Transitional Cell Carcinoma Of The Bladder Research Articles

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

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

Evaluation of proteolytic activity and serine proteases distribution in plasma from patients with bladder cancer.

Bladder cancer (BC) is an aggressive disease with a poor prognosis. A bladder tumor, like other malignant neoplasms, is characterized by the presence of both cancer cells and stromal cells which secrete cytokines, chemokines, growth factors, and proteolytic enzymes. One such class of proteolytic enzymes are serine proteases, which take part in the tumor microenvironment formation via supporting and contributing to tumor progression. This study aims to evaluate the proteolytic activity and serine protease contribution in plasma from BC patients. The research involved patients of Alexandrovsky city clinical hospital aged 52-76 with transitional cell carcinoma of the bladder. All examined patients were divided into five groups: the control group included conditionally healthy donors, while other patients were grouped according to their tumor stage (I, II, III and IV). Plasma plasminogen levels were determined by enzyme-linked immunosorbent assay, and the potential activity was measured by chromogenic plasminogen assay. Serine proteases fractions were obtained by the affinity chromatography method, and enzyme concentration in the selected fractions were determined by the Bradford method. Serine proteases distribution was investigated by electrophoresis in a polyacrylamide gel. It was determined that the concentration, potential activity of plasminogen, and the total amount of serine proteases in plasma from BC patients were greater than the values of the corresponding indicators in healthy donors. This could be one of the factors contributing to increased proteolysis seen in the process of carcinogenesis. Plasminogen concentration in BC patients with stage IV disease; however, displayed a tendency to be reduced compared to earlier stages, and the potential activity of plasminogen was significantly lower in patients with stages III - IV BC. Futhermore, a tumor stage specific gradual decline in the serine protease plasma content was shown. The results of electrophoretic analysis established a significant diminishment in the percentage of high molecular weight components (under non-reducing conditions) and their complete disappearance (under reducing conditions) in plasma serine protease fractions from BC patients. A decline in the percentage of heavy and light plasmin chains in BC patients was also observed. Additionally, a rise in the degraded forms of plasminogen/plasmin content was seen in BC samples, as well as the presence of fractions corresponding to trypsin and NE (under non-reducing conditions) that were absent in the control samples. The results indicate significant changes in the proteolytic activity of plasma, from BC patients when compared to healthy controls, which is accompanied by alterations in serine protease distribution caused by tumor microenvironment pecularlities at the different stages of oncopathology.

Radical Cystectomy in the Treatment of Invasive Bladder Cancer: Long-Term Results in 1,054 Patients.

To evaluate our long-term experience with patients treated uniformly with radical cystectomy and pelvic lymph node dissection for invasive bladder cancer and to describe the association of the primary bladder tumor stage and regional lymph node status with clinical outcomes. All patients undergoing radical cystectomy with bilateral pelvic iliac lymphadenectomy, with the intent to cure, for transitional-cell carcinoma of the bladder between July 1971 and December 1997, with or without adjuvant radiation or chemotherapy, were evaluated. The clinical course, pathologic characteristics, and long-term clinical outcomes were evaluated in this group of patients. A total of 1,054 patients (843 men [80%] and 211 women) with a median age of 66 years (range, 22 to 93 years) were uniformly treated. Median follow-up was 10.2 years (range, 0 to 28 years). There were 27 (2.5%) perioperative deaths, with a total of 292 (28%) early complications. Overall recurrence-free survival at 5 and 10 years for the entire cohort was 68% and 66%, respectively. The 5- and 10-year recurrence-free survival for patients with organ-confined, lymph node-negative tumors was 92% and 86% for P0 disease, 91% and 89% for Pis, 79% and 74% for Pa, and 83% and 78% for P1 tumors, respectively. Patients with muscle invasive (P2 and P3a), lymph node-negative tumors had 89% and 87% and 78% and 76% 5- and 10-year recurrence-free survival, respectively. Patients with nonorgan-confined (P3b, P4), lymph node-negative tumors demonstrated a significantly higher probability of recurrence compared with those with organ-confined bladder cancers (P < .001). The 5- and 10-year recurrence-free survival for P3b tumors was 62% and 61%, and for P4 tumors was 50% and 45% , respectively. A total of 246 patients (24%) had lymph node tumor involvement. The 5- and 10-year recurrence-free survival for these patients was 35%, and 34%, respectively, which was significantly lower than for patients without lymph node involvement (P < .001). Patients could also be stratified by the number of lymph nodes involved and by the extent of the primary bladder tumor (p stage). Patients with fewer than five positive lymph nodes, and whose p stage was organ-confined had significantly improved survival rates. Bladder cancer recurred in 311 patients (30%) . The median time to recurrence among those patients in whom the cancer recurred was 12 months (range, 0.04 to 11.1 years). In 234 patients (22%) there was a distant recurrence, and in 77 patients (7%) there was a local (pelvic) recurrence. These data from a large group of patients support the aggressive surgical management of invasive bladder cancer. Excellent long-term survival can be achieved with a low incidence of pelvic recurrence.

Volumetric tumor segmentation according to diffusion-weighted MRI data in predicting and evaluating the response to chemotherapy in bladder cancer

The purpose of the study was to develop and evaluate the technique for volumetric tumor segmentation based on diffusion-weighted magnetic resonance imaging (DW-MRI) in predicting and assessing the response to chemotherapy in patients with bladder cancer (BC). Material and Methods. We examined 26 patients with morphologically verified transitional cell carcinoma of the bladder. The group was characterized by the presence of one or several tumors with a size of 17 to 46 mm. Before planning chemotherapy according to the M-VAC scheme, a study and post-processing of DW-MRI with volumetric segmentation of lesions, assessment of the volume and apparent diffusion coefficient (ADC) in the entire tumor mass were performed. According to the ADC data, shape of the tumor and its relation to the bladder wall, the coefficient (C) for predicting the response to chemotherapy was calculated. Results. In the cases with a coefficient value below 0.51, a high risk of treatment failure was predicted, at C≥0.74, a positive effect of treatment was predicted. With a value of 0.51≤C&lt;0.74, the prognosis was uncertain, stabilization was more likely. The sensitivity and specificity of the method were 92.3 % and 92.4 %, respectively. Conclusion. The method of volumetric segmentation makes it possible to predict and evaluate bladder cancer response to chemotherapy with a sufficiently high accuracy. The advantages of the method are the possibility of assessing the tumor regardless of the degree of filling of the bladder, with non-contrast MRI, and with large lesions.

Long-Term Outcome of Patients with Stage II and III Muscle-Invasive Urothelial Bladder Cancer after Multimodality Approach. Which Is the Best Option?

Background and Objectives: There is no consensus regarding the optimal therapy sequence in stage II and III bladder cancer. The study aimed to evaluate the long-term oncologic outcomes in patients with bladder cancer after a multimodality approach. Materials and methods: Medical files of 231 consecutive patients identified with stage II (46.8%), IIIA (30.3%), and IIIB (22.9%) transitional cell carcinoma of the bladder (BC) treated with a multimodality approach were retrospectively reviewed. The treatment consisted of transurethral resections or cystectomy, radiotherapy alone or concurrent chemoradiotherapy as definitive treatment, or neoadjuvant chemotherapy using platinum salt regimens. Results: Median age at diagnosis was 65 ± 10.98 years. Radical or partial cystectomy was performed in 88 patients (37.1%), and trans-urethral resection of bladder tumor (TURBT) alone was performed in 143 (61.9%) patients. Overall, 40 patients (17.3%) received neoadjuvant chemotherapy and 82 (35.5%) received definitive chemoradiotherapy. After a median follow-up of 30.6 months (range 3-146 months), the median disease-free survival (DFS) for an entire lot of patients was 32 months, and the percentage of patients without recurrence at 12, 24, and 36 months was 86%, 58%, and 45%, respectively. Patients receiving neoadjuvant chemotherapy had a better oncologic outcome compared to patients without neoadjuvant chemotherapy (median DFS not reached vs. 31 months, p = 0.038, HR = 0.55, 95% CI 0.310-0.951). There was a trend for better 3-year DFS with radical cystectomy vs. TURBT (60 months vs. 31 months, p = 0.064). Definitive chemoradiotherapy 3-year DFS was 58% compared to 44% in patients who received radiotherapy or chemotherapy alone. Conclusions: In patients with stages II and III, both neoadjuvant chemotherapy and concurrent radio-chemotherapy are valid options for treatment and must be part of a multidisciplinary approach.

Histopathological Study on Patients with Transitional Cell Carcinoma of Urinary Bladder in Al-Diwaniyah City/ Iraq

This study conducted on inpatients admitted to Al-Diwaniyah teaching hospital at period from January to June 2010 to recognize the histopathological changes of tumor cells of urinary bladder in comparison with normal cells. The histopathological examination of urinary tract infections (UTIs) showed normal thickness of urothelium, in addition, the submucosa and the muscular tissue were congested and oedematous. The present study showed that the transitional cell carcinoma of the bladder divided into three major grades: Grade І , Grade ІІ, Grade ІІІ. In this study, the immunehistochemical expression of cytokeratin 7 used to confirm the diagnosis of urinary bladder cancer. The results revealed a positive and negative reaction between tumor cells and cytokeratin7 antibody.

A multicenter, open-label, phase 1a/b study of HC-7366, a modulator of integrated stress response (ISR) kinase GCN2 in subjects with advanced solid tumors.

TPS3179 Background: To survive harsh tumor microenvironments, cancer cells actively utilize ISR as an adaptive stress response and survival mechanism. General control nonderepressible 2 (GCN2), a serine-threonine kinase is essential for maintaining cellular homeostasis in amino acid stress conditions. HC-7366 is a novel, highly selective, and potent GCN2 kinase modulator. Single agent HC-7366 has demonstrated potent anti-tumor activity resulting in regression and complete responses in several pre-clinical tumor models. Methods: This is a first in human, multicenter, open label, Phase 1a/b dose escalation and expansion study to establish the maximum tolerated dose, evaluate safety and tolerability, and determine the recommended Phase 2 dose of daily oral dosing of HC-7366 in patients (pts) with advanced solid tumors. Up to 36 pts with squamous cell carcinoma of the head and neck (SCCHN), colorectal cancer (CRC), non-small cell lung cancer (NSCLC), or transitional cell carcinoma of the bladder (TCC) will be enrolled into Phase 1a; other solid tumors are eligible if selection criteria are met (capped at 50%). A 3+3 design will be employed and dose escalation determined by occurrence of dose limiting toxicities (DLT) within Cycle 1 (21 days). A Safety Monitoring Committee will review each cohort when the planned number of pts complete the DLT period. Six dose levels (10, 20, 40, 75, 125, 150 mg) of HC-7366 will be evaluated. Phase 1b will be an expansion of up to two Phase 1a dose levels and enroll 15 pts per cohort. Secondary endpoints include ORR, DOR, TTF, PFS, and OS. Pharmacokinetic data will be profiled. Exploratory objectives include evaluation of pharmacodynamic markers in tumor biopsies and immunophenotyping in blood samples. Main inclusion criteria include: SCCHN, CRC, NSCLC, TCC or other solid tumors; &gt;1 radiologically measurable lesion per RECISTv1.1; &gt;1 biopsiable lesion at baseline; no immune checkpoint inhibitor within 4 weeks (wks) of 1st dose; ECOG 0 or 1; &lt;10% body weight loss in 4 wks before 1st dose &amp; serum albumin &gt;3 g/dL; and normal/adequately controlled pan-endocrine function. Main exclusion criteria include: autoimmune disease, organ transplant, retinitis or photosensitive skin disorders; history of interstitial lung disease or pneumonitis within 1yr; and overt or latent disorders of the exocrine pancreas. Formal hypothesis testing will not be performed. Descriptive statistics of parameters of interest will be presented by dose level and safety parameters will be summarized. The trial is sponsored by HiberCell, Inc. Approximately 9 US sites will participate. Clinical trial information: NCT05121948.

PD21-06 INFLAMMATORY MYOFIBROBLASTIC TUMOR OF THE GENITOURINARY TRACT: A SYSTEMATIC REVIEW

You have accessJournal of UrologyCME1 May 2022PD21-06 INFLAMMATORY MYOFIBROBLASTIC TUMOR OF THE GENITOURINARY TRACT: A SYSTEMATIC REVIEW Nikolas Moring, Daniel Swerdloff, Mahmut Akgul, Tipu Nazeer, and Badar Mian Nikolas MoringNikolas Moring More articles by this author , Daniel SwerdloffDaniel Swerdloff More articles by this author , Mahmut AkgulMahmut Akgul More articles by this author , Tipu NazeerTipu Nazeer More articles by this author , and Badar MianBadar Mian More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002559.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Inflammatory myofibroblastic tumor (IMT) is a rare tumor that has been described in nearly every organ system in the body. IMT generally lack metastatic potential, but these tumors often exhibit locally invasive and progressive disease which can mimic locally advanced malignancy. In the genitourinary tract (GU), IMT can manifest with signs and symptoms (mass, hematuria, pain) of common GU cancers such as renal cell carcinoma, testicular mass, or transitional cell carcinoma of the bladder. Due to its novel nature and lack of a singularly agreed upon definition, IMT prevalence and incidence are difficult to ascertain. We conducted a comprehensive systematic review with the aim to identify all reports of IMT in the GU tract, and describe the presenting symptoms, contemporary management, and pathologic features. METHODS: Systematic review using the following search terms were performed: “Inflammatory Pseudotumor” OR “Pseudosarcoma” OR “Inflammatory Pseudo-Tumor” OR “Inflammatory Myofibroblastic Tumor” AND “Urology” OR “Urologic” OR “Genitourinary”. Two reviewers performed independent initial screening of all abstracts. All potentially eligible articles underwent full text review and data extraction. The data for each GU organ site was analyzed separately. RESULTS: Of the 259 articles initially identified, and 101 were used in the systematic review. The articles consisted primarily of small case series and case reports, for a total of 110 cases of GU IMT. Pediatric IMT accounted for 9% of GU IMT cases. Most common presenting symptoms included pain, mass, hematuria and voiding symptoms. The most frequently involved sites and treatment included bladder (63 cases; 52% had radical/partial cystectomy), kidney (19; 93% had radical/partial nephrectomy), epididymis (6), urachus (6), ureter (5), prostate (4), testis (4), and spermatic cord (3). Anti-inflammatory, antibiotic and antineoplastic therapy used in 8% of cases was ineffective. Anaplastic lymphoma kinase expression, noted in half the cases, is a favorable prognostic indicator. Incomplete excision is associated with risk of recurrence while complete surgical excision provides excellent disease control with rare recurrence or metastatic transformation (<2%). CONCLUSIONS: IMT exhibit locally invasive, symptomatic and progressive phenotype that can affect all GU organs, especially bladder, kidney and scrotal contents. Clinical and radiologic features mimic GU malignancy. IMT require complete surgical excision since incomplete resection increases the risk of symptomatic recurrence. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e362 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nikolas Moring More articles by this author Daniel Swerdloff More articles by this author Mahmut Akgul More articles by this author Tipu Nazeer More articles by this author Badar Mian More articles by this author Expand All Advertisement PDF DownloadLoading ...

Genitourinary Cancers Following Kidney Transplant: Our 20 Years of Experience With Mechanistic Target of Rapamycin Inhibitors.

We investigated patients with genitourinary cancer after kidney transplant and the effects of immunosuppression reduction and switching to mechanistic target of rapamycin inhibitors. We retrospectively evaluated kidney transplant recipients seen at our center between January 2000 and January 2020. Patients with <1 year of follow-up were excluded. Of 827 patients, genitourinary cancer was detected in 11 (1.3%): prostate cancer in 5 patients (45%), renal cell carcinoma in native kidney in 3 (27%), renal cell carcinoma in allograft kidney in 2 (18%), and transitional cell carcinoma of the bladder in 1 (9%). All patients had surgery. Two patients had bone metastasis due to prostate cancer at diagnosis. Two patients had allograft nephrectomy due to de novo renal cell carcinoma. Mean follow-up and age were 97 ± 45 months (range, 26-189) and 50 ± 10.2 years (19% female). After cancer diagnosis, excluding the 2 patients with allograft nephrectomy, immunosuppression was changed in 8 patients (88.8%) (1 patient received the same treatment before and after cancer diagnosis). Six patients received double-drug and 3 received triple-drug protocols. Of 9 patients, 2 were already using mechanistic target of rapamycin inhibitors before cancer diagnosis and 7 were switched: 4 to double-based and 3 to triple-based regimens. Six were switched from tacrolimus. With new treatments, patients showed no progressive kidney failure or rejection (38 ± 40 mo average follow-up). At last follow-up, mean glomerular filtration rate was 62.8 ± 34 mL/min/1.72 m2, which was similar to rate at cancer diagnosis (58.9 ± 24 mL/ min/1.72 m2; P = .78). During follow-up, no patients developed local recurrence of primary tumor or new metastasis, and none showed adverse effects after switch to mechanistic target of rapamycin inhibitors. Three patients died of malignancy-unrelated reasons (ileus, urinary sepsis, heart failure). Mechanistic target of rapamycin inhibitor-based drugs can be an important maintenance immunosuppressive treatment option for kidney transplant recipients with genitourinary cancers.

Methods of Sentinel Lymph Node Detection and Management in Urinary Bladder Cancer-A Narrative Review.

Introduction: Detection of lymph node status in bladder cancer significantly impacts clinical decisions regarding its management. There is a wide range of detection modalities for this task, including lymphoscintigraphy, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, positron emission tomography, and fluoroscopy. We aimed to study the pre- and intraoperative detection modalities of sentinel lymph nodes in urinary bladder cancer. Method: This narrative review was performed by searching the PubMed and EMBASE libraries using the following search terms: (“Transitional cell carcinoma of the bladder” OR “urothelial cancer” OR “urinary bladder cancer” OR “bladder cancer”) AND ((“sentinel lymph node”) OR (“lymphatic mapping”) OR (“lymphoscintigraphy”) OR (“lymphangiography”) OR (“lymph node metastases”)). Studies analysing the effectiveness and outcomes of sentinel lymph node detection in bladder cancer were included, while non-English language, duplicates, and non-article studies were excluded. After analysing the libraries and a further manual search of bibliographies, 31 studies were included in this paper. We followed the RAMESES publication standard for narrative reviews to produce this paper. Results: Of the 31 studies included, 7 studies included multiple detection methods; 5 studies included lymphoscintigraphy; 5 studies included computed tomography and/or single-photon emission computed tomography; 5 studies included fluoroscopy; 4 studies included magnetic resonance imaging; and 5 studies included positron emission tomography. Discussion: Anatomical, radioactive, and functional detection modalities have been studied independently and in combination. The consensus is that preoperative detection with imaging helps guide surgical management and intraoperative detection methods help capture any lymph nodes that may have been missed. Each of these types of detection represent their own set of benefits and drawbacks, but there is currently limited evidence to support any change in overall practice to replace conventional staging.

Squamous cell carcinoma of the bladder. a comparison of pathological features and survival outcomes with transitional cell carcinoma of the bladder

Objective: To directly compare differences in outcomes and tumour pathology between transitional cell carcinoma of the bladder (TCC) and non-bilharzial squamous cell cancer (NBSCC) of the bladder following radial cystectomy.

Elevated IL-37 Serum Levels in Patients with Transitional Cell Carcinoma of Bladder.

Interleukin-37 (IL-37) is a recently described cytokine that emerges as a natural inhibitor of inflammatory and immune responses. However, IL-37 has not yet been investigated in bladder cancer, and its biological role is unknown. The purpose of this study was to investigate IL-37 serum levels in patients with bladder cancer and determine whether they were linked to the patients' pathological characteristics. IL-37 serum levels were measured using a commercial ELISA kit in 60 patients with transitional cell carcinoma (TCC) of the bladder (mean age: 64.55±12.93) and 50 healthy controls (mean age: 62.94±12.69). Non-parametric tests were used for statistical comparisons, and the Cohen's d effect size was calculated to evaluate the practical and clinical significance of the results. Our findings indicated an increasing trend in IL-37 serum levels in patients with TCC (42.77±3.36 pg/ml) in comparison with controls (40.51±7.32 pg/ml, p=0.09). However, IL-37 serum levels were found to be significantly higher in male patients (44.72±3.81 pg/ml) and patients aged ≥70 (46.92±6.77 pg/ml) in comparison with male controls (29.96±3.30 pg/ml, p=0.026) and controls aged ≥70 (23.62±4.43 pg/ml, p=0.009). In comparison to similar controls, Cohen's d effect size for patients aged ≥70 years was found to be 0.90. The findings reveal a higher serum level of IL-37 in patients with TCC, which might be clinically associated with immunosuppression and tumor growth. However, this is a preliminary study, and more research on the biological role of IL-37 and its potential therapeutic effects in bladder cancer is required.

November 2021 Imaging Case of the Month: Let’s Not Dance the Twist

No abstract available. Article truncated after the first 150 words. History of Present Illness: An 82-year-old man presented to his physician for general health maintenance as well as a complaint of persistently poor quality sleep and poor appetite with weight loss. The patient had undergone robotic-assisted radical left nephroureterectomy and cystectomy with pelvic lymph node dissection and urinary diversion for left clear cell renal cell carcinoma (staged T2a, grade 2) and transitional cell carcinoma of the bladder (carcinoma in situ at surgery), approximately 9 months earlier. The patient’s bladder malignancy was initially treated with transurethral resection, with histopathology at that procedure showing high-grade papillary urothelial malignancy with lamina propria invasion, but no muscular invasion; this procedure was followed by formal complete resection approximately 3 months later. The patient’s post-operative course was complicated by significant bleeding which required transfusion of 3 units of blood. He had undergone inferior vena caval filter placement prior to surgery when preoperative testing revealed lower extremity …

Metastatic transitional cell carcinoma of the bladder in an ileal conduit stoma. A case report and literature review

Clinical case presentation: An 80-year-old man was admitted to our emergency department due to fever and progressively growing mass in the urinary diversion stoma four months after a radical cystectomy for muscle invasive bladder cancer.&#x0D; Surgical resection was done, and histo-pathological examination revealed metastases of high-grade urothelial carcinoma. After almost three years of follow-up any sign of recurrence did not seen. &#x0D; Relevance: Urothelial cancer at all stages can metastasize to other organs.&#x0D; Metastasis occurs hematogenously to all organs, most frequently the lungs, liver, bone, or lymphatically to regional lymph nodes in the pelvis, or further to retroperitoneal lymph nodes. Metastasis of bladder cancer in the ileal conduit stoma is unusual. Cancer recurrence after radical cystectomy has-been reported in ureteroileal anastomosis.&#x0D; Clinical implications: Surgical treatment is an option in these patients. Adjuvant radiotherapy and / or chemotherapy would be possible alternatives in more than one site of metastasis.  There are no clinical guidelines establishing their correct management.&#x0D; Conclusion: The urinary diversion stoma metastases secondary to a urothelial carcinoma is a rare entity. Direct implantation during the surgical act, hematogenous, lymphatic or mixed dissemination, could justify metastatic implantation.&#x0D;  

Collagen XI alpha 1 chain, a potential therapeutic target for cancer.

Extracellular matrix (ECM) plays an important role in the progression of cancer. Collagen is the most abundant component in ECM, and it is involved in the biological formation of cancer. Although type XI collagen is a minor fibrillar collagen, collagen XI alpha 1 chain (COL11A1) has been found to be upregulated in a variety of cancers including ovarian cancer, breast cancer, thyroid cancer, pancreatic cancer, non-small-cell lung cancer, and transitional cell carcinoma of the bladder. High levels of COL11A1 usually predict poor prognosis, while COL11A1 is related to angiogenesis, invasion, and drug resistance of cancer. However, little is known about the specific mechanism by which COL11A1 regulates tumor progression. Here, we have organized and summarized the recent developments regarding elucidation of the relationship between COL11A1 and various cancers, as well as the interaction between COL11A1 and intracellular signaling pathways. In addition, we have selected therapeutic agents targeting COL11A1. All these indicate the possibility of using COL11A1 as a target for cancer treatment.

The Incidence and Management of Urethral Stricture in Bladder Carcinoma

Background: Urethral stricture disease is one of the oldest and most difficult maladies known to the urologist. While references to the disease and its treatment date back to the writings of the Hindus, Egyptians, and Greeks. Objective: To elicit the incidence of urethral strictures, their severity and management in patients with superficial bladder tumor. Patients and Methods: From January 2018 to January 2020, we followed 98 patients admitted and treated at Baquba Teaching Hospital urology unit for having bladder carcinoma. Theywere all male subjects, their age range from 38-76y with a mean 56.8y. They were required to have a cystoscopically and histologically proven superficial transitional cell carcinoma of the bladder to be enrolled in this study (invasive tumors were excluded). For all the patients and after having the cystoscopic diagnosis ,transurethral resection of the tumor done and in most of them this is followed by six week courses of intravesical chemotherapy (either mitomycin or doxorubicin according to the availability). Intravesical Doxorubicin used in 13 cases (56.5%), Mitomycin C in 6 cases (26.1%) and 3 patients (13.0%) received both drugs (through multiple courses).while 1 patient (4.3%) received no chemotherapy. Thirteen strictures (56.5%) were managed by optical urethrotomy while 10 cases (43.5%) were mild strictures and opened just by introducing the cystoscope. Results: During the period of the study, a total of 23 urethral strictures were identified in the 98 male patients with superficial bladder tumor enrolled in this study, which constitutes an incidence of 23.5% all were diagnosed by the follow -up check cystoscopies . Patient age ranged from 38-75 years with a mean age 59.30+- 10.58 . Among those patients with urethral stricture ,14 patients had also B.P.H (60.9%), but only 7 patients (30.4%) had a history of retention of urine . The urethral stricture was bulbar in all patients and it was mild stricture in 10 cases (43.5%), moderate in 6 cases (26.1%) and severe in 7 cases (30.4%) . Prior to the diagnosis of stricture , 13 patients had been subjected to a single check cystoscopy (56.5%) ,6 patients (26.1%) had twice , while 4 patients (17.4%) had 3 or more cystoscopies prior to the occurence of stricture . Regarding intravesical chemotherapy prior to the occurance of stricture ,4 patients (17.4%) received 1-3 sessions , 10 patients (43.5%) received 4-6 sessions and 9 patients (39.1%) received more than 6 sessions . Intravesical Doxorubicin used in 13 cases (56.5%), Mitomycin C in 6 cases (26.1%) and 3 patients (13.0%) received both drugs (through multiple courses).while 1 patient (4.3%) received no chemotherapy. Thirteen strictures (56.5%) were managed by optical urethrotomy while 10 cases (43.5%) were mild strictures and opened just by introducing the cystoscope. Conclusion: Urethra stricture in patients with bladder carcinoma may be a substantial source of preventable morbidity, implementing a nursing education program may significantly decrease the incidence of stricture. Keywords: bladder carcinoma; urethral stricture; Baquba Teaching Hospital

Transitional cell carcinoma of the bladder with hepatoid differentiation: A case report

Hepatoid adenocarcinoma is a very rare disease and usually occurs in the stomach, ovaries and lungs. The term hepatoid adenocarcinoma was first introduced by Ishikura et al. in 1985 to describe a rare aggressive malignant neoplasm in the urinary bladder [1,3].

Abstract A110: Racial disparities in transitional cell carcinoma of the bladder: A population-based study

Abstract Introduction: Bladder cancer is among the most common cancers in the U.S. with an estimated 81,190 new cases diagnosed in 2018 as well as 17,240 estimated deaths. The vast majority, around 90%, of bladder cancer cases are transitional cell carcinoma. Due to the significant burden of the disease, and disparities in access to medical care, we aim to study the survival of patients diagnosed with transitional cell carcinoma based on ethnicity. Methods: Data of White and Black patients with transitional cell carcinoma of the bladder diagnosed between 1973 and 2014 were obtained using the SEER database. We compared the overall and cancer-specific survival of patients using Kaplan-Meier test and Cox models. Results: We reviewed a total of 199,535 patients with transitional cell carcinoma of the bladder, of whom 10,263 were blacks, while the others were whites. The median overall survival of white patients was 103 months (95%CI, 102.0.34-103.966), which was significantly better than the overall survival of black patients, which was 64 months (95%CI, 60.373-67.627). Bladder cancer-specific survival was also better for whites when compared to blacks. When we adjusted age, sex, grade and stage of cancer, and undergoing surgery for bladder cancer, being black was associated with worse overall survival outcomes and cancer-specific survival outcomes (HR=1.263, 95%CI [1.227-1.300], P&amp;lt;.001) and (HR=1.396, 95%CI [1.342-1.451] P&amp;lt;.001), respectively. Conclusions: Our results show that significant differences in cancer-specific survival between ethnicities with the majority of diagnosed patients being Whites, while Blacks are suffering from worse survival outcomes. More research can shine a light on the underlying reasons why ethnicity is a significant factor affecting the survival of patients with bladder cancer. Citation Format: Mohamed M. Gad, Anas M. Saad, Mariam A. Obaid, Muneer J. Husseini. Racial disparities in transitional cell carcinoma of the bladder: A population-based study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A110.

The relationship between ABO blood group type and tumor grade, stage, recurrence and progression in transitional cell carcinoma of the bladder: A preliminary report

Objectives: ABO blood grouping is a well-proven prognostic factor in many malignancies. This study aims to study the association and impact of ABO blood group on disease recurrence and progression in bladder carcinoma. Material and methods: Patients with bladder carcinoma undergoing transurethral resection of bladder tumor (TURBT) were studied prospectively for at least 1-year follow-up for recurrence and progression of the disease. Demographic profile along with blood group was noted. Results: Two hundred patients were included in the study and 194 patients were included in the final analysis. Muscle-invasive bladder cancer was present in 39 (20.1%) patients and the high-grade tumor was present in 88 (45.3%) patients. There was no statistical significance between the association of blood grouping and grade ( p=0.29) and stage of the disease ( p=0.20). During the follow-up period, there were 100 (64.5%) recurrences and 15 (9.7%) patients with non-muscle-invasive bladder carcinoma had progression. The association of blood group with recurrence ( p=0.66) and progression ( p=0.11) of disease was not statistically significant. Conclusion: There is no association between bladder cancer and ABO blood group in terms of grade and stage of the disease. The recurrence and progression of the disease did not differ significantly in different blood groups. Level of Evidence: 2b

[Algorithms for systemic therapy of prostate cancer, transitional cell carcinoma and renal cell carcinoma].

Systemic therapy in uro-oncology is currently undergoing major changes. In the past, drug therapies only showed good treatment results in metastasized testicular tumors. New developments indicate that an improved understanding of tumor biology will lead to targeted treatment strategies for metastatic prostate, urothelial and renal cell carcinoma. In the following article, we summarize the practice-relevant innovations in systemic therapy in the guidelines on prostate cancer, transitional cell carcinoma of the bladder and renal cell carcinoma.