Tumor cell-based glycolytic metabolism and single-cell sequencing of urinary exfoliated cells for the diagnosis and molecular profiling of urothelial carcinoma / 中华病理学杂志

Objective: To explore the diagnostic values of HK2 testing and single-cell sequencing in the urothelial carcinoma (UC). Methods: The qualified urine specimens of 265 suspected UC patients or postoperative patients from the Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China were collected. Both exfoliative cytology and HK2 testing were performed on clinically suspected UC or postoperative patients. The performance of diagnostic cytology and HK2, including consistency, sensitivity, specificity, positive predictive value and negative predictive value, was evaluated based on histopathological, clinical and imaging diagnosis. Isolated HK2 metabolically abnormal cells were subject to single-cell sequencing to verify the reliability of HK2 detection performance and to explore the molecular characteristics of UC. Results: The concordance rate of HK2 testing and cytology for detecting UC was 90.3% (102/113, Kappa=0.604). Compared with cytology, the sensitivity of HK2 was significantly higher (85.2% versus 75.6%, P=0.024). The detection sensitivity of combined HK2 testing and cytology was increased to 91.1%. HK2 testing was significantly more sensitive than cytology for diagnosing UC in the upper urinary tract (81.8% versus 65.5%, P=0.022). It was also more sensitive than cytology for diagnosing early-stage UC (82.6% versus 69.5%, P=0.375) and low-grade UC (69.6% versus 47.8%, P=0.125). Single-cell sequencing of the ten patients, whose samples were positive for HK2, demonstrated highly concordant copy number variations (CNVs) in tumor cells from the same UC patient, with heterogeneity in CNV profiles among different patients. Deletion of chromosome 8p was found in 3 of the 4 urine samples of renal pelvis UC. The 2 patients with benign lesions had no CNVs in all sequenced cells. Conclusions: The test for abnormal urinary glycolytic HK2 metabolism can assist urine cytology to improve the sensitivity of UC diagnosis, and it provides a novel and reliable approach for early detection of upper urinary tract UC and lower grade UC. Meanwhile, this study has preliminarily revealed the feasibility of single-cell sequencing in urinary samples, which is expected to improve the diagnostic specificity of HK2 testing.

Proteomic research and diagnosis in bladder cancer: state of the art review

ABSTRACT Purpose: Proteomic biomarkers have been emerging as alternative methods to the gold standard procedures of cystoscopy and urine cytology in the diagnosis and surveillance of bladder cancer (BC). This review aims to update the state of the art of proteomics research and diagnosis in BC. Materials and Methods: We reviewed the current literature related to BC research on urinary, tissue, blood and cell line proteomics, using the Pubmed database. Findings: Two urinary protein biomarkers are FDA-approved (NMP22® and BTA® tests), only if performed along with cystoscopy for surveillance after initial diagnosis, but not in the primary diagnostic setting due to high false-positive rates in case of infections, stones and hematuria. There are a great number of non-FDA approved proteins being studied, with good preliminary results; panels of proteins seem valuable tools to be refined in ongoing trials. Blood proteins are a bigger challenge, because of the complexity of the serum protein profile and the scarcity of blood proteomic studies in BC. Previous studies with the BC tissue proteome do not correlate well with the urinary proteome, likely due to the tumor heterogeneity. Cell line proteomic research helps in the understanding of basic mechanisms that drive BC development and progression; the main difficulty is culturing low-grade tumors in vitro, which represents the majority of BC tumors in clinical practice. Conclusion: Protein biomarkers have promising value in the diagnosis, surveillance and prognostic of BC. Urine is the most appropriate body fluid for biomarker research in BC due to its easiness of sampling, stability and enrichment of shed and secreted tumor-specific proteins. Panels of biomarkers may exhibit higher sensitivity than single proteins in the diagnosis of BC at larger populations due to clinical and tumor heterogeneity. Prospective clinical trials are warranted to validate the relevance of proteomic data in the clinical management of BC.

Comportamiento del cáncer de vejiga en Matanzas desde diciembre de 2014 hasta enero de 2020 / Behavior of bladder cancer in Matanzas from December 2014 to January 2020

RESUMEN Introducción: el cáncer de la vejiga es la segunda neoplasia urológica. En Cuba constituye la séptima causa de cáncer en el sexo masculino y entre las primeras quince, cuando se combinan ambos sexos. Objetivo: evaluar el comportamiento del cáncer de vejiga en pacientes del Hospital Universitario Comandante "Faustino Pérez Hernández". Materiales y Métodos: se realizó un estudio observacional, descriptivo y transversal en el período comprendido desde diciembre de 2014 hasta enero de 2020. Los pacientes se dividieron en tres grupos tratados con cirugía de mínimo acceso, cirugía abierta y no operados, se describieron los grupos histológicos y estadiaje tumoral y se les aplicó tratamiento según protocolo del servicio, sus complicaciones y la presencia de recidivas tumorales también fueron descritas. En el universo se incluyeron en el estudio 222 pacientes diagnosticados de cáncer de vejiga. Resultados: se comprobó que el mayor número de pacientes diagnosticados con cáncer de vejiga son del sexo masculino, el tipo histológico es el carcinoma de células uroteliales de bajo grado y el estadio T1. Las recidivas se presentaron antes de los 5 años en el 10,8% de los casos. 196 pacientes presentaron complicaciones. Conclusiones: el cáncer de vejiga es más frecuente en las edades comprendidas entre 60 a 69 años, las recidivas aparecieron mayormente entre 1 y 3 años. Se presentó complicaciones en 196 pacientes, siendo la cirugía la modalidad terapéutica que mayor por ciento tuvo con un 32.22% y las infecciones son las complicaciones más frecuentes (AU).

SUMMARY Introduction: Cancer of the bladder (CV) is the second urological neoplasm. In Cuba it constitutes the seventh cause of cancer in males and among the first fifteen, when both sexes are combined. Objective: To evaluate the behavior of bladder cancer (CV) in patients of the Faustino Pérez Hernández Hospital. Materials and methods: An observational, descriptive and cross-sectional study was carried out in the period from December 2014 to January 2020. The patients were divided into 3 groups treated with Minimum Access Surgery (CMA), Open Surgery (CA) and No Operated (NO), the histological groups and tumor staging were described and treatment was applied according to the service protocol, their complications and the presence of tumor recurrences were also described.Universe: 222 patients diagnosed with bladder cancer were included in the study. Results: It was found that the greatest number of patients diagnosed with CV are male, the histological type is low-grade urothelial cell carcinoma and stage T1. Recurrences occurred before 5 years in 10.8% of cases. 196 patients presented complications. Conclusions: The CV is more frequent in the ages between 60 to 69 years, the recurrences appeared mainly between 1 and three years. Complications occurred in 196 patients, with Surgery being the therapeutic modality with the highest percentage with 32.22% and infections being the most frequent complications (AU).

Bladder Cancer at the time of COVID-19 Outbreak

ABSTRACT The COVID-19 outbreak has led to the deferral of a great number of surgeries in an attempt to reduce transmission of infection, free up hospital beds, intensive care and anaesthetists, and limit aerosol-generating procedures. Guidelines and suggestions have been provided to categorize Urological diseases into risk groups and recommendations are available on procedures that can be or cannot be deferred. We aim to summarise updates on diagnosis, treatment and follow up of bladder cancer during the COVID-19 outbreaks.

Tumor miofibroblástico inflamatorio: presentación variable de una misma patología / Inflammatory myofibroblastic tumor: variable presentation of the same pathology

INTRODUCCIÓN: El tumor miofibroblástico inflamatorio (TMI) es una neoplasia benigna infrecuente, de comportamiento clínico impredecible. OBJETIVOS: describir 3 casos de TMI diagnosticados entre marzo 2014 y enero 2018 en Hospital Clinico San Borja Arriaran, y realizar una revisión actualizada de la literatura. CASO 1: Adolescente de género masculino de 14 años de edad, hospitalizado por dolor abdominal, diagnosticado de invaginación yeyunoyeyunal secundaria a un tumor de pared intestinal. La histología fue compatible con un tumor miofibroblástico inflamatorio. CASO 2: Adolescente de género femenino, edad 12 años, hospitalizada por neumonía y dolor lumbar en estudio asociado a pérdida de peso. Se diagnosticó una masa retroperitoneal que comprometía el músculo psoas derecho, músculos paravertebrales, vértebras, riñón derecho y diafragma ipsilateral. Se efectuó biopsia por punción cuyo resultado fue compatible con un tumor miofibroblástico inflamatorio. CASO 3: Preadolescente de género femenino de 11 años de edad, hospitalizada para estudio de infección del tracto urinario a repetición. Se identificó un tumor vesical y la biopsia mostró ser compatible con tumor miofibroblástico inflamatorio. CONCLUSIÓN: Debido al comportamiento variable del tumor miofibroblástico inflamatorio, el manejo de este dependerá de la localización, la expresión del anaplasic like lymphoma (ALK), el comportamiento del tumor y la posibilidad de resección.

INTRODUCTION: The inflammatory myofibroblastic tumor is an infrequent benign neoplasm with unpredictable cli nical behavior. OBJECTIVES: to describe three clinical cases at the San Borja Arriarán Clinical Hospital between March 2014 and January 2018 and to carry out an updated review of the literature. CASE 1: 14-year-old male adolescent, hospitalized due to abdominal pain, diagnosed with jejunojejunal intus susception secondary to an intestinal wall tumor. The histology was compatible with an inflamma tory myofibroblastic tumor. CASE 2: 12-year-old female adolescent, hospitalized due to pneumonia and low-back pain under study associated with weight loss. A retroperitoneal mass was diagnosed involving the right psoas muscle, paravertebral muscles, vertebrae, right kidney, and ipsilateral dia phragm. A puncture biopsy was performed and the result was compatible with an inflammatory myofibroblastic tumor. CASE 3: 11-year-old female pre-adolescent, hospitalized to study recurrent urinary tract infection. A bladder tumor was identified, and the biopsy showed compatibility with inflammatory myofibroblastic tumor. CONCLUSION: Due to the variable behavior of the inflammatory myofibroblastic tumor, its management will depend on the location, expression of the anaplastic lymphoma kinase (ALK), tumor behavior, and the resection possibility.

Carcinoma de uraco, una neoplasia maligna poco frecuente / Urachal carcinoma, a rare malignant neoplasm / Carcinoma de úraco, uma neoplasia maligna pouco frequente

El carcinoma de uraco es una neoplasia maligna poco frecuente de predominio masculino entre la quinta a sexta década de la vida. Se localizan típicamente en la cúpula de la vejiga, con patrón histopatológico predominante de adenocarcinoma en el 90% de los casos. Tiene un curso indolente con manifestaciones clínicas en etapas tardías caracterizadas por hematuria, dolor abdominal, disuria, mucosuria, entre otros. El diagnóstico se basa en el hallazgo de la lesión por métodos endoscópicos e imagenológicos. Dado lo infrecuente de esta patología, se describe el caso de una paciente en su cuarta década de vida con infección de vías urinarias recurrente, en quien se documentó por medio de urografía por tomografía computarizada multicorte (UROTAC) de pólipo vesical resecado por resección transuretral (RTU) con reporte histológico de adenocarcinoma de tipo entérico.

Urachal carcinoma is a rare malignant neoplasm of male predominance between the fifth to sixth decade of life. It is typically located in the dome of the bladder, with a predominant histopathological pattern of adenocarcinoma in 90% of cases. It has an indolent course with clinical manifestations in late stages characterized by hematuria, abdominal pain, dysuria, mucosuria, among others. Diagnosis is based on the finding of the lesion by endoscopic and imaging techniques. Given the infrequent nature of this pathology, we describe the case of a female patient in her fourth decade of life with recurrent urinary tract infection, who was documented by MSCTU of bladder polyp resected by TURP with a histological report of enteric-type adenocarcinoma.

O carcinoma de úraco, é uma neoplasia maligna pouco frequente, predominantemente masculina que se manifesta entre a quinta e a sexta década de vida. Sua localização típica é a cúpula vesical e em 90% dos casos sua histologia corresponde a adenocarcinomas. Apresenta evolução indolente com manifestações clínicas nas etapas tardias caracterizadas por hematúria, dor abdominal, disúria, mucosúria, entre outros. O diagnóstico está baseado no achado da lesão por métodos endoscópicos e de imagens. Considerando a baixa frequência desta patologia, descreve-se o caso de uma paciente de sexo feminino em sua quarta década de vida com infecção recorrente das vias urinarias, na qual foi registrado, através de UROTAC, um pólipo vesical ressecado por RTU com laudo histológico de adenocarcinoma de tipo entérico.

Cancer de la vessie : aspects épidémiologiques, diagnostiques et thérapeutiques au service d'OncoHématologie de l'Hôpital National de Niamey : à propos de 159 cas colligés de 2007 à 2014

Titre : CANCER DE LA VESSIE : aspects épidémiologiques, diagnostiques et thérapeutiques au service d'Onco-Hématologie de l'Hôpital National de Niamey. A propos de 159 cas colligés de 2007 à 2014. Objectifs : Objectif Général :  Contribuer à l'amélioration la prise en charge du cancer de la vessie. PATIENTS ET METHODES : Il s'agit d'une étude rétrospective sur huit (8) ans, réalisé du 1er Janvier 2007 au 31 Décembre 2014. L'étude a inclus les patients des deux sexes, tout âge confondu qui ont été pris en charge pour cancer vésical avec ou sans confirmation histologique au service d'OncoHématologie de l'HNN. RESULTATS : Au terme de notre étude, nous avons colligé 159 cas de tumeurs de la vessie. L'âge moyen est de 41 ans avec des extrêmes de 11 et 71 ans. La majorité des patients était des cultivateurs (38,36%) et des ménagères (27%) et proviennent de la région de Tillabéry (33,96%). Le sexe masculin était prédominant (69,20%) et sex ratio de 2,24. L'hématurie est le signe clinique le plus fréquent avec 69,18%. L'échographie abdomino-pelvienne a été réalisée chez 73,58% des patients, la radiographie pulmonaire dans 67,92% des cas, cystoscopie dans 59,75%, cytologie urinaire dans 9,43%, examen histologique dans 8,18% des cas et le carcinome épidermoïde retrouvé dans 77,77% des cas. La chimiothérapie a constitué le principal traitement dans 58,49% des cas et la chirurgie 5,66% des cas. Conclusion : Le cancer de la vessie est fréquent à l'HNN. Malgré les moyens d'explorations relativement limités, les patients bénéficient d'une prise en charge multi-disciplinaire. Le retard de consultation constitue un frein pour cette prise en charge et dans la majorité des cas la tumeur est diagnostiquée à un stade très avancé de maladie d'où un fort taux de décès est enregistré

Diagnosis of micrometastasis in muscle invasive bladder cancer through immunohistochemistry analysis: is there indication for routine evaluation?

Background: Muscle invasive bladder cancer (BC) has a mortality rate of 50% in 5 years, despite the aggressive treatments currently used. The diagnosis of latent tumor cells in histologically normal lymph nodes (LN) may have prognostic value and may explain the tumoral recurrence in BC. Methods: Here we evaluated the use of the AE1AE3 cytokeratin marker through immunohistochemical examination of LNs to diagnose micrometastasis in patients with BC undergoing radical cystectomy (RC) and lymph node dissection. Sixty-one patients with pN0 diseases who were submitted to RC were studied. Conventional histological evaluation indicated that these patients did not have lymph node metastasis. Histological sections were reviewed and analyzed by immunohistochemistry (IHC) using the AE1AE3 antibody in single sections. Results: The total number of removed LNs was 832, averaging 13.64 LNs per patient. The IHC evaluation revealed that LN from 2/61 (3.27%) patients had micrometastasis. At the time of the last follow-up, 41% of all patients were in complete disease remission and 41.1% had died from BC. Conclusions: Our study shows that histological analysis using hematoxylin eosin (HE) method by experienced pathologists is sufficient for the diagnosis of LN metastasis and, therefore, there is no indication for routine IHC evaluation in patients at histopathological pN0 stage. (AU)

Recurrencia y progresión del carcinoma transicional de alto grado superficial de vejiga tratado con Bacilo de Calmette-Guerín (BCG) en lesiones únicas o múltiples / Recurrence and progression of transitional cell carcinoma of high - grade surface treated with bacillus Calmette - Guerin (BCG) in single or multiple lesions

Introducción: El carcinoma transicional de vejiga ocupa el segundo lugar en frecuencia, detrás del adenocarcinoma de la próstata, dentro de los tumores malignos del tracto genitourinario. Entre el 75-85% de los pacientes afectos de carcinoma vesical se presentan en formas confinadas a la mucosa o a la submucosa. Son los considerados carcinomas superficiales de vejiga y se estima que entre el 10-20% de ellos su evolución es hacia formas clínicas invasoras músculo-infiltrantes y un 50-70% evolucionaránhacia la recurrencia de la enfermedad. Objetivo: Evaluar la incidencia de la recurrencia y progresión en pacientes con Carcinoma en estadio T1 tratados con BCG, teniendo en cuenta la uni o multifocalidad de las lesiones vesicales al diagnóstico. Materiales y métodos: Criterios de inclusión: Paciente con diagnóstico de carcinoma transicional de vejiga de alto grado superficial de Febrero del 2010 a Agosto del 2014, con un seguimiento de al menos 12 meses. Tratados conBCG endocavitario. Los criterios de exclusión fueron; controles cistoscópicos irregulares, ciclos incompletos de BCG y seguimiento menor a 12 meses. Resultados: 81 HC; Grupo “A” con lesión única, 54 pacientes (66.7%) y Grupo “B” con dos o más lesiones, 27 pacientes (33.3%). Grupo “A” 50 % de recurrencia, 16,6 % de progresión y 33,4 % libres de enfermedad. Grupo “B” 66,6 % de recurrencia, 18,6 % de progresión y 14,8 % libres de enfermedad Conclusión: La inmunoterapia intravesical con BCG después de la resección transuretral completa de una lesión por un carcinoma transicional de vejiga de alto grado superficial, se considera un tratamiento con resultados aceptables.

Introduction: The transitional bladder cell carcinoma is the secondone in frequency after the adenocarcinoma of prostate, withinmalignant tumors of the genitourinary tract. Between 75-85% ofpatients with bladder carcinoma are presented in ways confined tothe mucous membrane or submucous. These are consideredsuperficial bladder carcinomas and it is estimated that between 10-20% of them evolution is toward muscle-invasive clinical forms andevolve towards 50-70% recurrence of the disease.Objectives: To evaluate the incidence of recurrence andprogression in patients with carcinoma stage T1 treated with(BCG), taking into account the uni or multifocal lesions of bladderdiagnosis.Material and methods: Inclusion criteria: Patient diagnosed withtransitional bladder cell carcinoma of high-grade surface fromFebruary 2010 to August 2014, with a follow up of at least 12months treated with endocavity BCG. Exclusion criteria were;irregular cystoscopic controls, incomplete cycles of BCG and lowertrack of 12 months.Results: HC 81 was obtained; Group "A" with single lesion, 54patients (66.7%) and Group "B" with two or more lesions, 27patients (33.3%). Group "A": 50% of recurrence, 16.6% of disease progression and 33.4% of free disease. Group "B": 66.6% of recurrence, 18.6% of disease progression and 14.8% of freedisease Conclusion: Intravesical immunotherapy with BCG after completetransurethral resection of a lesion, by a transitional bladdercarcinoma of grade high surface, is considered a treatment with acceptable results.

Thunderclap-like headache triggered by micturition and angina as an initial manifestation of bladder pheochromocytoma. A case report / Cefaleia trovoada-símile desencadeada pela micção e angina como manifestação inicial de feocromocitoma de bexiga. Um relato de caso

CONTEXT: Pheochromocytoma is a catecholamine-producing tumor characterized by hypertension, headache, tachycardia, excessive diaphoresis and angina. The thunderclap headache is so named because the pain strikes suddenly and severely. Although the symptoms of bladder pheochromocytoma are rather evident, the diagnosis of this rare neuroendocrine tumor can be missed. CASE REPORT: This study reports the case of a woman diagnosed with bladder pheochromocytoma who experienced thunderclap headache triggered by micturition and angina as an initial manifestation. CONCLUSION: This case study suggests that thunderclap headache and angina occurring concurrently with sudden blood pressure elevation during or immediately after micturition are important diagnostic clues for bladder pheochromocytoma. .

CONTEXTO: Feocromocitoma é um tumor produtor de catecolaminas, caracterizado por hipertensão, cefaleia, taquicardia, sudorese excessiva e angina. A dor de cabeça trovão é assim chamada porque a dor ataca de repente e intensamente. Embora os sintomas de feocromocitoma de bexiga sejam bastante evidentes, o diagnóstico deste tumor neuroendócrino raro pode ser perdido. RELATO DE CASO: Este estudo relata o caso de uma mulher diagnosticada com feocromocitoma na bexiga que sentiu a dor de cabeça trovão, desencadeada pela micção e angina como manifestação inicial. CONCLUSÃO: Este estudo de caso sugere que a dor de cabeça trovão e angina ocorrendo simultaneamente com a elevação da pressão de sangue repentina durante ou imediatamente após a micção são dicas importantes de diagnósticos de feocromocitoma na bexiga. .

New and contemporary markers of prognosis in nonmuscle invasive urothelial cancer

Nonmuscle invasive (NMI) urothelial cancer (UC) is associated with varied biological potential. It is characterized by frequent recurrence and progression, which thus worsens the oncological outcome. Nearly three-quarters of NMI UCs recur within 5 years, whereas half can progress during follow-up. Progression is particularly seen in T1 and carcinoma in situ (CIS). Undoubtedly, NMI UC is one of the most expensive cancers to manage. The European Organisation for Research and Treatment of Cancer (EORTC) risk calculator is a commonly used tool for assessing the recurrence and progression potential of a newly diagnosed cancer. The parameters used in the assessment are tumor size and number, pathological stage and grade of the cancer, presence of CIS, and prior recurrence rate. The main advantages of the EORTC tool are its ease of use and the lack of need to run expensive molecular tests. However, reproducibility of pathologic stage and grade is modest, which is a concern to clinicians. Molecular markers have potential for predicting the clinical outcome of NMI UC, given that clinico-pathologic variables are not sufficient for prediction of prognosis in an individual. Significant work has been done in the past 2 decades in understanding the molecular biology of bladder cancer; however, the translational value of this knowledge remains poor. The role for molecular markers in predicting recurrence seems limited because multifocal disease and incomplete treatment are probably more important for recurrence than the molecular features of a resected tumor. Urinary markers have very limited value in prognostication of bladder cancer and are used (mainly as an adjunct to cytology) for detection and surveillance of urothelial cell cancer recurrence. Prediction of progression with molecular markers holds considerable promise. Nevertheless, the contemporary value of molecular markers over clinico-pathologic indexes is limited.

Novel Combination Markers for Predicting Survival in Patients with Muscle Invasive Bladder Cancer: USP18 and DGCR2

We performed gene expression profiling in bladder cancer patients to identify cancer-specific survival-related genes in muscle invasive bladder cancer (MIBC) patients. Sixty-two patients with MIBC were selected as the original cohort and another 118 MIBC patients were chosen as a validation cohort. The expression of USP18, DGCR2, and ZNF699 genes were measured and we analyzed the association between gene signatures and survival. USP18 and DGCR2, were significantly correlated to cancer-specific death (P=0.020, P=0.007, respectively). Cancer-specific survival in the low USP18 or DGCR2 expression group was significantly longer than the high expression group (P=0.018, P=0.006, respectively). In multivariate Cox regression analysis, a combination of USP18 and DGCR2 mRNA expression levels were significant risk factors for cancer-specific death (HR, 2.106; CI, 1.043-4.254, P=0.038). Overall survival and cancer-specific survival rates in the low-combination group were significantly longer than those in the high-expression group (P=0.001, both). In conclusion, decreased expressions of USP18 and DGCR2 were significantly associated with longer cancer-specific survival, and also the combination of two genes was correlated to a longer survival for MIBC patients. Thus, the combination of USP18 and DGCR2 expression was shown to be a reliable prognostic marker for cancer-specific survival in MIBC.

Usefulness of Urine Cytology as a Routine Work-up in the Detection of Recurrence in Patients With Prior Non-Muscle-Invasive Bladder Cancer: Practicality and Cost-Effectiveness

PURPOSE: To investigate the usefulness of urine cytology in the detection of tumor recurrence in terms of practicality and cost-effectiveness. MATERIALS AND METHODS: We retrospectively analyzed 393 patients who underwent transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) from January 2010 to June 2013. All patients underwent cystoscopy, urine cytology, urinalysis, and computed tomography (CT) at 3 and 6 months after TURBT. In 62 cases, abnormal bladder lesions were identified on cystoscopy within 6 months. Suspicious lesions were confirmed pathologically by TURBT or biopsy. Patients were grouped by modalities: group I, urine cytology; group II, CT; group III, urinalysis; group IV, urine cytology plus CT; group V, urine cytology plus urinalysis; group VI, CT plus urinalysis; group VII, combination of all three modalities. Each group was compared by cost per cancer detected. RESULTS: Forty-nine patients were confirmed to have tumor recurrence and 13 patients were confirmed to have inflammation by pathology. The overall tumor recurrence rate was 12.5% (49/393) and recurrent cases were revealed as NMIBC. Sensitivity in group I (24.5%) was lower than in group II (55.1%, p=0.001) and group III (57.1%, p<0.001). However, in group VII (77.6%), the sensitivity was statistically similar to that of group VI (75.5%, p=0.872). Under the Korean insurance system, total cost per cancer detected for group VII was almost double that of group VI (p=0.041). CONCLUSIONS: Routine urine cytology may not be useful for follow-up of bladder cancer in terms of practicality and cost-effectiveness. Application of urine cytology needs to be adjusted according to each patient.

Comparison of Urinary and Serum CA 19-9 as Markers of Early Stage Urothelial Carcinoma

Objectives Although the glycoprotein group tumor marker CA 19-9 has been detected in both serum and urine of bladder cancer patients, information about their comparative role in screening of low grade transitional cell carcinoma (LGTCC) and high grade transitional cell carcinoma (HGTCC) is rare. Materials and Methods In this study we measured both the urinary and serum levels of CA 19-9 in 35 LGTCC and 20 HGTCC patients by ELISA and determined the cut off value of both urinary and serum CA 19-9 levels by receiver operator characteristic curve (ROC) for both patient groups. Odds ratio (OR) for CA 19-9 was analyzed with its range at 95% confidence interval to analyze the role of this tumor marker as a screening parameter for both of these cancer types. Results For urinary CA 19-9 the OR was 20.16 with an interval of 4.91-82.71 whereas for the serum CA 19-9 it was 7.5 with an interval of 2.28-24.62. Conclusions From these data we suggest that urinary CA 19-9 is a better screening parameter with optimum sensitivity and specificity than its serum counterpart for diagnosis of low grade and early stages of transitional cell carcinoma of urinary bladder. Furthermore, it can be suggested that urinary CA 19-9 can be used as better prognostic marker for LGTCC than its serum counterpart. .

Extra Adrenal Pheochromocytoma Presenting as Hypertensive Crisis in a Young Male.

Pheochromocytoma is a tumor of aderenal medulla which secrets catecholamines and usually presents as hypertension. Extra-adrenal pheochromocytomas are extremely rare. They occur in the organ of zukerkundle, bladder, retroperitonium, posterior mediastinum and sympathetic chain. We present a case of a young male who presented with hypertension and eventually was found to have extra adrenal pheochromocytoma of the bladder.

Leiomyoma of the urinary bladder: a case report

The case of a 71-year-old woman who presented with one year history of pelvic pain and occasional dysuria is reported. Computed tomography and Magnetic Resonance Imaging revealed a well defined intramural bladder mass. The histological findings of the surgical specimen confirmed a leiomyoma of the urinary bladder. The clinical presentation, imaging findings and management of this relatively rare benign tumor are discussed.