Aim: Globally, primary adenocarcinoma (AC) accounts for only 0.5% - 2% of bladder cancer (BC). Bilharziasis predisposes to AC in ~10% of BC in endemic regions. The aim was to study the clinicopathologic characteristic...Aim: Globally, primary adenocarcinoma (AC) accounts for only 0.5% - 2% of bladder cancer (BC). Bilharziasis predisposes to AC in ~10% of BC in endemic regions. The aim was to study the clinicopathologic characteristics of this rare entity and define prognostic elements influencing disease-free (DFS) & overall survival (OS). Patients & Methods: A retrospective analysis of 42 cases of primary bladder AC presented to the National Cancer Institute of Egypt (NCI-E) during a five-year period (2010-2014), clinicopathologic profiles, management and survival were assessed. Results: The mean age was 55.5 years ± 9.77 with male predominance. Hematuria, bilharziasis & urachal type experienced in 88%, 35.7% & 4.8%, respectively. Radical surgery was employed in 64.3%. Metastatic disease (stageIVB) found in 14.3%, initially. Eleven patients (26.2%) received palliative chemotherapy for their advanced or metastatic disease, objective response rates (ORR) were 0% & 100% for those received gemcitabine/platinum & capecitabine/oxaliplatin, respectively. The 5-year DFS & OS rates were 40.7% & 27%, respectively. DFS was significantly enhanced in patients having GII, negative nodes (pN0) and absence of hydronephrosis (p = 0.001, 0.011 & 0.047, respectively). Presentation with hematuria, pN0 & stage II was linked significantly with longer OS (p = 0.007, 0.037 & < 0.001, respectively). Tumour grade & clinical stage were independent prognostic factors affecting DFS & OS, respectively on multivariate analysis. Conclusions: Notable reduction in incidence of bladder AC in Egypt is mostly due to decline in bilharzial infection. Tumor grade & clinical stage are independent prognostic factors for DFS & OS, respectively. Still no agreement about the role of adjuvant radiotherapy or chemotherapy, however, protocols employed for colorectal cancer seem to be profitable in advanced and metastatic cases. Further larger scale studies are needed to define the hazard factors, molecular characterises and optimal management of this rare type of BC.展开更多
A 75-year-old male presented with difficult defecationand increasing urinary frequency over a few months. He had a significant history of previous partial gastrectomy for gastric carcinoma 20 years prior. Computed tom...A 75-year-old male presented with difficult defecationand increasing urinary frequency over a few months. He had a significant history of previous partial gastrectomy for gastric carcinoma 20 years prior. Computed tomography of the abdomen and pelvis showed extensive lymphadenopathy, a gastric mass and rectal as well as bladder wall thickening with bilateral ureterohydronephrosis. Normal looking serosal surfaces of the bladder and bowel were seen on laparoscopy and a defunctioning ileostomy was created. Gastroscopy revealed a malignant mass while cystoscopy and sigmoidscopy found extensive tumour growth lining the mucosal surfaces. Biopsies from all sites were compatible with intestinal type adenocarcinoma of gastric origin with few signet ring cells. Metabolic response to palliative chemotherapy was good and the patient's symptoms have improved on follow-up four months post ileostomy. We discuss the immunohistochemical profile of the tumour and review the literature.展开更多
文摘Aim: Globally, primary adenocarcinoma (AC) accounts for only 0.5% - 2% of bladder cancer (BC). Bilharziasis predisposes to AC in ~10% of BC in endemic regions. The aim was to study the clinicopathologic characteristics of this rare entity and define prognostic elements influencing disease-free (DFS) & overall survival (OS). Patients & Methods: A retrospective analysis of 42 cases of primary bladder AC presented to the National Cancer Institute of Egypt (NCI-E) during a five-year period (2010-2014), clinicopathologic profiles, management and survival were assessed. Results: The mean age was 55.5 years ± 9.77 with male predominance. Hematuria, bilharziasis & urachal type experienced in 88%, 35.7% & 4.8%, respectively. Radical surgery was employed in 64.3%. Metastatic disease (stageIVB) found in 14.3%, initially. Eleven patients (26.2%) received palliative chemotherapy for their advanced or metastatic disease, objective response rates (ORR) were 0% & 100% for those received gemcitabine/platinum & capecitabine/oxaliplatin, respectively. The 5-year DFS & OS rates were 40.7% & 27%, respectively. DFS was significantly enhanced in patients having GII, negative nodes (pN0) and absence of hydronephrosis (p = 0.001, 0.011 & 0.047, respectively). Presentation with hematuria, pN0 & stage II was linked significantly with longer OS (p = 0.007, 0.037 & < 0.001, respectively). Tumour grade & clinical stage were independent prognostic factors affecting DFS & OS, respectively on multivariate analysis. Conclusions: Notable reduction in incidence of bladder AC in Egypt is mostly due to decline in bilharzial infection. Tumor grade & clinical stage are independent prognostic factors for DFS & OS, respectively. Still no agreement about the role of adjuvant radiotherapy or chemotherapy, however, protocols employed for colorectal cancer seem to be profitable in advanced and metastatic cases. Further larger scale studies are needed to define the hazard factors, molecular characterises and optimal management of this rare type of BC.
文摘A 75-year-old male presented with difficult defecationand increasing urinary frequency over a few months. He had a significant history of previous partial gastrectomy for gastric carcinoma 20 years prior. Computed tomography of the abdomen and pelvis showed extensive lymphadenopathy, a gastric mass and rectal as well as bladder wall thickening with bilateral ureterohydronephrosis. Normal looking serosal surfaces of the bladder and bowel were seen on laparoscopy and a defunctioning ileostomy was created. Gastroscopy revealed a malignant mass while cystoscopy and sigmoidscopy found extensive tumour growth lining the mucosal surfaces. Biopsies from all sites were compatible with intestinal type adenocarcinoma of gastric origin with few signet ring cells. Metabolic response to palliative chemotherapy was good and the patient's symptoms have improved on follow-up four months post ileostomy. We discuss the immunohistochemical profile of the tumour and review the literature.
