Nonurothelial Tumors Research Articles

Incidence of Pathological Types of Urinary Bladder Tumors Diagnosed at Ain Shams University Hospitals

Abstract Background Bladder cancers are the most common genitourinary malignancy in both males and females. They are broadly categorized as urothelial and non-urothelial tumors. The response to treatment and the overall survival among the cases with cancer bladder depend greatly on the pathological type of the tumors. Objective Detection of the incidence of different pathological types of bladder tumors diagnosed at Ain Shams University Hospitals. Patients and Methods This retrospective study was conducted by reviewing the medical records of patients admitted and treated for urinary bladder cancer along five years duration from January 2017 to December 2021. We applied our study on 1000 patients. Results TCC was the most common type among our cases 945 (94.5%) followed by SCC 1.5%, adenocarcinoma 1.0% and others (3.0%). As regard lymph nodes, metastasis and type of treatment, our study revealed that they were negative or couldn't be detected in 90% of cases that proved that the majority of urinary bladder tumors are usually localized with less liability of spread so most of cases (74%) treated by follow up cystoscopy with less need for radical cystectomy or chemo-radiotherapy. However, most of the SCC cases were positive lymph nodes (66.7%) with positive metastasis (66.7%) and required radical cystectomy. Most of tumors were located in posterior and posterolateral (right and left) parts of the urinary bladder. Bladder tumors were more frequent in age group of 57.34 ± 15.08 years with male predominance (86.0%). Conclusion Screening of bladder tumors should be scheduled for high risk cases.

Histological Spectrum of Urinary Bladder Biopsies with Special Emphasis on Unusual Non-urothelial Tumours

Histological Spectrum of Urinary Bladder Biopsies with Special Emphasis on Unusual Non-urothelial Tumours

Clinical Outcomes of Patients With Variant Histology of Urothelial Carcinoma After Radical Cystectomy

Purpose: The efficacy of standard chemotherapy or radical cystectomy in patients who have urothelial tumors with variant histology (VH) is very limited in terms of their prognosis. This study aimed to investigate the prognosis of bladder cancer (BC) patients with VH who underwent radical cystectomy (RC).Materials and Methods: We retrospectively evaluated 327 BC patients who underwent RC at Pusan National University Yangsan Hospital between February 2010 and June 2021. VH was categorized into less and more aggressive types according to the patient’s mortality risk relative to pure urothelial carcinoma (PUC). More aggressive types included micropapillary, plasmacytoid, and sarcomatoid variants. Less aggressive types comprised other variant types, including squamous differentiation, glandular differentiation, lipoid, and nested. Small cell carcinoma, pure adenocarcinoma, pure squamous cell carcinoma, and lymphoma BC were excluded from analysis. The progression-free survival (PFS) and overall survival (OS) rates were evaluated using Kaplan-Meier analysis and Cox regression.Results: After the exclusion of nonurothelial tumors, data from 299 patients were available for analysis. We identified 244 (74.6%) and 55 patients (16.8%) with PUC and urothelial carcinoma with VH, respectively. VH patients were categorized as having less aggressive (n=35) and more aggressive (n=20) types. Univariate analysis identified significant differences in PFS (p=0.031) between patients with PUC (n=244) and more aggressive VH (n=20). Multivariate analysis showed that more aggressive VH was significantly associated with OS and PFS. In the Kaplan-Meier analysis, a statistically significant difference was observed between PUC and more aggressive VH in OS and PFS.Conclusions: VH patients with more aggressive types showed more advanced TNM stages at presentation than PUC patients. Pathological upstaging after RC was more common in VH patients. Among VH patients, the presence of a more aggressive VH type can be an independent predictor of progression after RC, with a worse prognosis than that of PUC patients.

Rare histological subtypes of bladder cancer in clinical practice: a case series

Non-urothelial tumors account for less than 5% of all bladder malignant neoplasms. The most common non-urothelial tumor is squamous cell carcinoma, often found in the Middle East (about 30% of all cases of bladder cancer BC) due to the spread of schistosomiasis. The glandular type is the second most common non-urothelial morphological variant; it includes 5 tumor subtypes (intestinal, mucinous, signet ring cell, mixed, and adenocarcinoma not otherwise specified). The neuroendocrine variant is divided into 4 subgroups (small cell, large cell, highly differentiated, and paragangliomas), of which small cell is the most common, though still rare, and accounts for only about 1% of all BCs. The article presents the clinical cases of three rare BC subtypes: squamous cell, glandular, and neuroendocrine. In the first clinical case, a radical cure of a patient with signet ring cell BC was described: at the first stage, the bladder, prostate, and vesicles were removed with a cystoplasty using a small intestine segment according to the Bricker technique with an extended pelvic lymph node dissection; the second stage included 8 courses of adjuvant drug treatment according to the XELOX regimen. In the second clinical case, the treatment of the metastatic neuroendocrine BC was described using the following regimens: EP (etoposide + cisplatin), carboplatin + irinotecan, GemOx (gemcitabine + oxaliplatin). The third clinical case described a patient with bladder squamous cell carcinoma. The stage I treatment was based on the GC regimen; at stage II, the bladder, prostate, and vesicles were removed with intestinal orthotopic cystoplasty and extended lymph node dissection; due to progression revealed during the follow-up examination, the patient received another GC course. Although non-urothelial BCs are very rare, studies are currently being conducted on the effectiveness of immunotherapy and targeted therapy in treating this cohort of patients.

URINARY BLADDER LEIOMYOSARCOMA --- A RARE CAUSE OF HEMATURIA

Cases of bladder leiomyosarcoma represent 0.1% of all nonurothelial tumours. Nonurothelial neoplasms of the bladder account for <5% of all bladder tumours. Urinary bladder leiomyosarcoma is a very rare entity with few cases reported in the literature. Given its scarcity, little is known about its etiology and consensus lacking on therapeutic management. Here we present the case of a 36year old female patient diagnosed with bladder leiomyosarcoma and then treated with partial cystectomy of the bladder and bladder reconstruction with bilateral pelvic lymph node dissection..

Urinary Bladder Cancer in Bladder Exstrophy and Epispadias Complex: A Swedish Register Study and a Systematic Review of the Literature

Abstract The congenital malformation bladder exstrophy and epispadias complex involves multiple organs and includes 3 subtypes: epispadias, classic bladder exstrophy, and cloacal exstrophy. The risk of urinary bladder cancer is known to be higher in individuals with classic bladder exstrophy and appears at a younger age compared with the general population. Purpose: The purpose of this study was to evaluate urinary bladder cancer in individuals with bladder exstrophy and epispadias complex. Materials and Methods: We performed 2 studies, a Swedish register-based case series reporting 12 novel cases and a systematic review summarizing published cases thus far. MEDLINE, EMBASE, Web of Science, and Google Scholar were searched in January 2022 following the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Publications reporting at least 1 case of bladder exstrophy and epispadias complex with urinary bladder cancer were eligible. Ninety-seven publications were included, reporting 165 cases. Results: The main result from the register study was the tumors being predominantly urothelial. Conversely, earlier published cases from the literature had a nonurothelial tumor type in 95%, whereof the majority were adenocarcinomas. Both substudies consistently indicate a young age at cancer diagnosis, with the majority being younger than 65 years. Conclusions: Urinary bladder cancer affects individuals with bladder exstrophy and epispadias complex at a young age. The most common tumor type in the register study is urothelial. The divergence between the 2 substudies in tumor types could reflect a slightly older age in our case series, likewise a possible publication bias.

Occurrence and prognostic significance of different histology relative to urinary tract tumors: A SEER population-based study.

485 Background: To evaluate the prevalence and prognostic value of variant histology in urinary tract tumors according to primary location and metastatic status. Methods: Using the Surveillance, Epidemiology, and End Results registry (SEER, 2004-2015) databases, patients with urinary tract tumors were identified. Propensity Score Matching was used to balance the clinicopathologic features between different histologies. Kaplan-Meier plots were used to compare the cancer specific survival (CSS) and overall survival (OS) of different histologies. The cox regression analysis were also applied. Results: Of all 93,200 eligible patients with urinary tract tumors, 87,323 (93.7%) harbored bladder cancer (3,685 in M1 stage). Among them, urothelial tumors (UC) accounted for 96.67%, followed by squamous neoplasm (SCC), urachal carcinoma (Urachal), adenocarcinoma (Adeno), neuroendocrine tumors (NE) and tumor of Müllerian type (Müllerian). A total of 5877 (6.35%) harbored upper urinary tract tumors (950 in M1 stage). Among them, UC accounted for 96.39%, followed by SCC, Urachal, Müllerian, NE, Adeno. In patients with localized diseases, those with non-urothelial tumors had significantly worse prognosis in overall urinary tract tumors based on OS and CSS (P<0.001). In terms of specific histology in bladder cancer (BC), patients with UC had most favorable prognosis, followed by Adeno, Urachal and Müllerian, while those with SCC and NE were associated with the worst survival outcomes. In patients with upper urinary tract tumors (UUTT), those with Müllerian had the best survival outcomes, followed by UC, while those with NE, Adeno, SCC, and Urachal had relatively worse prognosis. In M1 stage, although there was a statistical difference in OS and CSS between all patients with urothelial and non-urothelial tumors (P<0.001), the 5-year survival rate (3.74%, 2.50%) and 5-year CSM (4.93%, 3.28%) were similar. In metastatic BC, there was no difference in OS among all histology. However, in terms of CSS, significant differences were still observed in patients with different histologies. In metastatic UUTT, no difference in survival was found among different histologies. After PSM, the similar results were observed in BC, while there is no statistical difference of survival among different histologies in UUTT, no matter the M stage. Cox analyses revealed that primary location, histology type, surgery, chemotherapy and M stage were the common and strong independent prognostic factors in both BC and UUTT. Conclusions: In urinary tract tumors, the incidence of different histology types between BC and UUTT is roughly similar. Overall, patient with variant histology have a worse prognosis than those with urothelial carcinoma. However, differences in survival among the histology types vary by primary location and metastatic status, especially the metastatic status.

El estado inmunológico-inflamatorio-nutricional predice los resultados oncológicos tras la cistectomía radical por carcinoma urotelial de vejiga

ObjectiveTo perform the first investigation of the role of immune-inflammatory-nutritional status (INS) on oncological outcomes in patients undergoing open radical cystectomy (ORC) for urothelial carcinoma (UC). Materials and methodsThe records of consecutive patients who underwent ORC for non-metastatic bladder cancer between 2009 and 2020 were retrospectively analyzed. Neoadjuvant chemotherapy, non-urothelial tumor biology, and absence of oncological follow-up were exclusion criteria. Systemic immune-inflammatory index (SII) and prognostic nutritional index (PNI) values were calculated and optimal cut-off values for these were used to designate four subgroups: «high SII-high PNI», «low SII-high PNI», «low SII-low PNI», and «high SII-low PNI». The low SII-high PNI INS group had best overall survival (OS) rate while the remainder were included in non-favorable INS group. Survival curves were constructed, and a multivariate Cox regression model was used for OS and recurrence-free survival (RFS). ResultsAfter exclusions, the final cohort size was 173 patients. The mean age was 64.31±8.35 and median follow-up was 21 (IQR: 9-58) months. Optimal cut-off values for SII and PNI were 1216 and 47, respectively. The favorable INS group (low SII-high PNI, n=89) had the best OS rate (62.9%). Multivariate Cox regression analysis indicated that non-favorable INS (n=84) was a worse independent prognostic factor for OS (HR: 1.509, 95% CI: 1.104-3.145, P=.001) and RFS (HR: 1.285; 95% CI: 1.009-1.636, P=.042). ConclusionPreoperative assessment of INS may be a useful prognostic panel for OS and RFS in patients who had ORC for UC.

Immune-inflammatory-nutritional status predicts oncologic outcomes after radical cystectomy for urothelial carcinoma of bladder

ObjectiveTo perform the first investigation of the role of immune-inflammatory-nutritional status (INS) on oncological outcomes in patients undergoing open radical cystectomy (ORC) for urothelial carcinoma (UC). Materials and MethodsThe records of consecutive patients who underwent ORC for non-metastatic bladder cancer between 2009 and 2020 were retrospectively analyzed. Neoadjuvant chemotherapy, non-urothelial tumor biology, and absence of oncological follow-up were exclusion criteria. Systemic immune-inflammatory index (SII) and Prognostic Nutritional Index (PNI) values were calculated and optimal cut-off values for these were used to designate four subgroups: “high SII-high PNI”, “low SII-high PNI”, “low SII-low PNI”, and “high SII-low PNI”. The Low SII-high PNI INS group had best overall survival (OS) rate while the remainder were included in non-favorable INS group. Survival curves were constructed, and a multivariate Cox regression model was used for OS and recurrence-free survival (RFS). ResultsAfter exclusions, the final cohort size was 173 patients. The mean age was 64.31 ± 8.35 and median follow-up was 21 (IQR: 9-58) months. Optimal cut-off values for SII and PNI were 1216 and 47, respectively. The favorable INS group (low SII-high PNI, n = 89) had the best OS rate (62.9%). Multivariate Cox regression analysis indicated that non-favorable INS (n = 84) was a worse independent prognostic factor for OS (HR: 1.509, 95%CI: 1.104–3.145, p = 0.001) and RFS (HR: 1.285; 95%CI: 1.009–1.636, p = 0.042). ConclusionPreoperative assessment of INS may be a useful prognostic panel for OS and RFS in patients who had ORC for UC.

Expression of Vitamin D Receptor (VDR) in Urinary Bladder Carcinoma: Immunohistochemical and Histopathological Study

Background: Bladder cancer is the most common malignancy of the urinary tract. Calcitriol [1,25 (OH)2vitamin D3] has anticancer effects mediated through binding to vitamin D receptor (VDR). The expression of VDR is present in many normal and cancer tissues. But, there is little information about its expression in urinary bladder carcinoma. This study aimed to analyze VDR immunohistochemical expression in 74 Egyptian patients with urinary bladder carcinoma and to evaluate its association with different clinicopathological parameters. Methods: Sections from formalin-fixed, paraffin-embedded tumor blocks were stained immunohistochemically using monoclonal anti-VDR antibody. VDR protein expression as well as its immunostaining patterns were recorded and scored separately in each case using semi-quantitative immunoreactive score. Results: VDR was consistently expressed in the included histologically normal urothelium while tumor cells showed variable degrees of expression. Cytoplasmic/membranous VDR expression was common among the studied cases especially those with urothelial morphology (p = 0.076). While, the mean nuclear VDR was significantly (p = 0.007) higher in non-urothelial tumors. Nuclear VDR was significantly associated with muscle invasion (p = 0.000) and tumor stage (p = 0.001) in urothelial carcinoma. It was also statistically related to tumor grade, stage and muscle invasion in non-urothelial tumors (p = 0.002, 0.003 and 0.012, respectively). Conclusion: there was a significant relation between nuclear VDR expression and prognostic markers suggesting its decrease as an indicator of a poorer prognosis. Vitamin D supplementation may represent a new treatment option for patients with bladder cancer.

PD43-12 WHAT PART DOES URETEROSCOPY PLAY IN THE DIAGNOSTIC PATHWAY OF UPPER TRACT TRANSITIONAL CARCINOMA? A TWO-YEAR REVIEW IN A HIGH-VOLUME INSTITUTION

You have accessJournal of UrologyBladder Cancer: Upper Tract Transitional Cell Carcinoma I (PD43)1 Sep 2021PD43-12 WHAT PART DOES URETEROSCOPY PLAY IN THE DIAGNOSTIC PATHWAY OF UPPER TRACT TRANSITIONAL CARCINOMA? A TWO-YEAR REVIEW IN A HIGH-VOLUME INSTITUTION Radha Sehgal, Shifa Wong, Yasmin Abu-Ghanem, Theodore Birks, Rajesh Kucheria, Darrell Allen, Anuj Goyal, Paras Singh, Leye Ajayi, and Gidon Ellis Radha SehgalRadha Sehgal More articles by this author , Shifa WongShifa Wong More articles by this author , Yasmin Abu-GhanemYasmin Abu-Ghanem More articles by this author , Theodore BirksTheodore Birks More articles by this author , Rajesh KucheriaRajesh Kucheria More articles by this author , Darrell AllenDarrell Allen More articles by this author , Anuj GoyalAnuj Goyal More articles by this author , Paras SinghParas Singh More articles by this author , Leye AjayiLeye Ajayi More articles by this author , and Gidon EllisGidon Ellis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002057.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy (URS) is an established diagnostic tool in the diagnosis of upper tract urothelial carcinoma (UTUC); it enables exclusion of UTUC in cases of diagnostic uncertainty and facilitates endoscopic kidney-sparing management in selected cases. However, its use is controversial due to the potential risk of tumour seeding into the bladder and delays incurred in the diagnostic pathway. We aim to review the diagnostic value of URS a large cohort of patients investigated for UTUC. METHODS: We performed retrospective review of diagnostic URS at our institution for suspected UTUC between January 2018 to December 2019. Demographics, CT urogram (CTU) findings, cytology and intra-operative appearances were obtained from electronic records. Histology was recorded from ureteroscopic biopsy and where applicable, final radical nephroureterectomy (RNU). RESULTS: A total of 161 diagnostic URS were performed for suspected UTUC. Patients presented predominantly with haematuria (42%). Pre-operative CTU w demonstrated a filling defect/lesion (48%), hydronephrosis (25%), urothelial thickening (21%) or no abnormality (6%), where URS was performed due to persistent haematuria or blood from the ureteric orifice at cystoscopy. Selective cytology was positive in 34 cases (27%). Urothelium was visually suspicious in 71 cases (44%) and biopsy results were malignant in 41 cases (25%). A diagnosis of UTUC was confirmed based on cytology and histology in 47 cases (29%). Of these, 31 patients (66%) underwent RNU, 14 patients (30%) underwent kidney-sparing management and 2 patients (4%) were unfit for further surgery. Two patients underwent RNU where the final histology was not UTUC (renal cell carcinoma and renomedullary interstital tumour). Following a negative URS, 68 patients (54%) were discharged or reassured and 8 patients (6%) were referred to other specialties for non-urothelial tumours. CONCLUSIONS: Diagnostic URS is crucial in accurately diagnosing and staging UTUC. Of the 47 confirmed cases of UTUC, 30% of patients underwent kidney-sparing management. RNU was avoided in 61% of patients who were subsequently discharged following negative URS or diagnosed with non-urothelial tumours. We conclude that in cases of diagnostic uncertainty and where kidney-sparing management is feasible, URS should remain in the diagnostic pathway of UTUC. Further research into diagnostic pathway delays and intravesical recurrence in this cohort is ongoing. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e735-e735 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Radha Sehgal More articles by this author Shifa Wong More articles by this author Yasmin Abu-Ghanem More articles by this author Theodore Birks More articles by this author Rajesh Kucheria More articles by this author Darrell Allen More articles by this author Anuj Goyal More articles by this author Paras Singh More articles by this author Leye Ajayi More articles by this author Gidon Ellis More articles by this author Expand All Advertisement Loading ...

A novel orthotopic murine model of neuroendocrine bladder cancer: Insights into the phenotypic plasticity of small cell bladder cancer (SCBC).

571 Background: SCBC is an aggressive subtype of bladder cancer with high metastatic potential and few effective treatment options. We developed an orthotopic mouse model of SCBC to understand the development of this rare bladder cancer variant and identify epigenetic drivers of neuroendocrine differentiation. Methods: Lentiviral particles carrying Cre recombinase were produced using Lenti-sgNeo#2/Cre. The bladders of Rb1fl/fl Trp53fl/fl MycLSL/LSL (RPM) mice was transduced with Cre recombinase expressing lentivirus via transurethral catheterization. Mice were monitored by micro-ultrasound (mUS) and detected tumors were verified by histology. SCBC morphology was confirmed by H&E staining and synaptophysin IHC. Whole transcriptome (RNAseq) analysis was performed to correlate transcriptomic profile of neuroendocrine mouse tumors to a cohort of human SCBC tumors. Results: Transurethral catheterization successfully transduced the bladder urothelium without evidence of exposure of ectopic (non-urothelial) tissues. RPM mice developed SCBC visible on mUS with a latency of 8-10 weeks. As expected in neuroendocrine tumors, mice developed liver and lung metastases. High grade neuroendocrine morphology and NE markers were confirmed on H&E and IHC, respectively, by a GU pathologist. Western blot analysis confirmed cMyc expression and suppression of TP53 and RB1. Synaptophysin expression was confirmed by IHC. Transcriptomic profiling of both mouse and human SCBC demonstrated concordant gene expression. Gene expression profiling of urothelial and non-urothelial neuroendocrine tumors suggested a phenotypic convergence. Conclusions: We developed a novel genetically engineered murine model of SCBC. Ongoing work seeks to identify epigenetic markers playing role in the development of this aggressive variant of bladder cancer. We are assessing the activity of immune checkpoint inhibitors in this immunocompetent background.

Tumores de vejiga no uroteliales , como reto diagnóstico y terapéutico

Introducción: El cáncer de vejiga se clasifica en general como urotelial y no urotelial. El no urotelial representa menos del 5% de todos los tumores vesicales y de estos el 90% son de origen epitelial, incluyendo: carcinoma de células escamosas, de células pequeñas y adenocarcinoma. El 10% restante es de origen no epitelial (linfoma, paranganglioma, sarcoma, etc.).
 Objetivo: Presentar la experiencia del cáncer de vejiga no urotelial y describir las características de los pacientes en nuestra institución.
 Materiales y métodos: Estudio retrospectivo y descriptivo de expedientes de pacientes con cáncer vesical no urotelial, diagnosticados y tratados en nuestro servicio de 2004 al 2016, obteniendo 7 casos.
 Resultados: 7 pacientes, 5 hombres y 2 mujeres. Edad 53 años (35-76). Síntomas principales hematuria 4, STUI 2 y mucosuria 1 . Histopatología: adenocarcinoma 3, carcinoma epidermoide 2, paraganglioma 1 y linfoma 1. Localización mas frecuente: domo vesical. Tratamiento: Adenocarcinoma (3): Cistectomía parcial 2, solo rtuv 1. Carcinoma epidermoide (2): 1 nefroureterectomía izquierda + cistoprostatectomía radical, 1 cistectomía radical + exenteración pélvica, ambos casos con RT adyuvante; Paraganglioma: 1 Cistectomía parcial laparoscópica asistida por robot, Linfoma: 1 rtuv + Quimioterapia + radioterapia. 2 defunciones por carcinoma epidermoide.
 Discusión: Dada la poca frecuencia de estos casos es difícil la estandarización entre el tratamiento y la histopatología, pero en general la cirugía es la mejor opción terapéutica para evitar la recurrencia y mejorar supervivencia, en algunos casos se recomiendan terapias conservadoras de órgano con terapias adyuvantes personalizadas a la histopatología.
 Conclusiones: El manejo de los tumores vesicales no uroteliales es complejo y requiere de un equipo multidisciplinario. Los tumores mas agresivos son epidermoides con alta posibilidad de extensión locorregional. La experiencia en México es limitada.

Bladder cancer survival: Women only fare worse in the first two years after diagnosis

ObjectivesIt has consistently been shown that women who are diagnosed with bladder cancer have lower survival than men, but the exact mechanism remains unknown. Most studies assumed that the sex-specific mortality ratio is constant over time, possibly resulting in inaccurate estimates in various periods of follow-up. This study aimed to investigate the sex-specific excess mortality in bladder cancer patients and its variation over follow-up time. MethodsObservational cohort study. Using data from the population-based Netherlands Cancer Registry, we studied 24,169 patients diagnosed between 2003 and 2014 with histologically confirmed ≥T1 bladder cancer with follow-up until January 2018. We used flexible parametric relative survival models to estimate excess mortality as a function of time for each sex and to explore the effect of covariates on these functions. ResultsFemale patients (24%) had worse clinical tumor, node, and metastasis-stage at diagnosis and more often a nonurothelial tumor histology. The excess mortality ratio of sex was not constant over time; in the first two years after diagnosis excess mortality rates for women were higher than for men, but lower thereafter; this applied to both nonmuscle-invasive and muscle-invasive bladder cancer subgroups. Baseline differences in age, tumor, node, and metastasis-stage and histology accounted for only part of the excess mortality gap. ConclusionsThe assumption of proportional hazards over time leads to underestimation of the excess mortality ratio for women in the first two years and overestimation thereafter, when excess mortality is comparable for women and men. Clinicians should incorporate the initial sex-specific poorer outcome in their considerations regarding prognosis and treatment options for female patients, e.g., more invasive treatment and neo-adjuvant treatment. These findings also point towards a mechanism of micrometastatic disease, warranting assessment of sex-specific efficacy in randomized controlled trials on treatments in this patient population.

Formidable Scenarios in Urothelial and Variant Cancers of the Urinary Tract.

Diagnostic and therapeutic challenges in the field of bladder and upper tract cancers provide opportunities for multidisciplinary care. Urothelial cancers make up the majority of the histologic subtype of bladder and upper tract cancers. Although the existence of variant histology, nonurothelial cancers, and urethral cancers is rare, these cancers pose a challenging clinical dilemma given the lack of well-defined consensus treatment guidelines. This review focuses on key issues of treatment: cisplatin ineligibility with emphasis on the definition, nuances of chemotherapy and frontline immune checkpoint inhibitor therapy, use of radiation in bladder-preservation strategies, upper tract urothelial cancer management, and highlights of urothelial variants and nonurothelial tumors and management.

Surgery after neoadjuvant chemotherapy for muscle invasive bladder cancer: clinicopathological and surgical outcomes

Background: Neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is the standard of care for muscle-invasive bladder cancer (MIBC) owing to the survival advantage, which has correlated with down-staging of the cancer to pT0. This approach is underused because it may be associated with increased perioperative morbidity and mortality rates. This study was designed to evaluate NAC plus RC regarding pathological response, perioperative morbidity and mortality outcomes. Methods: This is a prospective study that was carried out from August 2015 till July 2017 for patients with bladder carcinoma. We enrolled all cases with ≥ T2 bladder receiving NAC. Patients with metastatic disease, poor performance were excluded from this study.Results: pathological response rate and Complications occurred within 30 and 90 d after surgery. Heterologous blood transfusions, length of stay, readmission, and perioperative morbidity, and mortality were compared.Conclusions: Our results suggest that non-urothelial tumor showed no response to Platinum based combination chemotherapeutic regimens. NAC followed by RC gives no more perioperative complications.

Primary urinary bladder angiosarcoma with ascites

Non-urothelial tumors of the urinary bladder are rare. Sarcomas constitute less than 1% of all malignant neoplasms and angiosarcomas comprise 2% of all sarcomas [1]. We report a case of a 69-year old male with history of a low-grade prostatic adenocarcinoma for which he underwent external beam radiation therapy in 1/2010. He presented to the ER in 9/2015 with an abdominal distension and urinary retention and was found to have malignant ascites, hydronephrosis and a urinary bladder mass. Pathologic evaluation of the ascites and urinary bladder tumor revealed metastatic epithelioid angiosarcoma. Since the patient presented with an advanced stage inoperable disease, chemotherapy was initiated shortly thereafter. Unfortunately, the patient became septic and died 6weeks following the original diagnosis.

Histopathologic Differences between Jewish and Arab Population in Israel at First-Time Presentation with Bladder Cancer.

Background Pathology of urothelial carcinoma may vary in different populations at diagnosis. Our aim was to evaluate the histopathologic differences between Jewish and Arab patients in Israel at first diagnosis of urothelial cancer. Patients and Methods We retrospectively collected data of all patients with confirmed urothelial cancer, treated at our department between January 2010 and January 2015. We examined the distribution of the histopathologic data among the studied populations. To compare the categorical variables we used the Chi-Square Pearson test. Comparison of independent variables was made by Student's t-test. P value below 0.05 was considered significant. Results The study group included 413 patients, 345 Jews and 68 Arabs. The major differences were that Arab patients were younger (62.61 versus 68.55 years, P = 0.001), had more aggressive tumors that were detected at a more advanced stage, and had also a higher rate of metastatic disease (7.4% versus 3.2%, P = 0.05). Nonurothelial cell tumors were 2.3 times more prevalent in Arab population. Unlike Jewish population, Arab women had higher rate of invasive/metastatic disease compared with Arab men (40% versus 22.4%). Conclusion At time of diagnosis the tumors were more aggressive in Arab patients, especially in Arab women. The reasons for those differences constitute a target for a separate research. These results should have an impact on prevention medicine and education of physicians treating mixed populations.

871P - Incidence and Pattern of Second Neoplasms in Patients Diagnosed with Invasive Transitional Carcinoma of the Urinary Tract

ABSTRACT Aim: Few inherited familial syndromes include transitional cell cancer; however the field carcinogenesis is a common problem for patients diagnosed of transitional cell carcinoma. Besides smoking, other risk factors are associated with developing second neoplasms such as alcohol intake and aging. While there are some published studies about secondary smoking-related tumours in this population, data about the incidence of other not-smoking related tumours is limited. The objective of this study was to analyse the cumulative incidence of second neoplasms in this population and determine the type of second neoplasms: urinary tract vs not-related urinary tract. Methods: Retrospective analysis of 629 patients diagnosed with invasive transitional cell carcinoma of the urinary tract treated in a single medical center from 1999 to 2012. Patients with a follow-up shorter than 6 months were excluded. Synchronic prostate carcinoma were not included, tumours included in our analyses were those diagnosed during the follow-up. Cumulative incidence of secondary tumours was calculated by kaplan-meier. Results: Median age of patients was 67 years (30-87). Median follow-up time was 60 months. There were 45 patients who developed a second neoplasm (8%); 32 corresponded to non-urothelial tumours (71%) and 13 urothelial tumours (29%). The actuarial cumulative incidence of a second neoplasm was 27% at 10 years. Incidence of not-urinary tumours was 19% at 10 years. There were 14 cases of lung cancer (31,1 %) (2 oat cell and 12 NSCLC) 3 colon cancers (6,7%), 2 cancers of the rectum (4,4%), 2 renal cancers (4,4%), 2 Hepatocellular carcinomas (4,2%), 2 haematological tumours (4,4%), and 1 case of each of the following tumours: GIST, prostate, parotid, biliary track, glottis, thyroid, vagina and brain. The interval between the diagnosis of urothelial cancer and the second neoplasm was on average 46,88 months. Smoking was common in all patients with second neoplasms (93,3%). Conclusions: Diagnosis of second neoplasms is a major concern for this population, which is heavily exposed to risk factors, such as smoking. Specific follow-up is required as well as programs for smoking cessation. Disclosure: All authors have declared no conflicts of interest.

Leiomyosarcoma, a Nonurothelial Bladder Tumor: A Rare Entity With Therapeutic Diversity

A 22-year-old young woman presented with dysuria and lower urinary tract symptoms that had persisted for 6 months. She was diagnosed with a tumor near the bladder neck. Transurethral resection was done under anaesthesia. The histopathological examination with immunohistochemical staining showed the tumor to be a low-grade leiomyosarcoma. Adjuvant chemoradiation was given, and the patient has been doing well for 12 months of follow-up. Nonurothelial tumors of the bladder are rare and consensus is lacking regarding their definitive treatment. Furthermore, little is known about the natural history and prognosis of this type of bladder sarcoma. We present a minimally invasive treatment for this relatively rare tumor in which bladder preservation was achieved with no evidence of local or distant recurrences during the follow-up to date.