Preoperative hydronephrosis predicts adverse pathological features and postoperative survival in patients with high-grade upper tract urothelial carcinoma

ABSTRACT Purpose: Epidemiological studies reported conflicting results about preoperative hydronephrosis in upper tract urothelial carcinoma (UTUC). This study aimed to investigate the association between preoperative hydronephrosis and pathologic features and oncologic outcomes in patients with UTUC treated by radical nephroureterectomy (RNU). Materials and Methods: This was a retrospective, single-center cohort study of 377 patients treated by RNU without perioperative chemotherapy between January 2001 and December 2014. Logistic regression, Cox regression, and survival analyses were performed. Results: Among the 226 patients with high-grade UTUC, 132 (58%) had preoperative hydronephrosis. Multivariable logistic regression revealed that hydronephrosis was independently associated with advanced pT stage (P=0.017) and lymph node or lymphovascular invasion (P=0.002). Median follow-up was 36 months (interquartile range: 20-48 months). The 3- and 5-year overall survival (OS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P <0.001). The 3- and 5-year cancer-specific survival (CSS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P=0.001). Hydronephrosis was independently associated with OS and CSS (P=0.001 and P=0.004, respectively). Among the 151 patients with low-grade UTUC, hydronephrosis was not associated with pathologic features and postoperative survival. Conclusions: Preoperative hydronephrosis was significantly associated with adverse pathologic features and postoperative survival in patients with high-grade UTUC.

Preoperative hydronephrosis predicts adverse pathological features and postoperative survival in patients with high-grade upper tract urothelial carcinoma.

PURPOSE: Epidemiological studies reported conflicting results about preoperative hydronephrosis in upper tract urothelial carcinoma (UTUC). This study aimed to investigate the association between preoperative hydronephrosis and pathologic features and oncologic outcomes in patients with UTUC treated by radical nephroureterectomy (RNU). MATERIALS AND METHODS: This was a retrospective, single-center cohort study of 377 patients treated by RNU without perioperative chemotherapy between January 2001 and December 2014. Logistic regression, Cox regression, and survival analyses were performed. RESULTS: Among the 226 patients with high-grade UTUC, 132 (58%) had preoperative hydronephrosis. Multivariable logistic regression revealed that hydronephrosis was independently associated with advanced pT stage (P=0.017) and lymph node or lymphovascular invasion (P=0.002). Median follow-up was 36 months (interquartile range: 20-48 months). The 3- and 5-year overall survival (OS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P <0.001). The 3- and 5-year cancer-specific survival (CSS) rates in patients with hydronephrosis were significantly lower than in those without hydronephrosis (both P=0.001). Hydronephrosis was independently associated with OS and CSS (P=0.001 and P=0.004, respectively). Among the 151 patients with low-grade UTUC, hydronephrosis was not associated with pathologic features and postoperative survival. CONCLUSIONS: Preoperative hydronephrosis was significantly associated with adverse pathologic features and postoperative survival in patients with high-grade UTUC.

Bilateral double-pigtail ureteral stent placement for management of ureteral obstruction secondary to transitional cell carcinoma in a dog

Background: Transitional cell carcinoma (TCC) usually affects the trigone region of the bladder and proximal portionof the urethra. TCC in dogs is often complicated by local tumor invasion and obstruction of the urethra, ureters, or both.Urinary obstruction is the cause of death in approximately 60% of dogs with TCC. Radical surgeries are associated withmorbidity and mortality rates. Stents have recently been evaluated for use in dogs with ureteral obstruction resulting froma variety of urinary tract tumors. This report aims to describe bilateral ureteral stent placement for treatment of malignantureteral obstruction and long-term follow-up in a dog.Case: An 11-year-old female spayed Maltese dog with ureteral obstruction secondary to transitional cell carcinoma (TCC)in the bladder trigone. After palliative debulking procedure and diagnostic of TCC in bladder and NSAIDs treatment,recurrence has occurred causing ureteral obstruction and TCC had invaded the abdominal wall. Abdominal wall localtumor resection, trigone mass debulking and bilateral ureteral stent placement was made. A double-pigtail ureteral stentof appropriate length was advanced to bypass the ureteral obstruction. Stent sizes were 3.5 Fr in diameter and from 8 to32 cm in length. The patient underwent surgical resection of the transitional cell carcinoma in the abdominal wall. Thecorrect location of the bilateral ureteral pigtail stent was certified by abdominal radiography. Recovery was uneventfuland the dog was discharged 2 days after surgery. Eleven months after stent placement, the dog developed lumbar vertebrae metastasis, without evidence of recurrent ureteral obstruction. The owners elected euthanasia 517 days after originalpresentation and 337 days after ureteral stent placement. Euthanasia was unrelated to the local tumor obstruction but was...(AU)

Bilateral double-pigtail ureteral stent placement for management of ureteral obstruction secondary to transitional cell carcinoma in a dog

Background: Transitional cell carcinoma (TCC) usually affects the trigone region of the bladder and proximal portionof the urethra. TCC in dogs is often complicated by local tumor invasion and obstruction of the urethra, ureters, or both.Urinary obstruction is the cause of death in approximately 60% of dogs with TCC. Radical surgeries are associated withmorbidity and mortality rates. Stents have recently been evaluated for use in dogs with ureteral obstruction resulting froma variety of urinary tract tumors. This report aims to describe bilateral ureteral stent placement for treatment of malignantureteral obstruction and long-term follow-up in a dog.Case: An 11-year-old female spayed Maltese dog with ureteral obstruction secondary to transitional cell carcinoma (TCC)in the bladder trigone. After palliative debulking procedure and diagnostic of TCC in bladder and NSAIDs treatment,recurrence has occurred causing ureteral obstruction and TCC had invaded the abdominal wall. Abdominal wall localtumor resection, trigone mass debulking and bilateral ureteral stent placement was made. A double-pigtail ureteral stentof appropriate length was advanced to bypass the ureteral obstruction. Stent sizes were 3.5 Fr in diameter and from 8 to32 cm in length. The patient underwent surgical resection of the transitional cell carcinoma in the abdominal wall. Thecorrect location of the bilateral ureteral pigtail stent was certified by abdominal radiography. Recovery was uneventfuland the dog was discharged 2 days after surgery. Eleven months after stent placement, the dog developed lumbar vertebrae metastasis, without evidence of recurrent ureteral obstruction. The owners elected euthanasia 517 days after originalpresentation and 337 days after ureteral stent placement. Euthanasia was unrelated to the local tumor obstruction but was...

Ulceration in bladder cancer associates with extravesical disease, independent of cell cycle, or hypoxia pathways status: Integrating gross morphology and expression profiles in cystectomies.

OBJECTIVE: Ulceration is common in bladder tumors, but its prognostic role, although intuitive, is not established. We aim to explore the presence of gross ulceration and its relationship with other morphological and biological features classically associated with extravesical disease, in patients submitted to radical cystectomy. METHODS: Tumor size and morphology were noted on 101 cystectomy patients (2000-2010). Papillary, exophytic, and vegetant tumors were grouped as "papillary" and solid/nodular, ulcerated and infiltrative as "nonpapillary." Ulceration was noted grossly in every case as a binary parameter, regardless of morphology. Immunohistochemistry was performed for hypoxia (hypoxia-inducible factor-1α and vascular endothelial growth factor), and cell cycle proteins (pRb, p53, and cyclin D1). RESULTS: Mean age was 66.7 year, male:female ratio was 2:1, 20 patients received bacillus Calmette-Guerin and 10 neoadjuvant chemotherapy. Upstaging rate was 56.4%. Ulcerated lesions presented mostly as nonpapillary and nonorgan confined (nOC), whereas nonulcerated tumors were often papillary and organ confined (OC). Tumor size was smaller in nonpapillary tumors (P = 0.002), but did not associate with altered hypoxia or cell cycle expressions. pRb and cyclin D1 loss and p53 overexpression were more frequent in ulcerated and non-OC tumors as did the phenotype vascular endothelial growth factor-negative/hypoxia-inducible factor-1α-low (P<0.001). On a multivariate model, ulceration was an independent predictor of non-OC and extravesical disease. CONCLUSION: Patients with ulcerated tumors were often staged with extravesical disease, independent of other morphologic and biological features known to affect prognosis. Prospective studies are needed to confirm the predictive value of tumor ulceration at cystoscopy, which could improve patient stratification for neoadjuvant chemotherapy.

Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort.

INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. PATIENTS AND METHODS: We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery. RESULTS: We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The médium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients. CONCLUSIONS: In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.

Radical cystectomy with pelvic lymphadenectomy: pathologic, operative and morbidity outcomes in a Brazilian cohort

ABSTRACT Introduction and Objective Radical cystectomy (RC) with pelvic lymph node dissection is the standard treatment for muscle invasive bladder cancer and the oncologic outcomes following it are directly related to disease pathology and surgical technique. Therefore, we sought to analyze these features in a cohort from a Brazilian tertiary oncologic center and try to identify those who could negatively impact on the disease control. Patients and Methods We identified 128 patients submitted to radical cystectomy, for bladder cancer treatment, from January 2009 to July 2012 in one oncology tertiary referral public center (Mario Penna Institute, Belo Horizonte, Brazil). We retrospectively analyzed the findings obtained from their pathologic report and assessed the complications within 30 days of surgery. Results We showed similar pathologic and surgical findings compared to other large series from the literature, however our patients presented with a slightly higher rate of pT4 disease. Positive surgical margins were found in 2/128 patients (1.5%). The medium number of lymph nodes dissected were 15. Major complications (Clavien 3 to 5) within 30 days of cystectomy occurred in 33/128 (25.7%) patients. Conclusions In the management of invasive bladder cancer, efforts should focus on proper disease diagnosis and staging, and, thereafter, correct treatment based on pathologic findings. Furthermore, extended LND should be performed in all patients with RC indication. A critical analysis of our complications in a future study will help us to identify and modify some of the factors associated with surgical morbidity.

[Contribution of bladder biopsy to the study of urogynaecological patient]. / Contribución de la biopsia vesical al estudio de la paciente uroginecológica.

BACKGROUND: One of the characteristics of urinary symptoms in women is their lack of specificity. Patients with stress incontinence or urgency, local irritation, infection, distal stenosis or a neoplastic process have very similar symptoms. OBJECTIVE: Determine the frequency of bladder structural lesions detected by urethrocistoscopy in which we performed bladder biopsies. MATERIAL AND METHOD: Descriptive, retrospective, analytical study of files and videos of 331 patients treated in Urodifem de Occidente (private Urogynecology Center). Thirty-five biopsies were taken. The statistical analysis was expressed as means standard deviations, ranges, percentages and Fishers test. RESULTS: Patients ages range 30-90 years average 60+13.76. Predominant symptoms were: irritative vesical syndrome 62.8%; pelvic pain 45.71%; urge incontinence 31.4%; hematuria 31.4%; vesical voiding dysfunction 11.4%. Principal endoscopic findings: Urethrotrigonitis; glomerular lesions or Hunner ulcers; vesical trabeculations; tumor or suspect lesions. Histopathologic findings were: Interstitial Cystitis 42.9%; chronic Cystitis 11.4%; Cystitis glandularis 8.6%; Cystitis follicular 11.4%; bladder cancer 5.7%; Vesical Papilloma 5.7%. CONCLUSIONS: This study supports the practice of vesical biopsy when lesions other than those from chronic infection are observes in the presence of tumors or suspect lesions.

Carcinoma de células transicionales en paciente con enfermedad poliquística renal autosómica dominante / Transitional cell carcinoma in a patient with autosomal dominant polycystic renal disease

Objetivo: Reportar un caso de una paciente con enfermedad poliquística renal autosómica dominante(EPRAD) asociada a la presencia de un carcinoma de células transicionales (CCT).Métodos: Paciente de 46 años de edad, con antecedentes de tabaquismo crónico. Se realiza el diagnóstico de EPRAD complicada con hematuria recurrente con origen en la unidad renal derecha. Resultados: Se realiza nefrectomía laparoscópica mano asistida con un tiempo operatorio de 1 hora25 minutos. El informe anatomopatológico de la pieza operatoria es compatible con carcinoma de CCT Grado 1 de Ash, correspondiendo a un estadio T1 N0 M0 de la Clasificación TNM de la AJCCUICCde 1997.Conclusión: Si bien la existencia de neoplasias renales en pacientes portadores de EPRAD constituye una entidad poco común, y que no presenta mayor incidencia que en la población general, debe considerarse como posibilidad diagnóstica en todos aquellos pacientes que evidencien síntomas o signos de complicación de su enfermedad poliquística, sobre todo en aquellos en los que se plantea la resolución quirúrgica de su patología.

Objetive: We report a patient with autosomal dominant polycystic renal disease (ADPRD) associated with transitional cell carcinoma (TCC).Methods: A 46 year old patient with history of chronic cigarette smoking was diagnosed of ADPRD with recurrent hematuria originated in the right renal unit. Results: A right hand-assisted laparoscopic nephrectomy was performed. Operative time was 85minutes. Pathological analysis showed a Grade 1 TCC, pT1 N0 M0.Conclusions: Renal neoplasias in ADPRD patients are infrequent baring the same incidence as normal patients. However, in symptomatic ADPRD patients, renal neoplasias should be kept in mind, especially if patients are to undergo surgery.

Blindness in a bladder cancer patient.

Blindness is an unusual symptom in the clinical course of cancer. When it appears it is necessary to differentiate between benign and malign causes. Brain metastases in bladder cancer are extremely rare. MRI is the best diagnostic option. We present a deaf-and-dumb male with subacute blindness, 12 months after the diagnosis of a metastatic bladder cancer. Computerised tomography scan and MRI revealed a mass into the pituitary gland and sella, probably of metastatic origin.

Pseudo-Meigs' syndrome associated to renal pelvis tumor.

INTRODUCTION: Pseudo-Meigs' syndrome is associated with tumors different from the benign ovary tumor, but it has never been described in association to transitional cell carcinoma. CASE REPORT: A female 73 year-old patient presenting pleural effusion nonmetastatic associated with renal pelvis transitional cell carcinoma that resolved and did not recur after radical nephroureterectomy. COMMENTS: Renal pelvis transitional cell carcinoma can result in the Pseudo-Meigs' syndrome. Although being a rare clinical entity, the identification of such syndrome can result in an accurate diagnosis, leading to an efficient surgical treatment, without comorbidity for the patient.

Pseudo-Meigs' syndrome associated to renal pelvis tumor

INTRODUCTION: Pseudo-Meigs' syndrome is associated with tumors different from the benign ovary tumor, but it has never been described in association to transitional cell carcinoma. CASE REPORT: A female 73 year-old patient presenting pleural effusion nonmetastatic associated with renal pelvis transitional cell carcinomathat resolved and did not recur after radical nephroureterectomy. COMMENTS: Renal pelvis transitional cell carcinoma can result in the Pseudo-Meigs' syndrome. Although being a rare clinical entity, the identification of such syndrome can result in an accurate diagnosis, leading to an efficient surgical treatment, without comorbidity for the patient.

Recurrencia del cáncer vesical superficial con el uso de BCG / Recurrence in superficial bladder cancer with the use of BCG

La recurrencia del cáncer vesical superficial puede llegar a un 10-80 por ciento, la cual puede ser disminuida significativa con el uso de quimioterápicos o BCG post cirugía. El objetivo de este trabajo es analizar los resultados con el uso de BCG intravesical post cirugía, de acuerdo a nuestro protocolo de tratamiento. Se revisan retrospectivamente, las fichas clínicas de 108 pacientes, con diagnóstico de cáncer vesical, tratados en el Hospital Dr. Sótero del Río y en Clínica Integramédica. Sesenta y nueve pacientes con tumor vesical superficial (Tis, Ta, T1), (55 H y 14 M) fueron sometidos a resección transuretral. Un 55,1 por ciento (n=39) recibió BCG adyuvante y un 44,9 por ciento (n=31) fueron observados. El esquema de tratamiento fue de 25-27 mg de BCG/semana por 3 veces (esquema 1: n=4), 25-27 mg/semana por 6 veces (esquema 2: n=11) y 25-27 mg/semana por 6 veces más refuerzos (esquema 3: n=20). El control consistió en cistoscopia, con o sin citología urinaria, más estudio por imágenes del tórax y la vía urinaria superior. El seguimiento promedio fue de 36,2 meses, con una mediana de 16 meses (rango: 1-250 meses), en el 83,3 por ciento de los pacientes. La recurrencia global de los pacientes tratados y no tratados con BCG fue de 28,9 por ciento y 41,9 por ciento, respectivamente. En estadío 0is, 0a y I, la recurrencia con y sin BCG fue de un 25 por ciento y 100 por ciento, 25 por ciento y 37,5 por ciento, y de 35,7 por ciento y 38,5 por ciento, respectivamente. La recidiva de los tumores superficiales varió según el esquema de BCG empleado, siendo de un 50 por ciento con el esquema 1, 36,4 por ciento con el esquema 2 y 15,0 por ciento con el 3. En un subgrupo de 42 pacientes con tumores vesicales superficiales, todos seguidos por más de 12 meses, la recurrencia en los estadíos 0is y 0a y I, con y sin BCG, fue de 33,3 por ciento y 100 por ciento; 23,5 por ciento y 80 por ciento; y de 55,6 por ciento y 66,7 por ciento, respectivamente. En este subgrupo, la recidiva también resultó claramente dependiente del esquema de BCG utilizado, siendo de un 50 por ciento para el esquema 1, 44,4 por ciento para el esquema 2 y 20 por ciento para el 3. Estos resultados confirman la utilidad de un esquema de BCG con dosis de 25 o 27 mg por instilación. Para establecer fracaso o éxito en el tratamiento con BCG, el seguimiento debiera ser al menos de 12 meses, ya que una observación menor puede dar índices de recurrencia falsamente bajos...

Hepatitis granulomatosa por BCG / Granulamatous hepatitis due to BCG

Se reporta un caso de hepatitis granulomatosa secundaria a inmunoterapia con BCG por cáncer vesical, complicación infrecuente de este tratamiento. La evolución clínica fue favorable luego de tratar con fármacos antituberculosos

Metástasis peneanas por carcinoma transicional de vejiga / Metastasis in penis due to transitional carcinoma of bladder

Se presentan tres casos de metástasis en pene (una en glande y dos en cuerpos cavernosos), secundarias a carcinoma transicional de vejiga. Se exponen sus características clínicas e histológicas, así como la metodología diagnóstica empleada. Todos los pacientes fallecieron dentro de los dos meses de su descubrimiento. Se realiza una revisión de la literatura publicada. Se concluye que la presencia de estas lesiones indica mal pronóstico y progresión de la enfermedad de base

Metástasis peneanas por carcinoma transicional de vejiga / Metastasis in penis due to transitional carcinoma of bladder

Se presentan tres casos de metástasis en pene (una en glande y dos en cuerpos cavernosos), secundarias a carcinoma transicional de vejiga. Se exponen sus características clínicas e histológicas, así como la metodología diagnóstica empleada. Todos los pacientes fallecieron dentro de los dos meses de su descubrimiento. Se realiza una revisión de la literatura publicada. Se concluye que la presencia de estas lesiones indica mal pronóstico y progresión de la enfermedad de base(AU)

Transitional cell carcinoma of the ureter and struvite calculi.

CONTEXT: The association of primary carcinoma of the ureter and lithiasis is extremely rare. We report a rare case of a primary carcinoma of the ureter with corariform calculus. CASE REPORT: 60-year-old phaeodermal female, reported a history of right-side nephritic colic, hyperthermia and pyuria during the past 20 years and had received treatment for urinary infections a number of times. The first clinical presentation was related to lithiasis and the tumor had not been shown up by excretory urography, cystoscopy or ultrasonography. Two months after the calculus had been eliminated, the patient began to have serious symptoms and a grade III transitional cell carcinoma of the ureter was discovered. Total nephroureterectomy and M.V.A.C. (Methotrexate + Vinblastina + Doxo Rubicina + Cisplatina) chemotherapy were tried unsuccessfully. In this report we emphasize the diagnostic difficulty caused by the concomitant presence of the two pathologies. In our opinion, the rapid evolution in this case is directly related to the high grade of the tumor.

Transitional cell carcinoma of the ureter and struvite calculi

Context: The association of primary carcinoma of the ureter and lithiasis is extremely rare. We report a rare case of a primary carcinoma of the ureter with corariform calculus. Case Report: 60-year-old phaeodermal female, reported a history of right-side nephritic colic, hyperthermia and pyuria during the past 20 years andhad received treatment for urinary infections a number of times. The first clinical presentation was related to lithiasis and the tumor had not been shown up by excretory urography, cystoscopy or ultrasonography. Two months after the calculus had been eliminated, the patient began to have serious symptoms and a grade III transitional cell carcinoma of the ureter was discovered. Total nephroureterectomy and M.V.A.C. (Metrotrexate + Vinblastina + Doxo Rubicina + Cisplatina) chemotherapy were tried unsuccessfully. In this report we emphasize the diagnostic difficulty caused by the concomitant presence of the two pathologies. In our opinion, the rapid evolution in this case is directly related to the high grade of the tumor.

[Acquired ichthyosis caused by bladder neoplasia. Presentation of the 1st case in Cuba]. / Ictiosis adquirida por neoplasia vesical. Presentación del primer caso en Cuba.

Ichthyosiform dermatoses comprise a heterogeneous group of cutaneous disease characterized by keratin disorder that clinically manifests as dry, rough and scaly skin. The acquired form of ichthyosis has principally been associated with neoplastic disease. It has also been described in association with other disorders and as drug-induced cutaneous manifestations. We report on a patient with a bladder tumor who developed acquired ichthyosis, a complication and presenting feature of the underlying neoplastic condition. The clinical manifestations and associated conditions are described. To our knowledge, this is the first case of acquired ichthyosis from a bladder tumor reported in Cuba.