Primary large cell neuroendocrine carcinoma of the bladder:A case report

BACKGROUND Large cell neuroendocrine carcinoma(LCNEC)of the bladder is a rare nonurothelial tumor of the bladder.The treatment of LCNEC of the bladder is different from that of urothelial carcinoma(UC);therefore,early and accurate diagnosis is particularly important.As LCNEC of the bladder is rare and its clinical symptoms and radiographic features are similar to those of urothelial tumors,the clinical diagnosis of the disease remains challenging.CASE SUMMARY We report a 72-year-old female patient who presented with gross hematuria for 3 mo.A solitary tumor located in the anterior wall of the bladder was found by cystoscopy.Pathological examination after biopsy suggested UC of the bladder in the absence of immunohistochemical assessment.The patient underwent partial cystectomy and was finally diagnosed with LCNEC(pT2bN0M0)based on the results of postoperative immunohistochemical examination.During the 10-mo follow-up,no signs of tumor recurrence or metastasis were found.CONCLUSION Immunohistochemical examination is essential for diagnosing LCNEC of the bladder.Accurate diagnosis and multidisciplinary treatment in the early stage of the disease are crucial for improving the prognosis.

Diagnosing upper tract urothelial carcinoma: A review of the role of diagnostic ureteroscopy and novel developments over last two decades

Objective: The role of ureteroscopy in the diagnosis of upper tract urothelial carcinoma is yet to be fully determined. We aimed to provide an up to date evaluation of its role and the emerging technologies in the field.Methods: A literature search of the last two decades (from 24th May, 2001 to 24th May, 2021) was carried out identifying 147 papers for potential inclusion within this narrative review.Results: Diagnostic ureteroscopy is undeniably useful in its ability to visualise and biopsy indeterminate lesions, and to risk stratify malignant lesions that may be suitable for kidney sparing surgery. However, an increased risk of intravesical recurrence following nephroureterectomy when a prior diagnostic ureteroscopy has been performed, inadequate sampling at biopsy, complications from the procedure, and difficult ureteric access are all potential drawbacks. Furthermore, whilst generally an accurate diagnostic procedure, it risks missing carcinoma in-situ lesions. Despite this, evidence shows that routine use of ureteroscopy changes the management of patients in a large proportion of cases, preventing unnecessary surgery or facilitating kidney sparing surgery. The overall rate of complications is low, and improved biopsy techniques and the use of tissue biomarkers for improved staging and grading are encouraging. The risks of delays to definitive management and post-ureteroscopy intravesical recurrence do not seem to affect survival, and trials are in progress to determine whether intravesical therapy can mitigate the latter. Further promising techniques are being investigated to improve shortcomings, particularly in relation to improved diagnosis of carcinoma in situ and preoperative staging.Conclusion: Ureteroscopy has a role in the diagnosis of upper tract malignancy, though whether it should be used routinely is yet to be determined.

Clinical implications of single cell sequencing for bladder cancer

Bladder cancer(BC)is the 10th most common cancer worldwide,with about 0.5 million reported new cases and about 0.2 million deaths per year.In this scoping review,we summarize the current evidence regarding the clinical implications of single-cell sequencing for bladder cancer based on PRISMA guidelines.We searched PubMed,CENTRAL,Embase,and supplemented with manual searches through the Scopus,and Web of Science for published studies until February 2023.We included original studies that used at least one single-cell technology to study bladder cancer.Forty-one publications were included in the review.Twenty-nine studies showed that this technology can identify cell subtypes in the tumor microenvironment that may predict prognosis or response to immune checkpoint inhibition therapy.Two studies were able to diagnose BC by identifying neoplastic cells through single-cell sequencing urine samples.The remaining studies were mainly a preclinical exploration of tumor microenvironment at single cell level.Single-cell sequencing technology can discriminate heterogeneity in bladder tumor cells and determine the key molecular properties that can lead to the discovery of novel perspectives on cancer management.This nascent tool can advance the early diagnosis,prognosis judgment,and targeted therapy of bladder cancer.

Results of Trans-Urethral Resection of Bladder (TURB) for the Treatment of Non-Infiltrating Bladder Tumors (NMIBT) in Musk in Bouake

Background: bladder tumors rank 2nd among urological tumors in sub-Saharan Africa, particularly in Côte d’Ivoire. Objective: to report the results of transurethral resection of the bladder (TURB) for the treatment of non-muscle-infiltrating bladder tumors (NMIBT) in Bouaké. Patients and methods: we conducted a cross-sectional, descriptive study of transurethral resection of the bladder (TURB) for the treatment of non-muscle-infiltrating bladder tumors (NMIBT) between January 2022 and April 2023. All patients and their families were informed in advance and had signed an informed consent form. All patients with a non-muscle-invasive bladder tumor confirmed by an initial TURB were included, and patients with a bladder tumor infiltrating the bladder muscle were excluded. Diagnosis was based on cystoscopy and anatomopathological examination of resection shavings. Parameters studied were: age, sex, risk factors, reason for consultation, clinical signs, cystoscopy findings, stage, grade, Evolution. Results: 17 patients with a mean age of 53.7 years (22-73 years) underwent trans-ureteral bladder resection to treat a non-muscle-infiltrating bladder tumor (NMIBT). Male gender predominated with 88.23% (n = 15), the majority of patients came from the ME region with 47.05% (n = 8), farmers were the most numerous (52.94%;n = 9). The most frequent reason for consultation was macroscopic hematuria with 64.1% (n = 11), risk factors were dominated by urinary bilharziasis with 70.58% (n = 12), physical examination was normal in 47.05% (n = 8). Hemoglobin (HB) levels were between 7.5 and 8.5 g/dl in 52.94% (n = 9). On cystoscopy, the tumor was budding in 76.45% (n = 13), the localization was trigonal in 52.9% (n = 9) and the base of implantation was sessile in 70.52% (n = 12). On ultrasound, the tumor was 3 cm or larger in 70.52% (n = 12). Therapeutically, 82.35% (n = 14) of patients received a blood transfusion. TURB was complete in the majority of cases 88.23% (n = 15). Squamous cell carcinoma was the most frequent histological type with 76.47% (n = 13). PTa and PT1 grade accounted for 23.52% (n = 4) and 76.47% (n = 13) respectively. High-grade PT1 accounted for 64.70% (n = 11). Follow-up to TURB was straightforward in 94.11% (n = 16). At three months post-TURB, seven patients presented a tumor recurrence, with 41.17% (n = 7) requiring a second TURB. At 6 months, follow-up noted 14 patients free of any clinical or endoscopic signs of bladder tumors. Conclusion: TURB is a safe and effective means of treating non-muscle-invasive bladder tumors.

Analysis of low expression of ferroptosis-related gene DECR1 on poor prognosis and immune cell defects of bladder urothelial carcinoma

Background:Ferroptosis is an iron dependent form of cell death,which plays an important role in the pathogenesis of a variety of urinary malignancies.The down-regulation of DECR1 gene causes the accumulation of polyunsaturated fatty acids(PUFAs),increases the susceptibility to lipid peroxidation,and finally leads to cell death.Methods:We first searched the data to find reductase 1(DECR1)expression in bladder uroepithelial carcinoma and healthy surrounding tissues in the Cancer Genome Atlas(TCGA),and we then confirmed DECR1 expression with additional independent cohorts in the Gene Expression Omnibus(GEO)database and the Human Protein Atlas(HPA).In order to determine the link between DECR1 expression and clinical traits and overall survival(OS),as well as to create nomograms,multivariate analysis and Kaplan Meier survival curves were utilized.Through the use of an online string website,the network of proteins that interact with DECR1 was created.Through an online string website,the protein network interacting with DECR1 was built.Finally,we looked at the association between aggressive immune cells and the marker genes that belong to them and DECR1 expression.Results:When compared to normal tissues,bladder tumor tissues had higher DECR1 expression(P=0.002).Low DECR1 expression was linked with tumor grade and stage in tumor cells.BLCA patients with low DECR1 expression had a lower overall survival than BLCA patients with high DECR1 expression,according to a survival study(P=0.008).The protein network’s HSD17B4 and DECR1 connections are crucial.The expression of regulatory T cells,regulatory B cells,and their markers were decreased when DECR1 was missing in bladder cancer.Conclusion:Decreased DECR1 expression was associated with BLCA progression,poor prognosis and impaired infiltration of some immune cells.

Metachronous urothelial carcinoma in the renal pelvis,bladder,and urethra:A case report

BACKGROUND Urothelial carcinoma(UC)is a common malignancy of the urinary system that can occur anywhere from the renal pelvis to the proximal urethra.Most UCs are in the bladder and have multifocal growth.Upper urinary tract UC(UTUC),which occurs in the renal pelvis or ureter,accounts for only 5%to 10%of UCs.CASE SUMMARY In March 2015,a 70-year-old male who initially presented to a local hospital with a complaint of painless hematuria was diagnosed with UTUC of the right renal pelvis.The doctors administered radical nephroureterectomy and bladder cuff excision.Although the doctors recommended intravesical chemotherapy and regular follow-up,he rejected this advice.In December 2016,the patient presented at our hospital with dysuria.We identified UC in the residual bladder and administered radical cystectomy and left cutaneous ureterostomy.In November 2021,he presented again with urethral bleeding.We detected urethral UC as the cause of urethral orifice bleeding and administered radical urethrectomy.Since then,he has visited regularly for 6-mo follow-ups,and was in stable condition as of December 2022.CONCLUSION UTUC is prone to seeding and recurrence.Adjuvant instillation therapy and intense surveillance are crucial for these patients.

Hyperprogression after anti-programmed death-1 therapy in a patient with urothelial bladder carcinoma:A case report

BACKGROUND Immune checkpoint inhibitors,including programmed death-ligand 1(PD-L1)and programmed death-1(PD-1)have recently been approved to treat locally advanced and metastatic urothelial carcinoma(UC).However,some patients experience rapid tumor progression rather than any clinical benefit from anti-PDL1/PD-1 therapy.CASE SUMMARY A 73-year-old woman with bladder UC showed the progression of multiple metastases after surgery and chemotherapy for over 12 mo.The patient could not tolerate further chemotherapy.Next-generation sequencing was performed,and the results indicated that the tumor mutational burden was 6.4 mutations/Mb.The patient received the anti-PD-L1 agent toripalimab combined with albuminbound paclitaxel.Compared with the baseline staging before immunotherapy,the patient had a treatment failure time of<2 mo,an increase in tumor burden of>50%,and a>2-fold increase in progression,indicating hyperprogression.CONCLUSION Selecting patients most likely to respond to treatment with immunotherapeutic agents remains challenging.For older patients with advanced UC who have already exhausted multi-line chemotherapy options,immunotherapy should be used prudently if no effective biomarker is available.Further studies are required to clarify the causes and mechanisms of hyperprogression.

Expression of Snail in bladder urothelial carcinoma and its relationship with E-cadherin and a subset of T cell groups

Objective To investigate the expression of Snail in bladder urothelial carcinoma and evaluate its relationship with E-cadherin and a subset of T cell groups. Methods Immunohistochemical method was used to detect the expression of Snail and E-cadherin proteins in tissue

WNT/β-catenin signaling in urothelial carcinoma of bladder

Urothelial carcinoma of bladder is the second most prevalent genitourinary disease.It is a highly heterogeneous disease as it represents a spectrum of neoplasms,including non-muscle invasive bladder cancer(NMIBC),muscle invasive bladder cancer(MIBC)and metastatic lesions.Genome-wide approaches and candidate gene analysis suggest that malignant transformation of the bladder is multifactorial and a multitude of genes are involved in the development of MIBC or NMIBC phenotypes.Wnt signaling is being examined to control and maintain balance between stemness and differentiation in adult stem cell niches.Owing to its participation in urothelial development and maintenance of adult urothelial tissue homeostasis,the components of Wnt signaling are reported as an important diagnostic and prognostic markers as well as novel therapeutic targets.Mutations/epigenetic alterations in the key molecules of Wnt/β-catenin canonical pathway have been linked with tumorigenesis,development of drug resistance and enhanced survival.Present review extends our understanding on the functions of key regulatory molecules of canonical Wnt/β-catenin pathway in urothelial tumorigenesis by inducing cancer stem cell phenotype(UCSCs).UCSCs may be responsible for tumor heterogeneity,high recurrence rates and complex biological behavior of bladder cancer.Therefore,understanding the role of UCSCs and the regulatory mechanisms that are responsible for high relapse rates and metastasis could help to develop pathway inhibitors and augment current therapies.Potential implications in the treatment of urothelial carcinoma of bladder by targeting this pathway primarily in UCSCs as well as in bulk tumor population that are responsible for high relapse rates and metastasis may facilitate potential therapeutic avenues and better prognosis.

The role of aberrant promoter hypermethylation of DACT1 in bladder urothelial carcinoma

The purpose of this study was to determine the relationship between hypermethylation of DACT1 gene pro-moter and lower mRNA expression in bladder urothelial carcinoma tissue.The methylation status of 29 urothelial carcinoma samples and 29 normal tissue samples were examined by methylation-specific polymerase chain reac-tion（MSP）.The DACT1 mRNA transcript levels and DACT1 protein levels in all samples were then evaluated to define the relationship between the methylation status of the DACT1 promoter and its expression at the transcrip-tional and translational levels.Decreased expression of DACT1 was detected in 89.66% of urothelial carcinomas（26/29;P 〈 0.005）.Promoter hypermethylation was found in 58.62%（17/29） urothelial carcinomas and 25%（7/29） normal tissues,respectively（P 〈 0.05）.DACT1 expression was lower in tissues where the DACT1 gene promoter was hypermethylated than in unmethylated tissues（0.25±0.17 vs 0.69±0.30,P 〈 0.05）.DACT1 gene hyper-methylation was closely related to tumor size,grade and stage（P 〈 0.05）.Our results indicate that silencing and downregulation of DACT1 mRNA may be implicated in carcinogenesis and the progression of bladder urothelial carcinoma,and may be a potential prognostic factor.

MTHFR C677T polymorphisms are associated with aberrant methylation of the IGF-2 gene in transitional cell carcinoma of the bladder

The purpose of this study was to determine the relationship between methylation status of the insulin-like growth factor 2 （IGF-2） gene and methylenetetrahydrofolate reductase （MTHFR） C677T gene polymorphisms in bladder transitional cell carcinoma tissues in a Chinese population. The polymorphisms of the folate metabolism enzyme gene MTHFR were studied by restrictive fragment length polymorphism （RFLP）, PCR-based methods of DNA methylation analysis were used to detect the CpG island methylation status of the IGF-2 gene. The association between the methylation status of the IGF-2 gene and clinical characteristics, as well as MTHFR C677T polymorphisms, was analyzed. Aberrant hypomethylation of the IGF-2 gene was found in 68.3% bladder cancer tissues and 12.4% normal bladder tissues, respectively, while hypomethylation was not detected in almost all normal bladder tissues. The hypomethylation rate of the IGF-2 gene in cancer tissues was significantly higher in patients with lymph node metastasis than in those without lymph node metastasis （46.3% vs 17.2%, P = 0.018）. No association was found between aberrant DNA methylation and selected factors including sex, age, tobacco smoking, alcohol consumption and green tea consumption. After adjusting for potential confounding variables the variant allele of MTHFR C677T was found to be associated with hypomethylation of the IGF-2 gene. Compared with wildtype CC, the odds ratio was 4.33 （95% CI=1.06-10.59） for CT and 4,95 （95% CI=1.18-12.74） for TT. MTHFR 677 CC and CT genotypes might be one of the reasons that cause abnormal hypomethylation of the IGF-2 gene, and the aberrant CpG island hypomethylation of the IGF-2 gene may contribute to the genesis and progression of bladder transitional cell carcinoma.

Percutaneous resection of upper tract urothelial cell carcinoma:When,how,and is it safe?

Introduction:In the management of upper tract urothelial cell carcinoma(UTUC)endoscopic,nephron sparing procedures like ureterorenoscopy(URS)or percutaneous tumour resection(PCTR)still play a very limited role.This could lead to possible unnecessary radical nephroureterectomies(RNU),still being the gold standard treatment.The risk of chronic kidney disease(CKD)later in life is important.In this study we present the results of 24-year experience with PCTR in a single institution.Methods:We identified 44 patients who underwent PCTR between 1992 and 2015.Radical resection was achieved in 40 patients who were included in this study.Demographic and clinical data,including tumour recurrence,progression to RNU,tumour grade and overall survival(OS)were retrospectively acquired.An outcome analysis was conducted.Results:Median age at diagnosis was 68 years(range 42-94 years).Low grade tumours were found in 37 patients(92.5%)and high grade tumours in three patients(7.5%).Median followup was 53 months during which 20 patients developed upper tract recurrences(50.0%).The longest time to recurrence was 97 months.At follow-up 11 patients(27.5%)underwent an RNU and two patients died from UTUC.RNU could be avoided in 29 patients(72.5%).In this study we found that multifocality is a significant risk factor for recurrence,but not for stage progression to RNU.Conclusion:PCTR is a surgically and oncologically safe procedure.Renal preservation in patients with UTUC who are eligible for percutaneous resection can be achieved in the majority of patients.Selection criteria for PCTR should be further refined,leading to a wider application of PCTR in the future.Follow-up needs invasive procedures and should be long term.

A Combined Clinicopathologic Analysis of 658 Urothelial Carcinoma Cases of Urinary Bladder

Objective To study the clinicopathological features of patients with urothelial carcinoma of the urinary bladder (UCB), and analyze the association of clinicopathological characteristics with tumor recurrence and progression. Methods Altogether 658 UCB cases in Fudan University Shanghai Cancer Center were collected from January 2006 to December 2010. The histopathologic materials and the clinical records were reviewed. Univariate and multivariate analyses were preformed to detect the association. Results The mean age of the patients was 61.97±12.97 years (range, 20-90 years). Male to female ratio was about 5:1. A total of 517 cases (78.6%) were superficial at the time of diagnosis (stage Ta/T1). The mean follow-up period was 22.36±24.92 months. Twenty-five patients lacking follow-up information were excluded in calculating recurrence and progression rates, the recurrence rate was about 37.0% (234/633), and progression rate about 6.2% (39/633). Three variables (grade, tumor growth pattern, and pathological stage) were found to be significant risk factors for tumor progression in univariate and multivariate analyses (P<0.05). Conclusions Most of the newly diagnosed UCB cases may be superficial diseases. Grade, tumor growth pattern, and pathological stage are associated with tumor progression of UCB.

Predictive Factors of Bladder Tumor Recurrence after Nephro-Ureterectomy for Urothelial Carcinoma

Objectives: To evaluate the incidence of bladder cancer after nephro-ureterectomy (NUT) and determine the potential risk factors of bladder recurrence in patients with upper urinary tract urothelial carcinoma (UUT-UC). Materials and Methods: We retrospectively assessed 37 patients with UUT-UC including a significant follow-up after NUT of 34 months (range 12 - 120 months). The median age of the population was 72 years (range 48 - 83 years). Patients with a previous history of bladder cancer, concomitant diagnosis of bladder tumor and UUT-UC;or a metastatic UUT-UC were excluded from the study. Results: Out of these 37 patients, 17 presented a bladder recurrence within an average time of 12 months (range 3 to 31 months) after the NUT. In 94% of the cases, bladder recurrence occurred within the first 24 months following the NUT. Histological distribution was: 13 Ta tumors (76%), 2 pT1 tumors (11.7%);11 patients had a high stage lesion (76%), whereas 4 patients had a low stage lesion (23.5%). As regards the anatomo-pathological characteristics of the UUT-UC, the supra iliac localization of the tumor is a significant risk factor of bladder recurrence (p = 0.04). Conclusion: Bladder recurrence after NUT occurred frequently and could have possibly been under-estimated. The use of intra-vesical instillation of Mitomycin C after NUT has been recently recommended by the European Association of Urology, but no predictive factors have yet been identified. Early diagnosis of bladder recurrence could certainly have reduced mortality in this patient population.

Research on the prognosis of different types of microvessels in bladder transitional cell carcinoma

BACKGROUND At present,there is controversy on the role of microvessel density(MVD)in tumors as a prognostic indicator of bladder transitional cell carcinoma(BTCC).However,the MVD in tumors is simply classified based on the expression of several different vascular markers,which has not been related to analytical research on the prognosis of patients with BTCC.AIM To explore the classification of blood vessels in tumors and studied the relationship between MVD and the prognosis of patients with BTCC.METHODS The tissue mass was detected by tissue microarray and immunohistochemical analysis with monoclonal antibodies against CD31,CD34,CD105,and vascular smooth muscle actin to investigate the MVD in BTCC.The measurement data are expressed as the mean±SD.The difference between the groups was analyzed by the t-test,the counting data were analyzed byχ2 test.The Kaplan-Meier survival curve was estimated by the product-limit method.The log-rank time-series test was employed to compare the tumor-free survival curves.RESULTS The MVD was closely related to the pathological grade,invasive depth,and prognosis of BTCC.Significant differences were found between grade I and grade II,grade II and grade III,superficial and invasive type,and the tumor-free survival group and the recurrence or metastasis group(P<0.01).Multivariate analysis showed that undifferentiated MVD was an independent prognostic factor for patient survival time.An inverse correlation between undifferentiated tumor MVD and differentiated tumor MVD in BTCC was also shown.CONCLUSION The classification of blood vessels in BTCC could act as an important prognostic indicator and may also be of great significance in the treatment of cancer.

Mutational analysis of Ras hotspots in patients with urothelial carcinoma of the bladder

BACKGROUND Mutational activation of Ras genes is established as a prognostic factor for the genesis of a constitutively active RAS-mitogen activated protein kinase pathway that leads to cancer.Heterogeneity among the distribution of the most frequent mutations in Ras isoforms is reported in different patient populations with urothelial carcinoma of the bladder(UCB).AIM To determine the presence/absence of mutations in Ras isoforms in patients with UCB in order to predict disease outcome.METHODS This study was performed to determine the mutational spectrum at the hotspot regions of H-Ras,K-Ras and N-Ras genes by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)and DNA sequencing followed by their clinical impact(if any)by examining the relationship of mutational spectrum with clinical histopathological variables in 87 UCB patients.RESULTS None of the 87 UCB patients showed point mutations in codon 12 of H-Ras gene;codon 61 of N-Ras gene and codons 12,13 of K-Ras gene by PCR-RFLP.Direct DNA sequencing of tumor and normal control bladder mucosal specimens followed by Blastn alignment with the reference wild-type sequences failed to identify even one nucleotide difference in the coding exons 1 and 2 of H-Ras,NRas and K-Ras genes in the tumor and control bladder mucosal specimens.CONCLUSION Our findings on the lack of mutations in H-Ras,K-Ras and N-Ras genes could be explained on the basis of different etiological mechanisms involved in tumor development/progression,inherent genetic susceptibility,tissue specificity or alternative Ras dysfunction such as gene amplification and/or overexpression in a given cohort of patients.

The Expression and Significance of KAl1 and Ki67 in Bladder Transitional Cell Carcinoma

OBJECTIVE To explore the expression and significance of the tumor metastatic suppressor gene the KAI1 and Ki67 antigen in bladder transitional cell carcinoma （BTCC）. METHODS Two-stepped immuno-histochemical staining was used to detect the expression of the KAI1 protein and Ki67 antigen. The reverse transcription polymerase chain reaction （RT-PCR） was used to detect the KAI1 mRNA in 54 BTCC specimens and 32 normal bladder counterparts. 13-actin was the internal control. RESULTS The KAI1 protein was mainly expressed on cell membranes at cell-to-cell borders, with uniform and continuous staining in normal bladder transitional epithelium. However, the number of positive-staining cells was greatly decreased in BTCC epithelium, and with an increase in the stage and Grade and appearance of lymph node metastasis the staining was non-uniform and discontinuous. The Ki67 antigen was expressed in the nucleus, and with an increase in the stage and Grade and appearance of lymph node metastasis, the Ki67 expression increased. The Ki67 antigen was negatively related to the expression of KAI1 （P〈0.01）.The expression level of KAI1 mRNA was much greater in normal bladder transitional epithelium compared to BTCC, moreover, with an increase in the Grade, infiltration depth and appearance of lymph node metastasis, the expression of KAI1 mRNA was reduced. CONCLUSION The expression of KAI1 protein may be used as a prognostic marker to indicate the degree of infiltration and metastasis. Measurement of KAI1 and Ki67 expression together may be helpful in evaluating the metastatic potential and prognosis of BTCC patients.

SMALL CELL CARCINOMA OF THE URINARY BLADDER: THREE CASES REPORT

To study the clinical features of patients with primary small cell carcinoma (SCC) of the bladder and to improve the diagnosis and treatment. Methods: Clinical data of 3 cases with primary SCC of the bladder were discussed and the pathology, diagnosis, treatment and prognosis were reviewed. Results: 3 cases of primary SCC of the bladder were presented. Of them the diagnosis was confirmed by pathological examination after operation (2 cases) and biopsy (1 case). One case with stage T4M1 died after three months?chemotherapy. One case with stage T2M0 underwent partial cystectomy and was treated with chemotherapy and one year later died of miocardial infarction. Another case with stage T4M0 underwent radical cystectomy and postoperative irradiation therapy. The patient was alive and had no recurrence of symptoms during two years follow-up. Conclusion: Primary SCC of the urinary bladder is highly malignant. Radical cystectomy combined with radiotherapy appears to be the efficient treatment. Chemotherapy seems to be of no significant effect.

Case Report: Primary Urothelial Carcinoma of Ureteral Stump Following Radical Nephrectomy for Renal Cell Carcinoma

PUC is common in the urinary tract. It may occur in the urinary bladder and the collecting system of the upper urinary tract, such as the renal pelvis and ureter. However, PUC of ureteral stump after a nephrectomy is rare, and it’s even rarer in patients undergoing a radical nephrectomy for RCC. We describe a female patient with painless gross hematuria that was secondary to PUC of ureteral stump after a radical nephrectomy for RCC diagnosed 6 years ago. We discuss the etiology, diagnosis and treatment for PUC of ureteral stump following radical nephrectomy for RCC.

Bladder-Sparing Approach with Radiotherapy in Patients with Small Cell Carcinoma of the Bladder

Small cell carcinoma (SCCB) of the bladder is rare and has a poor prognosis. Because of its rarity, gold standard care has not been established. The purpose of this study was to analyze the feasibility of a bladder-sparing approach. Data for treatments and outcomes in patients with a diagnosis of SCCB who received bladder-sparing treatment in our facility in the period from February 2007 to August 2012 were retrospectively analyzed. Six eligible patients received definitive radiotherapy in the cancer network of Tohoku region. Mean age of the patients was 69.5 years (range: 44 - 83 years), and median follow-up period was 29.2 months (range: 4.1 - 54.5 months). The mean dose was 60 Gy (range: 60 to 63 Gy), and 1.2 - 2.0 Gy was given per fraction. The initial CTV was the whole pelvis or the small pelvis, and it was shrunk to the bladder or tumor as a boost. The 1-year and 3-year overall survival rates were 83.3% and 55.6%, respectively. The 1-year and 3-year local control rates were both 80.0%. Only one patient had local failure. Recurrence or metastasis in sites other than the brain occurred in three (50%) of the patients after primary treatment. Two of those patients did not receive any chemotherapy. None of the patients had serious toxicities, and the bladder could be preserved in all patients. In this study, radiotherapy was effective for patients with SCCB. There was no recurrence in the bladder, and it was possible to preserve the bladder in all patients. Distant metastases were observed frequently, and chemotherapy was considered to be essential. Local treatment with radiotherapy has an important role from the point of view of the patient’s QOL.