Leukemoid Reaction, a Rare Paraneoplastic Syndrome in Urothelial Cell Carcinoma: Is It an Indicator of a Poor Prognosis?

A leukemoid reaction is usually associated with malignancies of the lung, stomach, and thyroid. In contrast, urothelial cell carcinoma is rarely associated with leukemoid reactions, with few cases reported over the past 30 years. Here, we describe a patient with urothelial cell carcinoma who exhibited a leukemoid reaction. The patient had an elevated white blood cell count and experienced a rapid and aggressive clinical course, terminating in death. For urothelial cell carcinoma patients exhibiting a leukemoid reaction, removal of the inciting tumor is the definitive treatment. However, considering the aggressive nature of these tumors, if the patient is unsuitable for radical surgical management, palliative chemotherapy should be considered.

Clinical study of Gemcitabine and Cisplatin combination chemotherapy in treatment of 72 cases of patients with urothelial cell carcinoma / 国际外科学杂志

Objective To explore the efficacy and safety of Gemcitabine and Cisplatin combination chemotherapy in treatment of muscle-invasive urothelial cell carcinoma.Methods Analyse of 72 cases of patients with muscle-invasive urothelial cell carcinoma receiving chemotherapy from September 2010 to September 2012,including 47 male and 25 female,the avarage age was 65 (86-33).All patients were received GC chemotherapy (Gemcitabine 800-1 000 mg/m2,ivgtt,dl,d8,d15; Cisplatin 70 mg/m2,ivgtt,d2).Efficacy was reviewed after 1 cycle of chemotherapy.Results Fifty-one cases in all the patients completed two or more chemotherapy cycles and CR 10 cases,PR 27 cases,total effective rate was 51.39％ (37/72).The main toxic reactions included nausea,vomit,myelosuppression,and then damage of liver and renal function.Cconclusion GC regimen is a good choice for urothelial cell carcinoma.Close follow-up and the usage of adjuvant drugs can contribute to reduce the side effect of chemotherapy.

Effect of Overexpression of Glucose-Regulated Protein 78 and Bcl-2 on Recurrence and Survival in Patients With Ureter Tumors

PURPOSE: The utility of the expression of glucose-regulated protein 78 (GRP78) in the evaluation of prognosis depends on the type of tumor. Hence, we aimed to examine the impact of expression of GRP78 and Bcl-2, which are used in the existing prognostic evaluation of ureter tumors, in the evaluation of recurrence and survival rates of ureter tumors. MATERIALS AND METHODS: In 53 patients who had undergone radical nephroureterectomy for a ureter tumor from March 2002 to March 2012, age, sex, T stage, nuclear grade, bladder recurrence, and survival rate were analyzed at the time of the patient's surgery depending on the extent of immunohistochemical expression of GRP78 and Bcl-2. RESULTS: GRP78 was overexpressed in 25 patients (47.2%). When GRP78 was overexpressed, there was a high T stage (p=0.001) and nuclear grade (p=0.007) and a lot of bladder recurrence (40.0%, p=0.034). Bcl-2 was overexpressed in 16 patients (30.1%), and there were no significant associations with any risk factors (p>0.05, respectively). In the multivariate analysis regarding bladder recurrence, the recurrence rate was higher with higher pT stage (p=0.048) and when GRP78 (p=0.033) was overexpressed. In the Kaplan-Meier survival analysis, although the survival rate was significantly lower in the group in which GRP78 was overexpressed (p=0.03), there was no correlation between Bcl-2 overexpression and survival rate (p=0.07). CONCLUSIONS: Patients with ureter tumors who had overexpression of GRP78 had a high T stage and nuclear grade, a lot of bladder recurrence, and a low survival rate. Therefore, if GRP78 is overexpressed in ureter tumor patients, active postoperative follow-up should be carried out.

Skeletal Muscle Metastases from Urothelial Cell Carcinoma

Hematogenous metastasis to skeletal muscle from urothelial carcinoma is extremely rare and metastatic disease to skeletal muscle tends to be found in people with advanced-stage neoplasm. We report in this paper a case of left sartorius muscle metastasis from urothelial cell carcinoma. A left nephroureterectomy with bladder cuff excision was performed and revealed a high-grade papillary transitional cell carcinoma (TCC) of the pelvis. And 6 month later, recurrent bladder cancer was found regular cystoscopy and then treated with transurethral resection of the bladder. After 6 times resection of bladder, an invasion into the bladder muscle layer was found. We recommended additional radical cystectomy to prevent the disease from advancing. However, the patient refused additional surgery. 6 month later, the patient complained of left thigh pain, so ultrasonography-guided biopsy of the nodular mass lesion in the left sartorius muscle was performed. The pathological analysis of the biopsy specimen revealed poorly differentiated metastatic urothelial carcinoma.

Successful reinstitution of peritoneal dialysis after retroperitoneal nephroureterectomy / 대한내과학회지

Peritoneal dialysis is an important therapeutic option for patients with end-stage renal disease, and the peritoneal membrane is the lifeline for peritoneal dialysis patients. Therefore, strategies to maintain the health of the peritoneal membrane are very important. A 64-year-old female who had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for the past 6 years was admitted because of painless gross hematuria. On abdominal computed tomography (CT), a mass was found in her left renal pelvis. A nephroureterectomy was performed via a retroperitoneal approach without any complications. Peritoneal dialysis was resumed 4 hours later. We report peritoneum-preserving nephroureterectomy via a retroperitoneal approach in a patient on CAPD.

Role of Akt in Tumorigenesis and Angiogenesis of MC-SV-HUC T2 Cell Line / 대한해부학회지

Protein Kinase B (PKB/Akt) is a serine/threonine kinase that plays important roles in multiple physiological and pathological processes. Specially, Akt activation induces tumorigenesis in many cancers. However, molecular mechanism related in tumorigenesis is unclear in urothelial cell carcinoma. This study investigated Akt functions in the tumorigenesis and angiogenesis of tumorigenic human urothelial cell line, MC-SV-HUC T2. For this study, stable clonal cells were established by introducing myristrated Akt (Myr-Akt) or dominant-negative Akt (DNAkt) into MC-SV-HUC T2. As for the underlying mechanism, Western blot analysis for Akt and its related proteins and kinase activity assay were used. And BrdU incorporation and immunohistochemistry revealed cell proliferation and angiogenesis. DN-Akt expression decreased in vitro cell growth and proliferation. Akt inactivation decreased the phosphorylation of glycogen synthase kinase 3beta and retinoblastoma proteins and the expression of Cyclin D1 protein as well as cyclin dependent kinase 4 activity. A mouse xenograft model showed that DN-Akt overexpression reduced tumor growth and microvessel formation. Since these findings indicate that Akt is involved in a part of the mechanisms of tumorigenesis and angiogenesis, Akt may be useful as a target molecule for bladder cancer therapy.