ABSTRACT
Objective:To discuss the clinical features of lymphoma of the male urogentioal system.Methods:The clinical data of 9 patients in Beijing Friendship Hospital from August 2014 to August 2019 reviewed, including 5 males and 4 females. The mean age of those patients was 62 years, range from 50 to 69.3 cases were diagnosed as renal tumor, 2 cases were diagnosed as bladder tumor and 4 cases were testicular tumor. 2 cases of the renal tumor presented with fever primarily(1 case with abdominal pain and weight loss) , 1 case was found renal pelvis tumor in medical checkup. 1 case of bladder lesions suffered from gross hematuria with abdominal pain and the other case with urinary frequency and urgency. All of the 4 testicular tumor cases were admitted to hospital with painless testicle mass. 5 cases were examined by CT showed low density mass with mild to moderate enhanced. Testicular tumors were detected by ultrasound showed irregular and heterogeneous mass with blood flow signals in them. 4 cases received operation and chemotherapy, 2 cases only received chemotherapy, 2 cases only received operation and 1 case didn’t receive further treatment. 1 case of 3 renal tumor cases received ultrasound-guided tumor biopsy and accepted rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone(R-CHOP) chemotherapy. 1 renal pelvis tumor patient received laparoscopic nephroureterectomy and R-CHOP chemotherapy. 1 case received ultrasound-guided tumor biopsy and refused further treatment. Both of two bladder tumor patients accepted TURBT and refused radiotherapy and chemotherapy. For 4 testicular tumor cases, 3 patients received orchiectomy and 1 patient received ultrasound-guided tumor biopsy. 3 cases accepted R-CHOP chemotherapy, 1 case received chemotherapy and contralateral testis irradiation(specific proposals unknown). All of 4 cases received CNS prophylaxis by intrathecal injection(methotrexate 15mg, cytarabine 50 mg and dexamethasone 5 mg).Results:All 9 cases who received surgery or biopsy recovered favorably, no complications were found. The histological type of them were non-Hodgkin lymphomas. 8 of 9 cases were diffuse large B-cell lymphomas, 1 case was anaplastic large cell lymphoma. Belonged to Ann Arbor staging system, 4 cases staged Ⅰ-ⅡE and 5 cases staged ⅢE-ⅣE. 6 cases had international prognostic index(IPI) scores 0-2, 2 cases ≥3. The average follow-up time was 18 months (6-66 months). 7 cases still alive, 3 of them completed chemotherapy, 2 cases achieved complete remission(1 case was testicular lymphoma stage ⅡE IPI score 1 point and 1 case was testicular lymphoma stage ⅣE IPI score 2 points), 1 case achieved partial remission(renal pelvis lymphoma stage ⅣE IPI score 3 points). 3 cases which refused chemotherapy didn’t relapse or progress(2 cases were bladder lymphomas stage ⅠIE IPI score 1 point and 1 case was renal pelvis lymphoma stage ⅠIE IPI score 1 point). 1 case developed bacterial combine fungal pneumonia after 2 chemotherapy periods and stopped chemotherapy. 1 case of renal lymphoma( stage ⅢE IPI score 3 points) and 1 case of testicular lymphoma( stage ⅢE IPI score 2 point) died of the tumor progression of 6 months and 17 months after diagnoses.Conclusions:The main histological type of the male urogentioal system lymphoma is diffuse large B-cell lymphoma which clinical feature of it is nonspecific. Differential diagnosis should be done with other genitourinary system tumor according to clinical symptom and imaging findings. Histological diagnosis is the gold standard and R-CHOP chemotherapy is recommended as the primary treatment.
ABSTRACT
Objective:Assessing the prognosis of patients with bladder urothelial carcinoma by using multiple molecular markers [epithelial-cadherin (E-cadherin), fibroblast growth factor receptor 3 (FGFR3), Jagged2, Survivin and stromal antigen 2 (STAG2)] in combination method, and compared it with the traditional method of evaluating prognosis by clinical pathological parameters.Methods:Retrospective analysis of 128 cases of bladder urothelial carcinoma patients admitted to Beijing Friendship Hospital, Capital Medical University from January 2010 to December 2016, including 102 males and 26 females; the median age was 70.5 years, ranged from 41 to 93 years. E-cadherin, FGFR3, Jagged2, Survivin and STAG2 alterations by immunohistochemistry during the first surgical treatment. The Kaplan-Meier survival curve was used to evaluate the relationship between the above markers and overall survival (OS), recurrence-free survival (RFS), progression-free survival (PFS), and clinicopathological indicators of tumors. Use Cox regression model to find the most suitable molecular markers for judging the prognosis of bladder urothelial carcinoma, and compare it with the traditional clinical staging + pathological grading method to evaluate OS to detect its sensitivity and specificity.Results:After 36.4 months of follow-up, it was found that the expressions of E-cadherin, FGFR3, Jagged2 and Survivin were all related to the OS, RFS and PFS of bladder urothelial carcinoma (all P<0.05). The expression of STAG2 was related to the TMN stage of bladder urothelial carcinoma ( P=0.047) and pathological grade ( P=0.015). Cox regression analysis showed that Survivin ( P=0.001) and Jagged2 ( P=0.037) were independent risk factors for evaluating the OS of bladder urothelial carcinoma, and Survivin ( P<0.001) and Jagged2 ( P=0.006) were independent risk factors for RFS, Survivin ( P=0.001) was also an independent risk factor for PFS. Multivariate analysis of the above molecular markers showed that the prognosis of patients with more than 3 molecular markers was better than that of independent application or the use of two of them to evaluate the prognosis ( P<0.001). The combined application of Survivin and Jagged2 to evaluate the 5-year survival rate was not less sensitive and specific than the clinical and pathological indicators (93.5% vs 77.2%, 84.7% vs 81.3%). Conclusions:Five molecular markers of E-cadherin, FGFR3, Jagged2, Survivin and STAG2 have an evaluation effect on the prognosis of bladder urothelial carcinoma, and some can independently predict the OS and RFS of patients with bladder urothelial carcinoma, however, the combined application is better than the single molecular marker to evaluate the prognosis. Compared with the traditional method of evaluating the prognosis by clinical pathological parameters, the combined application of Jagged2 and Survivin may be a better choice for evaluating the prognosis of patients with bladder urothelial carcinoma.