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1.
Int. braz. j. urol ; 48(2): 367-368, March-Apr. 2022.
Article in English | LILACS | ID: biblio-1364961

ABSTRACT

ABSTRACT Introduction and Objective: Upper tract urothelial carcinoma (UTUC) represents 5% of all urothelial malignancies (1-3). Accurate pathologic diagnosis is key and may direct treatment decisions. Current ureteroscopic biopsy techniques include cold-cup, backloaded cold-cup and stone basket (4-6). The study objective was to compare a standard cold-cup biopsy technique to a novel cold-cup biopsy technique and evaluate histopathologic results. Materials and Methods: We developed a novel UTUC biopsy technique termed the "form tackle" biopsy. Ureteroscope is passed into ureter/renal collecting system. Cold-cup forceps are opened and pressed into the lesion base (to engage the urothelial wall/submucosal tissue) then closed. Ureteroscope/forceps are advanced forward 3-10mm and then extracted from the patient. We compared standard versus novel upper tract biopsy techniques in a series of patients with lesions ≥1cm. In each procedure, two standard and two novel biopsies were obtained from the same lesion. The primary study aim was diagnosis of malignancy. IRB approved: 21-006907. Results: Fourteen procedures performed on 12 patients between June 2020 and March 2021. Twenty-eight specimens sent (14 standard, 14 novel) (Two biopsies per specimen). Ten procedures with concordant pathology. In 4 procedures the novel biopsy technique resulted in a diagnosis of UTUC (2 high-grade, 2 low-grade) in the setting of a benign standard biopsy. Significant difference in pathologic diagnoses was detected between standard and novel upper tract biopsy techniques (p=0.008). Conclusions: The "form tackle" upper tract ureteroscopic biopsy technique provides higher tissue yield which may increase diagnostic accuracy. Further study on additional patients required. Early results are encouraging.


Subject(s)
Humans , Ureteral Neoplasms/pathology , Biopsy/methods , Carcinoma, Transitional Cell/pathology , Reproducibility of Results , Ureteroscopy
2.
Einstein (Säo Paulo) ; 20: eAO6450, 2022. tab, graf
Article in English | LILACS | ID: biblio-1364794

ABSTRACT

ABSTRACT Objective To understand the feasibility of FGFR3 tests in the Brazilian public health context, and to sample the mutational burden of this receptor in high-grade muscle invasive bladder cancer. Methods A total of 31 patients with high-grade muscle-invasive bladder cancer were included in the present study. Either transurethral resection of bladder tumor or radical cystectomy specimens were analyzed. Formalin-fixed paraffin-embedded tissue blocks were sectioned, hematoxylin and eosin stained, and histologic sections were reviewed. Total RNA was extracted using the RNeasy DSP formalin-fixed paraffin-embedded kit. Qualitative results were displayed in Rotor-Gene AssayManager software. Results Six patients were excluded. From the samples analyzed, four (16.7%) were considered inadequate and could not have their RNA extracted. Two patients presented FGFR3 mutations, accounting for 9.5% of material available for adequate analysis. The two mutations detected included a Y373C mutation in a male patient and a S249C mutation in a female patient. Conclusion FGFR3 mutations could be analyzed in 84% of our cohort and occurred in 9.5% of patients with high-grade muscle invasive bladder cancer in this Brazilian population. FGFR3 gene mutations are targets for therapeutic drugs in muscle-invasive bladder cancer. For this reason, know the frequency of these mutations can have a significant impact on public health policies and costs provisioning.


Subject(s)
Urinary Bladder Neoplasms/genetics , Carcinoma, Transitional Cell/genetics , Carcinoma, Transitional Cell/metabolism , Carcinoma, Transitional Cell/pathology , Receptor, Fibroblast Growth Factor, Type 3/genetics , Receptor, Fibroblast Growth Factor, Type 3/metabolism , Brazil , RNA , Prevalence , Eosine Yellowish-(YS) , Hematoxylin , Muscles/metabolism , Muscles/pathology , Mutation
3.
Int. braz. j. urol ; 45(4): 843-846, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1019883

ABSTRACT

ABSTRACT Introduction Cancer is one of the most important leading cause of death in man and woman in the world. The occurrence of new cancer has become more frequent in recent years due to strict screening protocols and occupational and environmental exposure to carcinogens. The incidence of secondary malignancies has also increased due to close medical follow-up and advanced age. Herein, we report a case and its management diagnosed as synchronous peritoneal malignant mesothelioma and muscle-invasive urothelial carcinoma. Case Description A 71-year-old male presented with macroscopic hematuria and abdominal distension increasing gradually. A contrast enhanced computerized tomography demonstrated bladder mass and diffuse ascites with nodular peritoneal thickening and umbilical mass. He was treated with the multidisciplinary team working including urologist, medical oncologist and general surgeon. Conclusions To our knowledge, this is the first case of peritoneal malign mesothelioma with synchronous muscle-invasive urothelial carcinoma. Because of the rarity of this condition, there is still no consensus on the definitive treatment protocols, yet. Individualized treatment with multidisciplinary close follow-up might improve the survival outcomes.


Subject(s)
Humans , Male , Aged , Peritoneal Neoplasms/pathology , Urinary Bladder Neoplasms/pathology , Carcinoma, Transitional Cell/pathology , Lung Neoplasms/pathology , Mesothelioma/pathology , Neoplasms, Multiple Primary/pathology , Peritoneal Neoplasms/diagnostic imaging , Urinary Bladder Neoplasms/diagnostic imaging , Immunohistochemistry , Carcinoma, Transitional Cell/diagnostic imaging , Tomography, X-Ray Computed , Mesothelioma, Malignant , Lung Neoplasms/diagnostic imaging , Mesothelioma/diagnostic imaging , Neoplasm Invasiveness , Neoplasms, Multiple Primary/diagnostic imaging
4.
Int. braz. j. urol ; 45(2): 315-324, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002193

ABSTRACT

ABSTRACT Objectives: To evaluate the neutrophil-to-lymphocyte ratio (NLR) as a prognostic factor for response of high risk non muscle invasive bladder cancer (HRNMIBC) treated with BCG therapy. Materials and Methods: Between March 2010 and February 2014 in a tertiary center 100 consecutive patients with newly diagnosed HRNMIBC were retrospectively analyzed. Patients were divided according to NLR value: 46 patients with NLR value less than 3 (NLR < 3 group), and 54 patients with NLR value more than 3 (NLR ≥ 3 group). At the end of follow-up 52 patients were high grade disease free (BCG-responder group) and 48 patients underwent radical cystectomy for high grade recurrence or progression to muscle invasive disease (BCG non-responder group). The average follow-up was 60 months. Intervention: analysis and correlation of preoperative NLR value with response to BCG in terms of recurrence and progression. Results: The optimal cut-off for NLR was ≥ 3 according to the receiver operating characteristics analysis (AUC 0.760, 95% CI, 0.669-0.850). Mean NLR value was 3.65 ± 1.16 in BCG non-responder group and 2.61 ± 0.77 in BCG responder group (p = 0.01). NLR correlated with recurrence (r = 0.55, p = 0.01) and progression risk scores (r = 0.49, p = 0.01). In multivariate analysis, NLR (p = 0.02) and EORTC recurrence risk groups (p = 0.01) were associated to the primary endpoint. The log-rank test showed statistically significant difference between NLR < 3 and NLR ≥ 3 curves (p < 0.05). Conclusions: NLR value preoperatively evaluated could be a useful tool to predict BCG response of HRNMIBC. These results could lead to the development of prospective studies to assess the real prognostic value of NLR in HRNMIBC.


Subject(s)
Humans , Male , Female , Aged , Urinary Bladder Neoplasms/drug therapy , BCG Vaccine/therapeutic use , Lymphocytes/pathology , Carcinoma, Transitional Cell/drug therapy , Adjuvants, Immunologic/therapeutic use , Neutrophils/pathology , Prognosis , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/pathology , Carcinoma, Transitional Cell/surgery , Carcinoma, Transitional Cell/pathology , Biomarkers, Tumor/blood , Cystectomy , Retrospective Studies , Lymphocyte Count , Disease Progression , Neoplasm Grading , Middle Aged , Neoplasm Recurrence, Local/surgery , Neoplasm Staging
5.
Int. braz. j. urol ; 43(2): 224-229, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-840826

ABSTRACT

ABSTRACT Introduction Recently, expression of the UHRF1 gene was found to be up-regulated in numerous neoplasms, including the urinary bladder transitional cell carcinoma (TCC). Objective The aim of our study was to determine if the expression levels of UHRF1 gene correlates with the major pathological characteristics of the tumor and patients’ clinical outcome. Materials and Methods In our study, we have analyzed the tissue samples derived from group of 70 patients with histologically confirmed TCC of the urinary bladder, while normal urinary bladder mucosa obtained from 40 patients with nonmalignant diseases was used as a negative control group. Expression of UHRF1 gene in each patient sample was determined using reverse transcriptase-polymerase chain reaction. Results UHRF1 gene expression was found to be app. 2.5 times higher in samples from patients with TCC in comparison with normal epithelium derived from control group patients. Analysis show that gene expression correlates with the malignancy of the tumor. A highly significant differences were found between the expression values of samples from low and high grade TCC, as well as between the high grade and control group. UHRF1 expression was higher in patients with non-muscle invasive disease than in those with muscle invasive disease. Conclusions The result of this study indicates that UHRF1 gene expression levels correlates with the major pathological characteristics of TCC samples and with the clinical outcome of those patients. Determination of UHRF1 gene expression could have a potential to be used as a sensitive molecular marker in patients with urinary bladder cancer.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Urinary Bladder Neoplasms/genetics , Urinary Bladder Neoplasms/pathology , Carcinoma, Transitional Cell/genetics , Carcinoma, Transitional Cell/pathology , Gene Expression Regulation, Neoplastic , CCAAT-Enhancer-Binding Proteins/analysis , CCAAT-Enhancer-Binding Proteins/genetics , Reference Values , Urinary Bladder/pathology , Genetic Markers , Statistics, Nonparametric , Reverse Transcriptase Polymerase Chain Reaction , Ubiquitin-Protein Ligases , Tumor Burden , Neoplasm Grading , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging
6.
Int. braz. j. urol ; 42(3): 431-437, tab
Article in English | LILACS | ID: lil-785717

ABSTRACT

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.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Urinary Bladder Neoplasms/surgery , Urinary Bladder Neoplasms/pathology , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/pathology , Carcinoma, Transitional Cell/surgery , Carcinoma, Transitional Cell/pathology , Cystectomy/methods , Lymph Node Excision/methods , Pelvis , Postoperative Complications , Prognosis , Time Factors , Biopsy , Urinary Bladder Neoplasms/complications , Brazil , Carcinoma, Squamous Cell/complications , Carcinoma, Transitional Cell/complications , Adenocarcinoma/surgery , Adenocarcinoma/complications , Adenocarcinoma/pathology , Cystectomy/adverse effects , Retrospective Studies , Operative Time , Lymph Node Excision/adverse effects , Lymph Nodes/surgery , Middle Aged
7.
Int. braz. j. urol ; 42(2): 234-241, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-782864

ABSTRACT

ABSTRACT Objective: To evaluate whether the use of [F-18]-FDG-PET/CT can accurately predict pelvic lymph node metastasis in patients with muscle invasive TCC of the bladder undergoing radical cystectomy. Materials and Methods: Fifteen patients with muscle invasive bladder cancer had undergone FDG-PET/CT scan from the skull base to the mid-thighs after IV injection of 6.5MBq (Mega-Becquerel)/Kg of FDG. After intravenous hydration IV furosemide was given to overcome the difficulties posed by urinary excretion of 18F-FDG. PET/CT data were analyzed as PET and CT images studied separately as well as fused PET/CT images. The imaging findings were correlated with the histopathology of the nodes (gold standard). Results: CT and FDG-PET had demonstrated positive lymph nodes in 9 & 8 patients respectively. Among the 15 patients 3 had documented metastasis on histopathology. Both CT and PET could detect the nodes in all these 3 patients (100% sensitivity). Nodes were histologically negative amongst 6&5 patients who had node involvement by CT and PET respectively. Therefore, specificity, positive predictive value (PPV) & negative predictive value (NPV) for CT and PET/CT were 50%, 33.3%, 100% and 58.3%, 37.5%, 100% respectively. Conclusion: The theoretical advantage of this cutting edge technology for whole body imaging has not been translated into clinical practice as we found minimal advantage of combined FDG-PET/CT over CT alone for nodal staging of muscle invasive bladder cancer. This may be due to substantial overlap between standardized uptake values (SUVs) from active inflammatory processes with those of malignant lesion.


Subject(s)
Humans , Male , Female , Adult , Aged , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/diagnostic imaging , Carcinoma, Transitional Cell/pathology , Carcinoma, Transitional Cell/diagnostic imaging , Radiopharmaceuticals , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography/methods , Cystectomy/methods , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Lymph Nodes/pathology , Lymphatic Metastasis , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging
8.
Int. braz. j. urol ; 42(2): 247-252, Mar.-Apr. 2016. tab, graf
Article in English | LILACS | ID: lil-782863

ABSTRACT

ABSTRACT Purpose The vast majority of urothelial carcinomas infiltrating the bladder are consistent with high-grade tumors that can be easily recognized as malignant in needle prostatic biopsies. In contrast, the histological changes of low-grade urothelial carcinomas in this kind of biopsy have not been studied. Materials and Methods We describe the clinicopathologic features of two patients with low-grade bladder carcinomas infiltrating the prostate. They reported dysuria and hematuria. Both had a slight elevation of the prostate specific antigen and induration of the prostatic lobes. Needle biopsies were performed. At endoscopy bladder tumors were found in both cases. Results Both biopsies showed nests of basophilic cells and cells with perinuclear clearing and slight atypia infiltrating acini and small prostatic ducts. The stroma exhibited extensive desmoplasia and chronic inflammation. The original diagnosis was basal cell hyperplasia and transitional metaplasia. The bladder tumors also showed low-grade urothelial carcinoma. In one case, the neoplasm infiltrated the lamina propria, and in another, the muscle layer. In both, a transurethral resection was performed for obstructive urinary symptoms. The neoplasms were positive for high molecular weight keratin (34BetaE12) and thrombomodulin. No metastases were found in either of the patients, and one of them has survived for five years. Conclusions The diagnosis of low-grade urothelial carcinoma in prostate needle biopsies is difficult and may simulate benign prostate lesions including basal cell hyperplasia and urothelial metaplasia. It is crucial to recognize low-grade urothelial carcinoma in needle biopsies because only an early diagnosis and aggressive treatment can improve the prognosis for these patients.


Subject(s)
Humans , Male , Aged , Prostatic Hyperplasia/pathology , Prostatic Neoplasms/pathology , Prostatic Neoplasms/secondary , Urinary Bladder Neoplasms/pathology , Carcinoma, Transitional Cell/pathology , Urothelium/pathology , Prostate/pathology , Biopsy, Needle , Prostate-Specific Antigen/blood , Diagnosis, Differential , Neoplasm Grading , Middle Aged
9.
An. bras. dermatol ; 91(1): 73-79, Jan.-Feb. 2016. graf
Article in English | LILACS | ID: lil-776425

ABSTRACT

Abstract In Brazil, without considering the non-melanoma skin tumors, bladder cancer in men is the eighth most common, and the urothelial carcinoma or transitional cell carcinoma is the most common among these. Cutaneous metastases from urothelial neoplasms appear as single or multiple erythematous, infiltrated nodules or plaques, and like other cases of distant disease, it is indicative of poor prognosis. The invasive urothelial carcinoma is recognized for its ability to present divergent differentiation and morphological variants. The sarcomatoid urothelial carcinoma is a rare cancer that consists of two different components: one composed of epithelial tissue and the other with sarcomatoid features of mesenchymal origin. The authors describe a case of cutaneous metastasis of sarcomatoid urothelial carcinoma in a 63-year-old male patient.


Subject(s)
Humans , Male , Middle Aged , Carcinoma, Transitional Cell/pathology , Carcinosarcoma/pathology , Skin Neoplasms/pathology , Urinary Bladder Neoplasms/pathology , Fatal Outcome , Neoplasm Invasiveness , Skin/pathology , Urothelium/pathology
10.
Int. braz. j. urol ; 41(6): 1067-1079, Nov.-Dec. 2015. tab, graf
Article in English | LILACS | ID: lil-769747

ABSTRACT

Objectives: The objective of this study was to update the long-term outcome in the treatment of locally advanced upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU) regarding the role of adjuvant chemotherapy. Materials and methods: Clinical data from 138 patients who underwent RNU for locally advanced UTUC (pT3/4 or pN+) were analyzed. Results: The adjuvant chemotherapy group comprised 66 patients, and other 72 patients did not receive adjuvant chemotherapy. Cisplatin-based chemotherapy was the most common regimen, depending on the patient's eligibility and renal function. The median follow-up period was 48.7 months (interquartile range: 29.2-96.9 months). The 3-and 5-year disease-specific survival (DSS) rates were 76.0% and 69.9% for the non-adjuvant chemotherapy group versus 74.6% and 54.5% for the adjuvant chemotherapy group (p=0.301, log-rank test). Overall survival (OS) rates for the same time period were 70.1% and 62.9% for the non-adjuvant chemotherapy group versus 73.8% and 53.2% for the adjuvant chemotherapy group (p=0.931, log-rank test). On multivariate analysis, adjuvant chemotherapy could not predict DSS and OS after surgery. When patients who received cisplatin-based adjuvant chemotherapy (n=59) were compared to those who did not receive adjuvant chemotherapy, similar results were found. Conclusions: There does not appear to be a significant DSS or OS benefit associated with adjuvant chemotherapy. Prospective randomized clinical trials are necessary to verify the effect of adjuvant chemotherapy on locally advanced UTUC.


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Antineoplastic Agents/therapeutic use , Carcinoma, Transitional Cell/drug therapy , Cisplatin/therapeutic use , Ureteral Neoplasms/drug therapy , Carcinoma, Transitional Cell/pathology , Carcinoma, Transitional Cell/surgery , Chemotherapy, Adjuvant/methods , Disease-Free Survival , Hospitals, University , Kaplan-Meier Estimate , Multivariate Analysis , Nephrectomy/methods , Prognosis , Retrospective Studies , Seoul , Time Factors , Ureteral Neoplasms/pathology , Ureteral Neoplasms/surgery
11.
Int. braz. j. urol ; 41(6): 1080-1087, Nov.-Dec. 2015. tab, graf
Article in English | LILACS | ID: lil-769750

ABSTRACT

Objective: We aimed to compare serum and urinary HER2/neu levels between healthy control group and patients with non-muscle invasive bladder cancer. Additionally, we evaluated relationship of HER2/neu levels with tumor stage, grade, recurrence and progression. Materials and Methods: Fourty-four patients with primary non-muscle invasive bladder tumors (Group 2) and 40 healthy control group (Group 1) were included the study. Blood and urinary samples were collected from all patients and HER2/neu levels were measured by ELISA method. Blood and urinary HER2/neu levels and additionally, ratio of urinary HER2/neu levels to urinary creatinine levels were recorded. Demographic data and tumor characteristics were recorded. Results: Mean serum HER2/neu levels were similar between two groups and statistically significant difference wasn't observed. Urinary HER2/neu levels were significantly higher in group 2 than group 1. Ratio of urinary HER2/neu to urinary creatinine was significantly higher in group 2 than group 1, (p=0,021). Serum and urinary HER2/ neu levels were not associated with tumor stage, grade, recurrence and progression while ratio of urinary HER2/neu to urinary creatinin levels were significantly higher in high-grade tumors. HER2/neu, the sensitivity of the test was found to be 20.5%, and the specificity was 97.5%, also for the urinary HER2/neu/urinary creatinine ratio, the sensitivity and specificity of the test were found to be 31.8% and 87.5%, respectively. Conclusions: Urinary HER2/neu and ratio of urinary creatinine urine were significantly higher in patients with bladder cancer compared to healthy subjects. Large series and controlled studies are needed for use as a tumor marker.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Transitional Cell/pathology , /blood , /urine , Urinary Bladder Neoplasms/pathology , Biomarkers, Tumor , Body Mass Index , Case-Control Studies , Creatinine/urine , Disease Progression , Enzyme-Linked Immunosorbent Assay , Neoplasm Grading , Neoplasm Staging , Neoplasm Recurrence, Local/pathology , Sensitivity and Specificity , Tumor Burden
12.
Korean Journal of Urology ; : 498-504, 2015.
Article in English | WPRIM | ID: wpr-171070

ABSTRACT

PURPOSE: The objective was to investigate the impact of statin use on prognosis after radical nephroureterectomy for upper urinary tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: A retrospective review of medical records identified 277 patients who underwent radical nephroureterectomy for primary UTUC at Asan Medical Center between January 2006 and December 2011. Information on preoperative statin use was obtained from patient charts in an electronic database. We assessed the impact of statin use on recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS: Of these 277 patients, 62 (22.4%) were taking statin medications. Compared to the statin nonusers, the statin users were older, had a higher body mass index, and had higher rates of cardiovascular disease and diabetes. The 5-year RFS rates of statin users and nonusers were 78.5% and 72.5%, respectively (p=0.528); the 5-year CSS rates were 85.6% and 77.7%, respectively (p=0.516); and the 5-year OS rates were 74.5% and 71.4%, respectively (p=0.945). In the multivariate analysis, statin use was not an independent prognostic factor for RFS (hazard ratio, 0.47; p=0.056), CSS (hazard ratio, 0.46; p=0.093), or OS (hazard ratio, 0.59; p=0.144) in patients who underwent radical nephroureterectomy for UTUC. CONCLUSIONS: Statin use was not associated with improved RFS, CSS, or OS in the sample population of patients with UTUC.


Subject(s)
Aged , Carcinoma, Transitional Cell/pathology , Female , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Kidney Neoplasms/pathology , Male , Middle Aged , Neoplasm Grading , Neoplasm Staging , Nephrectomy/methods , Preoperative Care/methods , Prognosis , Recurrence , Retrospective Studies , Survival Analysis , Ureteral Neoplasms/pathology
13.
Korean Journal of Urology ; : 453-459, 2014.
Article in English | WPRIM | ID: wpr-178076

ABSTRACT

PURPOSE: Systemic inflammatory responses, which are defined in terms of the Glasgow prognostic score (GPS), have been reported to be independent predictors of unfavorable outcomes in various human cancers. We assessed the utility of the GPS as a predictor of intravesical recurrence after radical nephroureterectomy (RNU) in upper urinary tract carcinoma (UTUC). MATERIALS AND METHODS: We collected data for 147 UTUC patients with no previous history of bladder cancer who underwent RNU from 2004 to 2012. Associations between perioperative clinicopathological variables and intravesical recurrence were analyzed by using univariate and multivariate Cox regression models. RESULTS: Overall, 71 of 147 patients (48%) developed intravesical recurrence, including 21 patients (30%) diagnosed with synchronous bladder tumor. In the univariate analysis, performance status, diabetes mellitus (DM), serum albumin, C-reactive protein, GPS, and synchronous bladder tumor were associated with intravesical recurrence. In the multivariate analysis, performance status (hazard ratio [HR], 2.33; 95% confidence interval [CI], 1.41-3.85; p=0.001), DM (HR, 2.04; 95% CI, 1.21-3.41; p=0.007), cortical thinning (HR, 2.01; 95% CI, 1.08-3.71; p=0.026), and GPS (score of 1: HR, 6.86; 95% CI, 3.69-12.7; p=0.001; score of 2: HR, 5.96; 95% CI, 3.10-11.4; p=0.001) were independent predictors of intravesical recurrence. CONCLUSIONS: Our results suggest that the GPS as well as performance status, DM, and cortical thinning are associated with intravesical recurrence after RNU. Thus, more careful follow-up, coupled with postoperative intravesical therapy to avoid bladder recurrence, should be considered in these patients.


Subject(s)
Adult , Aged , Aged, 80 and over , Carcinoma, Transitional Cell/pathology , Female , Humans , Male , Middle Aged , Neoplasm Grading , Neoplasm Recurrence, Local/etiology , Neoplasm Staging , Nephrectomy/methods , Prognosis , Retrospective Studies , Risk Factors , Survival Analysis , Systemic Inflammatory Response Syndrome/etiology , Ureter/surgery , Urinary Bladder Neoplasms/secondary , Urologic Neoplasms/pathology
14.
Int. braz. j. urol ; 39(6): 817-822, Nov-Dec/2013. tab, graf
Article in English | LILACS | ID: lil-699116

ABSTRACT

Objectives To evaluate the pathologic findings and outcomes after distal ureterectomy for a retained ureteral segment following incomplete nephroureterectomy for urothelial carcinoma of the renal pelvis or ureter. Materials and Methods After IRB approval, an institutional database identified patients who underwent distal ureterectomy for a retained ureteral segment after assumed complete nephroureterectomy for urothelial carcinoma of the upper ureter or renal pelvis. Clinical and pathologic variables were analyzed. Results From January 1993 to July 2007, 12 patients were identified with median age at the time of ureterectomy of 60.5 years (41-85 years). Initial approach to surgery was open in 9 patients and laparoscopic in 3 patients. The median time from nephroureterectomy to distal ureterectomy was 23.5 months (range 2-66). At the time of initial surgery, pathologic stage was Ta, T1, T2, and T3 in 3,4,1, and 4 patients respectively. Initial pathology was urothelial carcinoma; grade 2 in 6 patients and grade 3 in six patients. Pathology from the subsequent surgery demonstrated urothelial carcinoma in the retained ureteral segment in 8 patients, dysplasia or atypia in 3 patients, and 1 patient with chronic inflammation. Local recurrence in 2 patients was present in a segment of ureter discontinuous with the bladder after laparoscopic nephroureterectomy. Three patients (25%), all with initial grade 3 renal pelvis lesions, developed metastatic disease. Conclusions Tumor recurrence in a retained ureteral segment after incomplete nephroureterectomy is a significant problem and may contribute to intravesical recurrence or metastatic disease. Complete, en bloc resection is imperative to minimize these risks. .


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Transitional Cell/pathology , Carcinoma, Transitional Cell/surgery , Nephrectomy/methods , Ureteral Neoplasms/pathology , Ureteral Neoplasms/surgery , Neoplasm Grading , Neoplasm Recurrence, Local , Neoplasm Staging , Risk Factors , Time Factors , Ureter/pathology , Ureter/surgery
15.
Int. braz. j. urol ; 39(3): 364-370, May/June/2013. tab
Article in English | LILACS | ID: lil-680094

ABSTRACT

Purpose In 76% of radical cystectomy patients there is discrepancy between the initial stage at transurethral resection and the final pathological stage of the cystectomy specimen. More specifically in contemporary series the absence of tumor at radical cystectomy specimens (stage pT0) is estimated at 5-25%. Our aim was to determine which factors contributed to the absence of tumor in our series of radical cystectomy patients. Materials and Methods Fifty one patients were submitted to radical cystectomy in our department over the last 10 years (January 2002-January 2012). A thorough analysis of the patients' files with no residual tumor on the cystectomy specimen (pT0) was performed. Possible factors contributing to such a result were described and a systematic analysis of the relevant literature was performed. Results Five patients had a pT0 stage after radical cystectomy. Four of them had transitional cell carcinoma and one of them had squamous cell carcinoma of the bladder on the initial transurethral resection. None of the tumors presented lymphovascular invasion. Four patients are still alive and one died 45 months postoperatively from a cardiac cause. Conclusions Four factors were identified in our study to contribute towards a pT0 cystectomy result. Those included the absence of lymphovascular invasion, the completeness of transurethral resection, the experience of the surgeon and the use of a standardized technique for the transurethral resection. The time to cystectomy in our series did not have a negative effect on pT0 final pathology result. .


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Carcinoma, Squamous Cell , Carcinoma, Transitional Cell , Cystectomy/methods , Neoplasm Recurrence, Local , Urinary Bladder Neoplasms , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/surgery , Carcinoma, Transitional Cell/pathology , Carcinoma, Transitional Cell/surgery , Neoplasm Staging , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Risk Factors , Time Factors , Treatment Outcome , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgery
16.
Acta gastroenterol. latinoam ; 43(4): 316-20, 2013 Dec.
Article in Spanish | LILACS, BINACIS | ID: biblio-1157394

ABSTRACT

Metastases to the stomach from an extra-digestive neoplasm are an unusual event, identified in less than 2


of cancer patients at autopsy (between 1.7


). The stomach may be involved by hematogenous spread from a distant primary tumor (most commonly lung, breast and melanoma). Tumors of neighboring organs, such as esophagus, pancreas and gallbladder, may reach the stomach by continuity or by lymphatic-hematogenous spread. Endoscopic routine studies with biopsies have improved the diagnosis of this pathology. Nevertheless, in some cases the histologic study is a false negative because the neoplasia can be placed in the deepest layers of the stomach. We report the case of a 56-year-old man who presented a gastric metastasis of a high gradeuro thelial carcinoma of urinary bladder and we review the literature.


Subject(s)
Carcinoma, Transitional Cell/secondary , Stomach Neoplasms/secondary , Urinary Bladder Neoplasms/pathology , Carcinoma, Transitional Cell/pathology , Fatal Outcome , Humans , Male , Stomach Neoplasms/pathology , Middle Aged
17.
Assiut Medical Journal. 2013; 37 (1): 75-84
in English, Arabic | IMEMR | ID: emr-150535

ABSTRACT

This study was conducted to evaluate the efficacy of transurethral resection plus chemo radiation in achieving bladder preservation, using conformal radiotherapy and twice weekly Gemcitabine. Thirty seven TCC patients with good performance status, and maximum possible transuretheral resection .They received. 46 GY/23 fractions with twice weekly Gemcitabine 30mg/m2. An evaluation was done after 2 weeks by cystoscopy and biopsy from the tumor bed. Patients who had a complete response continued in phase II, 20 GY/2 weeks, with twice weekly Gemcitabine 30 mg/m2. Patients who had invasive bladder cancer were subjected to radical cvsteclomy. Thirty two patients had complete response. Treatment schedule was tolerable. It was associated with moderate toxicity that was tolerable apart of patients who developed G3 wxicity [hat required treatment interruption till improvement .After 2 years of follow up, 29 patients achieved good local control and the 2 years LRFS was 79%. The 2 years over al survival and bladder intact survival was 70%, 69%, respectively. Trimodality bladder-sparing approach consists of inmsureihral resection, chemotherapy twice daily using gemcitabine and radiotherapy is well tolerated with high rate of bladder preservation. This approach can be considered a reasonable alternative to cystectomy in the proper selected group


Subject(s)
Humans , Combined Modality Therapy , Radiotherapy, Adjuvant , Deoxycytidine/analogs & derivatives , Carcinoma, Transitional Cell/pathology
18.
Rev. Col. Bras. Cir ; 39(5): 394-400, set.-out. 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-656254

ABSTRACT

OBJETIVO: Investigar a expressão imunoistoquímica dos marcadores p53, Ki-67, CK20 em neoplasias uroteliais papilíferas superficiais da bexiga e correlacionar com o grau histológico, progressão tumoral e recidiva. MÉTODOS: Foram selecionadas amostras de 43 pacientes portadores de carcinoma de células transicionais superficiais da bexiga. Elas foram distribuídas em dois grupos, um denominado recorrente, de 18 indivíduos e outro não recorrente, com 25 casos. Foram confeccionados blocos multiamostrais. A técnica imunoistoquímica empregada foi de imunoperoxidase e os anticorpos foram: p53 (clone DO7), o Ki-67 (clone SP6) e CK20. RESULTADOS: A expressão do p53 foi observada em 11 casos, todos tumores de alto grau (p=0,0001). A progressão histológica ocorreu em seis indivíduos (p=0,0076). Dos 18 casos recorrentes, seis apresentaram imunorreação para o p53 e 12 foram negativos para este anticorpo (p=0,1715). O Ki-67 foi positivo em 17 dos 18 casos do grupo recorrente (p=0,0001) e dos 20 tumores de alto grau, 18 apresentaram reação para este anticorpo (p=0,0001). Dos 18 indivíduos que tiveram recorrência, 13 apresentaram expressão anômala para CK20 (p=0,0166). Nos carcinomas de alto grau, dos 20 casos, 16 apresentaram expressão anômala para este anticorpo, enquanto que 18 dos 23 indivíduos com tumores de baixo grau mostraram expressão habitual para a CK20 (p=0,0002). CONCLUSÃO: O p53 mostrou boa correlação com a progressão histológica e grau histológico. O Ki-67 apresentou forte associação com a recidiva e grau histológico, e a CK20 também associou-se com estas variáveis.


OBJECTIVE: To investigate the immunohistochemical expressions of p53, ki67, CK20 in superficial papillary urothelial neoplasms of the bladder and correlate them with histological grade, tumor progression and recurrence. METHODS: We selected samples of 43 patients with superficial transitional cell carcinoma of the bladder. They were divided into two groups, one called Recurrent (R), with 18 individuals, and other Non-Recurrent (NR), with 25. Multi-sampling blocks were prepared. The immunohistochemical technique employed was immunoperoxidase, and the antibodies were: p53: Novocastra (clone DO7) at a dilution of 1/100; Ki67: Spring (clone SP6) at a dilution of 1/100; and CK20: Dako (clone K20 .8) at a dilution of 1/50. RESULTS: The expression of p53 was observed in 11 cases, six in the Recurrent group and five in the Non-Recurrent, all high-grade tumors (p = 0.0001). The histological progression occurred in six patients (p = 0.0076). Of the 18 Recurrent cases, six showed immunoreactivity for p53 and 12 were negative for this antibody (p = 0.1715). Ki67 was positive in 17 of the 18 cases from the Recurrent group (p = 0.0001) and, from 20 high-grade tumors, 18 showed reaction to this antibody (p = 0.0001). Of the 18 individuals who had recurrence, 13 showed anomalous expression for CK20 (p = 0.0166). In high-grade carcinomas, of the 20 cases, 16 showed anomalous expression for this antibody, while 18 of the 23 patients with low-grade tumors showed normal expression for CK20 (p = 0.0002). CONCLUSION: The p53 showed good correlation with histological progression and histologic grade. Ki67 was strongly associated with recurrence and histological grade, and CK20 was also associated with these variables.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Transitional Cell/metabolism , /biosynthesis , /biosynthesis , /biosynthesis , Urinary Bladder Neoplasms/metabolism , Carcinoma, Transitional Cell/pathology , Carcinoma, Transitional Cell/surgery , Disease Progression , Neoplasm Grading , Neoplasm Recurrence, Local/epidemiology , Prognosis , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgery
19.
Indian J Cancer ; 2012 Jan-Mar; 49(1): 96-101
Article in English | IMSEAR | ID: sea-144558

ABSTRACT

Objectives: We prospectively evaluated our perioperative and five-year oncological results of 200 cases of open radical cystectomy with urinary diversion, for formulating contemporary benchmarks, for future comparison of minimally invasive techniques. This is one of the largest prospective series reported from India of open radical cystectomy. Materials and Methods: Between 2004 and 2009, patients undergoing open radical cystectomy with urinary diversion, at our institution, were prospectively enrolled in the study. Data were recorded and analyzed statistically. Results: Two hundred patients were enrolled in the study. The mean age was 65.1 years. The patients undergoing ileal conduit and orthotopic neobladder were 159 (79.5%) and 41 (20.5%), respectively. The mean operating time was 275 minutes. The mean operating time for ileal conduit and orthotopic neobladder were 262 minutes and 288 minutes, respectively. The mean estimated blood loss was 690 ml. Blood transfusion was required in 37 (18.5%) patients. The mean hospital stay was 6.1 days. Major and minor complications were recorded in 16 (8%) and 31 (15.5%) patients, respectively. Perioperative mortality was recorded in only two (1.5%) patients. The pathologically organ-confined and non-organ-confined cases were 135 (67.5%) and 65 (32.5%), respectively. Thirty-three (16.5%) patients had pathologically confirmed lymph nodes. Median follow-up was 60.1 months. Local recurrence and distant metastases were recorded in 16 (8%) and nine (4.5%) patients, respectively. A five-year disease-free survival, cancer-specific survival, and overall survival were 75.5, 71.5, and 63.5%, respectively. Conclusions: Open radical cystectomy has an acceptable perioperative morbidity and mortality, along with a favorable five-year oncological efficacy. Minimally invasive techniques need a long-term prospective comparison with this approach, before being accepted as a standard treatment for urinary bladder malignancy.


Subject(s)
Adult , Aged , Carcinoma, Transitional Cell/epidemiology , Carcinoma, Transitional Cell/pathology , Cystectomy/mortality , Disease-Free Survival , Female , Humans , India , Laparoscopy , Male , Middle Aged , Prospective Studies , Treatment Outcome , Urinary Bladder Neoplasms/mortality , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/surgery , Urinary Diversion/mortality
20.
Tehran University Medical Journal [TUMJ]. 2012; 70 (4): 228-235
in Persian | IMEMR | ID: emr-144441

ABSTRACT

Transitional Cell Carcinoma [TCC] is the most common type of urinary bladder cancer. Cyclooxygenase-2 [COX-2], a key enzyme in prostaglandins biosynthesis, has been introduced as a new candidate for targeted therapy in this cancer. In this study, we investigated the expression of COX-2 in urinary bladder TCCs and its relationship with clinicopathological parameters such as tumor grade and stage. This cross-sectional study was performed in the Pathology department of Sina Hospital in Tehran, Iran during 2006-2011. Pathology reports of patients with definite diagnosis of urinary bladder TCCs who had undergone Transurethral Resection [TUR] were reviewed and 40 cases were selected. Subsequently, COX-2 expression was assessed immunohistochemically by the examination of paraffin embedded tissue blocks. Staining in more than 5% of tumor cells was considered as positive expression. COX-2 was expressed in 52.5% of the patients. High-grade tumors revealed a higher [87.5%] COX-2 expression versus other grades of the lesions and there was a statistically significant difference in COX-2 expression between them [P<0.001]. Patients' age was also related to the expression of this marker [P=0.03]. In contrast, this marker did not correlate with other characteristics including gender, lymphatic invasion or tumor stage. In addition, perineurial or vascular invasions were not detected in any of the patients. COX-2 expression was seen in more than half of our patients and it had a marked relation to tumor differentiation. Accordingly, this molecule may be a useful tumor marker in the assessment of urinary bladder cancers


Subject(s)
Humans , Carcinoma, Transitional Cell/pathology , Carcinoma, Transitional Cell/diagnosis , Urinary Bladder Neoplasms/pathology , Urinary Bladder Neoplasms/diagnosis , Immunohistochemistry , Cross-Sectional Studies
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