The nephrogenic adenoma of the bladder: 8 cases and literature review

Objective To investigate the clinical and pathological characteristics of nephrogenic adenoma. Methods Eleven patients were diagnosed as nephrogenic adenoma including 5 men and 6 women, aged 37-78 years (56 on average). The pathological findings in all cases of nephrogenic adenoma were presented with a review of the literature. Results Eleven cases of nephrogenic adenomas were evaluated, 2 cases were in ureter and 9 cases were in the bladder. Eight of the 9 bladder cases underwent TUR-BT surgery in continuous epidural anesthesia, 1 case underwent partial cystectomy with general anesthesia. A right ureteroscopy and left ureterolithotomy were performed respectively in continuous epidural anesthesia for the 2 cases in ureter. The final diagnosis was based on histopathological findings. For all of cases, 8 cases were diagnosed as nephrogenic adenomas, 2 cases as atypical nephrogenic adenoma and 1 case as nephrogenic adenoma with malignant transformation. The microscopic appearance of nephrogenic adenoma demonstrated that morphology closely resembled aberrant tubules of the kidney. In addition, atypical nephrogenic adenomas appeared as the presence of cytologic atypia, including nuclear enlargement, nuclear hyperchromasia and prominent nucleoli. The morphologic changes of nephrogenic adenomas with malignant transformation were that tumor cells retained the basic structural characteristics of typical nephrogenic adenomas, and the similar morphological cells lost adhesion ability among cells and presented diffuse solid growth in the surrounding area.Intravesical perfusion was further performed for treating the patients with atypical nephrogenic adenomas or nephrogenic adenomas with malignant transformation. The mean patient follow up was 46 months (range, 24- 104 months), and there was only 1 case of recurrence. Conclusions Nephrogenic adenoma is an uncommon benign lesion of the urinary tract. The symptoms and cystoscopic manifestations are not unique. We reported one patient of nephrogenic adenomas with malignant transformation and provided some evidence for malignant alteration in morphology and invasive behavior. All patients underwent local excision of the lesions. Intravesical perfusion was further performed for treating the patients of atypical nephrogenic adenomas or nephrogenic adenomas with malignant transformation. Whether it is nephrogenic adenoma or atypical nephrogenic adenoma, long-term follow-up after treatment is necessary. Key words: Nephrogenic adenomas; Pathology, clinical; Malignancies

Objective To investigate the clinical features and treatment principles of inflammatory myofibroblastic tumor of the urinary bladder(IMTUB). Methods From April 2013 to October 2016, 6 cases of IMTUB patients were analyzed retrospectively. All cases were presented with gross hematuria. 4 cases underwent ultrasonography, of which 3 cases showed solid mass in bladder, 1 case showed inflammatory change. 6 cases underwent CT examination, 3 cases with bladder cancer, 1 case with bladder sarcoma, 1 case with malignant transformation of adenoma, 1 case with rich blood supply. No lymph node metastasis. Bladder occupying lesions were considered in 2 cases of MRI examination. 5 cases of cystoscopy showed bladder solid mass. In 6 cases involved, 2 patients received partial cystectomy, 2 patients underwent transurethral resection of bladder tumor, 1 patient underwent radical resection of urachal carcinoma and the other one was treated with chemotherapy. Results Immunohistochemical staining was positive in ALK (100.0%)、Vimentin(100.0%)、CK(100.0%)、SMA(83.3%)、EMA(66.7%) and Ki-67(5%-30%), negative in S-100 and Desmin. Final pathological diagnosis was IMTUB. So far, neither recurrence nor metastasis has been detected for 6~42 months in 5 cases and the other one lost to follow-up. Conclusions IMTUB is a kind of rare benign tumor of bladder. The golden standard of diagnosis is pathological diagnosis. Surgical resection is the first choice for treatment. Recurrence and metastasis are after the surgery treatment. All patients should be followed up closely. Key words: Bladder; Inflammatory myofibroblastic tumor; Diagnosis; Treatment

Objective To investigate the short-term efficacy, safety and factors affecting the efficacy of BCG intravesical therapy in high risk non-muscle-invasive bladder cancer (NMIBC) patients. Methods A total of 161 high-risk non-muscle invasive bladder cancer (NMIBC) patients were reviewed in our hospital from March 2014 to December 2017. They were all treated with BCG instillation after transurethral resection of bladder tumor (TURBT). There were 121 males (75.2%) and 40 females (24.8%). Median age was 65 years old, including 17 cases (10.6%) <50 years old, 23 cases (14.3%) within 50-59 years old, 72 cases (44.7%) within 60-69 years old, 49 cases ≥70 years old (30.4%). There were 112 patients (69.6%) with primary bladder cancer and 49 (30.4%) patients with recurrent bladder cancer. 56 cases (34.8%) had single tumor and 105 cases (65.2%) had multiple tumors. The tumors size in 106 cases (65.8%) was less than 3 cm, and tumor size in 55 cases (34.2%) was more than 3 cm. 43 patients (26.7%) suffered carcinoma in situ. 10 patients (6.2%) suffered urothelial carcinoma with variant types. According to the American Joint Commission for Cancer (AJCC) version 7 TNM staging system, 25 cases (15.5%) were classified into Ta stage, 129 cases (80.1%) were classified into T1 stage, and 7 cases (4.3%) were classified into Tis stage. There were 8 cases (5%) with low-grade cancer and 153 cases (95%) with high-grade cancer. 69 patients (42.9%) received chemo-instillation before. 43 cases were directly perfused without re-TURBT and 118 cases were perfused after re-TURBT. They were all treated with BCG instillation after transurethral resection of bladder tumor (TURBT). The 120 mg BCG were dissolved into 50 ml saline for instillation and were kept for 2 hours. Induction scheme of six-weekly and three fortnightly instillations started two weeks after the initial TUR or re-TUR. Maintenance instillations were then be offered in a scheme of ten monthly instillations. During treatment, patients were offered cystoscopy and cytology every three months, while CT and chest radiographs were reviewed every 6-12 months. Recurrence status and adverse effects were recorded. Univariate and multivariate regression analyses were performed to predict risk factors for failure of BCG instillation in bladder cancer. Results A total of 161 patients were followed up. The median follow-up time was 13 months, ranging 7-22 months. The overall recurrence rate was 26.1% (42/161) and the 1-year recurrence-free survival rate was 79.0%. On univariate analysis, recurrence history, history of instillation chemotherapy application and history of re-staging transurethral resection influenced recurrence. Multivariate regression analysis showed recurrence status was an independent prognostic factor regarding recurrence-free survival. The incidence of adverse events in all 161 instillation patients was 40.4% (26/65). Grade 1, grade 2 and grade 3 adverse events accounted for 53.8%(35/65), 40.0%(26/65) and 6.2%(4/65) respectively. 6 cases (3.7%) reduced the dose of BGC and 1 case stop the instillation due to the intolerance of BCG. Conclusion Short-term efficiency and safety were confirmed in BCG-treated high-risk NMIBC patients. And recurrence status was an independent prognostic factor for recurrence-free survival. Key words: Bacillus Calmette-Guerin; Bladder cancer; Intraversical instillation

Objective To evaluate the diagnostic and therapeutic role in bladder pain syndrome/interstitial cystitis (BPS/IC) of random bladder biopsy and hydrodistention with cystoscopy under anesthesia.Methods A retrospective review of cases in our BPS/IC center was performed from 2005 to 2010. One hundred and nineteen patients were included who are diagnosed as the bladder pain syndrome/interstitial cystitis (BPS/IC).There were 32 male patients,aged 47 to 64 years,and 56 years on average; 87 female cases,aged 23 to 67 years,49 years on average.Patients with bladder pain symptoms underwent a thorough evaluation which include voiding diary,pelvic pain、urgency and frequency questionnaire,urine culture,cytology,acid fast bacilli and upper tract imaging.Cystoscopy and random bladder biopsy had been undertaken with general anesthesia.Before and after hydrodistention with cystoscopy,the patients daily frequency of urination,the maximum urine volume,pain scores,symptom scores,QOL score were observed to understand whether there are significant improvement. Results One hundred and nineteen BPS/IC cases underwent random bladder biopsy and hydrodistention with cystoscopy under anesthesia,and finally 102 cases were confirmed of IC; 17 cases were not IC. Eight patients who were previously diagnosed as BPS/IC were found bladder transitional cell carcinoma as the cause of bladder pain symptoms( including 4 cases carcinoma in situ,1 case Low grade non-invasive bladder cancer,3 cases High grade invasive bladder cancers),and 4 of whom had no hematuria. Mean time from the occurrence of BPS to diagnosis of transitional cell carcinoma was 10.8 months. Three patients previously diagnosed as BPS/IC were found tuberculous cystitis as the cause of symptoms,and one eosinophilic cystitis,three chemical cystitis,two radiation cystitis were also detected.Before hydrodistention with cystoscopy under anesthesia,the daily frequency of urination in 102 cases diagnosed for IC patients was 42.1 ±5.6; the maximum urine volume was 141.0 ± 8.3 ml; pain score 7.6 ± 3.0; O'Leary-Sant questionnaire symptom score was 27.7 ± 4.2; QOL score was 7.6 ± 2.4.After hydrodistention with cystoscopy under anesthesia,the daily frequency of urination in 102 IC patients was 23.3 ± 3.4,and the maximum urine volume was 352.0 ± 1.7 ml ; pain score was 3.3 ± 4.3 ; O'Leary-Sant questionnaire symptom score was 12.5 ± 7.3 ; QOL score was 3.2 ± 5.1. Before and after hydrodistention with cystoscope under anesthesia,all of the daily frequency of urination,the maximum urine volume,pain scores,symptom scores,QOL score in 102 IC patients were significant improved (P ＜ 0.05 ). Conclusions BPS/IC remains a diagnosis of exclusion.Random bladder biopsy and hydrodistention with cystoscopy under anesthesia play an important diagnostic and therapeutic role in BPS/IC. Key words: Bladder pain syndrome; Cystitis; Interstitial; Random biopsy; Hydrodistention

Objective To investigate the clinical efficacy of transurethral thulium laser enucleation combined with intravesical instillation of pirarubicin in the treatment of non-muscle invasive bladder cancer. Methods The clinical data of 67 cases of non-muscle invasive bladder cancer who were treated in our hospital from January 2014 to January 2015 were analyzed retrospectively. Including 56 cases single tumor and 11 cases multiple tumors, the tumor diameter ranged from 0.5 to 2.7 cm [mean (2.1±0.4)cm]. All patients were treated by transurethral thulium laser enucleation combined with immediate postoperative instillation of pirarubicin and maintenance instillation of pirarubicin. Regular cystoscopy after operation and long-term follow-up was performed. Results All the operations were successfully enucleationed tumor with once time. The average time of tumor enucleation was (17.3 ± 6.8)min, the intraoperative blood loss was no more than 10 mL. There was no dilutional hyponatremia, bladder perforation, obturator nerve reflex were found in all patients. Postoperative complications included 7 cases of mild hematuria, 2 cases of urinary tract infection, 1 case of urethral stricture, and all patients were cured by symptomatic treatment. Followed up for 6 to 24 months with a mean of (13.6±3.4)months. Five cases were lost to follow up, 8 cases (12.9%) had recu-rrence, 1 case (1.6%) had progression, 13 patients had grade I adverse reactions during intravesical instillation of pirarubicin. Conclusions The transurethral thulium laser enucleation combined with intravesical instillation of pirarubicin for treatment of non-muscle invasive bladder cancer is safe and effective, it is worthy of clinical application. Key words: Urinary Bladder Neoplasms; Thulium; Epirubicin

Objective To study the expression of long non-coding RNA (lncRNA)- urothelial carcinoma associated 1(UCA1) and miR-34b in bladder cancer and its correlation to the clinicopathologic features of bladder cancer. Methods Between January 2011 and October 2012 , the expression of UCA1 and miR-34b in 5 bladder cancer cell lines (T24, BIU-87, EJ, T24-MMC, T24-ADM)and 1 normal bladder cell lines (SV-HUC-1) were measured by real-time reverse transcription-polymerase chain reaction (RT-PCR). Meanwhile, the 56 bladder cancer specimens and paraneoplastic normal bladder tissues, which diagnosed by pathology were collected from bladder cancer patients undergoing radical resection of bladder. Among them, 41 cases were male and 15 cases were female. The mean age was (68.4±7.5)years old, range 52 to 78 years.43 cases were older than 65 years old, and 13 cases were less than 65 years old. The pathological classification included non muscle-invasive bladder cancer (NMIBC) 18 cases, muscle-invasive bladder cancer 38 cases; low grade papillary urothelial carcinoma 22 cases, high grade papillary urothelial carcinoma 34 cases; 12 cases were primary lesion, the other 44 cases were diagnosed as tumor recurrence. Real-time RT-PCR was performed to analyze the expression of UCA1 and miR-34b. Results The relative expression levels of UCA1 in the normal bladder cell lines (SV-HUC-1) and 5 bladder cancer cell lines (T24, BIU-87, EJ, T24-MMC and T24-ADM)were (0.0675±0.0133), (0.2934±0.0531), (0.4246±0.0650), (0.4206±0.0826), (0.6472±0.0875) and (0.7165±0.1032), respectively (P<0.05). Moreover, the expression levels of UCA1 were up-regulated in 2 drug resistant bladder cancer cells lines T24-MMC(0.6472±0.0875)and T24-ADM(0.7165±0.1032), as compared with the T24 bladder cancer lines (0.2934±0.0531) , respectively (P<0.05). However, the expression levels of miR-34b in 5 bladder cancer cell lines [T24(0.1600±0.0455), BIU-87(0.1720±0.0658), EJ(0.1150±0.0352), T24-MMC(0.0576±0.0087), T24-ADM(0.0510±0.0125)]were decreased(P<0.05), as compared with normal bladder cell lines SV-HUC-1(0.6384±0.1083). Moreover, the expression levels of miR-34b were down-regulated in 2 drug resistant bladder cancer cells lines T24-MMC(0.0576±0.0087)and T24-ADM(0.0510±0.0125), as compared with the T24 bladder cancer lines T24(0.1600±0.0455), respectively (P<0.05). The relative expression levels of UCA1 and miR-34b in bladder cancer tissues and paraneoplastic normal bladder tissues were (0.4225±0.0714)vs.(0.0532±0.0192)and(0.0340±0.0134)vs.(0.5643±0.0616), respectively (P<0.05). Statistical correlation analysis showed that UCA1 to be significantly negative correlated with miR-34b in bladder cancer specimens(r=-0.54, P<0.05). The high level of UCA1 and low level of miR-34b were significantly correlated with tumor malignant grade, invasiveness and recurrence. The 3-year overall survival rate (OS) in UCA1(+ )/miR-34b(-) group (27.6%) were significantly worse compared with non UCA1(+ )/miR-34b(-) group(73.7%). Conclusion High expression of UCA1 and low expression of miR-34b were associated with the occurrence and development of bladder cancer. Key words: Urinary bladder neoplasms; Long non-coding RNA; Urothelial carcinoma associated 1; MicoRNAs

Objective To investigate the effect of cyclosporine on signal transducer and activator of transcription 1 (STAT1) genetic expression on bladder cancer in rats induced by BBN and its clinical significance.Methods Twenty SD rats were divide into experimental group or control group randomly.Ten samples of SD rats bladder cancer induced with BBN and cyclosporine simultaneously as experimental group,and 10 samples of SD rats bladder cancer induced with BBN only as control.Real time RT-PCR and immunohistochemistry stain were used to detect STAT1 mRNA and protein level expressions of bladder cancer in rats respectively.Results The STAT1 mRNA median expression fold was 4.5 (2.1-6.6) in experimental group and 5.6 (3.4-8.5) in control group.The STAT1 protein expression were 5 cases with (-),3 cases (+),2 cases (++) in experimental group and 0 case (-),5 cascs (+),5 cases (++) in control group.The expression of STAT1 mRNA and protein level of bladder cancer between experimental group and control group were both significant different (P ＜ 0.05).Conclusions Cyclosporine may stimulate the growth and development of bladder cancer through changing expression of some genes like STATI,and STAT1 maybe become one of the targets of chemoprevention for post-transplantation bladder cancer. Key words: Cyclosporine; Urinary bladder neoplasms; Signal transducer and activator of transcription 1; Gene expression; Organ transplantation

Potentialities of Bladder Epithelium

Objective To explore the impact of different anesthesia methods and anesthesia-related factors in initial bladder cancer patients with partial cystectomy, and to provide a reference for clinical anesthesia choice and the questions that should be concerned. Methods Ambispective cohort study was performed in consecutive case of illness with initial occurrence bladder cancer patients treated with partial cystectomy from 2009 to 2012. A historical cohort was from January 5, 2009 to January 4, 2011. A prospective cohort was from January 5, 2011 to December 31, 2011. Follow-up was terminated in December 31, 2012. All cases were followed up to one full year after surgery. The 402 cases who were diagnosed of initial occurrence bladder cancer and partial cystectomy patients, according to different anesthesia method, were divided into general anesthesia group and intraspinal anesthesia group. Postoperative recurrence was determined within 1 year of follow-up. Multivariate analysis was carried out based on univariate analysis to analyze the causal connection factors for one year recurrence in initial occurrence bladder cancer patients with partial cystectomy. Variables included gender, age, blood type, smoking history, drinking history, number of tumors, tumor size, pathologic TNM stage, anesthesia method, duration of anesthesia, postoperative visual analog scale (VAS) score at 12 h, tumor-associated factor Ki67, P53, CK20, VEGF (whether two or more positive). Tumor recurrence was considered the dependent variable (outcome). Univariate analysis used χ2 or rank sum test, and multivariate analysis used Logistic regression model fitting analysis and the maximum likelihood method. SPSS 16.0 software package was used for data analysis and processing. Results Four hundred and two patients were followed up and got a result of 396 cases (98.51%). Two hundred and eleven cases showed recurrence within one year (53.28%). Univariate analysis showed that age, smoking history, drinking history, duration of anesthesia, pathologic stage, postoperative VAS scores at 12 h less than 3 scores, blood type, tumor-associated factor Ki67, P53, CK20, VEGF (two or more positive) were associated with one year recurrence in initial occurrence bladder cancer patients (P 0.05). Multivariate Logistic regression model analysis showed that the following factors were associated with postoperative recurrence within a year in initial occurrence bladder cancer patients with partial cystectomy: age (RR= 0.371, 95% CI 0.183-0.752), drinking history (RR= 0.348, 95% CI 0.161-0.752), postoperative VAS scores at 12 h less than 3 scores (RR= 0.023, 95% CI 0.011-0.050), duration of anesthesia (RR= 3.042, 95% CI 1.495-6.192), and tumor-associated factor Ki67, P53, CK20, VEGF of two or more positive (RR= 8.676, 95% CI 4.018-18.733) . Among these, duration of anesthesia and tumor-associated factors Ki67, P53, CK20, VEGF of two or more positive were risk factors, and drinking history, age, and postoperative VAS scores at 12 h less than 3 scores were protection factors. Conclusions The impact of general anesthesia and intraspinal anesthesia on one year recurrence in initial occurrence bladder cancer patients with partial cystectomy is not statistically significant. Duration of anesthesia depends on the part of the surgical time which is associated with the postoperative recurrence within a year. Postoperative analgesic perfect (VAS score at 12 h less than 3 scores) is the protective factor. Age and drinking history are also the protective factors for one year recurrence in initial occurrence bladder cancer patients of partial cystectomy. Key words: Urinary bladder neoplasms; Anesthesia methods; Recurrence

Objective To discuss the need for performing intravenous urography(IVU) in patients with non-muscle invasive bladder cancer before surgery. Methods From 1997 to 2008,1968patients were diagnosed as non-muscle invasive carcinoma of the bladder with pathological confirmation. All patients underwent ultrasonography, cystoscopy and IVU prior to surgrey. The x2 test was used for statistical analysis. Results The incidence of upper urinary tract urothelial tumors (UUTUT) was 11. 0% (216 cases). Two hundred and fifteen (13. 6%) suffered simultaneous UUTUT detected by IVU in 1528 patients with bladder cancer who had intermittent painless gross hematuria, while only 1 (0.3 %) suffered simultaneous UUTUT in 386 non-symptomatic patients (P＜0.01). Among 120 patients with bladder cancer whose upper tract was abnormal detected by ultrasonography,120 (100. 0%) suffered simultaneous UUTUT detected by IVU, and of 1848 patients who were normal in upper tract by ultrasonography, 96 (5. 2%) suffered simultaneous UUTUT detected by IVU (P＜0. 01). Of the patients with no abnormalities in upper tract by ultrasound, 37(3. 0%) suffered simultaneous UUTUT detcted by 1VU in 1247 patients with single bladder tumor,and 59 (9.8%) suffered simultaneous UUTUT in 601 patients with multiple bladder tumors (P＜0.01). Of the patients with single bladder tumor who had no abnormalities in upper tract by ultrasonography, 2 (0.2%) suffered simultaneous UUTUT detected by IVU in 822 patients with the diameter of the tumor＜1.0 cm, and 35 (8. 2 %) suffered simultaneous UUTUT in 425 patients with the diameter≥1. 0 cm (P＜0.01). Of the 1541 patients with histological G1, 48 (3.1%) suffered simultaneous UUTUT detected by IVU, and of the 427 patients with histological G2- G3, 168 (39. 3%)suffered simultaneous UUTUT (P ＜ 0. 01 ). Conclusion Patients with the following characters should undergo IVU before surgery: hematuria, abnormal upper urinary tract by ultrasonography,multifocal tumours, the diameter of the single bladder tumor≥1. 0 cm and high gradc tumors. Key words: Urinary bladder neoplasms; Urography; Hematuria; Cystoscopy; Ultrasonography

Chemoprevention for Bladder Cancer

Objective To investigate the clinical feature , pathologic characteristics and prognosis of urothelial carcinoma of bladder with squamous differentiation . Methods From Jan.2010 to Jun.2013, the pathological and clinical data of 96 cases of urothelial carcinoma of bladder with or without squamous dif-ferentiation were compared .Of the group with squamous differentiation , there were 39 males and 9 females with a median age of 70 （29 to 87） years.44 cases presented with painless gross hematuria .4 cases presen-ted with finding of bladder tumors in annual physical examination .TURBT, partial cystectomy and radical cystectomy were performed in 25, 8 and 13 cases, respectively.In addition, one case was only underwent bi-lateral ureteral skin gastrostomy .The last one only performed cystoscopy .In accordance with sex , age, path-ological stage and classification and surgical approach , 48 controls were selected .For the other group , there were 40 males and 8 females with a median age of 68 （39 to 86） years.45 cases presented with painless gross hematuria.3 cases presented with finding bladder tumors by annual physical examination .TURBT, par-tial cystectomy and radical cystectomy were performed in 28, 7 and 13 cases, respectively.All patients with retaining bladder had postoperative intravesical instillation for one year .Some patients with or without bladder performed 3-6 cycles chemotherapy with the GC protocol . Results In squamous differentiation group , there were 1 （2.1%） pTa, 25 （52.1%） pT1, 17 （35.4%） pT2, 4 （8.3%） pT3 and 1 （2.1%） pT4 tumors. Whereas, 1 （2.1%） pTa, 28 （58.3%） pT1, 16 （33.3%） pT2, 2 （4.2%） pT3 and 1 （2.1%）pT4 tumors were selected in the control group .There were 2 （4.2%） cases with low grade and 46 （95.8%） cases with high grade carcinomain in both groups .Patients were followed up with a mean duration of 16 and 12 months in squamous differentiation and control group , respectively .In squamous differentiation group , eight recur-rences were recorded with a mean follow-up of 12 months.Of the 3 died patients, only one died from bladder cancer.In control group, seven recurrences were recorded with a mean follow-up of 22 months, and no pa-tient died.For patients with TURBT, 3 year recurrence rate of patients with squamous differentiation was 49.5%, while the control was 34.8%.The difference was statistically significant （P〈0.05）. Conclusions Urothelial carcinoma of bladder with squamous differentiation is at a high level of malignant and recurrence . The rate of myometrial invasion with squamous differentiation is higher than pure urothelial bladder cancer . Patients with squamous differentiation should be closely followed up . Key words: Bladder; Urothelial carcinoma; Squamous differentiation; Treatment; Outcome

Clinical data of 23 patients with T2a bladder cancer admitted from March 2008 to August 2013 were retrospectively analyzed. Among 23 patients, 11 cases were treated with transurethral resection (TURBT) plus arterial catheterization chemotherapy (study group) and 12 cases were treated with radical cystectomy (control group). The overall survival time and recurrence free survival time of two groups were compared. Patients in study group were followed up for 20-68 months, recurrence occurred in 5 cases (5/11), including 4 cases of invasive recurrence; patients in control group were followed up for 2~86 months, 1 case had superficial recurrent and underwent TURBT, 2 cases dead due to bladder tumor. During the course of chemotherapy, the main adverse effects were digestive reaction (7/11), fever (4/11), bone marrow suppression (2/11), symptomatic treatment was given, which was tolerated. There were no significant differences in overall survival time and recurrence free survival time between two groups (P>0.05). The quality of life of study group was better than that of control group (P<0.05). It is suggested that the arterial interventional chemotherapy combined with transurethral resection for T2a stage invasive bladder cancer has a certain curative effect with the advantage of preservation of bladder function and higher quality of life. Key words: Urinary bladder neoplasms; Drug therapy, interventional; Prognosis

Objective To explore the ultrasound findings of inverted papilloma of the bladder (IPB).Methods The clinical manifestation,cystoscopy examination,intraoperative observation and ultrasonographic imaging of 24 patients with IPB,which were confirmed by surgery and pathology examination,were analyzed retrospectively.Results 24 patients underwent ultrasound examination and 24 tumors were found.The maximum diameter of tumors were from 1.0 cm to 3.4 cm:1.0-2.0 cm (n =17),2.0-3.4 cm (n =7).Tumors were papillary (n =17) or cauliflower shape (n =7),6 cases had pedicles and none in 18 cases,2 cases swung in the bladder cavity.Tumors were slight hyperecho (n =14) or highlevel echo (n =10),and could be divided into three types:homogenous internal echoes (n =14),inhomogenous internal echoes with punctiform hyperecho in brim or internal part (n =7),inhomogenous internal echoes with peripheral hyperecho and hypoecho in internal part (n =3).Color Doppler flow imaging (CDFI) showed that there were no blood flow signal in 17 cases,punctiform blood flow signal in 4cases,point and strip blood flow signal or strip blood flow signal in 3 cases.Local bladder walls were continuous and there were no attenuation behind the tumors.The onset position were:triangular area (n =6),left posterior wall (n =5),internal urethral orifice (n =4),right lateral wall (n =3),right posterior wall (n =3),posterior wall (n =2),left lateral wall (n =1).5 cases were misdiagnosed as bladder carcinoma,and 17 cases were considered as solid tumors,and only 1 case was diagnosed as papilloma,and 1 case was considered as benign lesion.Conclusions The representative ultrasonographic imaging of IPB are mostly single,pedunculated,papillary or cauliflower shape with smooth surface,neck and trigone of bladder are the most risk position.Color Doppler ultrasonography can be used as the important screening process for IPB. Key words: Ultrasonography; Urinary bladder neoplasms; Papilloma,inverted

Nephrogenic adenoma of urinary bladder associated with malakoplakia