Diagnostic Ureteroscopy for Upper Tract Urothelial Carcinoma is Independently Associated with Intravesical Recurrence after Radical Nephroureterectomy

ABSTRACT Purpose: To determine the effect of diagnostic ureteroscopy on intravesical recurrence in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). Materials and Methods: We conducted a retrospective analysis of 664 patients who were treated with RNU for UTUC from June 2000 to December 2011, excluding those who had concomitant/prior bladder tumors. Of the 664 patients, 81 underwent diagnostic ureteroscopy (URS). We analyzed the impact of diagnostic ureteroscopy on intravesical recurrence (IVR) using the Kaplan-Meier method. Univariate and multivariate analyses were used to determine the independent risk factors. Results: The median follow-up time was 48 months (interquartile range (IQR): 31-77 months). Patients who underwent ureteroscopy were more likely to have a small (p<0.01), early-staged (p=0.019), multifocality (p=0.035) and ureteral tumor (p<0.001). IVR occurred in 223 patients during follow-up within a median of 17 months (IQR: 7-33). Patients without preoperative ureteroscopy have a statistically significant better 2-year (79.3%±0.02 versus 71.4%±0.02, p<0.001) and 5-year intravesical recurrence-free survival rates (64.9%±0.05 versus 44.3%±0.06, p<0.001) than patients who underwent ureteroscopy. In multivariate analysis, the diagnostic ureteroscopy (p=0.006), multiple tumors (p=0.001), tumor size <3cm (p=0.008), low-grade (p=0.022) and pN0 stage tumor (p=0.045) were independent predictors of IVR. Conclusions: Diagnostic ureteroscopy is independently associated with intravesical recurrence after radical nephroureterectomy.

C9orf72-related disorders: expanding the clinical and genetic spectrum of neurodegenerative diseases / Distúrbios relacionados ao C9orf72: expandindo o espectro clínico e genético das doenças neurodegenerativas

Neurodegenerative diseases represent a heterogeneous group of neurological conditions primarily involving dementia, motor neuron disease and movement disorders. They are mostly related to different pathophysiological processes, notably in family forms in which the clinical and genetic heterogeneity are lush. In the last decade, much knowledge has been acumulated about the genetics of neurodegenerative diseases, making it essential in cases of motor neuron disease and frontotemporal dementia the repeat expansions of C9orf72 gene. This review analyzes the main clinical, radiological and genetic aspects of the phenotypes related to the hexanucleotide repeat expansions (GGGGCC) of C9orf72 gene. Future studies will aim to further characterize the neuropsychological, imaging and pathological aspects of the extra-motor features of motor neuron disease, and will help to provide a new classification system that is both clinically and biologically relevant.

As doenças neurodegenerativas representam um grupo heterogêneo de condições neurológicas envolvendo fundamentalmente síndromes demenciais, doenças do neurônio motor e distúrbios de movimento. Relacionam-se, em sua maioria, a processos fisiopatológicos distintos, destacadamente nas formas familiares em que a heterogeneidade clínica e genética são exuberantes. Na última década, muito conhecimento se acumulou a respeito da genética das doenças neurodegenerativas, tornando-se bastante importante nos casos de doenças do neurônio motor e de demência frontotemporal as expansões de repetições do gene C9orf72. Esta revisão aborda os principais aspectos clínicos, radiológicos e genéticos relativos aos fenótipos relacionados à expansão de repetição do hexanucleotídeo (GGGGCC) no gene C9orf72. Estudos futuros vão objetivar a caracterização dos aspectos neuropsicológicos, de imagem e patológicos dos achados extra-motores da doença do neurônio motor e ajudarão a fornecer um novo sistema de classificação relevante em termos clínicos e biológicos.

Metástasis gástricas: un hallazgo no solo de autopsias / [Gastric metastases: not only identified at autopsies].

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.

Metástase cutânea rara de provável carcinoma basaloide de cólon simulando granuloma piogênico / Rare cutaneous metastasis from a probable basaloid carcinoma of the colon mimicking pyogenic granuloma

As acrometástases, principalmente para as mãos, são incomuns e representam cerca de 0,0070,2 por cento de todas as lesões metastáticas. O pulmão é o sítio de origem mais comum, colaborando com 4050 por cento dos casos relatados na literatura. Os rins e mamas são outras localizações também relacionadas a neoplasias que metastatizam para as mãos, além de, mais raramente, trato gastrointestinal, outros tumores sistêmicos e sarcomas. Seu diagnóstico precoce é difícil, pois pode ser assintomático, se assemelhar a tenossinovite, artrite, paroníquia, granuloma piogênico ou infecção local. No presente relato, os autores apresentam paciente com diagnóstico de acrometástase, em ambos os quartos quirodáctilos, oriunda de carcinoma basaloide de canal anal, com pobre resposta à radioterapia.

Acrometastasis is a rare occurrence, especially when affecting the hands. It represents around 0.007-0.2 percent of all metastatic lesions. The most common site of origin is the lung, accounting for 40-50 percent of all cases reported in the literature. Kidneys and breasts are other sites also associated with neoplastic lesions that disseminate to the hands. More rarely, the site of origin may be the gastrointestinal tract or other systemic tumors or sarcomas. Early diagnosis is difficult, since the condition may be asymptomatic or may mimic tenosynovitis, arthritis, paronychia, pyogenic granuloma or a local infection. In the present paper, the authors report on a patient with the diagnosis of acrometastasis on both hands originating from a basaloid carcinoma of the anal canal. Response to radiotherapy was poor.

Ureteral stump transitional cell carcinoma after radical nephrectomy: a case report with review of literature

Primary transitional cell carcinoma [TCC]] of the ureter accounts for less than 1% of all malignancies of upper genitourinary tract. Ureteral stump after radical nephrectomy may develop malignancy very rarely TCC being the commonest. Definite risk exists if the urinary bladder harbored TCC. Presence of TCC of the urinary bladder and persistent urinary tract infections in a nephrectomized patient may indicate closer evaluation

Analysis of the clinicopathological characteristics of patients with upper urinary tract transitional cell carcinoma

OBJECTIVE: To describe the clinicopathological characteristics of patients with upper urinary tract transitional cell carcinomas who are treated surgically and to analyze the occurrence of bladder tumors as well as the development of metastases outside the urinary tract. MATERIALS AND METHODS: The study comprised a retrospective analysis of 25 patients treated between February 1994 and August 2006. The variables analyzed were: patient age, gender, and clinical presentation; diagnostic methods; pathologic characteristics at the primary site of the tumor (pelvis or ureter); tumor stage and grade; and presence of carcinoma in situ, microvascular invasion and squamous differentiation. The Kaplan-Meier method and the Log-Rank test were used for statistical analysis of bladder recurrence-free survival. RESULTS: Eighty-four percent of patients were male, and macroscopic hematuria was the most common clinical presentation. The majority of cases (56 percent) were infiltrative (T2-T3) and high-grade (76 percent) tumors. Synchronous or metachronous bladder tumors were found in 72 percent of cases. Five (20 percent) patients had a history of bladder tumor before the diagnosis of upper urinary tract transitional cell carcinomas. The mean follow-up period was 36 months (range: 1.5 to 156). During the follow-up period, eleven (44 percent) patients developed bladder tumors. After five years, the probability of being free of bladder tumor recurrence was 40 percent. No pathological variable was predictive for bladder tumor recurrence. Four patients presented disease recurrence outside the urinary tract. CONCLUSIONS: The presence of metachronous bladder tumors is more often observed after the diagnosis of upper urinary tract transitional cell carcinomas. All of these patients should undergo rigorous follow-up during the postoperative period. Only patients with infiltrative and high-grade tumors developed metastases outside the urinary tract.

Pathological staging of muscle invasive bladder cancer: is substaging of pT2 tumors really necessary?

OBJECTIVE: Compare clinical outcomes in patients having urothelial tumors invading less than one half of the depth of bladder muscle and greater than one half of bladder muscle and, to determine various clinical variables as predictive factors for survival. MATERIALS AND METHODS: According to our inclusion criteria, 57 patients among cases with T2 bladder tumor were selected. Thirty-five patients (61.4 percent) had pT2a (Group-1) and 22 patients (38.6 percent) had pT2b (Group-2) muscle invasive tumors. Mean follow up time was 7.3 years for Group-1, and 6.1 years for Group-2. Multivariate analysis was performed in order to identify possible correlation of clinical variables like age, gender, grade of primary tumor, appearance of local and/ or distant metastasis with patient outcome. RESULTS: Five year recurrence-free and overall survival rates were 69.1 percent and 44.3 percent for patients with pT2a tumor, whereas these ratios were 66.1 percent and 43 percent, respectively for patients with pT2b tumor (p = 0.896; p = 0.975). Mean overall and progression-free survival times were 87.7 ± 13.8 and 116 ± 13.12 months for Group-1, while they were 73.8 ± 13.7 and 88.85 ± 12.55 months for Group-2, respectively. On both univariate and multivariate analysis, age was noticed as an independent predictive factor for survival. CONCLUSIONS: The depth of muscle invasion in bladder tumors has no prognostic significance. Recurrence of the disease either locally or at distant sites dramatically shortens patients' life. Being older than 60 years old during the time of radical surgery, is also a bad prognostic factor for overall and progression-free survival.

Implantation of bladder cancer into the abdominal wall; a case report

Implantation of high grade and invasive bladder carcinoma into the abdominal wall Is not common and can occur as side effects of urinary bladder interventions and surgical procedures, including perforation of bladder wall during transurethral resection of the tumor. Herein, we present a case of implantation of bladder transitional cell carcinoma into abdominal wall into an incisional hernia of a previous small bowel operation; three years after the bladder tumor had been diagnosed and treated. In evaluating any mass lesion in the abdominal wall, it is important to consider the possibility of bladder tumor implantation

Metastasis of Transitional Cell Carcinoma to the Lower Abdominal Wall 20 Years after Cystectomy

Iatrogenic implantation has been the main cause in the majority of cases of transitional call carcinoma (TCC) with metastasis to the abdominal wall. A 66-year-old woman had undergone radical cystectomy 20 years prior to presenting. Radiological investigations revealed one mass in the left lower abdominal wall and one mass in the right inguinal area. She underwent wide excision of the lesions that revealed metastasis of TCC. This report describes this case of a woman with bladder carcinoma who developed a metastasis in the anterior abdominal wall following an apparent disease-free interval of 20 years.

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...

Retroperitoneal metastases from carcinoma of the bladder.

We report two patients of metastatic retroperitoneal tumours from carcinoma of the bladder, one presenting with a retroperitoneal mass and the other with retroperitoneal fibrosis. Both cases had been previously treated by radiotherapy for invasive transitional cell carcinoma of the bladder and had no evident of recurrent tumour in the bladder during follow up or at the time of presentation with secondary tumours. Literature reviews revealed that urothelial tumours from the bladder rarely metastasize to the retroperitoneal space.