Non-papillary Tumor Research Articles

Metastasis of malignant melanoma to urinary tract: a case report

IntroductionMetastasis of malignant melanoma to urinary tract is reported to be rare. According to retrospective analysis of a single center study, improvement of overall survival was observed in patients with metastasis to the gastrointestinal tract that had undergone metastasectomy with curative intent. However, there is no significant evidence regarding resection for metastasis to urinary tract.Case presentationCase 1: an 86-year-old Japanese man was diagnosed with a small bladder tumor by computed tomography scan during post operative follow-up of malignant melanoma in the choroid of the left eye. Cystoscopy revealed black, nonpapillary tumors, suggesting metastatic malignant melanoma. Because no apparent invasive growth to muscle layer was observed by magnetic resonance imaging, transurethral resection was performed. Pathological appearance was compatible with metastatic malignant melanoma. No recurrence in urinary tract was observed; however, multiple liver metastasis was diagnosed at 3 months after surgery. Case 2: a 57-year-old Japanese man was diagnosed with right hydronephrosis due to ureteral tumor. He had a past history of subungual malignant melanoma to the left thumb 2 years prior to his visit. Right nephroureterectomy was performed, and pathological evaluation revealed metastatic malignant melanoma. He revisited 2 years later due to dysuria, and a large bladder tumor was revealed by ultrasound. Cystoscopy showed black-colored nonpapillary tumor, suggesting malignant melanoma. Total cystectomy was recommended; however, the patient withheld consent. Therefore, we performed transurethral resection. The resulting pathological finding was compatible with metastatic malignant melanoma without invasion to muscle layer. He remained free from local recurrence and metastasis for 22 years after surgery.ConclusionWe successfully performed metastasectomy for bladder and ureteral metastases without recurrence in the urinary tract. Long recurrence-free survival was observed in case 2. Complete resection for metastasis of malignant melanoma may have the potential to improve survival.

Does Bladder Cancer with Inchworm Sign Indicate Better Prognosis after TURBT?

Background: Inchworm sign is considered to be a characteristic finding in non-muscle invasive bladder cancer (NMIBC). Nevertheless, pathologically diagnosed muscle invasive bladder cancers (MIBCs) are occasionally diagnosed from tissue obtained by transurethral resection of bladder tumor (TURBT) in patients with inchworm sign. Methods: We retrospectively investigated the factors related to muscle invasive status in bladder cancer associated with inchworm sign and the role of inchworm sign in tumor outcomes following TURBT. Results: Of the 109 patients with inchworm sign, 94 (86.2%) and 15 (13.8%) were NMIBC and MIBC, respectively. Non-papillary tumors (hazard ratio (HR): 9.55, 95% confidence interval (CI): 2.07−44.10; p < 0.01) and tumors located in the bladder neck (HR: 7.73, 95% CI: 1.83−32.76; p < 0.01) were significant predictors of MIBC in bladder cancer with inchworm sign. Furthermore, recurrence-free survival (RFS) and progression-free survival were compared between patients with NMIBC with and without inchworm sign; however, no significant differences were found. In patients with NMIBC with inchworm sign, positive urine cytology was a prognostic factor for RFS (HR: 1.90, 95% CI: 1.04−3.48; p = 0.04). Conclusions: In bladder cancer with inchworm sign, 86.2% were NMIBC. Even in the case of inchworm sign, the presence of a non-papillary tumor or a bladder neck tumor before TURBT should be noted because of the possibility of MIBC. In this study, the inchworm sign was not a prognostic factor in patients with NMIBC.

Higher Expression of Annexin A2 in Metastatic Bladder Urothelial Carcinoma Promotes Migration and Invasion.

In this study, we aim to evaluate the significance of AnxA2 in BLCA and establish its metastatic role in bladder cancer cells. Analysis of TCGA data showed that AnxA2 mRNA expression was significantly higher in BLCA tumors than in normal bladder tissues. High mRNA expression of AnxA2 in BLCA was significantly associated with high pathological grades and stages, non-papillary tumor histology, and poor overall survival (OS), progression-free survival (PFS), and diseases specific survival (DSS). Similarly, we found that AnxA2 expression was higher in bladder cancer cells derived from high-grade metastatic carcinoma than in cells derived from low-grade urothelial carcinoma. AnxA2 expression significantly mobilized to the surface of highly metastatic bladder cancer cells compared to cells derived from low-grade tumors and associated with high plasmin generation and AnxA2 secretion. In addition, the downregulation of AnxA2 cells significantly inhibited the proliferation, migration, and invasion in bladder cancer along with the reduction in proangiogenic factors and cytokines such as PDGF-BB, ANGPT1, ANGPT2, Tie-2, bFGF, GRO, IL-6, IL-8, and MMP-9. These findings suggest that AnxA2 could be a promising biomarker and therapeutic target for high-grade BLCA.

Evaluation of the expression and role of adenosine receptor and programmed death ligand-1 in bladder urothelial carcinoma

Background Immune-checkpoint molecules are important regulators of physiologic inflammatory responses, and are highly effective in behavior of many cancers. They are involved in production of antitumor immune response. This study aims to evaluate the expression and role of both programmed death ligand-1 (PDL-1) and adenosine receptor (A2aR) antibodies in bladder urothelial cancer. Materials and methods This was a retrospective study on 45 bladder urothelial cancers obtained from archives of Pathology Department, Faculty of Medicine, Benha University and from International Medical Center Hospital (IMC) during the period from January 2015 to December 2019. Immunohistochemical expression of A2aR was evaluated and compared with those of PDL-1. A2aR expression was also correlated with tumor-infiltrating CD8+T cells. Relations to demographic data of the patients were evaluated. Results PDL-1 expression was detected in 24.4% of tumor cells±immune cells. PDL-1 was significantly related to advanced PT stage (P&lt;0.01), detrusor muscle invasion (P&lt;0.05), and nonpapillary tumor histology (P&lt;0.05). High expression of A2aR was detected in 40% of tumor specimens in tumor cells±immune cells. Higher A2aR expression was statistically significant related to higher tumor grade (P&lt;0.05), advanced PT stage (P&lt;0.01), detrusor muscle invasion (P&lt;0.01), and nonpapillary tumor histology (P&lt;0.01). The expression of A2aR was statistically significant related to PDL-1 expression (P&lt;0.01). Higher A2aR expression was statistically related to lower the density of tumor-infiltrating CD8+T lymphocytes (P&lt;0.01). Using receiver operating characteristic curve, A2aR was more accurate than PDL-1 as area under the curve (0.648 and 0.565, respectively). The specificity of A2aR is higher than PDL-1 (51.9 and 29.6, respectively). Conclusion Both PDL-1 and A2aR markers could be useful in monitoring urothelial bladder cancer immunotherapy. A2aR is higher to and more specific than PDL-1 in predicting tumor lymphocytic infiltrate. A2aR antagonists could have a positive role in cases that are resistant to anti-PDL-1 immunotherapy.

Implications of androgen receptor and FUS expression on tumor progression in urothelial carcinoma.

To examine the immunohistochemical expression of AR and FUS in urothelial carcinoma in relation to prognostic parameters and to extrapolate any possible link between the expression of both markers and tumor progression. Retrospective study using immunohistochemical staining for AR and FUS on (88) cases of urothelial carcinoma. AR shows statistically significant relations with late tumor stage, high tumor grade, and non-papillary tumor pattern. On the other hand, FUS expression correlates with early tumor stage, low tumor grade and papillary pattern. An inverse relation is found between AR and FUS expression (p=0.001). Cases with high AR IHC expression show statistically significant shorter OS, RFS and PFS compared to cases with low AR expression. Cases with high FUS IHC expression reveal statistically significant longer OS, RFS and PFS compared to cases with low FUS expression. FUS expression is associated with favorable prognostic parameters of UC. A possible interaction is suggested between FUS and AR pathways involved in urothelial cancer progression. Manipulating FUS levels and androgen deprivation therapy can provide new promising targets for treatment trials.

Impact of divergent differentiation in urothelial carcinoma on oncological outcome in patients with T1 high-grade bladder cancer.

T1 high-grade bladder cancer has a poor prognosis compared with other non-muscle-invasive bladder cancers. We investigated the clinical outcomes among patients with T1 high-grade bladder cancer to identify factors related to cancer recurrence and disease progression. We retrospectively reviewed the data of 148 patients who were diagnosed with T1 high-grade bladder cancer by transurethral resection from January 2001 to February 2015 at our institution. Clinicopathological factors were analyzed using univariate and multivariate analyses. The median age and follow-up duration were 72 years and 45.4 months, respectively. Sixty-two patients (41.9%) had recurrence, 28 (18.9%) experienced progression and 13 (8.8%) died of bladder cancer. In the multivariate analysis, divergent differentiation was an independent factor related to recurrence (P = 0.0096, hazard ratio = 2.5), whereas a non-papillary tumor shape, divergent differentiation and presence of a residual tumor at the time of the second transurethral resection were independent factors related to progression (P = 0.0349, hazard ratio = 3.8; P = 0.0074, hazard ratio = 6.8 and P = 0.0449, hazard ratio = 4.1, respectively). There were no independent factors related to cancer-specific mortality. Divergent differentiation was the only independent factor associated with both recurrence and progression. In addition, patients with divergent differentiation had significantly worse recurrence-free survival and progression-free survival rates than did patients without divergent differentiation (log-rank P = 0.0009 and P = 0.0019, respectively). In this study, the presence of divergent differentiation was related to worse oncological outcomes in patients with T1 high-grade bladder cancer. Patients with divergent differentiation may require stringent follow-up and early cystectomy after recurrence to improve oncological outcomes.

Huge left clear cell renal cell carcinoma present as right humeral pathologic fracture with predominant sarcomatoid change: A case and literature review

s / Urological Science 26 (2015) 301e310 304 urine retention for 3 months, anemia, and body weight loss 9 kgs. Except HIV infection, he had no other systemic disease. Due to detectable HIV viral load, the operation was delayed before visiting us. CT scan was done two months ago, revealing a 5 cm, round, heterogenous enhancement tumor, without lymphadenopathy. In our institute, transurethral resection of the bladder tumor (TURBT) was soon arranged after confirming his HIV viral load was undetectable. A large, broad-based, non-papillary tumor grew from bladder posterior wall was confirmed during the operation. However, the tumor size was much larger then 5 cm, which showed on the CT scan 2 months ago, and the total resected specimen was finally estimated to be 680 gm. After the operation, patient's recovery was smooth, and he was discharged on post-operative day 7. Final pathology report revealed inflammatory myofibroblastic tumor. There's no muscle invasion. Due to large broad-based tumor, and prolonged operation time with possible incomplete resection during 1st TURBT, 2nd-look TURBT was arranged one month later, and residual 35gm tumor was resected. The pathology report was the same. Conclusion: IMT is a rare tumor, and had been variously named before, such as inflammatory pseudotumor, plasma cell granuloma, atypical myofibroblastic tumor, and atypical fibromyxoid tumor. The pathogenesis of IMT remains obscure, with possible etiologies including autoimmune disease and infectious organisms. Controversy still exists that thether IMT is a truly neoplastic process, since its clinical course is generally indolent after surgical resection. Report showed local recurrence rate about 10%. No distant metastasis had been reported currently. Image findings are nonspecific and histologic confirmation is essential. The diagnosis should be differentiated from sarcomatoid carcinoma and leiomyosarcoma. IMT had been reported in lung, liver, spleen, testis, larynx, small bowel, CNS, lymph nodes, soft tissue of HIV/AIDS patients. To our best knowledge, this is the first case report of bladder IMT in an HIV patient. Some author suggested that IMT may be related to immune reconstitution inflammatory syndrome (IRIS) in HIV-infected patients receiving HAART, which is an augmentation of inflammation that can occur during immune reconstitution in an immunocompromised host. However, due to rarity of the cases, whether the incidence of IMT is higher in HIV patients is unclear. In conclusion, IMT is a tumor with borderline malignancy. Complete surgical resection is important to avoid possible local recurrence. For bladder IMT, TURBT is adequate according to literature. Close follow-up is required. NDP07: HUGE LEFT CLEAR CELL RENAL CELL CARCINOMA PRESENT AS RIGHT HUMERAL PATHOLOGIC FRACTURE WITH PREDOMINANT SARCOMATOID CHANGE: A CASE AND LITERATURE REVIEW Kai-Sheng Chan , Chi-Hao Hsiao , Chia Lang Fang , Liang-Ming Lee . Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pathology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan A 83 year old male presented to ER with progressive right arm pain for 1 month. Further image survey revealed osteolytic lesion of right humerus suspecting pathologic fracture. Whole body CT scan showed a tumor 15.7 cm x 12.6 cm with central necrosis at lower pole at left kidney suspecting renal cell carcinoma. Later surgery of ORIF revealed pathology of bone as metastatic renal sarcomatoid carcinoma. After surgery of open left radical nephrectomy, pathology report showed left clear cell renal cell carcinoma with no regional lymph node involvement, and sarcomatoid feature < 5%, pStage IV pT3aN0M1. The composition of sarcomatoid feature was described as a final common dedifferentiation pathway, caused by extensive chromosomal rearrangement, which does not represent a distinct subtype entity, but rather used to predict a worse prognosis than those without sarcomatoid differentiation. In addition, recent studies showed that a cutoff of greater or equal than 25% of sarcomatoid component represent significant predictor for worse prognosis. As a result, the treatment strategy designed for our patient was based on 2014 NCCN Guideline for Stage IV clear cell renal tumor; and Pazopanib was chosen over Sunitinib for better quality of life, with mainly less side effects of fatigue, hand-foot syndrome and mucosal inflammation. NDP08: RENAL SURGERY EXPERIENCE IN CHANG BING SHOW CHWAN MEMORIAL HOSPITAL ALMOST ONE YEAR Yuan-Tien Ting , Jungle Chi-Hsiang Wu, Cheng-Kuang Yang . Department of Urology, Division of Urology, Chang Bing Show Chwan Memorial Hospital, Taiwan; Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Taiwan; 3 Taichung Veterans General

Expression of OCT4A: the first step to the next stage of urothelial bladder cancer progression.

OCT4 (octamer-binding transcription factor) is a transcription factor responsible for maintaining the pluripotent properties of embryonic stem cells. In this paper, we present the results of studies to investigate the role of the OCT4 splicing variant in urothelial bladder cancer and the relationship between the OCT4 phenotype and the morphological parameters of tumor malignancy. Ninety patients who received a cystectomy for bladder cancer were enrolled. The expression of OCT4 protein was analyzed by immunohistochemistry. The ratio of OCT4-positive cells was the lowest in pT1 (pathological assessment (p)—tumor extent confined to mucosa (T1)) tumors and the highest in pTis (non-papillary tumor extent confined to urothelium) and pT2 (tumor extent including muscularis propria) tumors. Information about the percentage of OCT4A-positive tumor cells could facilitate choosing the treatment mode in borderline pTis–pT1 (crossing the border of the basement membrane; the first stage of progression) and pT1–pT2 (crossing the border of the muscularis propria; the second stage of progression) cases: a higher percentage of OCT4A-positive cells should support more radical therapy. A significantly higher percentage of cases with moderate OCT4 intensity was found in metastasizing (the third stage of progression) cases with >2 positive lymph nodes. The percentage of OCT4-positive cells was significantly higher for cancers with a high grade, higher non-classic differentiation number and greater aggressiveness of invasion. The differentiation, maturation and aggressiveness of tumor invasion appear to depend on the expression of the OCT4 phenotype in cancer cells, similar to the successive stages of malignancy progression in urothelial cancer.

A Case of Giant Bladder Carcinosarcoma without Submucosal Invasion

Carcinosarcoma is a rare biphasic neoplasia containing both malignant mesenchymal and epithelial elements. Bladder carcinosarcoma commonly presented as high-grade, advanced stage, and aggressive behavior with a poor prognosis. An 83-year-old male presented with painless gross hematuria to our hospital. Cystoscopy revealed massive nonpapillary bladder tumor on the right wall. The 91 g tumor could be completely removed with transurethral resection. Histology of the tumor was diagnosed as carcinosarcoma with no submucosal invasion composed of biphasic malignant epithelial and mesenchymal cells. Epithelial malignancy was urothelial cancer and mesenchymal one was chondrosarcoma and leiomyosarcoma. The specimens taken at the second-look TUR-Bt revealed that carcinoma in situ (urothelial cancer) but not sarcoma existed at the mucosa surrounding the previous tumor site. 80 mg of BCG instillation intravesically every week for six weeks was successfully administered to the patient. There is no tumor recurrence for 6 months after treatments.

播種性骨髄癌腫症を呈した前立腺癌の2例

Disseminated carcinomatosis of the bone marrow is caused by metastasis to the bone marrow and can cause disseminated intravascular coagulation (DIC), leucoerythroblastosis, and microangiopathic hemolytic anemia (MHA). The prognosis of this syndrome is poor. We report herein two rare cases of disseminated carcinomatosis of the bone marrow in association with prostate cancer. Case 1 involved a 61-year-old man admitted to our department with elevated prostate-specific antigen (PSA) levels. Prostate biopsy revealed prostate cancer, and imaging studies were performed. Under a diagnosis of prostate cancer (T3N1Mx), the patient was treated using hormonotherapy, but died 2 months after admission due to gastrointestinal bleeding of unknown cause, refractory DIC, and cachexia. Bone marrow biopsy after his death revealed metastasis of the prostate cancer to the bone marrow. Case 2 involved a 68-year-old man admitted to our department with gross hematuria. Cystoscopy revealed non-papillary tumor in the prostatic urethra. Transurethral biopsy was performed and histology identified prostate cancer. Treatment was initiated with hormonotherapy and zoledronate. After 8 months, he complained of general fatigue and blood testing identified anemia and thrombocytopenia. Bone marrow biopsy revealed adenocarcinoma in the bone marrow. Alternative androgen therapy and chemotherapy with docetaxel was started, and the patient recovered from pancytopenia and general fatigue.

Endoluminal metastasis of colon cancer to the urinary bladder via the ureter: Report of a case

A 67-year-old woman was admitted for intermittent gross hematuria. Her medical history included a right colectomy for cancer of the ascending colon and removal of metastatic nodes adjacent to the right internal iliac vessels, respectively at 63 and 65 years of age. Cystoscopy detected a semi-pedunculated, nonpapillary (3.5-4 cm diameter) tumor situated above the right ureteral orifice. The histological evaluation of the resected specimen revealed metastatic colonic adenocarcinoma. The history and pathological findings were consistent with a mechanism of endoluminal implantation of adenocarcinoma of the large bowel to the bladder via the right ureter.

IJU this issue

This issue contains seven Original Articles, four Editorial Comments, two Short Communications, and one Skills and Pitfalls. In general, chromophobe renal cell carcinomas (chRCC) are believed to have a more favorable prognosis than conventional RCC. Lee et al. (ChunCheon, Korea) analyzed the characteristics and prognostic importance of chRCC based on a large, multicenter experience. Surprisingly, the non-metastatic chRCC showed equivalent oncological outcomes compared to the conventional RCC. It is well recognized that T1 bladder cancer can be life-threatening in some cases. Using the cancer registration database of the Japanese Urological Association, Okajima et al. (Nara, Japan) found that non-papillary tumor appearance, positive urinary cytology and a tumor size greater than 3 cm were independent prognosticators, and claimed that these factors should be included in order to enable the assessment of risk criteria in cancer death from T1 bladder cancer. As not all men necessarily benefit from early secondary treatment for biochemical recurrence (BCR) after radical prostatectomy (RP), it is critical to properly select patients for adjuvant therapies in order to minimize side-effects and maximize their benefits. Moreir et al. (Durham, USA) developed and externally validated a new nomogram incorporating postoperative prostate-specific antigen nadir and other well-established predictors of BCR. Although high-intensity focused ultrasound (HIFU) is a minimally invasive therapy for prostate cancer (CaP), the most common adverse event reported during follow up is the formation of bladder outlet obstruction. Sumitomo et al. (Tokorozawa, Japan) introduced transurethral resection of the prostate immediately after HIFU treatment of CaP, which improved post-treatment urinary status without causing additional morbidity. Antimuscarinic agents have long been the drugs of choice for pharmacological treatment of overactive bladder. Using video urodynamics, Watanabe et al. (Mibu, Japan) demonstrated the efficacy of tolterodine ER for the treatment of neurogenic detrusor overactivity and/or low compliance bladder. Intracytoplasmic sperm injection has allowed patients with very few sperm to achieve fertilization, which leads to the possibility of cryopreservation of semen, even from patients with very low sperm counts. Bak et al. (Seoul, Korea) investigated the fate of patients with severely impaired semen status and warned that patients with severe oligozoospermia are at high risk of becoming azoospermic and hence sperm freezing should be encouraged as early as possible for this population. Electrosurgery is one of the most commonly used energy systems in transurethral prostate and bladder surgery. Chung et al. (Jeonju, Korea) identified several toxic and carcinogenic gases (1,3-butadiene, vinyl acetylene, and acrylonitrile) generated during transurethral resection of the prostate and vaporization. This important finding confirms the need for protective methods to be developed. Okegawa et al. (Tokyo, Japan) reported the usefulness of alternative hormonal therapy for treating resistance to first-line hormonal therapy, adding further evidence to the growing literature in this field. Prepubertal testicular tumors are different from their postpubertal counterparts in histopathological type and clinical behavior. Based on their 20-year experience, Hisamatsu et al. (Kobe, Japan) proposed a treatment algorism for this rare tumor in children. Complete hemostasis after transection of the dorsal vein complex (DVC) is an extremely important step during the course of radical prostatectomy. Sasaki et al. (Tokyo, Japan) found that bleeding from the DVC is easily controlled without suture ligation through a combination of a modest pneumoperitoneum with pinpoint coagulation of one or two small arteries that are found in the superficial layer of the complex. This simple technique can also be applied to the recent robot-assisted radical prostatectomy.

Editorial Comment to Cancer death from non‐muscle invasive bladder cancer: Report of the Japanese Urological Association of data from the 1999–2001 registry in Japan

The authors reported on 1919 clinical T1 (cT1) bladder cancer patients from the Japanese National Bladder Cancer Registry between 1999 and 2001, sponsored by the Japanese Urological Association. All survivors were followedup for at least 3 years (up to 5 years) and the 3-year cancer specific survival rate was 95.5%. The authors analyzed risk factors for bladder cancer death and concluded that large tumor size (>3 cm), positive urine cytology and nonpapillary tumor architecture were significant and independent risk factors. Histological grade is a well-known predictive factor for progression of non-muscle invasive bladder cancer. In the current study, however, the presence of a grade 3 lesion was not identified as an independent risk factor for bladder cancer death. This might be attributed to the lack of central pathology review and/or the relatively short-term follow up of the current study. Interestingly, urine cytology provided prognostic information on cT1 bladder cancer patients. Urine cytology reflects not only cellular atypia, but also the fragility of intercellular attachment of bladder cancer cells. Recent advances in translational research have shown that epithelial to mesenchymal transition (EMT) is critical for the progression of bladder cancer. During EMT of bladder cancer cells, expression of molecules determining epithelial features including E-cadherin and p63 is downregulated, leading to loosened intercellular attachment. At the same time, upregulation of mesenchyme-associated molecules, including Twist, Snail and N-cadherin, activates various oncogenic signaling pathways, increases cell motility and excretion of matrix metalloproteinases, and eventually promotes invasion and metastasis. Given these biological processes during progression of bladder cancer, it is conceivable that urine cytology provides prognostic value by reflecting EMT status. I look forward to further investigations to validate the prognostic value of urine cytology in non-muscle invasive bladder cancer patients.

Cancer death from non‐muscle invasive bladder cancer: Report of the Japanese Urological Association of data from the 1999–2001 registry in Japan

Our aim was to clarify the risk factors of cancer death in order to reduce mortality from T1 bladder cancer. The Japan registration database (1999-2001) was used for the analysis. Data were collected at least 3years after the initial diagnosis. Cause-specific survival using a Kaplan-Meier survival estimation with the log-rank method was evaluated. Univariate and multivariate analysis using the Cox proportional hazard model was also carried out. The 1997 TNM classification was used for pathological staging, and the 1973 WHO classification was used for pathological grading. There were 76 cancer deaths among a total of 1919 clinical T1 cases. Regardless of the subsequent treatment strategies, non-papillary tumor appearance, non-peduncular tumor stalk, multiple tumors, a tumor size greater than 3cm, positive urinary cytology and pathological grade 3 were found to be statistically significant in cancer death by univariate analysis. By multivariate analysis, non-papillary tumor appearance, positive urinary cytology and a tumor size greater than 3cm were confirmed as significant risk factors. Cancer death cases were found in 47.4% of worst-grade 2 tumors, and in 67.1% of predominantly grade 1 or 2 tumors. Non-papillary tumor appearance, positive urinary cytology and a tumor size greater than 3cm should be included to enable the assessment of risk criteria in cancer death from T1 bladder cancer.

Pediatric Thyroid Carcinoma: Incidence and Outcomes in 1753 Patients

To examine outcomes and predictors of survival for pediatric patients with thyroid carcinoma. The Surveillance, Epidemiology, and End Results (SEER) registry from 1973 to 2004 was queried for all patients with thyroid carcinoma less than 20 y of age. A total of 1753 patients with malignant thyroid neoplasms were identified with an age-adjusted annual incidence of 0.54 cases per 100,000 persons. There has been a significant increase in the annual incidence by 1.1% per y. Female patients outnumbered males 4 to 1. Tumors were classified as papillary (n=1044, 60%), follicular variant of papillary (n=389, 23%), follicular (n=165, 10%), and medullary (n=87, 5%). The majority of patients presented with localized and regional disease. Overall mean survival time (MST) was 30.5 y. The MST for females was 40 y, whereas males survived an average of 20.4 y (P=0.0001). Patients with medullary cancer had significantly shorter mean survival than those with papillary cancer (P=0.006). Surgical treatment significantly improved outcome. Multivariate analysis demonstrated that male gender, nonpapillary histology, distant disease, and no surgery were all independent prognostic factors of worse outcome. For patients with medullary thyroid carcinoma, radiation therapy was also identified as an independent predictor of lower survival. The incidence of pediatric thyroid cancer is increasing. Females have a higher incidence than males, but enjoy longer survival. Papillary thyroid cancer has overall excellent survival. Male gender, nonpapillary tumor, distant metastases, and nonsurgical treatment all predict worse outcome.

Ureteral small cell carcinoma

Ureteral small cell carcinoma is very rare; only eight cases have been reported in the literature. In this article, we report the ninth case of ureteral small cell carcinoma. A 79-year-old Japanese man presented with asymptomatic macrohematuria, and left nephroureterectomy was performed. The nonpapillary and broad-based tumor, which measured 3.7 x 3.7 x 2.0 cm, was seen in the lower portion of the left ureter just above the ureteral orifice. Microscopically, the tumor was composed of urothelial carcinoma and small cell carcinoma. Immunohistochemically, neoplastic cells of small cell carcinoma were focally positive for chromogranin A. In the normal ureteral mucosa adjacent to the tumor, some endocrine cells positive for chromogranin A and synaptophysin were identified. In conclusion, we suggest that endocrine cells in the ureteral urothelial epithelium may be precursor cells of ureteral small cell carcinoma.

Prognostic significance of non-papillary tumor morphology as a predictor of cancer progression and survival in patients with primary T1G3 bladder cancer

To investigate the prognostic significance of tumor morphology in relation to progression and survival in patients with primary T1G3 bladder cancer (BC) METHODS: After review of pathology, 194 patients who were diagnosed with primary T1G3 BC after clinically complete transurethral resection between 1989 and 2005 were seen. Of these patients, 144 underwent surveillance and 50 underwent immediate cystectomy. Tumor morphology (gross and microscopic) in addition to other clinicopathological factors such as tumor size, multifocality, lymphovascular invasion (LVI), carcinoma-in-situ (CIS), intravesical therapy, and the absence of proper muscle were evaluated with regard to recurrence, progression, upstaging, and survival. In addition, correlations between tumor morphology and other factors were analyzed. Median follow-up was 52.5 months. Five-year cancer-specific survival rates were 92.1% for entire cohort, 95.6% for surveillance group, and 84.0% for immediate cystectomy group, respectively. During surveillance, recurrence and progression were noted in 43.1, 13.2%, respectively. Of the potential prognostic factors analyzed, non-papillary morphology (both gross and microscopic) was a significant parameter of progression and intravesical therapy was significantly predictive of recurrence. After immediate cystectomy, 34% were upstaged. Non-papillary morphology and the absence of proper muscle were related to upstaging. For entire patients, non-papillary morphology and the absence of proper muscle were also significant predictors of patient's survival (P = 0.048, HR = 4.826, and P = 0.007, HR = 5.663, respectively). Non-papillary tumors were significantly related to the presence of LVI and CIS compared to papillary tumors. Non-papillary tumor morphology was a predictor of cancer progression and survival in patients with primary T1G3 BC.

Cystitis glandularis forming a tumorous lesion in the urinary bladder: A rare appearance of disease

We report a rare appearance of cystitis glandularis forming a tumorous lesion with blueberry spots in the urinary bladder. A 49-year-old woman was admitted to our hospital with pollakisuria and recurrent gross hematuria. Urine examination showed no pyuria. Computed tomography (CT) scan showed an extravesical invasive mass and cystoscopy revealed a non-papillary tumor with blueberry spots in the bladder. Transurethral resection (TUR) was performed. Histopathological examination revealed cystitis glandularis with cystitis cystica in the part. Postoperative CT scan and cystoscopy showed reduction of the mass in the bladder without any treatments. She is currently well with no evidence of tumor growth three months after TUR.

Invasive micropapillary carcinoma of the urinary bladder: An immunohistochemical study of neoplastic and stromal cells

A 66-year-old man complained of hematuria. A cystoscopy revealed a non-papillary tumor and radical cystectomy was performed. Macroscopically, an ulcerative lesion was observed. Microscopically, the neoplasm showed a mixture of urothelial carcinoma, squamous cell carcinoma and micropapillary carcinoma. Immunohistochemically, micropapillary carcinoma cells were positive for cytokeratins 7 and 20, carcinoembryonic antigen and CA125. Additionally, myofibroblasts were distributed in a chicken-wire pattern in the stroma of micropapillary carcinoma. Subsequently, the patient died of carcinoma 1 year after the onset of symptoms. Our results support the previous hypothesis that bladder micropapillary carcinoma runs an aggressive clinical course and suggest that micropapillary carcinoma may show the glandular differentiation of urothelial carcinoma and show the stromal reaction by myofibroblasts resembling that of carcinoma in other anatomic sites.

PROGNOSTIC SIGNIFICANCE OF ABSENCE OF PROPER MUSCLE IN THE RESECTED SPECIMEN OF PRIMARY T1G3 BLADDER CANCER

Purpose: According to the presence of proper muscle in the resected specimens from primary T1G3 bladder tumors, we compared the prognosis and investigated factors that were predictive of disease progression during the follow-up and upstaging after radical cystectomy. Materials and Methods: We reviewed the records of 157 patients who were diagnosed with primary T1G3 bladder cancer for the assessment and comparison of disease recurrence, disease progression and patient survival. There were 101 and 56 patients with and without proper muscle in the their transurethral resection (TUR) specimens (T1G3 and T1xG3, respectively); 30 and 20 of these patients, respectively, had undergone immediate cystectomy. Results: Among the patients who were followed up after transurethral surgery, there were no differences in the survival between the two groups. For the patients treated by immediate cystectomy, the 5-year cancer-specific survival was 100% for the T1G3 patients at a mean follow-up of 54.5 months while it was 76.6% for the T1xG3 patients at a mean follow-up of 46.0 months (p=0.042). With the absence of radiologic findings suggestive of invasive bladder cancer, 55.6% of the T1xG3 patients were upstaged after radical cystectomy, whereas only 12.0% of the T1G3 patients were upstaged (p=0.002). Between the followed-up group and the cystectomy groups, more patients in the cystectomy group had non-papillary shaped bladder tumor (75.0% vs. 38.9%, respectively, p=0.010). Similarly, the T1xG3 patients who progressed during follow-up or who were upstaged after radical cystectomy had more non-papillary shaped tumor than the patients who were without progression or upstaging (80.1% vs. 38.5%, respectively, p=0.006). Conclusions: For primary T1G3 bladder cancer, non-papillary shaped tumor without proper muscle in the resected specimen is a risk factor for the progression during follow-up or upstaging after radical cystectomy that should warrant consideration for repeated resection or early cystectomy. (Korean J Urol 2006;47:137-142)