Papillary Transitional Carcinoma Research Articles

ETS-1 oncoprotein expression is decreased in aggressive papillary transitional cell carcinoma of the urinary bladder: An immunohistochemical study

IntroductionETS-1 proto-oncogene is a transcription factor that plays multiple roles in the process of oncogenesis and helps in the process of tumor invasion. ETS-1 oncoprotein correlation with high grade and invasive tumors is controversial; as it is found to be upregulated with some tumors and down regulated with others. Expression of ETS-1 in urinary bladder carcinoma (UBC) and its correlation with tumor differentiation and invasiveness are still under-investigated. So far, there is no reliable prognostic marker has been proved for detection of the tumor progression and recurrence. ObjectivesTo analyze the correlation between ETS-1 oncoprotein immunohistochemical expression and the different stages and grades of the primary papillary transitional cell carcinoma of the urinary bladder. Patients and methodsThis is a retrospective cross sectional study that included archival material from 150 cancer cases and 24 control biopsies. ResultsThere was a decreased ETS-1 oncoprotein expression with increasing stage and grade of the tumor with a highly significant statistical correlation (P=0.001). With the quantitative assessment of the immunohistochemical results and using ROC (receiver operating characteristics) curve, cut-off values were found, that were associated with high grade and muscle invasive tumors (≤30% and ≤20%, respectively). ConclusionETS-1 oncoprotein is down regulated with high grade and highly invasive urinary bladder papillary transitional cell carcinomas. This oncoprotein may be used as an independent prognostic marker to predict the aggressive papillary transitional carcinomas with high invasive potential. More studies are needed to confirm our results.

COMPLICATIONS OF TRANSPERITONEAL RADICAL NEPHRECTOMY, A SINGLE CENTRE EXPERIENCE

Abstract Objective: To share our experience regarding compli-cations of transperitoneal radical nephrectomy. Material and Methods: After approval from ethical committee a retrospective study was conducted exten-ding from January 2012 to January 2014 to identify clinical characteristics of renal cell carcinomas, stag-ing of RCC, per operative and early post operative complications of transperitoneal radical nephrectomy. The study included all renal cancer patients presented to Sheikh Zayed Hospital Lahore with in this specified period. Detailed history and physical examination was performed. Haematological and radiological investi-gations including abdominopelvic ultrasonography, CT scan abdomen and pelvis were performed to stage the renal tumour. High resolution CT chest was per-formed where indicated. Radical nephrectomy perfor-med through transabdominal approach and outcomes measured in terms of pre and post operative complicat-ions. Results: There were total of 50 cases. The male to female ratio was 3:2. Mean age of patients was 52.38 (18 - 93) years. Most common clinical presentation was gross haematuria(66%).The mean tumour size was 8.34 (3 - 24) cm. Operative findings in 40 patients (80%) were tumor limited to Gerota's fascia and in 6 (12%) there was tumour involvement of renal vein or IVC. In 2 patients (4%) Lymphadenectomy was per-formed. Total operative time ranged between 120 to 180 minutes. Intra-operative splenic injury was seen in 2 (4%), while aortic injury was observed in one (2%) patient. Post operatively one (2%) developed pulmo-nary embolism, 2 (4%) chest infection while 2(4%) developed wound infection and 3 patients (6%) req-uired blood transfusion. Tumour histology was clear cell in (84%), papillary transitional cell carcinoma (12%) and oncocytoma contributed 4%. Conclusion: Transperitoneal approach for radical nephrectomy is safe with minimal peroperative and early post-operative complications. It is also safe whe-re tumour thrombus extends into IVC, as it provides good exposure of vessels. Key Words: Renal cell carcinoma, Radical nephrec-tomy, Complications.

Transitional Cell Carcinoma: A Case Report with Clinical, Histological and Cytological Findings

Papillary carcinoma of the uterine cervix with features reminiscent of Transitional Cell Carcinoma (TCC) of urothelial origin, is a poorly recognized subtype of cervical carcinoma. This tumour has a propensity for late metastasis and local recurrence, in spite of the fact that histologically it could be misinterpreted as CIN grade III with a papillary configuration or as a squamous cell papilloma. This tumour occurs mainly in post-menopausal females, it is potentially aggressive and it presents at a more advanced stage. Here, we are presenting a case of a 65-year-old female who presented with post-menopausal bleeding and pelvic pain, and underwent hysterectomy for pyometra. The cervix showed a focus of papillary transitional carcinoma.

Synthesis, in vitro cellular uptake and photo-induced antiproliferative effects of lipophilic hypericin acid derivatives

Hypericin, a naturally occurring hydroxylated phenanthroperylene dione, is used as a powerful photosensitizer for photodynamic therapy as well as a diagnostic tool for the fluorescence detection of flat neoplastic lesions in the bladder of patients. Both applications are based on the tumouritropic characteristics of the compound. To get more insight into some of the physicochemical properties of hypericin affecting its tumouritropic characteristics, we set out to synthesize a series of more lipophilic hypericins. For this purpose, a synthetic pathway to hypericin acid amides with hydrocarbon chains of different lengths stably attached by an amide bond at position C10 was explored. Hypericin acid proved inert in amide forming reactions, whereas the precursor protohypericin acid showed higher reactivity and resulted in the desired amide derivatives, which afterwards can be easily converted into their phenanthroperylene dione form. Hexyl-, octyl-, decyl- and dodecylamides of hypericin acid were successfully synthesized in this way. In vitro cellular uptake and photo-induced antiproliferative effects of the compounds were evaluated, using the human moderately differentiated non-invasive papillary transitional carcinoma RT-112 cell line. Whereas the more lipophilic amides were taken up limitedly, the hexylamide accumulated approx. as well as hypericin itself. From the antiproliferative data it can further be concluded that not only the cellular uptake, but also the light-induced activity, is affected by the introduced structural changes.

Immunohistochemical Expression of Keratin Proteins in Urinary Bladder Carcinoma

Transitional carcinomas of the urinary bladder were examined immunohistochemically for keratin proteins with the use of polyclonal antiserum (TK, 41-65 kDa) and 3 monoclonal antibodies (KL 1, 55-57 kDa; PKK 1, nos. 19, 18, 8; and K 8.12, nos. 16, 13). Umbrella cells gave particularly strong staining for TK, KL 1 and PKK 1, whereas they were negative for K 8.12. Basal- and intermediate-layer cells in urothelial epithelium were moderately positive for all keratins. Brunn's nests cells showed comparatively slight or moderate keratin staining, and K 8.12 staining of Brunn's nests was higher than in urothelial epithelial cells. Transitional carcinoma (grades I and II) indicated uniform keratin distribution, and staining was strong with TK, while that of KL 1, PKK 1 and K 8.12 varied, and grade III tumors showed the lowest intensity of staining. K 8.12 staining in papillary transitional carcinomas was strongly positive in basal located tumor cells, as compared with apical tumor cells. Squamous cell carcinoma was varying positive to keratin reactions dependent on the degree of keratinization. Heterogenity of keratin distribution in papillary transitional carcinomas was given between basal tumor cells and well differentiated tumor cells including umbrella-like cells.

Superficial bladder cancer. Risk of recurrence and potential role for interferon therapy

Superficial bladder tumors--cancer in situ (CIS) and papillary transitional carcinoma of the bladder--are the most frequent presentations of bladder cancer, the second most common disease of the urethelial tract. These superficial tumors demonstrate a tendency to recur, either at the same stage and grade or as deeply invasive tumors. To some extent, the likelihood of tumor recurrence can be predicted, based on certain risk factors. Furthermore, the probability of recurrence can be altered through appropriate clinical interventions. A review of the literature, much of which is preliminary, suggests that interferon therapy for bladder cancer may modify the biologic behavior of this disease and provide clinical benefit for some patients.

Hemangiopericytoma and Other Tumors of Urinary Tract of Guinea Pigs

Hemangiopericytoma, transitional cell carcinoma, squamous cell carcinoma and adenosquamous carcinoma developed in the urinary bladder of 6 of 95 guinea pigs of a noninbred stock and 16 of 87 guinea pigs of inbred strains 2 and 13 all gamma or X-ray irradiated. An additional 7 of 66 untreated guinea pigs of the two inbred strains also developed bladder tumors. Twenty-four guinea pigs had multiple tumors of the bladder. In the irradiated animals, the tumors arose significantly earlier but the increase in number of tumor bearing guinea pigs did not reach statistical significance. The tumors extended through the superficial muscularis into the underlying connective tissues and occasionally into lymphatic vessels and veins but none metastasized. Of 29 animals with tumor of the bladder, 21 had papillary proliferation of the renal pelvic mucosa, two papillary transitional carcinoma and one hemangiopericytoma. The EM and light microscopic criteria for the identification of hemangiopericytoma are described.

ABH isoantigens and the normal and tumorous urogenital tissues (author's transl)

The study was done with the use of specific red cell adherence test (SRCA), a modification of Coombs' mixed cell agglutination test, to examine the presence or abscence of ABH isoantigens in normal urogenital tissues, as well as their change in the evolution of carcinoma in those tissues.1) The ABH isoantigens were strongly present in the glomerulus and the collecting duct of the kidney, the transitional epithelium of the pelvis, ureter, bladder, and urethra, and weakly in the seminal vesicle and epididymitis, but are absent in the tubulus in the kidney.2) The ABH isoantigens are present in 22 of 30 cases of benign prostatic hyperplasia, but only in 2 of 23 cases of prostatic cancer.3) In the bladder, the ABH isoantigens are present in 11 of 16 cases of normal epithelium, 2 of 2 cases of the Brunn's nest, 0 of 1 cases of ca, in situ, 16 of 48 cases of low grade tumor, and 0 of 11 cases of high grade tumor. This study comfirmed the previous findings in other organs; the loss of tissue ABH isoantigens corresponds with the degree of anaplasia.4) Positive ABH isoantigens in the low grade papillary transitional carcinoma of the bladder seemed to correlate well with low incidence of tumor recurrence as 3 of 12 cases with positive ABH isoantigens showed recurrence for at least 3 years, while 17 of 23 cases without ABH isoantigens did so. The 2 cases, in whom the cancer became eventually invasive and caused cancer death, did not show ABH isoantigens even in their original low grade tumor. SRCA is an immunohistological method that is expected to improve the diagnosis, therapy and survival in the low grade bladder cancer.