Urothelial cell carcinoma

Aims and objectives: The aim of this paper was to study the impact of neoadjuvant chemoradiation on downstaging of locally advanced rectal carcinoma, sphincter saving procedures and toxicity profile of chemoradiation.
Method: 31 patients were studied who had locally advanced adenocarcinoma of rectum. They were treated preoperatively with 20 frations of 225 cGy (5 days/wk) radiation (total of 45Gy over 28 days). Chemotherapy consisted of 5-FU (500mg/m.sq) only for day 1, 2, & 3. After an interval of of 4-6 wks, all patients were submitted to surgery.The principles of TME was
Results: The median follow up in our study was 1year. At 1 year the overall survival in operated cases was 100% with no disease relapse. 67% of patients underwent low anterior resection,6.5% had proctosigmoidectomy with end colostomy,16.5% had a palliative surgical procedure, 6.5% became non compliant after neoadjuvant and 3.2% expired preoperatively during chemoradiation. At the time of surgery 82.6% of patients had pathological downstaging of tomour and 45.4% had lymphnode downstaging.Consequently 67.7% of patients underwent a sphincter preserving surgical procedure.
The incidence of complication was 29% with grade 2 mucositis and 9.7% with grade 1 mucositis. Myelosuppression was seen in non.
Conclusion: Significant downstaging of disease was seen with this regime of treatment and with improved subsequent sphincterv preserving procedures with acceptable toxicity profile.

The most common histological type of urinary bladder cancer is urothelial carcinoma (UC). In contrast, the clear cell variant of urothelial carcinoma (CCUC) is quite a rare neoplasm. In this study, we report a case of an 81-year-old male, presenting with gross hematuria and acute urinary retention, which was subsequently diagnosed with CCUC at our pathology department. Furthermore, we provide a short systematic review of the literature (PubMed, Scopus, and Science Citation Index) for this rare histopathological entity and a brief discussion about its morphological and immunohistochemical (IHC) characteristics.

AIM: To evaluate the perioperative and long term outcomes of cystectomy in obese patients.

METHODS: This is a retrospective review of 580 patients for whom radical cystectomy (RC) was performed for primary urothelial bladder cancer between November 1996-April 2013 at a single institution. Body mass index (BMI) was available for 424 patients who were categorized as underweight (< 18.5), normal (18.5-24.9), overweight (25.0-29.9), and obese (≥ 30). Baseline demographics, perioperative outcomes, and survival were assessed. Overall survival (OS) and disease specific survival (DSS) was estimated by Kaplan-Meier method. Medians were compared using the Mann-Whitney U Test. Categorical variables were compared using the χ2 test. A P-value of < 0.05 was considered statistically significant. Statistical analyses were performed using the Software Package for the Social Sciences (SPSS), Version 20 (International Business Machines SPSS, Chicago, IL, United States).

RESULTS: The median age of all patients was 69 years (inter-quartile range 60-75) and median follow-up was 23.4 mo (8.7-55.1). Patients were characterized as underweight [9, (2.1%)], normal [113, (26.7%)], overweight [160, (37.8%)], or obese [142, (33.5%)]. Estimated blood loss during RC was higher in the obese group (800 mL) as compared to the normal weight group (500 mL). However, need for transfusion (47.7% vs 52.1%), number of lymph nodes resected (32 vs 30), length of stay (9 d vs 8 d), and 30-d readmission (29.7% vs 25.2%) between obese and normal BMI patients were similar. Obese patients underwent ileal neobladder diversion in 42% of cases, compared to 24% of normal BMI patients (0.003). Normal BMI and obese patients had comparable urinary incontinence (21.4% vs 25.6%, P = 0.343), and need for intermittent catheterization (14.3% vs 5.2%, P = 0.685) at 2 years follow-up. Overall survival was better in obese compared to normal BMI patients on univariate analysis, with median survival of 67 mo vs 37 mo, respectively (P = 0.031). Disease specific survival in these populations followed the same Kaplan Meier curve, with the obese group having a significantly improved OS, P = 0.016. Underweight patients had a significantly worse prognosis, with a median overall survival of 19 mo (P = 0.018). Disease specific survival was significantly worse in the underweight group compared to the obese group, P = 0.007. On multivariate analysis underweight patients remained at increased risk for death (HR = 3.1, P = 0.006), as were older patients (HR = 1.6, P = 0.006), those with multiple nodal metastases (HR = 3.7, P = 0.007), and those who had received neoadjuvant chemotherapy (HR = 2.0, P = 0.015).

CONCLUSION: Perioperative outcomes and survival following RC in obese patients is comparable with non-obese patients. Underweight patients have the worst OS and DSS.

Keywords: Urinary bladder neoplasms, Body mass index, Obesity, Cystectomy, Underweight

Core tip: As obesity rates increase, more obese patients will require radical cystectomy for muscle invasive bladder cancer. Anecdotally, obesity increases the technical difficulty of an operation. Literature regarding outcomes of obese patients undergoing radical cystectomy is limited. This study shows obese patients do better than their non-obese counterparts in terms of perioperative outcomes and overall and disease specific survival. However, we found that underweight patients have a significantly decreased overall and disease specific survival compared with obese and patients.

Scan to discover online Background & Objective: Urothelial carcinoma is the seventh most common cancer in the world. The histological classification of papillary carcinoma is one of the most important determinants for its prognosis. Sometimes there is an overlap in the extent of the tumor, and the accurate microscopic diagnosis of the tumor is not always easy. The aim of this study was to evaluate P53 and CK20 immunohistochemical markers in comparison with morphologic findings in low-and high-grade urothelial carcinomas. Methods: For this descriptive study, urinary bladder samples were collected from 50 cancer patients who had undergone biopsy and surgery in Shohaday-e Tajrish Hospital of Tehran, Iran, during the years 2015-2016. P53 and CK20 were studied, and the demographic and histopathological characteristics of the tumor were also analysed. Results: The mean age of patients enrolled in this study (48 males and 2 females) was 65.8±11.9. Twenty-five cases presented with low-grade and 25 cases presented with high-grade papillary urothelial carcinomas. Sensitivity, specificity, and positive and negative predictive values for P53 were 48%, 80%, 70.5%, and 60.6%, respectively, while the same values for CK20 were 44%, 92%, 84.6%, and 62.2%, respectively. Immunohistochemical results were also positively correlated with the extent of the tumor. Conclusion: Based on the results, P53 and CK20 may serve as specific markers for diagnosis of low-and high-grade papillary urothelial carcinoma but not sensitive. P53 and ck20 staining have also a high specificity as 80% and 92% and low sensitivity compared to the low and high morphology of papillary carcinoma, thus their positive and their staining intensity are valuable for diagnosis, but their negative results are not determinant.

Tumor markers such as beta Human Chorionic Gonadotropin (bHCG) and Carboxyhydrate Antigen 19-9 (CA19-9) have long been associated with bladder cancer and although their expression is associated with poorer oncological outcomes, they have little role in the routine clinical management of this disease. Recent advances in engineered antibody technology have led to renewed interest in these markers as potential targets for new therapeutics. Here we report the case of a patient with locally advanced bladder cancer and the response of serum bHCG and CA19-9 to endoscopic resection and then radical cystectomy and serves to highlight how these tumor markers might be used to measure treatment effect.

Objective To validate a prognostic nomogram (Xylinas’ nomogram) for intravesical recurrence after radical nephroureterectomy for primary upper urinary tract urothelial carcinoma patients of Asian descent. Methods Clinicopathological and survival data from 243 primary urinary tract urothelial carcinoma patients who underwent radical nephroureterectomy with bladder cuff excision between January 2004 and May 2017 were collated. Univariate and multivariable Cox regression analyses were performed to identify independent risk factors associated with intravesical recurrence-free survival. External validation was determined using regression coefficients abstracted from previously published data. Performance was then quantified through calibration and discrimination, according to concordance indexes (c-index) in receiver operating characteristic curves. Results 163 patients met our eligibility criteria and were finally included in this study. At a median follow-up of 60 months, intravesical ...

Background: Tumor lysis syndrome (TLS) is an oncologic emergency with limited treatment options. Although the vast majority of TLS is
associated with rapidly proliferating hematologic malignancies, it is often overlooked in solid tumor cases and has only been rarely associated
with urothelial carcinomas. The objective of this review is to investigate the clinical characteristics and outcomes of TLS in patients with urothelial
carcinoma.
Methods: Retrospective literature and case review and pooled analysis.
Results: Four cases of TLS in urothelial carcinoma were identified in over 180 published cases of TLS in solid tumors; one additional case
was included from our patient database. The median age of these patients was 72 years (range: 63-77) and 60% were female. Two patients had
urothelial carcinoma of the renal pelvis and three had bladder cancer with metastases. All of these cases were associated with therapy-induced TLS
with a median time to event of 14 days (range: 8-22 days) after receiving chemotherapy. Laboratory parameters were consistent among all cases
with elevations in uric acid and LDH, hypocalcemia, hyperphosphatemia, and hyperkalemia. Treatment for TLS included aggressive supportive
measures with intravenous hydration. One patient received hemodialysis; four of the five patients received urate oxidase, while one patient received
allopurinol as treatment support. The mortality in this case series was 60%.
Conclusion: TLS in urothelial cancer is associated with very high mortality. TLS should be considered as a differential diagnosis when evaluating
acute kidney injury and electrolyte abnormalities in patients with urothelial cancer especially in cases of high tumor volume and rapid growth.

Renal hemangioma is a rare tumor which can be capillary or cavernous. There have been less than 30 renal capillary hemangioma cases reported in the English literature. Herein we will report a case of renal hemangioma which was detected in a 74-year-old man operated with the impression of urothelial carcinoma of hilum. Article Info

Background and Objective: This study was undertaken to analyze the immunohistochemical expression of fibroblast growth factor receptor (FGFR3) in urothelial carcinoma and correlate its expression with the pathological stage, recurrence and other clinicopathological parameters. Material and Methods: A retrospective study was undertaken on paraffin blocks of 55consecutiveurothelial carcinoma specimens in 28 months received in Sri Ramachandra Medical College, Chennai, India. Blocks with the sections containing the tumor and adjacent normal epithelium were chosen for the immunohistochemical (IHC) study of FGFR3. Results: IHC expression of FGFR3 in high grade (HG) invasive urothelial carcinoma was positive in 18% cases, 66.7% of HG non-invasive urothelial and 82.6% of low grade (LG) non-invasive urothelial carcinomas. The FGFR3 expression was presented in 78.1% of non-invasive carcinoma. In case of invasive urothelial carcinoma, the FGFR3 positivity was observed in 18.2% of tumors (P<0.05). FGFR3 expression in LG tumors was positive in 82.6 % of the cases whereas 32.3% of HG cases were positive for FGFR3 (P<0.05). FGFR3 was expressed in 14.3 % of HG invasive tumors which recurred. HG non-invasive tumors were positive for FGFR3 in 80% of the cases. LG non-invasive tumors were positive for FGFR3 in 72.7% of cases (P<0.05). Conclusion: The expression of FGFR3 is higher in low grade, non-invasive tumors and recurrent non-invasive tumors. The targeted therapy for FGFR3 may be used as one of the modes of treatment for urothelial carcinoma. It can also be used as a marker to determine the grade in difficult cases and the risk of recurrence. Article Info

Background:  Pioglitazone  is  widely  prescribed  oral
hypoglycaemic  thiazolidinediones  acting  through  Peroxisome
Proliferators  Activated  Receptor  gamma  (PPAR  ƴ)  as  agonist.
Apart  from  potent  anti-hyperglycaemic  action  by  improving
insulin sensitivity, it also has positive effects on lipid metabolism
and endothelial function. Controversies about use of Pioglitazone
have  been  raised  with  regard  to  risk  of  bladder  cancer.  Hence recently drug was banned in India, but again ban was revoked for its use with special precautions. So there is a lot  of debate about benefit  to  risk  ratio  of  this  drug.  With  this  background  we  are presenting  a  case  of  carcinoma  of  urinary  bladder  developed  in type  2  diabetes  mellitus  (T2DM)  patient  who  was  receiving Pioglitazone for glycemic control.
Case presentation: A  65 year old man was admitted to our centre
for tumor in urinary bladder. He was diagnosed as a case T2DM 8
year’s  back  at  his  village  and  started  therapy  with  Metformin.
After  2  years  Pioglitazone  was  added  for  glycemic  control.  He received Pioglitazone in combination with Metformin for 6 years and  then  diagnosed  urinary  bladder  cancer.  First  we  shifted  him from Pioglitazone to Mixtard Humiinsulin therapy. We  managed him  by  transurethral  resection  of  bladder  tumour  followed  by  6 cycles  of  intravesical  Mitomycin  40  mg  weekly  chemotherapy regimen.  After  completion  of  total  treatment  he  is  in  remission period for 11 months.
Conclusion:  To  study  long  term  safety  of  Pioglitazone,  large
population based prospective studies are required. But till that time physicians should pay careful attention to assess the possibility of bladder cancer in patients receiving Pioglitazone.