Bladder Infiltration Research Articles

Endothelial cell proliferation and vascular patterns in urothelial carcinoma.

The bladder cancer has some characteristics: the sixth most incident neoplasm in the United States, the majority of diagnosed cases in those 55 years of age and older, four times more common in man than women, a reduced five-year survival rate in case of metastatic disease. Despite the beneficial effects of the combination therapy and immunotherapy, the low response rate and drug resistance were reported. The main goal of this work was evaluation of the endothelial cell proliferation from urothelial carcinomas. Fifty-two cases of T2-T4 infiltrative bladder tumors, aged between 46 and 78 years, were investigated. Morphological, simple and cluster of differentiation 31 (CD31)∕Ki67, CD31∕smooth muscle actin (SMA) double immunostaining were performed. In all the analyzed infiltrative bladder tumors, three types of vessels were noticed: immature, intermediate and mature. In the central part of the tumor area, the following distribution of vessel types was noticed: immature (62.25%), intermediate (35.1%), and mature vessels (2.65%). In the peripheral tumor area, the intermediate vessels increase numerically, up to 54% and the mature ones, up to 18.6%. The peritumoral area was characterized by the absence of immature vessels and the presence of intermediate and mature ones only. It was found the presence of endothelial cell nuclei stained for Ki67 only for immature and intermediate vessels, and never for mature ones. The vascular patterns may contribute to a better stratification of the patient subgroups and antiangiogenic treatment algorithms.

Xanthogranulomatous Cholecystitis - An Intimidating Diagnostic Dilemma - A Case Report

Xanthogranulomatous cholecystitis (XGC) is an uncommon form of chronic cholecystitis[1] characterized by inflammation and infiltration of gall bladder (GB) wall by lymphocytes and multinucleated histiocytic giant cells. There is transudation of bile into gall bladder wall and involvement of the Rokitansky-Aschoff sinuses leading to formation of submucosal abscess and xanthogranulomas.[2] On CECT, they appear as submucosal hypoattenuating nodules and circumferential wall thickening of gallbladder wall, a sign highly specific of XGC.[3]

Mycobacterial surface characters remodeled by growth conditions drive different tumor-infiltrating cells and systemic IFN-γ/IL-17 release in bladder cancer treatment

ABSTRACT The mechanism of action of intravesical Mycobacterium bovis BCG immunotherapy treatment for bladder cancer is not completely known, leading to misinterpretation of BCG-unresponsive patients, who have scarce further therapeutic options. BCG is grown under diverse culture conditions worldwide, which can impact the antitumor effect of BCG strains and could be a key parameter of treatment success. Here, BCG and the nonpathogenic Mycobacterium brumae were grown in four culture media currently used by research laboratories and BCG manufacturers: Sauton-A60, -G15 and -G60 and Middlebrook 7H10, and used as therapies in the orthotopic murine BC model. Our data reveal that each mycobacterium requires specific culture conditions to induce an effective antitumor response. since higher survival rates of tumor-bearing mice were achieved using M. brumae-A60 and BCG-G15 than the rest of the treatments. M. brumae-A60 was the most efficacious among all tested treatments in terms of mouse survival, cytotoxic activity of splenocytes against tumor cells, higher systemic production of IL-17 and IFN-ɣ, and bladder infiltration of selected immune cells such as ILCs and CD4TEM. BCG-G15 triggered an antitumor activity based on a massive infiltration of immune cells, mainly CD3+ (CD4+ and CD8+) T cells, together with high systemic IFN-ɣ release. Finally, a reduced variety of lipids was strikingly observed in the outermost layer of M. brumae-A60 and BCG-G15 compared to the rest of the cultures, suggesting an influence on the antitumor immune response triggered. These findings contribute to understand how mycobacteria create an adequate niche to help the host subvert immunosuppressive tumor actions.

M6A Classification Combined With Tumor Microenvironment Immune Characteristics Analysis of Bladder Cancer.

BackgroundStudies have shown that N6-methyl adenosine (m6A) plays an important role in cancer progression; however, the underlying mechanism of m6A modification in tumor microenvironment (TME) cell infiltration of bladder cancer remains unclear. This study aimed to investigate the role of m6A modification in TME cell infiltration of bladder cancer.MethodsThe RNA expression profile and clinical data of bladder cancer were obtained from The Cancer Genome Atlas and Gene Expression Omnibus. We assessed the m6A modification patterns of 664 bladder cancer samples based on 20 m6A regulators through unsupervised clustering analysis and systematically linked m6A modification patterns to TME cell infiltration characteristics. Gene ontology and gene set variation analyses were conducted to analyze the underlying mechanism based on the assessment of m6A methylation regulators. Principal component analysis was used to construct the m6A score to quantify m6A modification patterns of bladder cancer.ResultsThe genetic and expression alterations in m6A regulators were highly heterogeneous between normal and bladder tissues. Three m6A modification patterns were identified. The cell infiltration characteristics were highly consistent with the three immune phenotypes, including immune rejection, immune inflammation, and immune desert. The biological functions of three m6A modification patterns were different. Cox regression analyses revealed that the m6A score was an independent signature with patient prognosis (HR = 1.198, 95% CI: 1.031–1.390). Patients with a low-m6A score were characterized by increased tumor mutation burden, PD-L1 expression, and poorer survival. Patients in the low-m6A score group also showed significant immune responses and clinical benefits in the CTLA-4 immunotherapy cohort (p =0.0069).ConclusionsThe m6A methylation modification was related to the formation of TME heterogeneity and complexity. Assessing the m6A modification pattern of individual bladder cancer will improve the understanding of TME infiltration characteristics.

A Case Report of Placenta Percreta

There has been an increased incidence of placenta accreta in recent decades, which is associated with an increase in cesarean delivery. A woman aged 39 years GIVP1111 at 8 months of gestation was a breech location with antepartum bleeding et. causa placenta previa totalis suspected percreta bladder infiltration and hematuria. The last abdominal ultrasound showed no visible clot retention and mild right-sided hydronephrosis (possibly a physiological condition). Due to doubts regarding the suspicion of placental invasion of the bladder, an MRI examination of the abdomen was performed. A network was irregular in shape and can not be oriented either right or left, some of which have been split. Attached to the placenta. It was not clear that the cervix and bladder were visible, the total weight was 500 grams, the size was 15x13x5 cm. Based on both macroscopic and microscopic histopathological examinations, it could be concluded that the uterus, adnexa, surgery: placenta percreta, adenomyosis uteri. 
 
 Keywords: placenta percreta; uterus; antepartum bleeding

Risk factors and dose-effects for bladder fistula, bleeding and cystitis after radiotherapy with imaged-guided adaptive brachytherapy for cervical cancer: An EMBRACE analysis

PurposeTo identify patient- and treatment-related risk factors for fistula, bleeding, cystitis, pain and difficulty in voiding in locally advanced cervical cancer patients treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT). Material and methodsMorbidity within the EMBRACE-I study was prospectively reported for physician-assessed (CTCAE) fistula, bleeding and cystitis and patient-reported (EORTC) pain and difficulty in voiding. Analysis of risk factors was performed in patients without bladder infiltration. Risk factors were tested with Cox regression for grade (G) ≥ 3 cystitis, for G ≥ 2 fistula, bleeding and cystitis, and for EORTC “very much” and “quite a bit” or worse. ResultsOf 1416 patients enrolled, 1153 and 884 patients without bladder infiltration were evaluable for the analysis of CTCAE and EORTC items, respectively. Median follow-up was 48[3–120] months. Crude incidence rates for G ≥ 2 fistula, bleeding and cystitis were 0.7%, 2.7% and 8.8%, respectively, and 16% and 14% for ”quite a bit” or worse pain and difficulty in voiding, respectively. Baseline urinary morbidity and overweight/obesity were significant risk factors for most endpoints. Bladder D2cm3 correlated with G ≥ 2 fistula, bleeding and cystitis, while ICRU bladder point dose correlated with EORTC pain “quite a bit” or worse. An increase from 75 Gy to 80 Gy in bladder D2cm3 resulted in an increase from 8% to 13% for 4-year actuarial estimate of G ≥ 2 cystitis. ConclusionClinical and treatment-related risk factors for bladder fistula, bleeding and cystitis were identified within a prospective and multi-institutional setting. A dose–effect was established with bladder D2cm3, reinforcing the importance of continued optimization during individualized IGABT planning.

Endovesical Metastasis of a Colic Adenocarcinoma: A Case Report

<i>Background</i>: Bladder infiltration by neighbourhood tumors is a common situation and can be found in prostate, colo-rectum and genital tumours in women. The main mechanism is a direct invasion of the bladder by the tumor. Intraluminal bladder metastases from distant primary tumors remain exceptional. <i>Patient</i>: We report the case of a 56-year-old patient without any particular medical history initially admitted for an occlusion caused by a transverse colic tumor. The patient did not have clinically haematuria and the initial scan did not show a location or abnormality in the bladder. Initial surgical exploration did not find peritoneal or bladder abnormalities. The patient's evolution will be marked by the appearance of bladder thickening at a distance from the primary tumor and peritoneal carcinosis. The immunohistochemical study in addition to the anatomopathological examination resulted in positive marking of the chorion tubes by anti CDX2 and anti CK 20 and positive marking of surface vesical epithelium by anti P63, anti GATTA3 and anti CK7 which confirmed the colorectal origin of endo-vesical metastasis. <i>Conclusion</i>: We will try through this case report and a review of literature to shed light on this unusual situation and it is important to keep in mind the possibility of remote metastatic location at the bladder of another primary tumor.

Importance of the ICRU bladder point dose on incidence and persistence of urinary frequency and incontinence in locally advanced cervical cancer: An EMBRACE analysis

PurposeTo identify patient- and treatment-related risk factors and dose-effects for urinary frequency and incontinence in locally advanced cervical cancer (LACC) treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT). Material and methodsPhysician-assessed (CTCAE) and patient-reported (EORTC) frequency and incontinence recorded in the EMBRACE-I study were analysed. Risk factors analysis was performed in patients without bladder infiltration and with baseline morbidity available. Cox regression was used for CTCAE grade (G) ≥ 3 and G ≥ 2 and for EORTC “very much” and “quite a bit” or worse. Logistic regression was used for late persistent morbidity defined when CTCAE G ≥ 1 or EORTC ≥ “quite a bit” were scored in at least half of follow-ups. ResultsLongitudinal data on 1153 and 884 patients were available for CTCAE and EORTC analysis, respectively. Median follow-up was 48[3-120] months. Crude incidence rates of G≥2 were 13% and 11% for frequency and incontinence, respectively. Baseline morbidity and overweight-obesity were risk factors for both symptoms. Elderly patients were at higher risk for incontinence. Patients receiving conformal-radiotherapy were at higher risk for frequency. ICRU bladder point (ICRU-BP) dose was a stronger predictor for incontinence than bladder D2cm3. The 5-year actuarial estimate of G ≥ 2 incontinence increased from 11% to 20% with ICRU-BP doses > 75 Gy compared to ≤ 65 Gy. Frequency showed weaker associations with dose. ConclusionICRU-BP dose, in addition to clinical parameters, is a risk factor for urinary incontinence and shows a dose–effect after radio(chemo)therapy and IGABT. ICRU-BP dose should be monitored during treatment planning alongside volumetric parameters. Frequency seems associated with larger irradiated volumes.

Application value of 18F-FDG PETCT imaging in the clinical initial diagnosis and follow-up of primary lesions of cervical cancer.

BackgroundCervical cancer is a common malignant tumor in gynecology with a high death rate. his study aims to analyze the application value of 18F-fluorodeoxyglucose imaging examination (18F-FDG PETCT) imaging in the initial clinical diagnosis and follow-up examination of cervical cancer.MethodsThe clinical data of 71 patients with cervical lesions who were admitted to our hospital from March 2017 to March 2019 were retrospectively collected all patients underwent 18F-FDG PETCT examination. The results of the pathological examination were a benchmark to calculate the sensitivity, specificity, and accuracy of 18F-FDG PETCT imaging in the diagnosis of primary lesions of cervical cancer and the diagnosis of postoperative recurrence, residual, and metastasis.ResultsThere were 39 patients initially suspected, and 30 cases were diagnosed as cervical cancer by pathological examination, including 22 cases with squamous cell carcinoma, 4 cases with adenocarcinoma, 3 cases with carcinoma in situ, and 1 case with adenosquamous carcinoma. The maximum standard uptake (SUVmax) value was (10.36±5.22), and the patient’s lesions showed different degrees of increase of 18F-FDG metabolism. The necrotic area in the patient's lesion showed reduced/defect metabolism. The sensitivity of 18F-FDG PETCT imaging in the diagnosis of primary lesions of cervical cancer was 86.66%, specificity was 44.44%, and accuracy was 76.92%. In the 32 cases followed up for monitoring after the operation, 16 cases showed recurrence, metastasis, residual and other conditions, and 7 cases showed local recurrence/metastasis. 18F-FDG PETCT images showed: abnormal widening of the cervix, stump nodules/mass in the vagina, and rectal and bladder infiltration. All patients with local recurrence were treated with local tissue biopsy or surgical resection under 18F-FDG PETCT image localization. The diagnostic sensitivity, specificity and diagnostic coincidence rate of 18F-FDG PETCT imaging for postoperative follow-up of cervical cancer patients were 100%, 75.00% and 87.50%, respectively.ConclusionsFor patients with cervical cancer who are initially diagnosed or followed up, they can all be tested by 18F-FDG PETCT imaging, which can provide a reference for the formulation of diagnosis and treatment plan and the evaluation of prognosis.

1959 Laparoscopic Resection of Bladder and Uterine Cervix Endometriotic Nodule

Video Objective Laparoscopic resection of bladder endometriosis is associated to the benefits of a minimally invasive approach. In this video, we aim to describe the surgical strategy applied in the treatment of anterior compartment deep endometriosis with bladder and uterine cervix infiltration. Setting Academic and public hospital. Patients A 37-year-old patient, with dysmenorrhea since the menarche, dysuria and dyspareunia for the last 3 years, without improvement with medical treatment. Complementary exams showed a 2,18cm bladder endometriosis nodule with an extension to cervical and anterior isthmic region of 1,87cm, and a proximity to the ureters bilaterally. The patient desired possible future fertility. Interventions Laparoscopic approach for treatment of bladder and uterine lesion. Measurements and Main Results Laparoscopic surgery identified the limits of the lesion. Nodule affected the round ligament bilaterally, bladder, and uterine serous layer. Both ureters were dissected since iliac bifurcation until uterine vessels. Horizontal incision was performed on the bladder around the lesion until the foley catheter visualization to avoid de ureteral meatus. Vesicouterine space was dissected and an 5cm lesion compromising the uterine serous to the cervix was removed. Yabuki space was recognized during the nodulectomy. Vaginal closure was made primordially followed by the vesical suture using 0 and 2-0 polygactin respectively. Operation was successfully completed. Patient was discharged 5 days later. Foley catheter and prophylactic antibiotic were used for 10 days. Social, urinary and sexual activities with improvement in pain and better quality of life. Conclusion Urinary tract endometriosis is a rare disease, but when it occurs the bladder is the most affected site. Patients often complain of dysuria, hematuria, and chronic pelvic pain. Partial bladder cystectomy offers complete removal of endometriotic nodule promoting improvement of urinary symptoms and quality of life.

The coexpression of fibroblast activation protein (FAP) and basal-type markers (CK 5/6 and CD44) predicts prognosis in high-grade invasive urothelial carcinoma of the bladder

High-grade urothelial carcinoma (UC) of the bladder is a heterogeneous disease with dismal prognosis. Bladder tumors with basal phenotype are intrinsically aggressive, and morphological parameters that define disease staging remain main prognosticators. We intend to evaluate the role of cancer-associated fibroblasts (CAFs) in the prognosis of bladder cancer and its association with basal and luminal phenotypes. Clinical and pathological parameters, including the immunohistochemical expression of fibroblast activation protein (FAP) and markers of basal (CK5/6, CD44) and luminal (CK20, GATA3) phenotypes, have been investigated in a series of 121 patients with UC of the bladder treated by radical cystectomy with lymph node dissection, and their implication in long-term cancer-specific survival has been evaluated. A cytoplasmic immunostaining of FAP in CAFs implies worse disease-specific survival (hazard ratio [HR] = 1.68; P = .048). FAP expression is associated with tumor staging (P < .0001), with best discrimination at T2a/T2b level, and with negative expression of markers of luminal phenotype, such as CK20 (P < .0001) and GATA3 (P = .005). In the multivariate analysis, simultaneous expression of FAP, CK5/6, and CD44 is a strong prognosticator of disease-specific survival (HR = 2.3; P = .001), together with nodal invasion (HR = 3.47; P < .0001) and bladder infiltration up to deep muscle or beyond (HR = 2.47; P = .02). There is no association between positive FAP expression in primary tumor and nodal disease (P = .22). FAP expression in CAFs favors tumor invasion in high-grade invasive UC of the bladder with basal phenotype. This new immunohistochemical marker could be added to the routine immunohistochemical protocol to predict clinical behavior in these patients.

Predictive factor for successful retrograde ureteral stent insertion in obstructive uropathy due to advanced cervical cancer

Cervical cancer is the 3rd most common cancer in women. Some of the patients came with kidney failure due to malignant ureteral obstruction. Retrograde ureteral stent insertion as palliative urinary diversion often performed on these patients, but it has high failure rate and often has to be converted to nephrostomy, giving the patient unnecessary burden due to failed procedure. In this study, we evaluate factors that may predict successful ureteral stenting in cervical cancer patients to avoid unnecessary burden to the patient. Data were collected from 2014-2017. We evaluate the clinical, ultrasound and laboratory findings before stent insertion of the patient with successful compared to failed insertion. Comparative study was done using independent T-test and Mann-Whitney U test for nonparametric data. Odds ratio (OR) were calculated using contingency table and P value calculated using Fisher exact test. There were 41 patients diagnosed with cervical cancer performed retrograde ureteral stenting. From 41 patients, 20 (48.7%) were successful and 21 (51.3%) failed. Low hydronephrosis grade (OR=85.8; P&lt;0.0001), low stage (OR=6.0; P=0.0098), radiotherapy (OR=3.7; P=0.04) were strong predictor for successful stent insertion. In bilateral hydronephrosis, more daily urine output (OR=29.2; P=0.002) and normal creatinine level (OR=6.3; P=0.03) were strong predictors for successful retrograde stenting, while bladder infiltration was strong predictor for stent failure (OR=0.0684; P=0.0021). Low hydronephrosis grade, no bladder infiltration, normal creatinine level, more daily urine output, low clinical staging and radiotherapy are predictive factors to predict a successful ureteral stenting in cervical cancer patients.

Intra-Peritoneal Bupivacaine Instillation for Post-Operative Pain Relief after Laparoscopic Cholecystectomy: A Prospective Study

Background Pain relief remains milestone achievement ascribed to laparoscopic cholecystectomy. Post laparoscopic cholecystectomy patient still complains of port site/incisional pain, shoulder pain and vague upper abdominal pain. A simple method of portal or incisional infiltration and intra-peritoneal spraying of a local anesthetic agent over gall bladder fossa can reduce postoperative pain. Method This study was conducted to determine whether Bupivacaine wash at gall bladder fossa and infiltration of local anesthetic at trocar sites has any effect in postoperative pain relief. This prospective study was conducted on 68 patients, where 20 ml of normal saline wash was given in group A and 20ml of 0.25% bupivacaine wash was given in group B at the gall bladder fossa and in both the groups, the same local anesthetic was infiltrated at the port sites and the outcomes was studied. Results Pulse rate and blood pressure were significantly low in group B than group A. The median pain score was significantly low in group B than group A. Also, the total number of analgesic doses used in group B was significantly less than the group A. Conclusions Instillation at gall bladder fossa and infiltration to the port sites using 0.25% bupivacaine is an effective method of postoperative pain relief after laparoscopic cholecystectomy.

Detection of genetic instability and proliferative activity in urinary bladder intraepithelial flat lesions using UroVysion fluorescence in-situ hybridization and flow cytometry

Background Chromosomal abnormalities play a key role in neoplastic potential for flat urothelial lesions, irrespective of whether cytologic atypia is present or not. Having information about lesions with malignant potential in the urinary bladder can help clinicians in taking logical actions concerning management after urinary bladder-conserving resections.Aim The aim of the study was to differentiate various flat urothelial lesions by detecting its genetic abnormalities and proliferative activity using UroVysion fluorescence in-situ hybridization and flow cytometry.Patients and methods Ninety-eight paraffin-embedded tissue sections from 35 patients with infiltrative bladder cancer and flat urothelial lesions [reactive atypia, hyperplasia, dysplasia, carcinoma in situ (CIS), squamous metaplasia, glandular metaplasia, histologically normal urothelium in patients with tumor and control] were assessed by flow cytometry and fluorescence in-situ hybridization using UroVysion targeted against the band 9p21 locus and pericentromeric areas of chromosomes 3, 7, and 17.Results Gain of at least one of the chromosomes was observed in 60% of samples being more than 90% in CIS, dysplasia, and infiltrating bladder tumors. The mean percentage of cells with polysomy in reactive atypia, flat urothelial hyperplasia, glandular metaplasia, keratinizing squamous metaplasia, and histologically normal urothelium in patients with tumors ranged from 12 to 20%, but in CIS and dysplasia it was 67 and 44%, respectively. Deletion of the P16 locus was detected in 49% of lesions. Flow cytometry displayed aneuploidy pattern in 60% of lesions with higher percentage in CIS, dysplasia, and infiltrating bladder tumors. High S-phase fraction (SPF) was observed in 44% of samples. High S phase showed significant association with polysomy and DNA ploidy (P=0.02 and 0.01, respectively). In addition, there was association between polysomy expression with del 9p21 (P=0.03) and between del 9p21 with DNA ploidy and SPF (P=0.003 and 0.02).Conclusions Our analysis has shown that combined evaluation of flat urothelial lesions using UroVysion, DNA ploidy, and SPF help in the recognition of these lesions, especially those with higher genetic abnormalities and having higher S phase because follow up of these lesions showed a higher tendency for malignant transformation. Furthermore, estimation of continuing chromosomal instability such as polysomy, DNA aneuploidy, and high SPF might deliver further interpretation of urinary bladder cancer risk assessment away from the position and histopathology of precancerous lesions.

THE ROLE OF CYSTOSCOPY IN THE STAGING OF CERVICAL CANCER

(Objectives) For the staging of cervical cancer, we investigated the relationship between computed tomography/magnetic resonance imaging (CT/MRI) and cystoscopy and evaluated the need for cystoscopy to diagnose bladder invasion resulting from cervical cancer. (Patients and Methods) We retrospectively reviewed the patients who underwent cystoscopy because of a diagnosis of bladder invasion of cervical cancer from April 2012 to March 2017 in our hospital. A total of 217 women (median age 53 years old) underwent cystoscopy. We also reviewed whether or not there were findings showing bladder wall infiltration on CT/MRI and cystoscopy. (Results) CT was performed in all cases, and MRI was performed in 216 cases. Seventy cases were judged to have possible bladder infiltration by CT, and 35 were judged to have possible bladder infiltration by MRI. In cystoscopy, 24 cases were reported to have "suspicion of bladder invasion" by urologists, but only 12 cases had bladder mucosal findings with "ridges and furrows" (defined as bladder infiltration without a bladder biopsy in this study). The sensitivity and negative predictive values of CT/MRI were both 100%. Only one case underwent a bladder biopsy, and the histological diagnosis was cystitis. (Conclusions) The findings of our investigation suggested that cystoscopy is not required when there were no obvious findings of bladder invasion by CT/MRI at the clinical staging of cervical cancer.

Unrecognised urinoma caused by infiltrative bladder cancer

Introduction. Urinoma develops after disruption of collecting system of urinary tract and urine leak in surrounding tissue. Most common causes of urinoma are blunt or penetrating trauma. Less common causes are iatrogenic injuries or urinary tract obstruction. In this article we presented a rare case of the urinoma caused by infiltrative bladder cancer. Case report. Acutely ill, a septic patient with ileus and profound azothaemia was admitted to medical intensive care unit. Native computed tomography revealed moderate ileus, right kidney hydronephrosis, extensive retroperitoneal urinoma and vesical thickening with excluded infiltration of ureteral orifices. Computed tomography guided percutaneous drainage was done. Upon stabilization, patient underwent transurethral bladder tumor electroresection (histopathology report was: infiltrative transitional cell tumor of urinary bladder). Radical cystectomy was done. The patient?s recovery was uneventful. Conclusion. Urinoma formed due to spontaneous rupture of collecting system based on ureteral obstruction caused by urinary bladder tumor is very rare clinical case scenario. In case of urinoma of unclear etiology invasive bladder cancer should be excluded.

Characteristics of bladder transitional cell carcinoma with E-cadherin and N-cadherin double-negative expression

The aim of the present study was to examine the characteristics of bladder transitional cell carcinoma with E-cadherin and N-cadherin double-negative expression. An immunofluorescence assay was used to detect E-cadherin and N-cadherin expression in infiltrative bladder cancer tissues, and immunofluorescence and western blot analysis were used to detect E-cadherin and N-cadherin expression in human urinary bladder grade II carcinoma 5637, transitional cell carcinoma UMUC-3 and invasive bladder carcinoma EJ cells. Cell proliferation, migration, invasion and plate colony formation assays were used to detect the proliferative, migratory and invasive abilities and the efficiency of plate colony formation of 5637, UMUC3 and EJ cells. A tumor xenograft formation assay was used to evaluate the tumorigenic abilities of 5637, UMUC-3 and EJ cells in vivo. E-cadherin and N-cadherin double-negative expression was identified in various pathological grades of infiltrative bladder cancers. E-cadherin positive and N-cadherin negative expression was exhibited by 5637 cells. By contrast, E-cadherin negative and N-cadherin positive expression was exhibited by EJ cells, and E-cadherin and N-cadherin double-negative expression was exhibited by UMUC-3 cells. The ability of cells to proliferate, migrate, invade, and the efficiency of plate colony formation and tumorigenic abilities of the cells were significantly different among 5637, UMUC-3 and EJ cells. These cell characteristics were significantly increased in UMUC-3 cells compared with 5637 cells; however, the characteristics were significantly decreased compared with EJ cells. The biological characteristics of bladder cancer cells with E-cadherin and N-cadherin double-negative expression was between bladder cancer cells that exhibited a E-cadherin positive and N-cadherin negative expression, and bladder cancer cells that exhibited E-cadherin negative and N-cadherin positive expression. The present study deduces that the status of E-cadherin and N-cadherin double-negative expression may participate in the process of epithelial-mesenchymal transition in the pathogenesis of bladder urothelial carcinoma.

Role of high resolution MR in assessment of cervical uterine carcinoma: staging, treatment planning and correlation with histopathology findings

Conclusion Cervical cancer remains a major threat to women’s health worldwide. MR is the imaging modality of choice to depict the primary tumour and assess local extent. Comparing the radiological findings with the postoperative histological reports, high resolution MR with a dedicated protocol demonstrated to be useful for primary tumour detection and for the assessment of myometrium invasion, lymph node commitment, parametrium invasion, bladder and rectal infiltration and vaginal involvement. This ability of MRI to demonstrate accurately the local extension of the tumour in patients with cervical cancer has become a useful tool to identify prognostic risk factors such as the depth of the infiltration, the tumour volume and the commitment of the adjacent structures. A correct evaluation of these factors is crucial for choosing and planning the most appropriate treatment.

Hematologic lesions in urine cytology

Bladder infiltration by leukemia or lymphoma is rare and can mimic benign processes such as follicular cystitis (FC). Eight benign and malignant hematologic diseases encountered in urine cytology were retrospectively reviewed for clinical, radiographic, and cytologic findings. There were 2 cases of acute myeloid leukemia, 2 cases of diffuse large B-cell lymphoma, and 4 cases of FC. The most common presenting symptom was hematuria. Imaging findings included echogenic debris within the bladder or an adjacent soft tissue mass in acute myeloid leukemia cases and bladder wall thickening in diffuse large B-cell lymphoma cases. No FC cases had any imaging abnormalities. Cytologic material of the leukemia cases showed numerous myeloid blasts with markedly increased nuclear-to-cytoplasmic ratios, centrally located nuclei, inconspicuous nucleoli, nuclear indentations, and some irregular nuclear membranes. The background showed sparse urothelial cells and histiocytes. Both lymphoma cases showed a discohesive population of atypical large lymphoid cells with irregular nuclear borders and prominent nucleoli. The FC cases had a background lymphoid cell population with a maturation spectrum from small lymphocytes to large lymphoid cells (immunoblasts) and histiocytes including tingible body macrophages. Additionally, there were many mature squamous cells and reactive urothelial cells. Bladder leukemia, lymphoma, and FC are infrequently encountered on urine cytology. FC can be distinguished from a hematologic malignancy by the presence of a lymphocytic maturation spectrum and tingible body macrophages. Radiologic abnormalities are associated with malignant processes; however, discrete bladder masses are usually not identified.

Concealed enterovesical fistula associated with forgotten intra-abdominal haemostat and intravesical towel.

Introduction. Enterovesical fistula is rare and is often caused by bowel inflammatory diseases and tumours in the urinary bladder or the intestine with local infiltration of bowel or bladder, respectively. The fistula usually presents with lower urinary tract symptoms, pneumaturia, and faecaluria or with food particles in the urine. Intra-abdominal retained surgical foreign bodies have also been reported as causes. Case Presentation. A case of atypical presentation in a woman with enterovesical fistula following abdominal hysterectomy. Investigations confirmed the presence of surgical towel in the urinary bladder and a pair of artery forceps in the abdomen. The towel was removed at cystoscopy after which she presented with food particles in the urine. She later had laparatomy to remove the haemostat and to repair the fistula. Discussion. A typical presentation of enterovesical fistula delayed the diagnosis and treatment in this patient. Conclusion. Managing patients with recurrent urinary tract infection after abdominal operation should include appropriate imaging of the abdomen with emphasis on pelvic organs. Also, surgical operation should always be given the best shot the first time and strict operation room standards and guidelines should always be followed.