Transitional Cell Cancer Research Articles

Complications Subsequent to Urinary Tract Stent Placement: An Overview Focusing on the Imaging of Cancer Patients.

Ureteral involvement by a tumor is common, and both partial and complete obstructions can result in symptoms that are distressing and debilitating, especially in cancer patients for whom the resection of the primary tumor is not considered an option. Maintaining ureteric patency in these patients is a challenge. In addition, in cases where a patient has undergone nephroureterectomy due to primary transitional cell cancer, it becomes necessary to decompress the urinary tract to preserve the contralateral kidney from irreversible damage. This is possibly due to ureteral stenting, both retrograde and anterograde, and percutaneous nephrostomy (PCN). Since imaging plays an important role in the routine monitoring of stents, their more and more increasing use requires radiologists to be familiar with these devices, their correct position, their potential complications, and their consequences. The aim of this review is to offer a comprehensive review of the imaging features of some urinary stents and to show the complications encountered in cancer patients as a direct consequence of an invasive diagnostic or therapeutic procedure. Specifically, we focus on ureteral stents and PCN.

Resection of Solitary Lung Metastasis of Urinary Tract Transitional Cell Cancer Can Prolong Survival in Selected Patients

There are only a few small published studies on pulmonary metastasectomy for urinary tract transitional cell carcinoma (TCC). In this study, we examined the long-term outcome and the prognostic survival factors associated with pulmonary metastasectomy of urinary tract TCC, as based on our centre's 20-year experience. Between 2000 and 2020, curative pulmonary metastasectomy was performed in 18 patients (14 males and 4 females). Clinical, demographical and surgical data were retrospectively analysed. The disease-free interval between treatment of the primary tumour and pulmonary metastasectomy ranged from one to 48 months. Survival analysis was conducted with the Kaplan-Meier method and log-rank test. The 3- and 5-year survival rates were 84.7% and 52.9%, respectively. Resection of solitary metastases was a positive and independent factor for survival (p=0.04). Pulmonary metastasectomy of urinary tract TCC is associated with a favourable outcome and solitary metastasis is associated with long-term survival. Surgical resection of solitary pulmonary metastasis and repeated lung metastasectomy by pulmonary recurrence from a urinary tract TCC is feasible in selected patients.

Clinical significance of the pathological type of tumor in common forms of ovarian cancer: A retrospective study

Background. Epithelial forms of ovarian cancer account for up to 90% of all ovarian malignancies. Epithelial forms of ovarian cancer are classified according to the WHO criteria of 2014 into several types: the most common are serous carcinomas (70%), mucinous carcinomas (3%), endometrioid tumors (10%), light cell cancer, transitional cell cancer, mixed and undifferentiated carcinomas are rare.
 Aim. To study the overall survival and progression-free survival depending on the stage of the disease, the pathological type of tumor and the degree of differentiation of tumor cells.
 Materials and methods. A retrospective analysis of the treatment of 467 patients with stage IIICIVB ovarian cancer in the Primorsky Regional Oncological Dispensary for the period from 2003 to 2021 was carried out. The obtained parameters were processed using standard statistical analysis methods using the IBM SPSS Statistics 26 program.
 Results. The overall results showed that the most favorable course of stage IIICIVB ovarian cancer has a serous type of ovarian cancer, probably due to its sensitivity to chemotherapy and aggressive surgical tactics. Patients with a mutation in the BRCA1/2 genes have a better prognosis in overall survival rates. BRCA1/2 mutations are associated with an improved response to chemotherapy with platinum-based drugs.
 Conclusion. The analysis made it possible to determine the most favorable prognostic factors for advanced stages of ovarian cancer, when comparing the groups of high-grade and low-grade IIIIV stage serous carcinoma, it was noted that the median overall survival, depending on the histological type, is better in the group of patients with low-grade IIIIV stage serous carcinoma. When comparing, depending on the timing of the operation performed, it can be noted that the median overall survival and median progression-free survival rates are better in the group of patients who received primary cytoreductive surgery.

The Impact of Histological Variants on Oncological Outcomes in Patients with Muscle Invasive Bladder Cancer Treated with Radical Cystectomy.

Bladder cancer is a heterogeneous entity characterized by a wide range of different morphologies. The aim of this study was to investigate the prognostic effect of bladder tumor with variant histology that is treated with radical cystectomy on oncological outcomes. One hundred eighty-six patients who underwent radical cystectomy between September 2001 and June 2020 were included in the study. The patients were divided into 2 groups variant histology group (n = 54) and transitional cell cancer group (n = 132). Clinicopathologic data were compared between the two groups. The groups were similar in terms of demographic characteristics. In the mul- tivariate analysis of cancer-specific survival in transitional cell cancer against variant histology, high-grade detection of primary transurethral bladder tumor pathology, cystectomy pT, cystectomy positive lymph node, and positive surgical margin in cys- tectomy were determined to be statistically significant. Diagnosis of pT2 and high grade of primary transurethral bladder tumor pathology, cystectomy ≥ pT3, cystec- tomy positive lymph node, and positive surgical margin in cystectomy were statis- tically significant in multivariate analysis of overall survival. Cancer-specific survival time was estimated at 65.1 ± 8.3 months for variant histology and 134.2 ± 10.4 months for transitional cell cancer (P=.004). The estimated overall survival time was 61.9 ± 8.0 months in variant histology and 119.0 ± 9.8 months in transitional cell cancer (P = .014). Pathological features and prognosis of bladder cancer with variant histol- ogies are worse than those of pure urothelial bladder cancer. Overall survival and can- cer-specific survival are shorter in bladder cancer with variant histology than in pure urothelial bladder cancer. Following the diagnosis of variant histology in transurethral bladder tumor, poor prognosis must be considered in the treatment plan.

The Immunohistochemical Staining of Vimentin and E-Cadherin in Bladder Cancer Patients Infected with Hepatitis C Virus

The invasion and spread of cancer cells are two of the most notable characteristics of malignant tumors. Recent studies suggest that the epithelial-mesenchymal transition (EMT) has been linked to this significant occurrence. It is linked to the absence of the epithelial brow and the presence of mesenchymal facial hair. The aims of the present study were to explore the immunohistochemical staining of vimentin and E-cadherin ex vivo as EMT markers and assess their potential as predictive biomarkers for transitional cell cancer (TCC). In this study, 55 paraffin-embedded biopsies from TCC patients and 10 autopsies that appeared to be normal were included. Immunohistochemistry was used to produce patterns of vimentin and E-cadherin expression. When compared to female patients, the expression of E-cadherin and vimentin significantly increased with increasing age in male patients (> 50 years). In contrast to the considerable rise in vimentin expression in higher grades and stages of the tumor, E-cadherin expression was significantly reduced with tumor stage and grade. The findings of this study reveal that elevated vimentin and reduced E-cadherin are important indicators associated with a poor prognosis for TCC.

S2156 When the Pseudopolyps End up Deceiving You: Transitional Cell Cancer Masquerading as Inflammatory Bowel Disease

S2156 When the Pseudopolyps End up Deceiving You: Transitional Cell Cancer Masquerading as Inflammatory Bowel Disease

ADXBladder molecular urine testing to risk stratify and prioritise management of suspected and known bladder cancers during the COVID-19 pandemic

Objective: COVID-19 has challenged diagnostic and surveillance pathways for suspected and known bladder transitional cell cancer (TCC). Exclusion of high-grade/invasive TCC by molecular urine testing could risk stratify patients for priority flexible cystoscopy and transurethral resection (TUR). We evaluated ADXBladder (ArquerDx), which has a high negative predictive value (NPV) for high-grade and ⩾ pT1 TCC. Patients and methods: Prospective cohort study of patients referred with haematuria for diagnostics or on TCC surveillance (Dec 2020–Feb 2021). Patients underwent ADXBladder testing, flexible cystoscopy and imaging (for haematuria), followed by TUR/biopsy as necessary. Clinico-radiological/pathology findings were compared with ADXBladder results. Results: Of 117 eligible patients, 39 and 78 had positive and negative ADXBladder tests, respectively. Of 15 suspected TCC on cystoscopy, eight were confirmed on TUR/biopsy. Overall ADXBladder NPV was 96.2% (CI: 91.0–98.4). NPV for high-grade and ⩾pT1 TCC was 97.4% (CI: 94.4–98.8) and 98.7% (CI: 95.0–99.7), respectively. Conclusions: Our ‘real world’ evaluation confirmed a high NPV for high grade and ⩾pT1 TCC using ADXBladder. Further larger studies are required to determine whether a negative ADXBladder test combined with negative imaging and patient risk factors may justify patient downgrading on timed diagnostic pathways. Level of evidence: IV

Radical Cystectomies at the University Teaching Hospital, Lusaka: Baseline Characteristics, Short-term Complications, and Role of Nursing Care

Bladder cancer is the ninth most common cancer in the world and the 11th most common cancer in Zambia. Bladder cancer is of three histological types, Squamous cell cancer, Transitional cell cancer, and Adenocarcinoma. The most common histological type in Zambia is Squamous cell cancer accounting for 60 percent of cases of muscle-invasive bladder cancer. The treatment of muscle-invasive bladder cancer is radical cystectomy, Lymph node dissection, and urinary diversion. Globally, radical cystectomy is associated with high morbidity and mortality. The most common diversion used was uretero-sigmoidostomy, accounting for 60 percent of cases. In our case series, the most common complications were wound dehiscence, hypo-proteinemia, bowel ileus, deep vein thrombosis, and electrolyte imbalance. Identification and prevention of complications associated with this procedure play a crucial role in improving survival for these patients. The role of nursing staff in the early recognition of these complications cannot be overemphasized.

English

BACKGROUND The advent of Multidetector Computed Tomography (MDCT) has created several important advances in the detection and characterization of renal masses due to its high accuracy, low cost, and easy availability. There is a growing need to separate benign lesions from malignant ones so as to provide an appropriate timely treatment. It can be used with contrast agents and helps in providing data during multiple phases along with the possibility of multiplanar image reconstruction anytime in the future. We wanted to study the role of CT imaging as a diagnostic modality for the evaluation of renal masses. METHODS This is a prospective study conducted among 50 cases, with clinically or radiologically diagnosed renal mass who were referred to our department . A detailed clinical history, thorough clinical examination, ultrasonography and multiphase - CECT using a Philips 128 - slice multi detector scanner (Ingenuity), were performed using the set - protocol followed by multiplanar reconstruction and detailed evaluation. Findings of CT scan were correlated with clinical / biopsy / surgical findings. RESULTS Renal cell carcinoma (RCC) was the most common renal mass in our study group (48 %) followed by renal cyst (30 %). The most common presenting symptom of RCC was haematuria (91.6 %) followed by flank pain (58.3 %). Renal cyst was a fairly common lesion with majority (93.3 %) being BOSNIAK - I category. RCC most commonly showed malignant extension via lymph nodes (83.3 %) while transitional cell cancer (TCC) most commonly spread via ureteric extension (75 %). Inferior vena cava (IVC) extension, even though seen only in a small fraction of cases (4 %), was only associated with RCC. On correlation with histopathological findings, a sensitivity of 95.8 %, specificity of 96.15 % and a diagnostic accuracy of 96 % was found, for diagnosing RCC in our study. CONCLUSIONS MDCT is a robust technique for detection and characterisation of renal mases. It is rapid and easily available with excellent patient compliance. MDCT has excellent sensitivity and specificity for characterisation of renal masses. KEY WORDS MDCT, Renal Mass, Renal Cell Carcinoma, Cyst, Attenuation, Enhancement

Recent trends in histopathological spectrum of malignancies among females in western Maharashtra

Introduction: Aim of this study is to evaluate the histopathological spectrum of female malignancies with a motive to understand the prevalent trends of this complex disease. Materials and Methods: This was a retrospective and prospective study carried over a period of three years. All female patients with histopathologically confirmed malignancies were included in the study. Result: Total of 1016 cases of malignant lesions were included of which majority were in age group of 40 to 69 years. Breast was the commonest site for primary malignancies followed by cervix. Oropharyngeal squamous cell carcinoma ranked third while colorectal carcinomas emerged as the fourth most prevalent malignancy followed by ovarian cancer. Infiltrating duct carcinoma of the breast was the commonest histopathologic type of malignancy. Majority of the cervical and oropharyngeal cancers were squamous cell type. Colorectal adenocarcinoma was the most common malignancy in the GI tract. Among skin malignancies, squamous cell carcinoma were the most prevalent type followed by basal cell carcinoma and malignant melanoma. Adenocarcinomas were the commonest lung lesions while papillary carcinoma was the most prevalent thyroid malignancy. Transitional cell cancers were the most frequent urinary bladder lesions while renal cell carcinomas were most common kidney malignancy. Conclusion: In spite of many recently developed diagnostic modalities; histopathological examination remains the gold standard for the diagnosis of malignant lesions. Hospital based Cancer Registries should be established since they provide data which can prove to be an invaluable tool to understand and plan effective remedial measures in the battle against cancer. Keywords: Histopathological spectrum, Malignancies in Females, Western Maharashtra.

Tulium laser in urothelial carcinoma of the bladder with spread to the ostium of the ureter

Urothelial transitional cell cancer in developed countries is the 4th most common. In terms of frequency, it is outstripped only by prostate, breast, lung, and colorectal cancer. In the vast majority of cases, urothelial carcinoma develops in the bladder. It accounts for 90—95 % of all cases of transitional cell cancer of the urinary tract. Much less often, in 5—10 % have to deal with its localization in the upper urinary tract (in the calico-pelvic system or ureter). In 17 % of upper urinary tract cancers, bladder cancer is simultaneously diagnosed. The incidence of urothelial transitional cell cancer has increased over the past few decades as a result of improved diagnosis and improved survival of patients with this nosology. The use of modern, high-tech equipment for visualization and direct surgical intervention contributes to such results. The use of laser energy as the main tool for tissue dissection in endoscopic oncourology reveals the undeniable advantages of this method in comparison with the traditional electrosurgery.We present a clinical observation of the diagnosis and surgical treatment of urothelial bladder cancer with invasion of the ureter, performed by en-bloc tulium laser. An operation was performed-transurethral resection of a urothelial bladder tumor with invasion of the ureter, performed by en-bloc tulium laser. Intraoperatively, ureteropieloscopy was performed, and the tumor did not spread to the upper urinary tract beyond the intramural part of the ureter. Thanks to the precision of the action of the tulium laser on the tissue, not resection, but, in fact, dissection of the bladder wall, a high-quality macropreparation was obtained, which made it possible to establish a final diagnosis. Histological conclusion: from the bladder — non-invasive urothelial cancer G2-3; from the mouth of the left ureter — fragments of fibrous tissue lined with urothelium from atypia. 3 months after the operation — no recurrence of urothelial cancer was revealed, which indicates a high quality of the operation.This clinical observation demonstrates the superiority of laser en-bloc dissection compared to the treatment of bladder tumors. Obtaining a macro-product of urothelial transitional cell cancer of the highest quality can contribute to avoiding unjustified radical nephrureterectomies and conducting organ-preserving treatment, for absolute and elective indications. The 1.94 µm Tulium Erbium laser is an effective tool for performing minimally invasive transurethral interventions in non-invasive bladder cancer.

Отдаленные результаты комбинированного лечения пациента, страдающего первично множественным местнораспространенным раком почки, уротелиальным раком мочевого пузыря и контралатеральной почки

A clinical case of the successful surgical treatment of patient with multiple primary cancers, including locally-advanced right renal cell cancer, transitional-cell cancer bladder cancer and metachronous transitional-cell cancer of the left kidney with one of the longest follow-up and survival time described in the literature.

Abstract A05: Expansion of tumor-infiltrating lymphocytes (TIL) using Iovance's Gen 2 process from advanced bladder cancer for adoptive immunotherapy

Abstract Background: Patients with advanced bladder cancer have limited therapeutic options, apart from cisplatin-based chemotherapy and use of immune checkpoint inhibitors (ICI). Median survival for patients with metastatic disease is 15 to 18 months. Hence there is a need for more effective therapies. Adoptive cell therapy using tumor-infiltrating lymphocytes (TIL) has demonstrated durable and complete responses with long-term survival of > 10 years in patients with metastatic melanoma. Previous attempts to generate TIL from bladder cancer showed some success; however, the process required an extended manufacturing time (35–50+ days). Iovance has developed a second-generation GMP manufacturing process (Gen 2) with a significantly reduced time to expand functional TIL from melanoma, cervical, and head and neck tumors. The goal of this study was to determine the feasibility of generating TIL from patient-derived bladder cancer tumor specimens using the 22-day Iovance Gen 2 manufacturing process. Methods: The TIL manufacturing process for the resected bladder tumor samples includes a pre-Rapid Expansion Protocol (pre-REP) and Rapid Expansion Protocol (REP) over 22 days. Pre-REP (1/10th scale) and REP (1/100th scale) was performed to align with the Iovance Gen 2 manufacturing process. During the pre-REP 1- to 3-mm size tumor fragments are placed in media containing IL-2 for 11 days. To further stimulate TIL growth, TIL are expanded using REP that includes irradiated PBMC feeders, IL-2, and anti-CD3 for 11 days. Release testing parameters (total viable cells, % viability, TIL phenotype) were tested on the harvested final product. TIL purity, differentiation, memory, activation, and exhaustion status were extensively characterized using multicolor flow cytometry. TIL functionality was determined by measuring IFNγ and Granzyme B release after restimulation. Results: Four bladder tumor samples were obtained from Roswell Park Comprehensive Cancer Center (RPCCC). Total viable count of REP TIL harvested on Day 22 was 18.4 +/- 8.9 × 109 (numbers adjusted to full scale), with 92.7 +/- 2.5% viability at harvest. The phenotype of harvested TIL were 92.4 +/- 4.8% CD3+/CD45+ cells, and non-T cell population including B cells and NK cells were < 4%. TIL expanded from bladder cancer samples secreted IFNγ and Granzyme B in response to anti-CD3/CD28/CD137 beads at similar levels to Iovance-manufactured melanoma TIL. Conclusions: All four bladder carcinoma-derived TIL have demonstrated growth, phenotype, and function comparable to that for other tumor types (i.e., melanoma, cervical, HNSCC). TIL generation from bladder cancer samples is feasible and allows for the application of Iovance's Gen 2 manufacturing process for an autologous cellular infusion product to treat bladder cancer patients. An early-phase trial testing autologous TIL therapy in transitional cell cancer of the urothelium is being planned. Citation Format: Qiang J. LI, Khurshid Guru, Amit Lugade, Elizabeth Brese, Kunle Odunsi, Anand Veerapathran, Kenneth Onimus, Adrian Wells, Cecile Chartier, Arvind Natarajan, Maria Fardis, Gurkamal Chatta. Expansion of tumor-infiltrating lymphocytes (TIL) using Iovance's Gen 2 process from advanced bladder cancer for adoptive immunotherapy [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2019 May 18-21; Denver, CO. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(15_Suppl):Abstract nr A05.

Importance of public awareness of the association of tobacco products to bladder cancer.

e13564 Background: Many cancers have well-known association with the use of tobacco products. Cancers of lung, esophagus, head and neck, urinary tract including bladder, kidney, pancreas, cervix, etc. have proven causation to tobacco use. This study highlights the close association of the use of tobacco products to bladder cancer and emphasizes the need for increased public awareness in this regard. Methods: Data were collected from the medical records of patients treated during a five-year period (2012-2017). Three hundred sixty-two (362) biopsy proven bladder cancers were analyzed retrospectively. The association of bladder cancer to tobacco use was established and presented. Results: Three hundred sixty-two pathology proven bladder cancers were studied. Eighty percent (80%) of the occurrences were in men and twenty percent (20%) were in women. Twenty-five percent (25%) of the events were multiple occurrences in same patients. The most common histology was urothelial (transitional cell) cancer. A majority, eighty-one percent (81%) had a history of using tobacco products. Only thirteen percent (13%) were non-smokers. However, several of the non-smokers had exposure to secondary smoking or to chemicals of uncertain nature. About six percent (6%) of the cases had no definitive documentation of their risk factors. Conclusions: Bladder cancer is the ninth most common malignancy in the United States. Urothelial carcinoma is the most common histology. The most important risk factors are the use of tobacco products and exposure to certain environmental factors. More than sixty known carcinogens in tobacco smoke are attributed as the casual factors. Field cancerization is one of the hypotheses that account for multiple occurrences of urothelial cancer. The risk due to tobacco use is associated in 50%-65% in men and 20%-30% in women, which triples the incidences of malignancies as compared to non-smokers. Although, the public are well aware of the association of the use of tobacco products with cancers, such as lung, esophagus, and head and neck, there is less awareness that it is also a casual factor for bladder cancer. This study stresses the importance of this conclusion and the need to create a wide spread awareness among the public on the use of tobacco products as a cause for bladder cancer in both men and women.

FDG-PET/CT imaging findings of hepatic tumors and tumor-like lesions based on molecular background.

The usefulness of whole-body 18-fluoro-2-deoxyglucose (FDG)-fluorodeoxyglucose positron emission (PET)/computed tomography (CT) is established for assessment of disease staging, detection of early disease recurrence, therapeutic evaluation, and predicting prognosis in various malignancies; and for evaluating the spread of inflammation. However, the role of FDG-PET/CT for the liver is limited because CT and magnetic resonance imaging (MRI) can provide an accurate diagnosis of most tumors. In addition, in other potentially useful roles there are several pitfalls in the interpretation of FDG uptake in PET/CT imaging. Accurate evaluation demands knowledge of the FDG uptake of each lesion, including potential negative and positive uptakes, and requires an understanding of the underlying background of the molecular mechanisms. The degree of FDG uptake is dependent on cellular metabolic rate and the expression of glucose transporter, hexokinase, and glucose-6-phosphatase, which in turn are closely affected by biological characteristics such as pathological category (e.g., adenocarcinoma, squamous cell carcinoma, small cell cancer, transitional cell cancer, neuroendocrine tumor, sarcoma, lymphoma), tumor differentiation, histological behavior (e.g., solid, cystic, mucinous), and intratumoral alterations (e.g., necrosis, degeneration, hemorrhage). Correlation with the CT and MRI findings, which also precisely depict the pathological findings, is important to avoid misdiagnosis.

Design of a randomized controlled phase III study of dose dense methotrexate, vinblastine, doxorubicin and cisplatin (dd-MVAC) or gemcitabine and cisplatin (GC) as peri-operative chemotherapy for patients with locally advanced transitional cell cancer of the bladder. The French GETUG/AFU V05 VESPER trial

The main objective of the French GETUG/AFU V05 VESPER randomized phase III study was to assess the efficacy of dd-MVAC and GC in term of progression-free survival in patients for whom chemotherapy has been decided, before or after surgery.A total of 500 patients have been randomized in 28 reference centers. Inclusion criteria were urothelial carcinoma without neuro-endocrine variant, disease defined by a T2, T3 or T4a N0 (pelvic lymph node ≤ 10 mm on CT scan) M0 staging for patients receiving neoadjuvant chemotherapy or pT3 or pT4 or pN+ and M0 for patients receiving adjuvant chemotherapy. Secondary endpoints include overall survival, safety, response rate. The peri-operative chemotherapy schedule was experimental arm dd-MVAC for a total of 6 cycles versus standard arm GC 4 cycles. The toxicity was evaluated according to NCI CTCAE (v 4.0). The progression-free survival rate will be estimated at 3 years by the Kaplan-Meier method. All the patients will be followed for 5 years.The last patient was randomized in March 2018 and the primary endpoint results are expected for mid-2021. As the dd-MVAC schedule is associated with higher response rates in metastatic disease, the real question today is to confirm such benefit in the peri-operative setting, taking also in consideration the chemotherapy toxicity. Tomorrow, the challenge may be the best chemotherapy and immunotherapy association, the authors hope that final Vesper Trial results will help to determine the gold standard chemotherapy.

Follow-up criteria and cystoscopic classifications of bladder lesions: A retrospective analysis

Aim: To screen cystoscopically bladder cancer mimicking lesions and to present its clinical importance.Material and Methods: After receiving anamnesis of patients, hematological, biochemical, microbiological, cytological, pathologic and radiological assessments were performed. Randomized cold cup bladder biopsy, transurethral resection or open surgical excision were performed. The lesions were classified according to their cystoscopy appearance. Practical approach criterias were compiled based on their treatments and follow-up, throughout 9 years. Results: A total of 297 patients were reached .The mean age of all were 62±6 years. Almost all bladder lesions (95 %) were pre-diagnosed as bladder cancer according to the radiologic screening results like bladder wall thickening and irregularities. The precancerous /cancerous lesions were detected incidentally at a rate of 3.36 %. PAP (Papanicolaou) III urine cytology was observed at a rate of 3.4 %. Carcinoma in situ developed in the follow-ups and one converted to Grade I transitional cell cancer. Total cystectomy was required in a patient who was diagnosed with urinary tuberculosis.Conclusions: There may be precancerous or cancerous lesions in the background of these lesions which do not respond to treatment or constantly recur. There may be changes in favor of malignancies in lesions. The study created a different perspective on these lesions with cystoscopy classification.

ENOS gene polymorphisms and transitional cell cancer of the bladder

Aim: In this case-control study, we examined the association between two types of eNOS gene polymorphisms (intron 4 a/b and Glu298Asp) and transitional cell carcinoma (TCC) of the bladder.Nitric Oxide (NO) is a free radical that plays a key role in various physiological and pathophysiological processes, particularly in the circulatory system. Endothelial Nitric Oxide Synthase (eNOS), as a member of NOS family, is the enzyme, responsible for the physiological production of nitric oxide in the endothelium. Polymorphisms of eNOS have been related to increased risk for different types of cancers. Material and Methods: A total of 64 patients with bladder TCC and 80 controls with similar epidemiological characteristics of patients group were evaluated and compared in terms of eNOS gene polymorphisms of two different types ((intron 4 a/b and Glu298Asp). Following DNA isolation from the blood samples, eNOS gene was replicated via PCR. The genomic distribution of two types of eNOS polymorphism was determined by gel electrophoresis following the process of restriction, for both groups. Results: The alleles most commonly observed in patient group were “ab” for intron 4 (OR= 1.80, 95% CI: 0.71-4.64; P=0.20) and “GT” for Glu298Asp polymorphisms (OR= 1.65, 95% CI: 0.85-3.22; P=0.14). Neither bladder cancer risk nor disease grade was associated with these polymorphisms. Conclusions: This study suggests that the intron 4 a/b and Glu298Asp eNOS gene polymorphisms are not associated with bladder cancer susceptibility. However, it is mandatory to conduct further trials with more patients to confirm these findings and to evaluate the association between bladder cancer and eNOS gene polymorphisms.

Squamous cell carcinoma of the urinary bladder associated with large vesical calculus

Squamous cell carcinoma is a histological diagnosis rarely seen in bladder cancers. It is classically associated with chronic mucosal inflammation or urinary retention. Very few studies have clearly defined the management guidelines, however multimodality treatment is frequently offered along the lines of more common transitional cell cancer. We report the case of a 50-year-old male who presented with obstructive urinary symptoms and on evaluation was found to have a large vesical calculus associated with squamous cell cancer of the bladder. He was treated with surgery in the form of radical cystectomy followed by adjuvant locoregional radiotherapy. He has remained on regular follow-up for the last 2 years and has been disease free.

Sex-related differences in urothelial cell carcinoma of the bladder in Germany.

BackgroundUrothelial cell carcinoma (UCC), also called transitional cell cancer, occurs significantly more often in males than in females. Essential for the prognosis of recovery is depth of infiltration (muscle-invasive or non-muscle invasive) and tumor-differentiation at initial diagnosis. The current study aimed to explore sex-related differences after initial diagnosis of UCC in Germany.MethodsWe identified patients who underwent transurethral resection of the bladder tumor (TUR-BT). Data were retrospectively analyzed, including TNM classification, histopathological grading, risk group according to the European Association of Urology (EAU), use of photody-namic diagnosis (PDD), and early intravesical chemotherapy (IVC).ResultsA total of 539 male and 190 female patients with UCC underwent TUR-BT. Approximately 75% were non-muscle invasive bladder cancer (NMIBC). Females evidenced significantly higher rates of muscle-invasive bladder cancer (MIBC; P=0.04). Carcinoma in situ (CIS) was significantly more common among males (P=0.01). Recurrence and progression rates showed no significant sex differences – only in the small subgroup of EAU low-risk NMIBC females, we found a significantly higher progression rate (P=0.03). In a Cox proportional hazards model, we found for MIBC, an HR for progression of 6.5 (95% CI, 1.29–33.2; P=0.02) after a median follow-up of 56 months. Use of PDD or IVC showed no significant differences in recurrence and progression between females and males.ConclusionFemales were significantly more likely to suffer from MIBC at the time of first diagnosis. In NMIBC, males showed a significantly higher prevalence of CIS and EAU low-risk NMIBC females showed significantly higher rates of progression. Sex was not associated with recurrence rates in NMIBC. PDD and IVC were equally effective in both sexes. Based on the collected data we suggest to further investigate possible sex differences in UCC with therapeutical impact. Additional prospective multicenter studies are needed to evaluate both sex-related long-term disease courses and effectiveness of therapies.