Transurethral Biopsy Research Articles

FGFR testing from matched tissue and urine samples within the prospective real world clinico-pathological register trial BRIDGister.

e16532 Background: The objective of the present study was to assess FGFR mutattions and fusions from matched urine and tissue samples from patients suspicious of bladder cancer and undergoing first TURB at the pilot center of the multicentric BRIDGister RealWorld Experience trial Methods: For this pilot study paraffin fixed pretreatment tissue samples from the first TURB of 28 pts participating in the BRIDGister trial and matched urine samples were prospectively collected and analyzed. RNA from FFPE tissues were extracted by commercial kits and analyzed by Therascreen FGFR IVD kit (Qiagen GmbH, Hilden). In addition urine samples were shipped for central isolation of extracellular vesicles and extraction of RNA (exoRNA.Exosome Diagnostics GmbH, Martinsried) and subsequently centrally analyzed by QIAcuity digital PCR (Qiagen, Hilden). Additional urine testing was performed by further technologies including central cytology. Concordance, Kruskal-Wallis, MannWhitney and Sensitivity/Specificity tests were analyzed by JMP 9.0.0 (SAS software). Results: The pilot cohort of the BRIDGister trial consisted of 28 patients (median age: 73, male 71% vs female 29%) of diverse clinical stages (Benign lesions/no tumor 21%, pTa 32%, pT1 21%, pT2 21%) and WHO 1973 grade (G1 7%, G2 43%, G3 21%). Based on FFPE tissue testing using Therascreen FGFR IVD kit 9 out of 28 patients exhibited FGFR alterations (32%). Based on exosomal RNA (exoRNA) and subsequent dPCR testing 8 out of 21 matched urine sampels were FGFR positive (38%). Comparison with tissue testing as probable gold standard revealed 71% sensitivity, 78% specificity, 63% PPV and 85%NPV. There were 3 patients being FGFR positive for exoRNA from urine with no mutation found in the corresponding TUR biopsy. One of these mutations could be validated by independent urine test. Furthermore one tumor harbored two tissue mutations (R248C, Y373C) but three urine mutations (R248C, Y373C, G370C) indicating substantial tumor heterogeneity. One FGFR3-TACC3 fusion was detected from a benign lesion, which was not found by the exosomal urine test. Conclusions: Extraction of exosomal RNA from urine followed by highly sensitive dPCR mutation testing is feasible with good concordance to matched tissue testing. Urine testing bears the potential of detecting additional mutations in a real world setting and might evolve as alternative approach for FGFR3 screening in a non invasive fashion without the need of transurethral biopsy. Discordant cases are further followed up and might reveal validation of mutation status in upcoming recurrences.Further exploration is warranted and includes the potential of monitoring patients with FGFR before and after therapeutic intervention. By the time of the congress an update of the data with approximately 50 matched pairs will be presented.

Ultrasound‐guided transurethral urinary bladder biopsy using an endoscopic biopsy forceps in dogs: 27 cases (2016–2019)

To describe an ultrasound-guided transurethral bladder biopsy technique using endoscopic forceps and its results in dogs of different sizes with different lesion locations. Medical records of dogs that underwent ultrasound-guided transurethral bladder biopsy with endoscopic forceps were retrospectively reviewed. Patient signalment, lesion location, use of urinary catheter as a guide, outcome of the procedure and histopathology results were retrieved. Twenty-seven dogs underwent this procedure. Biopsy samples were successfully obtained in 23 dogs. Insertion of the endoscopic forceps without a urinary catheter allowed the procedure to be performed in patients with a small urethral diameter without complication. The procedure was unsuccessful in dogs with a urethral diameter smaller than the outer diameter of the biopsy forceps (i.e. 1.8 mm), either due to small patient size or obstructive urethral lesion. All biopsy samples allowed histopathological diagnosis. No complications were reported after the procedure. This non-invasive biopsy technique should be considered in patients with bladder lesions in which histopathological diagnosis is needed, especially when endoscopic examination is not feasible. By use of the Doppler mode, biopsy retrieval was safe also when the lesion ​was highly vascularised.

GATA3 and CK5/6 Immunohistochemical Expression in Urothelial Carcinoma: Diagnostic, Biological and Prognostic Significance

Background: Urothelial carcinomas [UCs] can be diagnostically challenging, particularly transurethral bladder tumors resection biopsies with limited material. Immunohistochemistry is a valuable instrument for diagnosis when morphology alone is inadequate. GATA-binding protein 3 [GATA3] and cytokeratin 5/6 [CK 5/6] contributes to the growth of UC. However, their correlative expression in UC and prognostic value has not been sufficiently investigated. The aim of the work: The current study aimed to evaluate the utility of GATA3 expression in UC and correlate that with CK 5/6 expression to verify different subtypes of UC and assess their prognostic significance. Methodology: Here, we immunohistochemically stained GATA3 and CK 5/6 in 90 UCs samples by transurethral bladder tumor resection in a retrospective study, between May 2018 and February 2020. All were histopathologically evaluated and immunohistochemically stained for GATA3 and CK 5/6, and then correlated them with the clinicopathological parameters to investigate their clinical significance. Results: GATA3 expression was seen in 76 patients [84.44 %]. There was significant correlation between GATA3 expression with the tumor histological grade and degree muscle invasion. There was a weak or even negative expression in high‑grade, invasive than the low‑grade, non-invasive tumor [P= <0.001]. CK5/6 was positive and focally positive in 27.78% with a significant correlation of CK5/6 expression with tumor grade and muscularis propria invasion. On the other side, tumors with diffuse GATA3 expression had low CK5/6 expression. Conclusion: GATA3 and CK 5/6 should be used as sensitive and specific markers for UC. They can also be effectively used in the prediction of probable grade and tumor invasion in biopsied material with poor morphological characters; and thus, help in the future appropriate treatment.

Clear cell carcinoma of Mullerian origin in the urinary bladder: A rare entity

Mullerian neoplasms of the urinary system are rare but complex tumor-like lesions. The identification of the Mullerian neoplasm is crucial for patient management owing to its etiology, natural history, and prognosis. We present a case of a 42-year-old female with a history of three lower segment cesarean sections presenting with complaints of dysmenorrhea and suprapubic pain with no history of hematuria or any urinary symptoms. Magnetic resonance imaging revealed a 2 cm×2 cm exophytic lesion suspicious of being either a bladder lesion or an endometrial lesion infiltrating the urinary bladder. Cystoscopy and transurethral biopsy of this suspicious bladder tumor revealed a malignant tumor with papillary and tubulocystic architecture. Based on the overall histomorphological and immunohistochemical features, a diagnosis of clear cell carcinoma of Mullerian origin was made, and the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and partial cystectomy. The patient was kept on regular surveillance and showed no signs of recurrence at the one-year follow-up. Clear cell carcinoma of the bladder of Mullerian origin is a rare entity and is established on histopathology. Prompt diagnosis and a multidisciplinary approach are indispensable for management. Level of evidence: Level 4.

Achieving the Best RNA Quality in Urologic Tumor Samples Intended for Transcriptome Analysis

Purpose: To conduct research on the molecular oncology, physiology, and immunology of urologic tumors requires dissociated viable samples. Improper collection compromises the quality of data attained in molecular and functional assays due to the increased quantities of degraded proteins and RNA. We sought to improve the methods for tissue collection which can avoid generating considerable loss in the viability of cells for further analyses. Materials and Methods: Fifty resected tumor samples from 35 patients were obtained with different surgical techniques and at various time points for viability and RNA quality evaluation. The degradation of RNA was evaluated by its Qubit IQ score, OD 260/280 ratio, total yield, and quantity of β-actin. Results: Snap-frozen tissue samples obtained within 30 min showed better cell viability (P &lt; 0.0001), RNA total yield (P = 0.0081), Qubit ratio (P = 0.003), OD 260/280 ratio (P = 0.4213), and quantity of β-actin (P = 0.0015). Moreover, the bladder tumor samples collected from transurethral biopsy presented more satisfied cell viability results than the ones resected by transurethral electroresection (P &lt; 0.0001). Conclusion: Tumor samples should be processed or frozen freshly within 30 min once removed from human body. Furthermore, transurethral biopsy of bladder tumor is considered a better method for collecting samples for further molecular oncology studies. The high-quality RNA produced enable researchers to conduct more reliable studies by avoiding the experimental artifacts due to the presence of cellular debris or dead cells.

Histomorphological evaluation of non-neoplastic lesions of the urinary bladder

Aim: The aim of this study is to evaluate the urinary bladder biopsies for non-neoplastic lesions. Materials and Methods: This study includes 41 non-neoplastic bladder lesion cases out of 125 urinary bladder samples received by histopathology laboratories of two medical colleges between October 2017 and January 2020. The samples included transurethral tumor resections and bladder biopsies. Results: In the present study, seventy-two (59%) cases had neoplastic lesions, 29 (24%) cases had non-neoplastic lesions and 12 (10%) cases showed neoplastic in association with non-neoplastic lesions. The most common non-neoplastic lesions encountered were follicular cystitis, chronic cystitis, and hemorrhagic cystitis. Conclusion:In symptomatic lower urinary tract disease, cystoscopy and histopathological evaluation is rewarding in the diagnosis of various non-neoplastic causative lesions. Awareness of these entities facilitates easy diagnosis and differentiation from malignant processes.

A Tubular Dual-Roller Bending Mechanism Toward Robotic Transurethral Prostate Biopsy

Prostate biopsy procedures as a gold standard for early screening of prostate cancer often suffer from multipass needle perforations to irrelevant perineal tissue, high complication risk, and time consumption. To address these challenges, this article proposes a transurethral prostate biopsy robot that can deliver a flexible biopsy needle inside the prostate from different angles and thus obtain tissue samples from multiple locations. Emphasis is on the design and validation of the transurethral prostate biopsy robot with a detailed introduction of the working principle, mechanism modeling, and function testing. Phantom experiments in kiwi fruit puncture experiments and prostate phantom puncture experiments have demonstrated their potential in clinical application. The transurethral biopsy robot features a 7-mm tubular dual-roller bending mechanism together with a compact driver mechanism. The flexible biopsy needle can bend from 16.0 $^\circ$ to 55.8 $^\circ$ with a translational stroke of 32.5 mm and an overall rotational stroke of 360 $^\circ$ , which enable coverage a volume of 142.2 mL, more extensive than that of an enlarged prostate. The average angle positioning and overall positioning error are 0.82 $^{\circ }$ and 1.2 mm, respectively. It can provide a minimum of 6.3-N puncture force. The proposed transurethral prostate biopsy procedure is a unique inside-out robotic prostate biopsy method, contributing to a safer and less invasive prostate biopsy procedure.

Interpretation of Prostatic Biopsy at a tertiary care centre

Introduction: Worldwide prostatic carcinoma is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. Prostate-specific antigen (PSA), digital rectal examination, and transrectal ultrasound are the tools most commonly used to screen for prostate cancer. Prostatic biopsy is most often preceded by abnormalities found on digital rectal examination (DRE) or serum prostate specific antigen (S.PSA) elevation. This study was planned to know proportion of malignant and benign lesions in histopathologic examination for prostatic lesions in patient who attend OPD/IPD and to analyze the usefulness of serum PSA & ultrasound examination by histopathological confirmation. Methods: Patients visited to urology department with urinary incontinence and other complaints were evaluated which includes clinical history, signs and symptoms. Rectal examination of patients was done. Serum PSA level and prostatic biopsy were sent of those who were suspected for prostatic disease. Prostate biopsy was obtained by using any one of the following method 1.Transurethral resection biopsy 2. Transrectal biopsy Trucut biopsy. Results: Out of 300 cases of prostatic biopsy 265 (88.33%) are benign and 35 (11.66%) cases are malignant lesions. Out of 300 cases, 191 (63.66%) are pure benign prostatic hyperplasia, 48(16%) are BPH with chronic prostatitis and 11(3.66%) are BPH with severe prostatitis. Out of 35 cases of prostatic carcinoma 33 (94.28%) cases are adenocarcinoma and 2 cases (5.71%) are transitional cell carcinoma. Out of 262 cases with clinically benign lesions, 258 cases proved benign histopathologically but 4 cases (1.52%) are diagnose malignant. 151 patients have S.PSA less than 4 ng/ml, out of 151, 149 turned to be benign on histopathological examination. 52 patient have S.PSA above 10 ng/ml, out of these 52 cases, 29 have malignancy in HPE examination. Out of 278 cases diagnosed as benign isoechoic by ultra sonography 262 cases have benign lesion on histologic diagnosis and 16 have malignant lesion. Out of 22 cases diagnosed as malignant (hypoechoic asymmetrical) by ultrasonographicaly 19 proved malignant histologically. Conclusion: The results of this study indicate that transrectal ultrasound, serum prostate specific antigen and digital rectal examination were good tool to differentiate between malignant and benign lesions of prostate. Proportion of malignancies are quiet significant in prostatic lesions and increased with age. Key words: Prostae, Malignancy, Biopsy, PSA, DRE

Burkitt\u2019s lymphoma of the prostate presenting as acute urinary retention: a case report

BackgroundNon-Hodgkin lymphomas, which include Burkitt’s lymphoma, affect the prostate in only 0.1% of cases. They most commonly present as painless lymphadenopathy elsewhere in the body and can cause abdominal or thoracic pain and systemic symptoms such as fever, weight loss and night sweats. Here we report a rare case of sporadic Burkitt’s lymphoma of the prostate whose initial clinical presentation was acute urinary retention.Case presentationA 28-year-old Caucasian male presented repeatedly with urinary retention. First, he was misdiagnosed with alcohol-induced urinary retention and later with benign prostatic hyperplasia. After the appearance of new symptoms, including hematuria and hydronephrosis, endoscopic and radiographic evaluation was performed. Transurethral biopsy of the prostate secured the diagnosis of Burkitt’s lymphoma. The symptoms receded under chemotherapy and complete remission of the disease was established.ConclusionThis case report brings lymphomas into focus as a differential diagnosis for urinary retention in young males. Early use of extensive diagnostic measures is advised in patients with urinary retention for uncertain reasons to make prompt diagnosis and start appropriate treatment early.

Ureteral and urethral recurrence after radical cystectomy: a systematic review.

The clinical significance of ureteral and urethral recurrence in patients treated with radical cystectomy for bladder cancer is scarce and heterogeneous. The aim of the current review is to summarize the recent literature on incidence, diagnosis and oncologic outcomes of ureteral and urethral recurrences after radical cystectomy. Frozen section analysis (FSA) of ureteral margin had a sensitivity and specificity of 69-77 and 83-96%, respectively. Considering the ureteral margin, the reported sensitivity and specificity were 33-93 and 99-100%, respectively. Transurethral biopsy of the prostatic urethra might help in counseling patients' treatment, although its accuracy and prognostic role is highly questionable. In patients treated with radical cystectomy, recurrence of the urethra or ureteral are rare, occurring approximately in 5% of patients. During the follow-up, urinary cytology and cross-sectional imaging improve the early detection of recurrence in asymptomatic patients, although the majority are diagnosed for symptomatic presentation. Their use should be tailored to the patient's risk of ureteral and/or urethral recurrence. Urethrectomy is indicated in case of singular urethral recurrence, whereas no clear data exists regarding the best management of ureteral recurrence, except surgical removal. Intraoperative FSA of ureters and urethra share good specificity but poor sensitivity. Recurrence at urethra and upper tract are rare and discordant data exists regarding survival outcomes. Oncologic surveillance after radical cystectomy with the aim to detect these recurrences should be tailored to the individualized patient's risk.

Bladder Cancer Involving Smooth Muscle of Indeterminate Type or Muscularis Mucosae in Transurethral Biopsy Specimens.

Bladder cancers invading the muscularis mucosae (MM) are treated differently from those invading the muscularis propria (MP). However, it may be difficult to determine the type of smooth muscle in transurethral resection (TUR) or biopsy specimens. We aimed to investigate the clinicopathologic features of bladder cancers involving smooth muscle of indeterminate type (SMIT) in TUR specimens in comparison with those invading the MM. We identified 103 patients with bladder cancer involving SMIT (n = 27) or the MM (n = 76) in TUR specimens. All patients underwent subsequent restaging TUR or cystectomy. Bladder cancer with SMIT invasion showed a significantly higher rate of MP invasion in the subsequent specimens than those invading the MM (52% vs 29%). Lack of MP in the TUR specimens had a significantly higher risk of MP invasion in the subsequent specimens than those with the MP (61% vs 40%). The overall survival time for patients with SMIT invasion was significantly shorter than those with MM invasion. Bladder cancers with SMIT invasion in TUR specimens show more frequent cancer upstaging in the subsequent specimens and a poorer clinical outcome than those invading the MM, which highlights the importance of a cancer restaging procedure for these patients.

Accuracy of diffusion-weighted magnetic resonance imaging in evaluation of muscle invasion and histologic grading of the urinary bladder carcinoma

BackgroundCarcinoma of the urinary bladder is a common malignant tumor of the urinary tract in both men and women. Proper management of the urinary bladder cancer depends on the stage of the lesions. The aim of this prospective study was to determine the accuracy of diffusion-weighted images in early detection of muscle invasion, local tumor staging of urinary bladder carcinoma, and to measure the correlation between apparent diffusion coefficient (ADC) and histologic grade. Sixty patients with urinary bladder mass lesions underwent transurethral cystoscopy and biopsy after MR imaging. Radical cystectomy was done for lesions infiltrating muscularis propria. Different MR image sets (T2WIs, DWIs images) were interpreted; ADC values of tumors were calculated.ResultsKappa agreement was better in DWI than T2WI (Kappa was 0.756 and 0.484) and the overall agreement was (83.6% and 63.6%) among both respectively. Accuracy of DWI in diagnosis of tumor stages were 80%, 43%, 96%, and 100% while in T2WI were 55%, 43%, 74%, and 80% for T1, T2, T3, and T4 stages respectively. ANOVA test showed statistically significant difference between mean ADC values of different tumor grades.ConclusionDWI showed higher accuracy than T2WI in detection of the degree of muscle invasion of the urinary bladder carcinoma, so it can be added to the routine protocol of MRI examination especially in patients with renal impairment. ADC value can predict the histological grade of the tumor.

Incidental Prostate Carcinoma Diagnosed at Radical Cystoprostatectomy for Bladder Carcinoma A Case Report

Introduction: The incidence of concomitant urothelial carcinoma of the bladder and adenocarcinoma of the prostate varies from 17% to 70% as per various literature studies. Case report: We report the case of 82 year old male who presented with hematuria and lower urinary tract symptoms. A cystoscopy was performed which was suggestive of a 6x4x5cm mass arising from the left anterolateral wall and dome of the bladder. A Transurethral biopsy of the bladder mass showed a high grade papillary urothelial carcinoma invading the muscularis propria. Following this, the patient underwent a radical cystoprostatectomy. Histopathological examination of the bladder mass confirmed High -grade urothelial carcinoma. The entire prostate was sampled which revealed Adenocarcinoma prostate, Gleason score 3+4=7, tumor volume 6cc. Conclusion: The incidence of incidentally detected prostatic adenocarcinoma in Carcinoma bladder cases is extremely variable. Complete sampling of the prostate helps in detecting these lesions.

Prostatic ductal adenocarcinoma: an unusual case of a rare prostate cancer

A 65 year old gentleman was referred with symptoms of haematuria and haematospermia in association with an elevated prostate specific antigen (PSA). He was investigated with a flexible cystoscopy, Ultrasound scan and a computed tomography (CT) of his abdomen and pelvis. These failed to reveal any abnormality. Magnetic resonance imaging (MRI) revealed a Prostate Imaging Reporting and Data System PIRADS 2 lesion in the left peripheral gland and PIRADS 3 lesion on the right side posterolaterally at the level of mid gland of the prostate. He went on to have Transrectal ultrasound biopsies of his prostate (TRUS Bx) that excluded any pathology. On follow up visits his PSA continued to rise and he underwent Template biopsies of the prostate. The histological features had no evidence of any Prostatic intraepithelial carcinoma (PIN) or other malignancies. Flexible cystoscopy was repeated due to his persistent haematospermia. This showed prominent papillary lesions over his verumontanum and prostatic urethra. Biopsies from these areas revealed Ductal Adenocarcinoma of the Prostate (DACP). A subsequent staging MRI revealed unchanged appearance of the PIRADS2 nodule. There was however some low signal extending into the right seminal vesicle which is more pronounced than on the previous scan reported as PIRADS3. Subsequent mapping Template biopsies and Transurethral biopsies revealed a Gleason 4+4 DCAP. A staging CT and bone scan excluded any metastasis. He went on to receive an open radical prostatectomy and pelvic lymph node dissection as a curative treatment for his locally advanced disease.

Metastatic urachal cancer treated effectively with gemcitabine/cisplatin combination chemotherapy and radiotherapy: A case report.

Urachal cancer often presents at an advanced stage with poor prognosis due to the lack of an effective systematic therapeutic strategy. We experienced a case of metastatic urachal cancer treated effectively by combination chemotherapy and radiotherapy. A 55-year-old female presented to our department with right lower abdominal pain. A transurethral biopsy of an urachal tumor suggested urachal adenocarcinoma. The patient underwent chemotherapy with gemcitabine and cisplatin for metastatic urachal cancer. As tumor markers declined and the radiological findings indicated stability of disease, external beam radiotherapy was then administered to the primary site. Chemotherapy was then administered again in response to tumor markers gradually increasing and the progression of multiple peritoneal metastases. However, the patient did not complete chemotherapy due to hematological toxicity. The patient succumbed to primary disease 23 months after initial diagnosis. Previous studies have reported that the median time from the diagnosis of metastatic urachal cancer to mortality is just over 1 year. By contrast, in the present case the patient survived up to 2 years with combination chemotherapy and radiotherapy, a rare incidence worthy of reporting.

Diagnosis of urothelial carcinoma in situ using blue light cystoscopy and the utility of immunohistochemistry in blue light–positive lesions diagnosed as atypical

Carcinoma in situ (CIS) is difficult to visualize with white light cystoscopy (WLC), whereas blue light cystoscopy (BLC) using photosensitizing agents improves detection rates. We retrospectively reviewed transurethral biopsies of bladder tumors in which both WLC and BLC evaluations were performed (n = 135 samples from 79 patients). Biopsies were classified based on the presence/absence of fluorescence under BLC and the final pathological report (CIS/benign/atypical). Forty-one (30%) cases were diagnosed as CIS; of those, 38 (93%) were BLC(+), including 23 that were WLC(-). Conversely, 51 (38%) lesions were BLC(+) but classified as non-CIS. Eleven BLC(+) cases were diagnosed as "atypical." These cases were anonymized and reviewed by 7 pathologists for concordance and then immunostained for CK20, p53, and Ki-67. Immunohistochemistry results were interpreted as consistent with CIS if there was full-thickness staining of CK20, more than 50% p53-positive cells, and more than 50% Ki-67-positive cells. Review of BLC(+)/atypical cases showed a mean agreement of 79%, and none of the cases showed staining pattern consistent with CIS. Therefore, all 11 cases of BLC(+)/atypical were considered non-CIS for the final analysis. All patients with BLC(+)/atypical lesions had a history of intravesical Bacillus Calmette-Guerin and/or mitomycin. Using final pathology as the reference, sensitivity, specificity, and negative predictive value of BLC were 93% (confidence interval [CI], 80.1%-98.5%), 46% (CI, 35.4%-56.3%), and 94% (CI, 82.5%-97.8%), respectively. The low specificity of BLC leads to BLC(+) lesions with atypical diagnosis. Morphological classification of these lesions is fairly consistent among different pathologists. Immunohistochemistry for p53/CK20/Ki-67 in this setting is only helpful to potentially avoid overcalling CIS.

Evaluation of the Dwell-Time and Dose Difference in Intravesical Bacillus Calmette-Guèrin Therapy

Objective:Bacillus Calmette-Guèrin (BCG) intravesical therapy is currently established using a low dose because of the high incidence of side-effects. Moreover, shortening the dwell time of BCG is conducted in some facilities owing to the complications associated with a long dwell time after injection. The method of BCG administration varies in each facility and even with each doctor. We evaluated whether the dwell-time and dose differences in patients who underwent intravesical BCG therapy is related to completion rates, adverse effects, and nonrecurrence rates.Methods:From November 2006 to April 2016, a total of 173 patients who received intravesical BCG therapy after transurethral resection of bladder tumor or transurethral biopsy were evaluated retrospectively. We allocated them into 4 groups based on the dose (40 or 80 mg BCG) and the dwell time (1 or 2 hours). Completion rate, side effects, and nonrecurrence rates were evaluated.Results:No significant improvement in the completion rate or reduction in side-effects was observed in any of the regimens. Although nonrecurrence rates for the 1-hour dwell time tended to be lower than the 2-hour dwell time, the difference was not significant.Conclusion:Our study suggests that reducing the BCG dose or shortening the dwell time does not reduce adverse effects or affect the nonrecurrence rate.

A Case of Localized Amyloidosis of the Right Ureter Treated Effectively by Occulusive Dressing Technique Therapy Using Dimethyl Sulfoxide : Long-Term Follow-Up of Eight Years

The patient was a 56-year-old female. She was referred to our department for further examination of right hydronephrosis in 2010. Computed tomography (CT) showed right hydronephrosis, and retrograde pyelography (RP) revealed stenosis of the right lower ureter. Urine cytology was negative. Transurethral biopsy of the right ureter was performed using ureteroscopic cup forceps and the histopathlogical diagnosis was ureteral amyloidosis. A whole-body search was performed, including rectal biopsy, but no evidence of amyloidosis was obtained. She was diagnosed with localized amyloidosis of the right ureter. A ureteral stent was indwelled and the patient was given occulusive dressing technique (ODT) therapy using dimethyl sulfoxide (DMSO) for 1 year. After ODT therapy, right hydronephrosis improved. After a 2-year followup, it worsened. ODT therapy was restarted and continued for 2 years. She consulted our department because of fever and right lumbago in April 2017 after a 4-month interruption of ODT therapy. CT revealed progression of the right hydronephrosis. A ureteral stent was indwelled and ODT therapy was restarted. The right hydronephrosis improved after 1 year. ODT therapy using DMSO was effective for localized ureteral amyloidosis, but periodic follow-up was necessary and ODT therapy was also effective when it recurred after the interruption of treatment.

Sex steroid hormone receptors in bladder cancer: Usefulness in differential diagnosis and implications in histogenesis of bladder cancer

ObjectiveIn rare cases, differential diagnosis between bladder cancer (BC) and gynecological tract cancer (GTC) is difficult because of anatomical proximity and morphological similarity. We analyzed expression status of sex steroid hormone receptors in BC in this study. First, we investigated their usefulness as a histological marker for differential diagnosis. Second, we considered their roles in BC histogenesis. MethodsEstrogen receptor α (ERα) and progesterone receptor (PgR) expression was investigated by immunohistochemistry in 125 BCs obtained by transurethral resection or biopsy, then in nonneoplastic background mucosa (trigone, fundus, and dome) of 33 total cystectomy samples. They were evaluated as positive when ≥ 1% of 500 subject cells were immunoreactive with moderate or strong intensities. ResultsERα and PgR were positive in 38.4% and 3.2% of BCs, respectively, suggesting that ERα status alone could not definitely differentiate between BC and GTC. ERα expression was not significantly associated with age and sex of BC patients and histopathology of BCs. Although not significant, ERα expression was more frequent in higher grade (G1/G2 vs. G3/G4; P = 0.143) and marginally associated with advanced stage of BCs (pTis/pTa/pT1 vs. pT2/pT3, P = 0.056). ERα expression was significantly more frequent in background mucosa with ERα-positive BC (In the epithelium and stroma; both P < 0.001). ERα expression was continuously observed from normal to malignant epithelium in some cases. Although not significant, Brunn's nest or cystitis glandularis was more frequent in background mucosa with ERα-positive BC (P = 0.218). Analyses of nonneoplastic mucosa in cystectomy revealed that ERα was more frequently positive in urothelium of trigone, a predilection site for cystitis glandularis, than those of fundus and dome, with a significant difference between trigone and dome (P = 0.034). These data suggest that chronic inflammation may up-regulate ERα in the background epithelium, especially in trigone, and ERα expression in BC might be the reflection of bladder epithelium from which BC arose. ConclusionsUsefulness of ERα was limited in differential diagnosis between BC and GTC. ERα up-regulation might not play a critical role in the development of BC because it was already noted in the background bladder mucosa.

Urethral diverticulum carcinoma in females-a case series and review of the English and Japanese literature.

The aims of our study were to describe our case series of three urethral diverticulum carcinomas (UDC) in women and to review the literature on UDC in females to determine patient characteristics, presenting symptoms and outcomes along with optimal investigations and treatment modalities. A literature search was performed utilizing Medline, EMBASE and the Cochrane library for all papers including case reports on UDC in women published to date. The results along with those of our three cases are detailed. A total of 126 cases of UDC in women have been reported; 75% adenocarcinoma (Adenoca), 15% transitional cell carcinoma (TCC) and 10% squamous cell carcinoma (SCC). Median age at presentation was 53 years (range, 14–81 years). The commonest presenting symptoms were bleeding and retention. Cystoscopy, MRI and trans-urethral biopsy were the commonest methods of diagnosis. Treatment was radiotherapy +/− chemotherapy alone in 21%, local excision +/− radiotherapy in 44%, urethrectomy in 3% and anterior exenteration +/− radiotherapy in 32%. At last follow-up 63% were alive and well, 10% were alive with recurrent cancer and 25% had died from their disease. UDC is rare in women. It is predominantly adenocarcinoma. There is no established treatment and survival is at best moderate. An international registry and consensus on management is needed if this is to be improved.