suggesting that HPV may not be a factor in multiple bladder tumor development. Definite findings from the present study are: (1) there is multiple development of papillary cancers but they remain superficial, whereas nodular cancers develop singly and are invasive, (2)) there was no steady tendency towards a relation between multiplicity and associated mucosal changes, (3) HPV was not, to our knowledge, involved in the multiple development of papillary cancers in the bladder.