Invasive Transitional Cell Carcinoma Research Articles

Gemcitabine versus Bacillus Calmette-Guérin (BCG) in Non Muscle Invasive Transitional Cell Carcinoma of the Bladder after Trans-Urethral Resection

Abstract Background To overcome Bacillus Calmette–Guérin (BCG) shortage and its side effect several studies have compared the safety and efficacy of intravesical gemcitabine with (BCG) for non-muscle invasive bladder cancer. The aim of this work is to evaluate the efficacy of Gemcetabine as a local intravesical treatment of superficial TCC in reducing the risk of recurrence and progression after TURBT in comparison to BCG. Patients and Methods This single blind controlled randomized study Included 82 patients which randomly divided into 2 groups by 1:1 method.Each group included 41 patients, group I will receive gemcitabine. Group II will receive BCG.These patients were diagnosed with superficial bladder tumor (TCC) after TURBT. These patients were followed in the out-patient clinic in the Department of Urology Ain Shams University Hospital and 6th October Health Insurance Hospital during the period from 2017 till 2021. Results After 1 year of follow up 67.6% of group I on the other hand 63.4% of group II were free of tumors. As regard tumor progression, only 2.7% of group I patient had tumor progression while 4.9% of group II had tumor progression but all of these results were statistically not-significant with P. value 0.475. As regard side effects after 1 year of follow up. Regarding dysuria 24 patients 96% in group (I) complained of mild dysuria. On the other hand, 39 patients 95.1 % in group (II) complained of dysuria, 9 of them 21.9 % had sever dysuria and 30 patients 73.2 % had mild dysuria. which was statistically not significant with P. value 0.078. Urine analysis was done after treatment. 33 patients (89.2%) had pus cells in the patients of group I while in group II, all patients had pus cells in urine analysis, which was statistically significant with (P. value 0.046). Conclusion Gemcitabine was associated with nearly similar efficacy and a clinically significant better toxicity profile compared with BCG. Intravesical gemcitabine is a promising drug that may be an option in treating patients with non muscle invasive bladder cancer.

Long term outcomes and impact on renal function following radical cystectomy.

To assess clinical, oncological outcomes and impact on renal function in patients who underwent the radical cystectomy with pelvic lymphadenectomy for muscle invasive and high risk non-muscle invasive transitional cell carcinoma of urinary bladder without evidence of non-regional lymph nodes and distant metastasis. With curative intent total 156 patients underwent radical cystectomy with pelvic lymphadenectomy from January 2015 to December 2022. Total 132/156 patients had primary transitional cell carcinoma of bladder. Thirty patients, presented with obstructive nephropathy, operated after stabilization of renal function. Pre-operatively and post-operatively eGFR calculated using modified diet in renal disease formula. In present study 114 (86.36%) patients had high grade TCC, 70 (53.02%) patients had organ confined disease. Nodal extension seen in 74 (56.06%) patients. Perioperative mortality noted in 36 (27.2%) patients. The overall survival and recurrence free survival (RFS) over 5 years was 66.67 and 45.45%. RFS was significantly related to pathological stage, nodal status, histological-grade, positivity of surgical margin and time of surgery from diagnosis. Total 92/132 (69.7%) patients had recurrence. Pelvic recurrence in 10/92 (10.87%) whereas 82/92 (89.13%) patients had distant recurrence. Pre-operatively mean creatinine was 2.6 mg/dl and mean eGFR was 38.9 ml/h in patients who presented with obstructive nephropathy after stabilization of renal function. Post-operatively in 46/132 (34.8%) patients had improvement in eGFR while 86/132 (65.2%) patients had deterioration of eGFR over 62 months of median follow up. Radical cystectomy provides good overall survival outcomes. Pre-operative eGFR has significant impact on post-operative renal function in long term.

Novel uses of complement inhibitors in myasthenia gravis-Two case reports.

Myasthenia gravis (MG) is a rare, life-threatening immune-related adverse effect (irAE) of immune checkpoint inhibitor (ICI) treatment. C5-complement inhibitors are effective treatments for acetylcholine receptor antibody (AChR ab) positive generalized MG. We describe the use of eculizumab/ravulizumab in two patients with MGreceiving concomitant pembrolizumab. This was a retrospective review of two medical records. Patient 1: An 80-year-old male with recurrent, non-muscle invasive transitional cell carcinoma of the bladder developed ICI-induced AChR ab positive MG (ICI-MG), myositis, and myocarditis 2 weeks after the first dose of pembrolizumab. Myositis responded to corticosteroids. MG responded to eculizumab, followed by ravulizumab. He died of metastatic cancer 8 months later. Patient 2: A 58-year-old male had refractory thymoma-associated AChR ab-positive MG, which responded to eculizumab. He developed metastatic Merkel cell cancer necessitating pembrolizumab. MG remained stable on eculizumab. He had no irAEs for 22 months, with positron emission tomographic resolution of cancer. He then developed mild, indolent retinal vasculitis, which responded to prednisone. Discontinuation of pembrolizumab for 5 months resulted in cancer recurrence; pembrolizumab was resumed with peri-infusion pulse prednisone. MG remained stable and he continues eculizumab. In the first patient, eculizumab, followed by ravulizumab, improved ICI-MG. In the second patient, eculizumab treatment may have had a prophylactic effect on the development of ICI-induced irAEs. The effect of complement inhibition on cancer outcomes of ICI therapy is unknown. A possible biologic basis for complement inhibitors in reducing irAEs of ICI, especially in the presence of underlying autoimmune disease, merits evaluation.

Urinary Bladder Cancer-Epidemiological and Histopathological Study

Urinary bladder cancer is the main reason for morbidity and mortality throughout the world. Urothelial carcinoma is a common primary tumor of urinary bladder (90%). To investigate the epidemiological and histopathological aspects in Libyan patients suffering from urinary bladder cancer, we performed a study on 39 bladder cancer biopsies from transurethral resection of bladder tumor (TURBT) and cystoscopic samples obtained from Oncology Department- Al Hawari Hospital, over the period of (2021- May 2022), Tiba Medical Laboratory (2021- July 2022), and Alnoon Medical laboratory (2019- January 2022) at Benghazi, Libya. Of the 39 cases, 34 (87.2%) were diagnosed in men, and 5 (12.8%) were found in women, the men/ women ratio being of 6.8/1. The highest incidence of bladder tumors was recorded in individuals aged between 61 and 80 years old. In this age group, there were admitted 24 patients with bladder cancer, representing 61.5%. The most common pathological types of urinary bladder carcinoma found was Invasive Urothelial Carcinoma TCC (48.72%) followed by noninvasive Urothelial Carcinoma TCC (46.15%), and Squamous Cell Carcinoma SCC in (5.13%). A case of SCC on top of Schistosomiasis was also seen. Grade III was found in 51.2% of our patients and 43.5% of them had stage II. This study has highlighted upon the importance of histopathological study in evaluating urinary bladder cancer. Cystoscopic studies and biopsies help in early detection of bladder neoplasms and they form the mainstay of the diagnosis and follow up. The objects of this work were to assess epidemiological features of the bladder cancer in Benghazi - Libya with regard to frequency, age and sex distribution. Furthermore, to describe the Histopathological features of the urinary bladder cancer, particularly Transitional Cell Carcinoma (TCC) in urinary bladder biopsies.

The Regulatory Role of Nuclear Respiratory Factor 1 in Bladder Cancer Cells.

Nuclear respiratory factor 1 (NRF1) is a key mediator of genes involved in mitochondrial biogenesis and the respiratory chain; however, its role in bladder cancer remains unknown. Transitional cell carcinoma, also known as urothelial cell carcinoma, is the most common type of bladder cancer resistant to chemotherapy. An established high-grade and invasive transitional cell carcinoma line from patients with urinary bladder cancer, known as T24, has been extensively used in cancer research. In this study, we aimed to investigate the mechanisms through which NRF1 regulates proliferation and cell migration of bladder cancer cells using the T24 cell line. Cells were transfected with plasmid cloning DNA for NRF1 to evaluate the effect of NRF1 overexpression on bladder cancer cells. Western blot was used to examine epithelial and mesenchymal markers (E-cadherin and α-smooth muscle actin), transcriptional regulators for epithelial-mesenchymal transition (snail family transcriptional repressors), components of transforming growth factor-β1/SMADs signaling, high-mobility group box 1 (HMGB1), and receptor for advanced glycation end-products (RAGE). The in situ expression of E-cadherin, α-smooth muscle actin and SMAD7 was determined using immunofluorescence staining. Cell migration capacity was assessed by wound-healing assay. Transfection with NRF1 expression vector repressed the migration capacity of bladder cancer cells, diminishing HMGB1/RAGE expression and reducing transforming growth factor β-associated epithelial-mesenchymal transition in T24 cells. Therapeutic avenues that increase NRF1 expression may serve as an adjunct to conventional treatments for bladder cancer.

The Bristol Bladder Trial: Five year outcomes in patients treated with neoadjuvant cabazitaxel and cisplatin chemotherapy for muscle invasive transitional cell carcinoma of the urinary bladder.

493 Background: Neoadjuvant cisplatin-based combination chemotherapy (NAC) improves survival in muscle invasive bladder cancer (MIBC). However, response rates and survival remain suboptimal. We sought to evaluate the efficacy of cabazitaxel with cisplatin in this patient group. These patients have now been followed for survival status for 5 years post NAC and radical cystectomy. Methods: This was a single arm (Simon 2 stage), phase 2 study. Patients with MIBC were included if fit to receive NAC and to undergo radical cystectomy. 26 evaluable patients were required to detect an objective response rate (ORR) of >35% with 80% power. ORR was defined as pathological complete response (pCR) plus partial response (pathological downstaging, ≥T2 at diagnosis to ≤T1 at cystectomy). Treatment was with cisplatin 70mg/m2 and cabazitaxel 15mg/m2 on day 1 of a 21-day cycle, for 4 cycles prior to surgery. Toxicity was recorded using CTCAE v.4.03. QoL data was assessed during and after chemotherapy using EQ-5D-5L and EORTC-QLQ-C30, BLM30 questionnaires. Patients were followed for 5 years post cystectomy for progression free survival (PFS) and overall survival (OS). Results: ORR was seen in 15 out of 26 evaluable patients, 57.7%, with 24.6% achieving pCR. 1 out of 15 patients who achieved ORR died due to disease progression in the 5 year follow up period. The median PFS and OS were not reached by the 5 year follow up time point with a 5 year survival rate of 65.4% being seen in this patient cohort. Median OS in non-responders (11 patients) was 20.5 months and 5 year survival rate for the non-responders was 36.4% compared to 93.3% for responders. Conclusions: Neoadjuvant cabazitaxel with cisplatin chemotherapy is an effective regimen with 65.4% patients alive and progression-free at 5 years. It also indicates that ORR (and not just pCR), is a good predictor of patient survival at 5 years post radical cystectomy with only 1 out of 15 patients who achieved ORR progressing and dying in this period. However, in current clinical practice, there are no validated predictive biomarkers regarding potential response to NAC. Taken together with our previously published data, cabazitaxel with cisplatin as neoadjuvant chemotherapy is a safe, well-tolerated and effective regimen and should be compared to the regimens e.g. cisplatin/gemcitabine considered as standard in this setting. Clinical trial information: NCT01616875 .

Metastatic non-muscle invasive transitional cell carcinoma of urinary bladder: a case report

BackgroundAxillary lymphadenopathy is a common clinical presentation of variety of benign and malignant diseases. However, majority of patients with unilateral axillary lymph node enlargement have an underlying malignancy in which association with breast carcinoma being the commonest one. In most of these patients there will be a discernible primary tumor, either clinically or radiologically. However, in axillary lymphadenopathy with negative mammogram is not very common, and in this case other malignant causes should also be considered in addition to occult breast cancer and these can be metastases from other primary tumors for, e.g., lung, genitourinary tract, gastrointestinal, ovarian, thyroid carcinomas and malignant melanoma.Axillary node is an uncommon site of metastases from Transitional cell carcinoma (TCC) of urinary bladder even from its muscle invasive form, and distant metastasis from low grade superficial tumors without muscle invasion or regional metastasis is a very rare occurrence. Here we present a case of axillary nodal metastases from non-muscle invasive (superficial) bladder cancer without history of local recurrence and regional metastases.Case presentationWe present a case of female patient who complaint of hard swelling in right axilla and right breast enlargement. Patient had past history of non-muscle invasive transitional cell carcinoma of urinary bladder (pTa, grade II A) which had been treated accordingly. No recurrence of bladder growth had been observed on serial check cystoscopies. On clinical examination of breast and axilla, right breast appears enlarged and there were palpable hard fixed axillary lymph nodes. Ultrasound showed enlarged malignant looking lymph nodes. Occult breast carcinoma with metastatic axillary lymph nodes was our initial impression; however, subsequent biopsy of axillary lymph nodes showed Transitional cell carcinoma.ConclusionsThis patient’s case emphasizes the importance of having sound knowledge of natural behavior of primary tumor and common and uncommon sites of distant metastases. The causes of unilateral axillary lymphadenopathy include both benign and malignant disease.

A phase 3 study of the subcutaneous programmed cell death protein 1 inhibitor sasanlimab as single agent for patients with bacillus Calmette-Guérin, unresponsiv,e high-risk, non-muscle invasive bladder cancer: CREST Study Cohort B.

TPS4614 Background: Bacillus Calmette-Guérin (BCG) therapy is the standard of care for high-risk non-muscle invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor. However, disease recurrence or progression is common and patients with BCG-unresponsive disease are unlikely to respond to further BCG therapy. In these patients, the current standard of care is radical cystectomy and bladder-preserving treatment options, limited to intravesical chemotherapy or intravenous pembrolizumab. In a phase 1 study, sasanlimab (PF-06801591), a monoclonal antibody to programmed cell death protein 1 (PD-1), was administered subcutaneously at 300 mg every 4 weeks. Sasanlimab had an acceptable safety profile and showed clinical activity aligned to other anti-PD-1/PD-ligand 1 (PD-L1) agents in patients with advanced urothelial carcinoma and non-small cell lung cancer, while offering the convenience of subcutaneous administration. Therefore, CREST Study Cohort B aims to evaluate sasanlimab administered subcutaneously in patients with BCG-unresponsive NMIBC. Methods: CREST Study Cohort B is a non-randomized, multicenter, multinational, open-label, phase 3 study and will enroll ̃160 patients with histologically confirmed BCG-unresponsive, high-risk, non-muscle invasive transitional cell carcinoma of the bladder urothelium (high-grade Ta or T1 tumor, or carcinoma in situ [CIS]) in 2 separate Cohorts, B1 and B2 (̃110 and ̃50 patients, respectively). Cohort B1 will enroll patients with persistent or recurrent CIS with or without concomitant recurrent high-grade Ta/T1 disease, within 12 months of completing adequate BCG therapy. Cohort B2 will enroll patients with recurrent high-grade Ta/T1 disease within 6 months of completing adequate BCG therapy. All patients will receive subcutaneous sasanlimab as a single agent. Efficacy will be assessed at regular intervals by cystoscopy, urine cytology, biopsy, and imaging. The primary endpoint is complete response (CR) and event-free survival (EFS) for Cohort B1 and B2, respectively. Secondary endpoints include duration of CR (Cohort B1 only), EFS (Cohort B1 only), overall survival, time to cystectomy, safety, health-related quality of life, pharmacokinetic parameters, PD-L1 expression, and incidence of anti-drug antibodies. Recruitment of patients in CREST Study Cohort B will be opened in Canada and the United States of America, with other sites in Asia, Australia, and Europe. Clinical trial information: NCT04165317.

Omega-3 polyunsaturated fatty acids: a modified approach for chemo-prevention of bladder cancer in a rat model and molecular studies of antineoplastic mechanisms

To test the chemo-preventative effects of omega-3 against bladder cancer (BC) induction in a rat model and its potential antineoplastic mechanisms. Ninety male Fisher rats were divided into three groups during a 22-week protocol: group 1 (control), group 2 (Placebo + N-butyl-N-4- hydroxybutyl nitrosamine (BBN) for induction of BC and group 3 received omega-3 (1200mg/kg/day) + BBN. At the end, blood samples and bladder tissues were collected and checked for the presence of malignancy, markers of angiogenesis (VEGF relative gene expression), inflammation (IL-6), proliferation (KI-67 expressions), oxidative stress (serum MDA and serum SOD) and epigenetic control (miRNA-145 level). At the end of the study, 60% and 86.6% rats survived in group 2 and 3 with significant weight loss among rats in group 2 when compared with other groups. In group 2, all rats developed visible bladder lesions of which five and 13 developed squamous cell carcinoma (SCC) and transitional cell carcinoma (TCC). In omega3-treated group, only one developed low grade SCC and one developed high grade non- invasive TCC. Bladders from omega-3-treated rats showed lower expression ofKI-67 (p < 0.05), VEGF (p < 0.001) and IL-6 (p < 0.001) and significant higher expression of mi-RNA (p < 0.001). Also, omega-3-treated group showed statistically significant lower MDA level (p < 0.001). Omega-3 inhibits bladder tumor growth in the BBN-induced BC rat model, due to anti-inflammatory, antioxidant, anti-proliferative, and anti-angiogenic properties together with epigenetic control.

A New Era in the Management of Tumors in Dogs Based on Liquid Biopsy

The naturally occurring high-grade invasive transitional cell carcinoma or canine invasive urothelial carcinoma localized in bladder can be successfully treated surgically, however, at time of your diagnosis, it may present itself at an advanced stage, and distant metastases occur in 50% of cases. The urothelial carcinoma has a poor prognosis due to its muscle-invasive nature and high degree of metastases to regional lymph nodes or distant organs

Muscle-invasive bladder cancer

Bladder cancer, which is a complex disease, can be treated with a variety of stage-oriented treatment options. In this article, the treatment recommendations of the German S3 guideline "Early detection, diagnosis, treatment and aftercare of bladder cancer" are applied in a fictitious case study. In a patient with invasive transitional cell carcinoma, the treatment options-ranging from bladder preservation to radical cystectomy with neoadjuvant chemotherapy-are discussed on the basis of the current literature.

Treatment Modalities of Muscle Invasive Transitional Cell Carcinoma of Bladder

The treatment of muscle invasive bladder cancer (MIBC) is complex. This review describes the available therapies for invasive urothelial carcinoma. Neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) and lymph node dissection has been considered the slandered treatment for MIBC. Many patients those are unfit for surgery or cisplatin ineligible, bladder sparing strategies are considered in highly selected patients. Even though there are no level I data, the treatment outcomes for highly select patients given bladder sparing therapy appear promising, with many patients retaining a functional bladder. So it can be concluded that treatment of MIBC is a multidisciplinary collaborative program of surgery, radiation and medical oncology.&#x0D; Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.205-209

Intravesical Gemcitabine and Mitomycin C Chemotherapy in the Treatment of Non Muscle Invasive Transitional Cell Carcinoma of Urinary Bladder - a Randommized Clinical Trial

Objective:To compare the efficacy of Gemcitabine and Mitomycin C in the treatment of non muscle invasive transitional cell carcinoma of urinary bladder.&#x0D; Methods: This study was a randomized clinical trial conducted between the periods of November’2013 to October’2014 in the Department of Urology, Bangabandhu Sheikh Mujib Medical University (BSMMU) The patients with histopathologicaly diagnosed as non muscle invasive transitional cell carcinoma of urinary bladder after complete TURBT were included in the study. Total 54 patients were included in this study ( 27 patients in each group). Those treated with intravesical Gemcitabine were considered as experimental group and those treated with intravesical Mitomycin C (MMC) considered as control group. Intravesical Inj. Gemcitabine and Mitomycin C mg dissolved in 50 ml of normal saline and instilled into the urinary bladder through Foley urethral catheter in the considered group and kept for two hour after getting the histopathology report. Same schedule was maintained weekly for 6 weeks. All patients were followed up at 6 weeks after 1st cycle of intravesical instillation then 3 monthly for 1 year.&#x0D; Result : Presence of recurrence of tumour was found non-significant in Gemcitabine and Mitomycin C group (18.5% vs. 40.7%, p= 0.074). Recurrence free survival was found 81.5% patients in Gemcitabine group and that of 59.3% patients in Mitomycin group. Though there was more recurrence free survival in gemcitabine group than mitomycin group, there was no statistically significant difference. Tumour grade progression was found in 20% and 27.3% cases in Gemcitabine and Mitomycin C group respectively. On the other hand, tumour stage progression was found 40.0% and 27.3% patients in Gemcitabine and Mitomycin C group respectively. No statistically significant difference was observed between Groups (P&gt;0.05). Haematuria, dysuria, urinary frequency, urgency and contact dermatitis were found non-statistically significant in both groups.&#x0D; Conclusion : Gemcitabine and Mitomycin C both drugs are effective as intravesical chemotherapy in the treatment of non muscle invasive transitional cell carcinoma of urinary bladder and have a better recurrence free survival. But, accounting statistical significance on chemopreventive activity, neither Gemcitabine nor Mitomycin C therapy showed superiority over each other.&#x0D; Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.25-29

LASER ABLATION OF NON-MUSCLE INVASIVE BLADDER TUMORS; ANY ADVANTAGE OVER STANDARD RESECTION PROSPECTIVE COMPARATIVE STUDY

Background: The choice of treatment modality in patients with Non muscle invasive bladder cancer (NMIBC) is one of the most discussed issues in urology.One of major problems in management of NMIBC in high recurrence and progression rates. In recent years, the laser has increasing role in different urological fields.Aim of the Work: Evaluation of the value of adding LASER ablation of the tumor bed after resection of the non-muscle invasive transitional cell carcinoma of the urinary bladder.Patients and Methods: 136 patients with non-muscle invasive bladder cancer randomly divided into two groups: Group 1 underwent Laser ablation of tumor bed after resection (Laser group)(n=68), and Group 2 underwent conventional transurethral resection of bladder tumor (TURBT group) (n=68). Operation time, irrigation time, Catheterization time, postoperative hospital stay, Postoperative clot retention or any postoperative complications, and results after each follow up cystoscopy were collected and compared.Results: after one year follow up for all patients we found that patients who underwent laser ablation after resection has less recurrence or progression rates than patients of the other group which was significant statistically. Also they had less postoperative hospital stay and early catheter removal.Conclusion: laser found that it can decrease the recurrence and progression rates in NMIBC after 1 year follow up, it also found to improve postoperative hematuria and decrease postoperative catheterization time and postoperative hospital stay when compared to conventional TURBT.

Total intracorporeal robot-assisted laparoscopic Mainz II rectosigmoid pouch

Objective To report the surgical techniques and results of robot-assisted laparoscopic radical cystectomy (RRC) with bilateral pelvic lymphadenectomy and the Sigma rectum pouch (Mainz II) performed with an intracorporeal robotic technique at our center. Methods There was 1 female 63 years old with organ confined, muscle invasive transitional cell carcinoma of the bladder who underwent completely robot assisted surgery. The procedure included pelvic lymph node dissection, radical cystectomy with uterus and tubal structures, creation of the rectal sigmoid pouch and bilateral stented antireflux implantation of the ureters into the pouch. A 20 cm segment of the sigmoid was isolated. The posterior wall of the pouch were anastomosed side-to-side. And a nipple was formed by suturing the mucosa over the ureters to accomplish an antireflux mechanism. The F8 mono-pigtail ureteral stents were led out through the rectum, and a F26 Foley catheter was placed transanally for pouch drainage. Finally the anterior wall of the pouch was closed two layers. Results Operating time was 470 min and blood loss was 600 ml. The rectal tube was removal on the 9d postoperative day and the ureteral stents were removed 11 d and 12 d postoperatively. No intraoperative or postoperative complications were observed. The patients were followed up for 2 years, urinating 4-5 times per day and 1-2 times at night, CO2CP is 17.8mmol/L. The patient showed no upper urinary occlusion, reflux or urine incontinence. Conclusion To our knowledge, this is the first robotic radical cystectomy with intracorporeal continent urinary diversion (Mainz Ⅱ), RRC with the Mainz Pouch Ⅱ may become a simple and effective alternative surgical method for treating select patients with localized muscle invasive bladder cancer. Key words: Bladder cancer; Robot-assisted laparoscopic surgery; Radical cystectomy; Controlled urinary diversion

Lipoxygenase-5 Expression in Canine Urinary Bladder: Normal Urothelium, Cystitis and Transitional Cell Carcinoma

Transitional cell carcinoma (TCC) is the most common canine urinary tract tumour and mimics human invasive TCC. Human TCCs overexpress lipoxygenase (LOX)-5 and the use of target inhibitors has proven effective in inhibiting neoplastic growth. In this study, we investigated the immunohistochemical expression of LOX-5 in normal canine urinary bladder, cystitis and TCC. The comparative expression of LOX-5, cyclo-oxygenase (COX)-1 and COX-2 among the three tissue groups was also examined. Biopsy samples from cases of cystitis and TCC were reviewed from 2012 to 2016; samples of histologically normal bladder were used as controls. Dogs were excluded if they had received glucocorticoids, non-steroidal anti-inflammatory drugs (NSAIDs) and/or chemotherapy prior to tissue collection. LOX-5 was expressed in 95% of TCCs, 23% of cases of cystitis and 10% of controls. LOX-5 and COX-2 immunohistochemistry scores were significantly (P<0.01) higher in TCCs versus cystitis and normal bladders. Results of this study support the rationale for further investigation of the use of NSAIDs with dual anti COX-2 and LOX-5 effect for the treatment of canine TCC.

Utility of Exfoliative Cytology of Voided Urine in Comparison with Ultrasonogram and Cystoscopy Findings in the Diagnosis of Urothelial Cancers

Carcinoma of the urinary bladder affects men more often than women and occurs in patients over the age of 50 years. Transitional cell carcinoma (TCC) comprises about 90% of all primary tumor of urinary bladder. In this study a total of 57 cases were taken. The aim of the study was to establish diagnostic role of voided urine cytology, ultrasonography and cystoscopy in urothelial cancers. Out of 57 cases, cytological diagnosis was positive in 53 cases (93%) and negative in 4 cases (7%). There were no atypical or suspicious cases. Of the total cases, cytology was negative only in 7% cases. Among 42 invasive carcinomas 14 (33%) grade III invasive flat carcinoma, one (2%) invasive papillary adenocarcinoma and two (5%) invasive squamous cell carcinoma, each of them gave 100% positive cytology. Of the remaining 25 (60%) invasive papillary TCC, 21 were in grade II and 4 were in grade III. They gave 90% and 100% positive cytologic results. Ultrasonogram of urinary bladder gave 95% (approx.) positive results and out of 57 cases, 3 cases failed to give positive results in ultrasonogram (USG) of the urinary tract. Cystoscopy detected tumor mass in 98% cases and it gave false negative result in 2% cases. Fifty-two tumors had a diameter ranging 1.1- 6 cm. Single lesions were seen in 40 cases, double lesion in one case and multiple in 13 cases. The probability of later invasive carcinomas nearly tripled in-patients with multiple lesions on presentation (13.6%) compared with those who presented with a single lesion (4.6%). Consistent with previously published data, this study showed the highest diagnostic accuracy with high-grade tumors and lowest with low-grade tumors. So in a proper clinical setting, non-invasive technique like voided urine cytology and ultrasonography could be done as a first line cost effective method in the diagnosis of urothelial cancers.TAJ 2017; 30(2): 39-46

A CASE SERIES OF SARCOMATOID TRANSITIONAL CELL CARCINOMA OF RENAL PELVIS AND COLLECTING DUCT CARCINOMA OF KIDNEY

Sarcomatoid transitional cell carcinoma (TCC) of the renal pelvis and collecting duct carcinoma (CDC) of the kidney are rare types of malignant renal tumors with aggressive behavior. Here, we report a case series of these tumors, in males of age 65 years and 72 years, respectively. In both the cases, the left kidney was affected and they underwent the left-sided radical nephroureterectomy. Histologically, sarcomatoid TCC showed two components with invasive TCC and areas with spindle cells and osteoclastic type of giant cells. The immunohistochemistry showed diffuse positivity for CK7 and negativity for CK20 and p63 in both the components. CDC showed tubule-papillary patterns with marked desmoplasia. The patients were disease free after a follow-up of 12 months and 2½ years, respectively, without any adjuvant therapy.

Results of Postoperative Instillation of Mitomycin C in Non Muscle Invasive Bladder Cancer after Complete Resection Versus BCG (Recurrence and Progression)

AbstractBackground: Intravesical immunotherapy or chemotherapy for non-muscle invasive bladder cancer is a well-established treatment for preventing or delaying tumour recurrence after tumour resection. However, up to 70% of patients may fail. New protocols and new intravesical agents with improved effectiveness are neededAim of Study: Is to evaluate the oncological outcome as regard progression, local recurrence and side effects of non-muscle invasive transitional cell carcinoma of the urinary bladder managed by complete resection followed by postop-erative intravesical instillation of Mitomycin C compared with BCG.Patients and Methods: This is a prospective study that included 51 patients with non-muscle invasive TCC bladder (Ta and T1) at Urology Department, Al-Azhar University hospitals between 2011 and 2015. Patients divided into two groups, the Mitomycin group received immediate MMC and periodic 6 doses of MMC and the other group, BCG received 6 doses of BCG one dose per week. Follow-up by cystoscope for two years at 3th, 6th, 9th, 12th, 18th, 24th month to detect the recurrence, progression and side effects.Results: The mean age of the patients was 60.58 (37 yrs. - 79 yrs.) in the MMC group and 61.76 (48 yrs-83 yrs) in the BCG group. The main comparison in this study is recurrence rate and progression rate of the tumor. Three patients (11.5%) had recurrence in the 1st year while four patients (15.4%) in the 2nd year with total recurrence seven patients (26.9%) in MMC group.In the BCG group, patients who had a recurrence in the 1st year were, two patients (8%) and three patients (12%) in the 2nd year with total recurrence, five patients (20%).The total progression in two years were 4 pts (15.38%) (One patient (3.8%) in the 1st year) (3 patients (11.5%) in the 2nd year) in the MMC group while were 4 pts (16%) (One patient (4%) in the 1st year) (year 3 patients (12%) in the 2nd year) in the BCG group.Conclusion: Our study confirmed the positive effect of immediate Mitomycin C intravesical instillation in patients who received periodic Mitomycin C instillation and either the positive effect of intravesical instillation of BCG in patients with non-muscle-invasive bladder tumors. Our present study showed that MMC and BCG equally reduced recurrence and progression in NMIBC patients while showed the superiority of MMC regarding to the adverse effects.

Partial cystectomy and bilateral ureteroneocystostomy for resection of invasive transitional cell carcinoma involving the trigone area of the bladder in a dog - case report

ABSTRACT This study aims to report the technique of partial cystectomy and bilateral ureteral reimplantation for resection of transitional cell carcinoma (TCC) in the trigone region of the bladder and the long-term follow-up in a Bernesse Mountain dog. The proposed surgical technique was considered viable and a potential treatment option for TCC in bladder trigone, with benefits regarding the prevention of urinary tract obstruction due to neoplastic growth and local removal of the primary tumor, which may limit or delay the spread of the disease even without adjuvant chemotherapy. The main disadvantages related to the described technique are ureteral stricture, intermittent cystitis and local relapse. However, the results are acceptable considering the long-term survival of 610 days in the case described.