High-grade Transitional Cell Carcinoma Research Articles

Outcome of Post-resection Intravesical BCG and Mitomycin C Therapy on Non-muscle Invasive High- Grade Transitional Cell Carcinoma of Urinary Bladder

Objective: This study aimed to compare the outcome of postoperative intravesical BCG and Mitomycin C therapy on non-muscle invasive high grade superficial bladder tumor. Methods: This prospective quasi experimental study was carried out among the patients with non-muscle invasive high grade transitional cell carcinoma (TCC) of urinary bladder, who underwent complete transurethral resection of bladder tumor of primary tumor attended at the urology department of DMCH, during March 2017 to August 2019. After pre-operative evaluation and counselling, 70 patients with histologically documented high grade superficial bladder tumor were included and divided in two groups. We instilled intravesical BCG in one group and Mitomycin C (MMC) therapy in other group. The patients were followed up at 3rd ,6th , 9th , 12th and 18th month. Results: The mean age of BCG group was 55.8 years while 60.2years in MMC group with majority between 45 to 65 years (>80%). Sex distribution in both groups were almost equal (p=0.062). There were equal number of TaG3 and T1G3 disease in each group (p=0.809). Local adverse reactions were significant in BCG group (p= 0.016), among them UTI, between two groups, was statistically significant (p=0.039). Incidence of hematuria (p=0.324), voiding frequency (p=0.163) and local rash (P=0.642) had no statistically significant difference. The incidence of post-instillation systemic adverse reactions between two groups were statistically significant (p=0.034). Fever (p=0.028) was significant among them. Intavesical BCG was significantly more effective than MMC in terms of disease recurrence (p=0.047) and progression (p=0.008). Conclusions: We analysed the efficacy and safety of intravesical BCG and MMC in two groups, showing that BCG was more effective in terms of disease recurrence and progression but local and systemic side effects were higher in BCG group. Bangladesh J. Urol. 2021; 24(1): 62-71

V11-10 ROBOTIC RETROPERITONEAL NEPHROURETECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-10 ROBOTIC RETROPERITONEAL NEPHROURETECTOMY FOR UPPER TRACT UROTHELIAL CARCINOMA Zachary McDowell, and James Porter Zachary McDowellZachary McDowell More articles by this author , and James PorterJames Porter More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Nephroureterectomy is the standard of care for high grade upper tract urothelial carcinoma (UTUC) or low grade UTUC when nephron-sparing surgery is not possible, and a retroperitoneal approach can be advantageous in the setting of previous abdominal surgeries. The patient in this case is a 67 year old female that was found to have high grade urothelial carcinoma of the left renal pelvis. She underwent 3 cycles of gemcitabine and cisplatin chemotherapy, and subsequent nephroureterectomy. A retroperitoneal approach was chosen for this patient because she had a history of multiple abdominal surgeries including exploratory laparotomy. This video will demonstrate the retroperitoneal approach for robotic nephroureterectomy as definitive surgical management of this patient's high grade UTUC. METHODS: The surgery was performed using the daVinci Xi robot. The patient was placed in full flank position and 4 robotic ports were placed in a line midway between the iliac crest and the 12th rib. A 12mm high-flow insufflator assistant port was placed near the anterior superior iliac spine. The retroperitoneal space was developed using balloon dilation. The initial step was mobilization of the ureter. Once the ureteral dissection was carried distally to the point of decreased range of motion for the robotic arms, the arms were undocked, the boom rotated 180 degrees, and the direction of dissection was into the pelvis. An additional 5mm assistant port was placed cephalad to the robotic ports near the 11th rib. After completion of the ureteral and bladder cuff dissection the robot was redocked and returned to the initial arm configuration. We then proceed to adrenal sparing radical nephrectomy with retroperitoneal lymph node dissection. RESULTS: We have experience with 3 robotic retroperitoneal nephroureterectomies. All patients had high grade transitional cell carcinoma of the kidney as the indication for surgery, and all had history of significant abdominal surgery. The mean age was 70 years, mean operative time was 251 mins, mean estimated blood loss was 42 cc, mean lymph nodes removed was 13, and mean length of stay of 2 days. There were no complications, readmissions, and recurrences. CONCLUSIONS: The retroperitoneal approach is a safe and effective technique for robotic assisted nephroureterectomy. This approach allows complete access to the kidney, ureter and bladder cuff and avoids adhesions in patients with prior abdominal surgery. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e860-e861 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary McDowell More articles by this author James Porter More articles by this author Expand All Advertisement Loading ...

Transitional cell carcinoma of the upper urinary tract: a puzzle

Transitional cell carcinoma (TCC) of the upper urinary tract has a puzzling presentation. This is a case report of a 44 year old male with history for smoking 20 pack years presenting with cough, haemoptysis and microscopic haematuria. His sputum was positive for acid fast bacilli. He was treated as pulmonary tuberculosis (PTB) but had gross haematuria a month after initiation of anti-tubercular drugs (ATD). He was investigated with computed tomography (CT) imaging and was found to have thickened renal pelvis and ureter. It was initially thought as a case of genito-urinary tuberculosis (GUTB). Expectant management for gross haematuria failed. The patient was stabilised and taken up for open nephroureterectomy under general anaesthesia (GA). Histopathological report suggested it to be high grade TCC of the left renal pelvis extending to upper ureter. He did well with completion of ATD. He was not started on adjuvant chemotherapy for fear of exacerbation of PTB. He is under regular and uneventful follow up in the outpatient department (OPD).

Evaluation of the Role of Early Second Look Cystoscopy after Complete Resection of Non-Muscle Invasive Bladder Tumors

Abstract Background most of the bladder cancers are non-muscle invasion at the time of diagnosis. Non-Muscle invasive tumors confined to the mucosa and invading the lamina propria are classified as stage Ta and T1, respectively, according to the Tumor, Node, Metastasis (TNM) classification system. Aim of the Study to determine the efficacy of early second look cystoscopy after complete resection of non-muscle invasive urinary bladder tumors and its impact on subsequent treatment policy. Patients and Methods this is a prospective clinical study that was done at Urology Department, Faculty of Medicine, Ain Shams University and Damanhur Oncology Centre. A total of 40 consecutive patients with newly diagnosed non-muscle invasive bladder cancer will be enrolled in this prospective study for second-look cystoscopy with TURBT in two to six weeks after initial TURBT and follow them up in one year. Results Single tumor was found in 22 cases (55%), while multiple tumors were recognized in 18 cases (45%) with average sizes ranging from 12mm to 70mm. Low-grade transitional cell carcinoma (TCC) was found in 26 cases (65%), whereas high-grade TCC was found in 14 cases (35%). Stage PTa tumors was found in 12 cases (30%) while 28 cases (70%) have had tumors of PT1 stage. All cases underwent an early second TURBT after (2-6) weeks which has reviled the following data. The majority of cases (28 cases) representing 70% of whole study population were free with no detection of any tumors either residual or recurrence. Residual tumors were detected in six cases (15%) all of which detected in patient with large primary tumor size exceeding 50mm or patients with multiple tumors. Whole detected residual tumors were found at edges of primary tumors ranging 2-5 mm in size which were completely resected and they were of the same stage and grade as the initial tumor. Conclusion Our findings in this study support the notion that second-look cystoscopy with or without TURBT is a prerequisite in patients with superficial bladder cancers except for patients with solitary, small low-grade pTa tumors. It is particularly highly recommended for patients with extensive and multiple tumors at the first TURBT

Adaptive genetic algorithms combined with high sensitivity single cell-based technology derived urine-based score to differentiate between high-grade and low-grade transitional cell carcinoma of the bladder.

572 Background: We previously showed that adaptive genetic algorithms (AGA), in combination with single-cell flow cytometry technology, can be used to develop a noninvasive urine-based score to detect bladder cancer with high accuracy. Our aim in this analysis was to investigate if that same score can differentiate between high grade (HG) and low grade (LG) transitional cell carcinoma of the bladder (BC). Methods: We collected urine samples from cystoscopy confirmed HG and LG superficial bladder cancer patients and healthy donors in an optimized urine collection media. We then examined these samples using an assay developed from AGA in combination with single-cell flow cytometry technology. Results: We examined 50 BC and 15 healthy donor urine samples. Patients were majorly White (59.2%), males (61.2%), and had HG BC (66.7%). AGA derived score of 1.1 differentiated between BCa and healthy patients with high precision (AUC 0.92). The median score was 2.8 for LG BC and 6 for LG BC. Mann-Whitney Rank Sum Test indicated that the difference between the median score of HG and LG BC was significant at P value = 0.003. The score performed well independent of patients’ sex or smoking history. Conclusions: Using single-cell technology and machine learning, we developed a new urine-based score that can potentially differentiate between HG and LG bladder cancer. Future studies are planned to validate this score.

Green-laser assisted laparoscopic partial cystectomy for selective muscle-invasive bladder cancer: technique and initial outcome

To describe a green-laser marking technique to assist partial cystectomy, which allows accurate identification of tumour margins, and provide our initial experience with ten patients. Between January 2014 and February 2018, ten patients suspected with muscle-invasive bladder cancer and request of bladder-preserving treatment were selected. In each case, bilateral pelvic lymphadenectomy was performed before green-laser assisted laparoscopic partial cystectomy. Under the direct view of cystoscope, the front-firing green-laser incision was performed 0.5-1cm away from the exterior margin of lesion with adequate depth into the fat tissue. Tumours were then en bloc removed via laparoscope under the tracing of laser beam. The location of 12 tumours in 10 patients was superior wall in 7 cases, lateral wall in 3 cases, anterior wall in 1 case, and posterior wall in 1 case. All procedures were completed without serious complications. The median operating time was 270 (210-360) min with a median haemoglobin decrease of 11 (3-38) g/L. Nine patients were high-grade transitional cell carcinoma and one patient was urachal carcinoma, and the clinical stage was pT1 in 1 case, pT2 in 4 cases, and pT3 in 5 cases. The pathological evaluation of tumour margins was negative in 10 patients. During the follow-up, no recurrence or metastasis were detected in 8 patients, but 2 patients presented regional recurrence. The use of green-laser marking technique during laparoscopic partial cystectomy is a feasible manoeuvre in assisting the accurate incision and minimizing injury to the remaining bladder.

Micropapillary variant of transitional cell carcinoma in a young adult: a rare case report

Micropapillary carcinoma is an uncommon variant of urothelial carcinoma with high metastatic potential. Usually seen in elderly individual, we herein report a case of 42 years old man presented with macroscopic hematuria for 1 month. Evaluation with CECT whole abdomen revealed irregularly marginated hyperattenuated mildly enhancing intraluminal mass lesions in right lateral wall and in floor of urinary bladder. No perivesical infiltration and no regional lymphadenopathy were detected. TURBT done and subsequent histopathological examination showed a high-grade transitional cell carcinoma with micropapillary variant. He was subjected to radical cystoprostatectomy with pelvic lymph node dissection. The pathological examination revealed a high-grade transitional cell carcinoma with micropapillary variant invading the perivesical adipose tissue. No tumor recurrence or metastasis was reported at the 18-months follow-up.

An unusual natural history of a rare bladder tumor: Primitive neuroectodermal tumor.

A primary primitive neuroectodermal tumor (PNET) of the urinary bladder is a very rare bladder tumor. There are few described cases in the literature to date. We presented a 70-year-old man with primary nonmetastatic bladder PNET. The diagnosis was confirmed according to immunohistochemistry evaluation. The patient underwent bladder-sparing protocol using radiotherapy and standard systemic multidrug chemotherapy (vincristine + doxorubicin + cyclophosphamide). At the end of three years of follow-up, we performed radical cystoprostatectomy due to newly diagnosed high-grade transitional cell carcinoma of the bladder at the site far from the primary bladder PNET. In conclusion, multimodal bladder sparing protocol including radiotherapy and standard systemic chemotherapy can be used for the management of primary bladder PNET with acceptable oncological outcomes.

Somatic Mutations Profile of a Young Patient With Metastatic Urothelial Carcinoma Reveals Mutations in Genes Involved in Ion Channels

Background: Urothelial carcinoma is the most common malignancy of the bladder and is primarily considered as a disease of the elderly. Studies that address bladder tumor occurrence in young age groups are rare.Case Presentation: A 19-year-old male presented with a gross total painless hematuria. A histology after biopsy revealed a high-grade transitional cell carcinoma with lymph node metastasis. The patient succumbed to the disease on day 72 of the treatment. Here, we used whole-exome sequencing of a paired tumor-normal sample to identify the somatic mutations and the possible targets of treatment.Result: We predicted eight potential driver mutations (TP53 p.V157L, RB1 c.1498+1G>T, MED23 p.L1127P, CTNND1 p.S713C, NSD1 p.P2212A, MED17 p.G556V, DPYD p.Q814K, and SPEN p.S1078*). In addition, we predicted deleterious mutations in genes involved in the ion channels (CACNA1S p.E1581K, CACNG1 p.P71T, CACNG8 p.G404W, GRIN2B p.A1096T, KCNC1 p.G16V, KCNH4 p.E874K, KCNK9 p.R131S, P2RX7 p.A296D, and SCN8A p.R558H).Conclusions: Most likely, mutations in genes involved in ion channels may be responsible for the aggressive behavior of a tumor. Ion channels are the second largest class of drug targets, and may thus serve as a putative potential therapeutic target in advanced stage urothelial carcinoma.

EXPRESSION OF CANCER STEM CELL MARKER OCTAMER-BINDING TRANSCRIPTION FACTOR 4 IN HIGH-GRADE TRANSITIONAL CELL CARCINOMA

Objectives: The objectives of this study were to provide an outlook of urothelial carcinoma through the immunohistochemical expression patterns of octamer-binding transcription factor 4 (OCT4) in high-grade transitional cell carcinoma (TCC) of the urinary bladder.
 Methods: A total number of 60 tissue samples were collected for the study. Patients were divided into two groups according to the pathological diagnosis of the bladder tissue, Group A: 30 cases with high-grade TCC of the bladder and Group B: 30 cases with apparently normal bladder tissue. Tissue immunohistochemical analysis was applied to investigate the expression patterns of cancer stem cell (CSC) markers OCT4 in bladder samples.
 Results: OCT4 was positive in 80% of specimens of Group A and 3.3% in specimens of Group B. The association between OCT4 marker result and certain histopathological features in high-grade group: Positive OCT4 result was found in patients with inflammation and necrosis (90.9%) with a significant association (p=0.013). Regarding muscular invasion, we noticed that 87.5% of patients with muscular invasion showed positive OCT4 marker result with a significant association (p=0.039) between OCT4 marker result and muscular invasion. As well, OCT4 marker was highly sensitive and specific (sensitivity=66.7%, specificity=96.7%, and accuracy=76.7%).
 Conclusion: There was a significant expression of CSC OCT4 in high-grade TCC, OCT4 can be considered as a key regulator of tumor progression, aggressive behavior, and metastasis.

Diagnosis and Management of a De Novo Urothelial Carcinoma in a Kidney Allograft: A Case Report

IntroductionFollowing renal transplantation, the incidence of malignancies is 3–5 times higher than that of healthy individuals. Among other type of cancers, the risk of urological tumors is also elevated. However, only a few cases of de novo transitional cell carcinomas occurring in renal allografts have been reported. Case reportA 63-year-old tertiary transplanted male patient was urgently hospitalized for a painless macroscopic hematuria. Ultrasonography revealed pyelectasis and a hematoma in the renal pelvis. A percutaneous nephrostomy tube was inserted. An anterograde pyelography was performed later, where a filling defect was still observable in the location of the previously reported hypoechoic mass. Contrast-enhanced ultrasonography showed enhancement of the lesion. An ultrasound-guided percutaneous biopsy was performed. The histologic evaluation revealed a high-grade transitional cell carcinoma. A whole-body staging computed tomography scan did not show signs of metastatic disease. The renal allograft was surgically removed. No disease progression was observed during the 21-month follow-up period. ConclusionsPainless hematuria and asymptomatic hydronephrosis occurring after kidney transplantation should raise the possibility of urothelial carcinoma in the kidney graft. Contrast-enhanced ultrasound should be considered as a first-line diagnostic modality because it is easily accessible and does not raise concerns about nephrotoxicity or radiation burden.

Expression of FOXA1 and GATA3 correlates with invasivity and pathological stage a grade of primary transitional cell carcinoma of the bladder

Bladder cancer is the fifth most common malignancy in men and the second most commonly diagnosed urogenital tumor. Approximately 400,000 new patients with this disease occur each year in the world. Incidence rates are 4 times higher in men than in women. Diagnosis is based on cystoskopy, radiological examination and histological examination. Histological evaluation provides definitive diagnosis and also provides information about pathological stage and grade. Recently, methods of molecular biology are used to predict biological behavior an prognosis more precisely. In this study we evaluated 73 patients with primary transitional cell carcinoma (TCC) of urinary bladder (39 patients pTa and 34 pT1 TCC). Total RNA was extracted from bladder tissue samples using GeneJET RNA Purification Kit (Thermo Scientific, USA) according to the manufacturer's recommendations. First‐strand cDNA was synthesized from total RNA with Maxima First Strand cDNA Synthesis Kit for RT‐qPCR (Thermo Scientific, USA). Reaction was performed according to protocol recommended by manufacturer. Obtained cDNA was used as a template for quantitative PCR to determine the expression level of selected genes (TP53, BCL2, FOXA1 and GATA3). The PCR reactions were performed on Eco Real‐Time PCR System (Illumina, USA). Expression of all analyzed genes was normalized to housekeeping gene, glyceraldehyde‐3‐phosphate dehydrogenase (GAPDH). Obtained results showed that expression levels of TP53 and BCL2 showed no significant differences in both groups. Conversely, significantly lower expression of FOXA1 and GATA3 were detected in pT1 TCC when compared to pTa TCC. Moreover, significantly higher expression of FOXA1 and GATA3 was detected in high grade TCC when compared to low grade tumors. Based on our findings, expression of FOXA1 and GATA3 correlates with invasivity and pathological stage a grade of primary bladder TCC, and may be used for further research in prospective studies.Support or Funding InformationVEGA No. 1/0207/16.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

IS NEOBLADDER SAFE FOR HIGH GRADE BLADDER CANCER PATIENTS?: EVALUATION OF RADICAL CYSTECTOMY COMPLICATIONS AND ILEAL NEOBLADDER RECONSTRUCTION IN AMC KARIADI GENERAL HOSPITAL

Objective: The purpose of this study was to evaluate complications of ileal neobladder reconstruction in high grade bladder cancer patients. Material & Methods: The descriptive study included 12 patients who underwent radical cystectomy and bladder reconstruction with ileal neobladder in Academic Medical Center Kariadi General Hospital Semarang from 2009 until 2016. Base data recorded retrospectively and followed at outpatient clinic. The complications were evaluated from perioperative care, postoperative care, and outpatients clinic. Clavien Dindo classification use to rank complication. Results: The average ages distribution range from 39-70 year. There were 2 patients with comorbid of renal failure, 11 patients with history of TUR and 1 patient underwent adjuvant external radiation. There were 11 patients in high grade bladder cancer (≥T3) and 1 patient with T2. Of the 8 patients underwent orthotopic neobladder procedure and 3 patients underwent cutaneous w-shape procedure. From the histopathology results, 10 patients with high grade transitional cell carcinoma, and 2 patients with invasive urothelial cell carcinoma. There were complication caused by neobladder-related of 1 patient with urinary leakage from ureteroileal anastomose, 1 patient with peritonitis caused by ileo-ileal anastomose leakage, and 1 patients with bowel necrosis caused by internal hernia who need re-operation. All neobladder related complication were 4/33%. From neobladder nonrelated of 1 patient with chronic renal disease and sepsis, and 1 patient with acute renal failure and hyperchlor metabolic acidosis. All of neobladder related complications described above end with mortality (2/16%), except the urinary leakage. Conclusion: Our complication and mortality radical cystectomy - neobladder related rate were 33% and 16% compare with literature show 28-64% and 5.1-8.1%, respectively. Patients selection (<T3, no comorbid) and experience according high volume operation can reduced the mortality rate.

A Single Case of Two Synchronous Metastatic Tumours

The incidence of multiple primary tumours increases with age and due to multiple other factors as environmental and genetic predisposition. The authors describe a case of a 77-year-old female patient with diagnosis in September 2009 of colon mucinous adenocarcinoma. She was submitted to surgery, considered R1 and adjuvant chemotherapy. Six months after treatment she had abdominal recurrence on a nodular lesion in peritoneal fat. The patient was submitted to surgery and did multiple courses of systemic treatment. She underwent cytoreductive surgery with hyperthermic chemotherapy, too. In December 2014 she presented a nodular lesion on the bladder and after excision, the histology confirmed a high-grade transitional cell carcinoma and she maintains treatment with endovesical BCG instillations. After that, she had no evidence of peritoneal disease progression. Besides the bad prognosis associated to peritoneal disease, our case report describes a long survival (5 years with no disease progression) in a patient with high risk at diagnosis to peritoneal recurrence. This case shows the importance of multimodal approach and the impact of locoregional treatment in localized metastatic disease.

V06-03 ROBOTIC DISTAL URETERECTOMY AND BOARI FLAP URETERONEOCYSTOSTOMY AFTER AORTO-BIFEMORAL BYPASS

You have accessJournal of UrologyAdrenal, Testis, UTUC Oncology & More1 Apr 2018V06-03 ROBOTIC DISTAL URETERECTOMY AND BOARI FLAP URETERONEOCYSTOSTOMY AFTER AORTO-BIFEMORAL BYPASS Jaya Sai Chavali, Daniel Sagalovich, Juan Garisto, Julien Dagenais, and Robert Stein Jaya Sai ChavaliJaya Sai Chavali More articles by this author , Daniel SagalovichDaniel Sagalovich More articles by this author , Juan GaristoJuan Garisto More articles by this author , Julien DagenaisJulien Dagenais More articles by this author , and Robert SteinRobert Stein More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1582AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We report our technique of distal ureterectomy with boari flap ureteral re-implantation in previous aorto-bifemoral bypass using the da-Vinci robotic surgical system. METHODS An 80 year old patient (BMI 38) with stage 4 chronic kidney disease (CKD) was noted to have a left mid-ureteral high grade transitional cell carcinoma (TCC) at the location that her ureter was passing between the native iliac artery and an aorto-femoral synthetic graft. Distal ureterectomy with preservation of the contralateral kidney was opted due to the patient's renal insufficiency. The descending colon was reflected medially. The left ureter was dissected proximal and distal to the left aortofemoral bypass graft which was crossing anterior to the ureter. The ureter was transected distally with a bladder cuff. The ureter at the level of the tumor was carefully dissected free of the posterior native iliac artery and the anterior graft. The ureter was transected proximal to the tumor and frozen section demonstrated no tumor at the margin.Due to the short length of ureter remaining, a boari flap ureteroneocystostomy was required for reconstruction. The ureter was able to reach the bladder in a tension-free manner and the ureterovesical anastomosis was completed with interrupted 3-0 polysorb sutures. A 7x24 double J ureteral stent was inserted robotically and the remaining bladder defect was repaired in a watertight fashion with a running 2-0 V-Loc suture. RESULTS Overall operative time was 450 min, estimated blood loss was 450 cc and there were no postoperative complications. The patient was discharged on postoperative day 5. Pathology was consistent with T3 high grade urothelial carcinoma. The Foley catheter was removed on postoperative day 14 and the ureteral stent was removed 4 weeks after surgery. CONCLUSIONS We demonstrate a robotic technique for management of a mid-distal ureteral tumor in the setting of a synthetic aorto-bifemoral bypass graft. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e661 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jaya Sai Chavali More articles by this author Daniel Sagalovich More articles by this author Juan Garisto More articles by this author Julien Dagenais More articles by this author Robert Stein More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Transitional Cell Carcinoma Arising in a Duplication of the Colon: A Case Report

Background: Duplications of the gastrointestinal tract are many and variable, the most common sites being in the esophagus and ileum. The colon is infrequently involved. Even less frequent is malignant change in these anomalies. This paper reports a case of Primary transitional cell carcinoma (TCC) arising in a duplicated colon. Transitional cell carcinoma (TCC) arising in a duplicated colon is rare. We report a case of 61 years old male presented by epigastric swelling. Computarized tomography (CT) revealed the presence of cystic mass related to transverse colon. At surgery a firm perforated cystic mass with mural component connected to transverse colon was noted. Methods: The mass was completely excised and gross examination revealed rounded cystic mass measuring 15x15 x3 cm in diameter attached to colon. Microscopic evaluation and immunohistochemistry study were performed. Results: The mass was diagnosed as high grade TCC developed in duplicated colon and infiltrate the attached colonic wall. Conclusion: To our knowledge, this is the first reported case of “pure” TCC arising in a duplication of the colon.

Histopathological Spectrum of Bladder Lesions : Our Observation in 128 Cystoscopic Specimen

Background : Diseases of the bladder, particularly, inflammation (Cystitis), constitutes an important source of clinical signs & symptoms. Tumours of the bladder are an important source of both morbidity and mortality. The aim of the study was to make a histopathological evaluation of various bladder lesions and to observe the frequency of different bladder lesions. Material and methods : The study was conducted in the Department of Pathology, Chittagong Maa-O-Shishu Hospital Medical College (CMOSHMC) from Jan 2012 to Dec 2016. Patients particulars and histopathological diagnosis were kept in records. Tissue was processed in paraffin section technique and stained with routine Hematoxilin and eosin stains. Results : One hundred and twenty eight (128) cystoscopic sample were studied. Out of 128 cases males were 103 and 25 were females with a male to female ratio of 4.21:1. In malignant lesions the male to female ratio was 3.82:1. Age distribution ranges from 13 to 85 years with an average age of 57 years. The maximum age group belonged to 51 to 60 years and 61 to 70 years. The spectrum of lesions included non neoplastic and neoplastic lesions. Non neoplastic lesions were eosinophilic cystitis, granulomatous cystitis, radiation induced cystitis, chronic follicular cystitis and cystitis gladularis etc. The neoplastic lesions were, transitional cell papilloma, Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP) low and high grade Transitional Cell Carcinoma (TCC) and leiomyosarcoma. Low grade TCC was the predominant type. Conclusion : Cystoscopic biopsy followed by histopatholigical examination is essential to diagnose any organic bladder lesion for proper management. Smooth muscle should be included in biopsy whenever malignancy is suspected.
 JCMCTA 2017 ; 28 (1) : 42 - 44

Abstract 3934: Bladder cancer tumor heterogeneity: development of a system-level mutation assay

Abstract Survival rates for patients with muscle-invasive bladder cancer have not improved in the past 20 years, and new therapies are imperative. Intratumor heterogeneity can complicate molecular profiling attempts to optimize therapy for cancers harboring several actionable tumor subclones. To develop personalized treatment strategies, there is a need for assays to measure intratumor heterogeneity in bladder cancers. We conducted a pilot study of two muscle invasive high-grade transitional cell carcinoma cases. We used a comprehensive cancer panel (Thermo Fisher) covering >400 cancer genes to analyze distinct tumor loci and matched normal tissues. Based on the identified somatic mutations, we designed a bladder-specific panel to (1) validate our results with increased coverage, and (2) analyze liquid biopsy samples. Using the comprehensive cancer panel, we sequenced 6 tumor loci to an average sequencing depth of approximately 100x. We detected intratumor heterogeneity in both patients: By applying a combination of frequency-based (minor allele frequency >10%) and probabilistic (probability of difference between observed frequencies due to sampling) filters, we identified 44 credible somatic SNVs, including mutations that were not shared among all three loci. We used these SNVs to design a custom amplicon panel covering 42 SNVs across 38 genes that is suitable for highly fragmented DNA. The custom panel was used to validate the SNVs in the same tumor regions and in liquid biopsy samples from plasma and urine (approximate coverage 6,000x). In both cases, we identified private mutations reported in The Cancer Genome Atlas Urothelial Bladder Carcinoma (TCGA-BLCA) data collection, reflecting tumor evolution. Liquid biopsy samples from urine revealed all trunk mutations but only 1 out of 5 private mutations. We conclude that tumor evolution can affect distinct loci within bladder tumors, which may not be fully represented in liquid biopsy samples. These results suggest the need for analyzing multiple tumor regions to identify all actionable driver mutations. In the future, we plan to apply our assay to additional foci and patients in order to identify optimal bladder tumor sampling strategies. Citation Format: Katherin Patsch, Naim Matasci, Anjana Soundararajan, John Nicoll, Jonathan Katz, Antonio Sanchez, Erika Feierstein, Christina Van Loy, Zhao Xu, David B. Agus, Mitchell E. Gross, Daniel Ruderman. Bladder cancer tumor heterogeneity: development of a system-level mutation assay [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3934. doi:10.1158/1538-7445.AM2017-3934

Overexpression of UHRF1 gene correlates with the major clinicopathological parameters in urinary bladder cancer.

ABSTRACTIntroduction Recently, expression of the UHRF1 gene was found to be up-regulated in numerous neoplasms, including the urinary bladder transitional cell carcinoma (TCC).Objective The aim of our study was to determine if the expression levels of UHRF1 gene correlates with the major pathological characteristics of the tumor and patients’ clinical outcome.Materials and Methods In our study, we have analyzed the tissue samples derived from group of 70 patients with histologically confirmed TCC of the urinary bladder, while normal urinary bladder mucosa obtained from 40 patients with nonmalignant diseases was used as a negative control group. Expression of UHRF1 gene in each patient sample was determined using reverse transcriptase-polymerase chain reaction.Results UHRF1 gene expression was found to be app. 2.5 times higher in samples from patients with TCC in comparison with normal epithelium derived from control group patients. Analysis show that gene expression correlates with the malignancy of the tumor. A highly significant differences were found between the expression values of samples from low and high grade TCC, as well as between the high grade and control group. UHRF1 expression was higher in patients with non-muscle invasive disease than in those with muscle invasive disease.Conclusions The result of this study indicates that UHRF1 gene expression levels correlates with the major pathological characteristics of TCC samples and with the clinical outcome of those patients. Determination of UHRF1 gene expression could have a potential to be used as a sensitive molecular marker in patients with urinary bladder cancer.

Peritoneal carcinomatosis in urinary bladder cancer: A case report

Transitional cell carcinoma (TCC) is associated with malignant tumors that arise from stem cells near the basement membrane of the epithelial bladder surface. Exposure of carcinogens to the urothelium leads to genetic alterations in cells, increasing the malignant potential. Of the different environmental exposures, cigarette smoke is considered the greatest risk factor in the development of TCC in the United States. Pathological tumor growth patterns are classified as papillary (most common), sessile/mixed, or nodular, with TCC often arising via the flat or papillary pathways. Most commonly, TCC involves the papillary pathway, with formation of a tumor projecting into the bladder lumen and possible invasion of the lamina propria and bladder muscle. Constitutional symptoms such as weight loss, fatigue, along with lower abdominal pain or bone pain are often indicative of metastatic disease and poor prognosis. Metastasis of TCC most commonly occurs to the lungs, liver, or bone. Metastasis to the peritoneum with abdominal ascites, however, is very rare. In our case, TCC with peritoneal carcinomatosis and ascites in a 48-year-old male smoker can be appreciated. Abdominal pain with nausea, weight loss, and hematuria lead to computed tomography (CT) scan, which depicted ascites, omental thickening, and soft tissue mass in the urinary bladder. Biopsy and pathologic cytology revealed high-grade TCC with papillary morphology. Transitional cell carcinoma with peritoneal carcinomatosis is a rare cause of bladder carcinoma. Poor prognosis is due to advanced disease stage, poor performance status, and metastasis. Effective treatment often cannot be initiated, because of the grim presentation. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 7 No. 11, November 2016. ISSN – [0976-3198] Int J Case Rep Images 2016;7(11):749–753. www.ijcasereportsandimages.com Khosla et al. 749 CASE REPORT OPEN ACCESS Peritoneal carcinomatosis in urinary bladder cancer: A case report Manraj Khosla, Ali Imran, Panagiotis Fidias