Clinical value of inflammatory biomarkers in predicting prognosis of patients with ureteral urothelial carcinoma / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the clinical value of inflammation-related markers in predicting the prognosis of patients with ureteral urothelial carcinoma.@*METHODS@#200 patients with ureteral urothelial carcinoma were randomly divided into two groups by split sample validation: modeling group and validation group. Paraffin embedded pathological specimens of the patients were reviewed. Immunohistochemical method was used to detect tumor-infiltrating neutrophil (TIN) (CD66b+), tumor-associated macrophage (TAM) (CD163+), lymphocyte (CD+, CD4+, CD8+) counts, peripheral blood neutrophil / lymphocyte ratio (NLR) and tumor tissue neutrophil/monocyte ratio (NMR). According to the results of pathological staging, the patients were divided into non-muscle-invasive and muscle-invasive ureteral urothelial carcinoma group. The resolution of the models was evaluated, and the prognostic nomogram models including only peripheral blood parameters and all parameters were established to compare the accuracy of the two models in predicting the prognosis of patients with urothelial carcinoma of the ureter.@*RESULTS@#The median follow-up time was 36 months, the progression-free survival was 40 months, and 42 cases (21.0%) showed tumor progression within 3 years. Tumor size, pathological stage and pathological grade were all single-factor variables predicting the first recurrence of ureteral urothelial carcinoma three years after operation. Tumor size, pathological stage, pathological grade, TIN, TAM, NLR and NMR were multi-factor variables predicting the first recurrence three years after operation. Among 104 cases of non-muscle-invasive ureteral urothelial carcinoma, 10 cases (9.6%) recurred for the first time 3 years after operation, 96 cases (33.3%) of muscle invasive ureteral urothelial carcinoma, and the diffe-rence between the two groups was statistically significant (χ2=15.53, P < 0.05). The predictive nomogram model of progression free survival was established. The concordance index of progression free survi-val was 0.722 (95%CI: 0.70-0.78) in non-muscle-invasion group, and 0.725 (95%CI: 0.71-0.79) in muscle-invasion group, which was in good agreement with the observed 3-year survival rate. The results of discrimination test showed that the concordance index of the whole parameter prediction model of ureteral urothelial carcinoma was 0.726, which was higher than that of peripheral blood parameters (consistency index 0.672). The immune microenvironment of ureteral urothelial carcinoma improved the prediction accuracy of the model.@*CONCLUSION@#The prognosis prediction model based on immune inflammation-related markers was established as a perfection and supplement for the existing pathological grading and staging system, providing a basis for accurate individualized treatment of patients with urete-ral urothelial carcinoma. The prognosis prediction model based on the relevant indicators of peripheral blood samples is established, which is easy to obtain specimens, and the detection method is simple and economical, which is more conducive to clinical application.

ODF4, MAGEA3, and MAGEB4: potential biomarkers in patients with transitional cell carcinoma

Background: This study aimed to evaluate the diagnostic value of outer dense fiber 4 [ODF4], melanoma associated antigen A3 [MAGEA3], and MAGEAB4 mRNAs in transitional cell carcinoma [TCC], using a small amount of cell reverse transcriptase-polymerase chain reaction [RT-PCR] on urinary exfoliated cells

Methods: We recruited a total of 105 suspected TCC patients and 54 sex- and age-matched non-TCC controls. The candidates' genetic expression patterns were investigated with RT-PCR, while reverse transcription quantitative PCR was applied to quantify and compare each mRNA level between cases and control groups

Results: The sensitivity of ODF4, MAGEA3, and MAGEAB4 RT-PCR was 54.8%, 63%, and 53.4%, whereas the specificity was 73.7%, 86%, and 94.7%, respectively. Combining ODF4, MAGEA3, and MAGEAB4 RT-PCR offered a relatively higher sensitivity [83.6%]

Conclusion: RT-PCR with ODF4, MAGEA3, and MAGEAB4 on urinary exfoliated cells could provide clinicians with a promising method to improve TCC diagnosis, especially in the case of gross hematuria and catheterization. The method used here is non-invasive, simple and convenient, and unlike cytology, it does not rely directly on expert professional opinions. These features can be of particular importance to the management of TCC patients in whom regular and lifelong surveillance is required

Transitional cell carcinoma of urinary bladder with metastasis in lumbar vertebrae and spinal cord compression in an ocelot(Leopardus pardalis) / Carcinoma de células de transição de bexiga urinária com metástase em vértebras lombares e compressão de medula espinhal em uma jaguatirica (Leopardus pardalis)

This paper reports a case of nonpapillary and infiltrative transitional cell carcinoma (TCC) of the urinary bladder with metastasis of lumbar vertebrae and spinal cord compression in an adult female ocelot (Leopardus pardalis), from the Mato Grosso state, Brazil. The ocelot had pelvic limb paralysis and skin ulcers in the posterior region of the body and was submitted to euthanasia procedure. At necropsy was observed a multilobulated and irregular shaped, yellowish to white nodule in the urinary bladder. The nodule had a soft consistency and arised from the mucosa of the urinary bladder extending throughout the muscular layers and the serosa. Nodules of similar appearance infiltrating the vertebral column the at L6 and L7 vertebrae with corresponding spinal canal invasion were also observed. The histological evaluation showed epithelial neoplastic proliferation in the urinary bladder with characteristics of nonpapillary and infiltrative TCC, with positive immunohistochemical staining for pancytokeratin, and strong immunostaining for cytokeratin of low molecular weight, and weak or absent labeling for high molecular weight cytokeratin. This is the first report of TCC of urinary bladder in ocelot in Brazil...

O presente trabalho relata um caso de carcinoma de células de transição (TCC) da bexiga urinária com metástase em vértebras lombares e compressão da medula espinhal em uma jaguatirica fêmea adulta (Leopardus pardalis), no estado do Mato Grosso. A jaguatirica manifestava paralisia de membros pélvicos e úlceras de decúbito na região posterior do corpo e foi submetida a eutanásia. Na necropsia observou-se um nódulo multilobulado e irregular, brancoamarelado na bexiga urinária, de consistência macia com origem na mucosa vesical e que se estendia às camadas musculares e à serosa. Nódulos de aspecto semelhante infiltrando as vértebras L6 e L7 e invasão do canal vertebral correspondente. No exame histológico foi observada proliferação neoplásica na bexiga urinária com com características de TCC não papilar e infiltrativo, com marcação imuno-histoquímica positiva para pancitoqueratina, forte marcação para citoqueratina de baixo peso molecular e fraca ou inexistente para citoqueratina de alto peso molecular. Este é o primeiro relato de TCC em bexiga urinária de jaguatirica no Brasil...

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.

Flexible cystoscopy a valuable diagnostic tool for lower urinary tract pathology

To assess the role of flexible cystoscopy in the diagnosis of lower urinary tract pathologies and its suitability as a routine diagnostic protocol in outdoor patients. The quasi-experimental study was conducted at the Urology Department, Pakistan Ordinance Factory Hospital, Wah Cantt., from June 2009 to June 2010. All adult patients presenting with lower urinary tract symptoms to outdoor department were included on the basis of universal non-probability sampling technique. Cystoscopy was performed as a clinic-based procedure without sedation. SPSS 17 was used for data analysis. Of the 1500 patients in the study, 810[54%] were females and 690[46%] were male. Lower urinary tract pathologies were found in 480[32%] patients. The most common pathology among males was enlarged prostate in 127[8.4%] patients. Among females, urethral stenosis was the most common pathology in 57[3.8%] patients. Transitional cell carcinoma was seen in 57[3.8%] patients having haematuria with inconclusive ultrasound and intravenous urography. All patients tolerated the procedure well. Flexible cystoscopy is an effective, well-tolerated and easy way of detecting lower urinary tract pathologies among outpatients

Radiofrequency-Treated Recurrence of Urothelial Carcinoma of the Upper Urinary Tract After Nephroureterectomy

Local recurrence after radical nephroureterectomy (RNU) owing to urothelial carcinoma of the upper urinary tract is rare. The usual treatment is systemic chemotherapy followed by optional resection of the mass. We introduce the case of a 73-year-old male patient with multiple comorbidities in whom retroperitoneal carcinoma recurrence of 31 mm was diagnosed via positron emission tomography-computed tomography scan with 18-fluorodeoxyglucose about 5 years after he had undergone RNU owing to urothelial carcinoma of the upper urinary tract. The patient was treated with computed tomography-guided percutaneous radiofrequency ablation. Later scans with contrast controls showed lack of contrast uptake and a decrease of the lesion's size. Twenty-four months after the procedure, the patient is free of the disease. To date, this is the first case of recurrence of urothelial carcinoma that was treated with percutaneous radiofrequency ablation, thus establishing an alternative to chemotherapy in patients with substantial comorbidities.

Role of 18F-fluorodeoxy glucose PET-CT in asymptomatic epithelial ovarian cancer with rising serum CA-125: A pilot study.

Background. We evaluated the role of 18F-fluorodeoxy glucose (FDG) PET-CT scan in the diagnosis of early relapse in patients with epithelial ovarian cancer (EOC) who were asymptomatic but had a rising serum CA-125 level. Methods. Between May 2006 and July 2008, 16 patients with advanced EOC (stages III and IV) who had achieved complete response after cytoreductive surgery and platinumbased chemotherapy were included. These patients were asymptomatic but had a rising serum CA-125 level with normal physical examination and contrast-enhanced CT scan of the abdomen and pelvis. Patients were evaluated with 18F-FDG PET-CT scan. Written informed consent was taken. Patients with a positive PET-CT scan were advised ultrasoundguided fine-needle aspiration cytology (FNAC) from the area showing increased uptake. Patients in whom FNAC was negative or inconclusive or those with negative PET-CT scan were followed up closely for the next 6 months with repeat clinical evaluation and CT scan. Results. Fifteen patients (15/16) had a positive PET-CT scan. In 9 patients the positive PET lesion was confirmed on FNAC, while in 5 patients this was confirmed on follow-up CT scan after 6 months. One patient who had a single positive lesion in the pelvis on PET-CT was initially considered falsepositive because a follow-up CT scan at 6 months did not show the lesion. However, on regular follow-up after 2 years, she was detected to have an isolated lesion in the PET-positive area which was confirmed on secondary cytoreduction. This patient was considered as true-positive in the current analysis. One patient, who had a negative PET-CT scan and a negative CT scan at 6 months’ follow-up was considered true-negative. The sensitivity and specificity of PET-CT scan was 100%. We could confirm positivity on histopathology/FNAC in 10 of the 15 (66.7%) true-positive cases. Conclusion. 18F-FDG PET-CT scan is a sensitive and specific technique for early diagnosis of relapse in asymptomatic EOC patients with rising CA-125. However, its role in the management of recurrent ovarian cancers needs further evaluation.

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. .

Epithelial mesenchymal transition in urothelial carcinoma: Twist in the tale.

Context: Epithelial to mesenchymal transition (EMT) is a process involving conversion of cells from an epithelial to mesenchymal phenotype. The role of candidate genes promoting EMT and favoring a promigratory phenotype has been demonstrated in epithelial cancer. Existing scientific research has not yielded a clinically relevant biomarker with predictive capacity beyond grade and stage in bladder cancer. Aim: The purpose of this study is to evaluate the immunohistochemical expression pattern of a panel of epithelial and mesenchymal markers in paraffin-embedded archival material of primary urothelial carcinoma as evidence of EMT. Materials and Methods: Immunohistochemical expression of transcription factor twist, epithelial (E-cadherin, cytokeratin) and mesenchymal (vimentin, N-cadherin) markers was analyzed on archival paraffin-embedded tissue samples from 48 patients with diagnosis of primary urothelial carcinoma of bladder. Statistical Analysis: Karl Pearson's χ2 test was used to evaluate the association between the expression of immunohistochemical markers and various clinico-pathologic variables. Non-parametric Kendall's tau-b statistics was used to determine the correlation between categorical variables. Results and Conclusion: The study demonstrated statistically significant association of cytokeratin, E-cadherin, vimentin, and twist with stage and grade of bladder cancer. Since these markers form part of the spectrum of changes associated with EMT, the study establishes proof of concept of the existence of this process in vivo. A significant negative correlation was noted between the expression of twist and E-cadherin. Exploiting its role as a transcriptional repressor of E-cadherin, twist may prove to be a useful candidate for targeted therapy in urologic oncology.

Tumor de Brenner maligno: caso clínico / Malignant Brenner tumor: clinical case

El tumor de Brenner es una neoplasia rara, que representa el 1-2 por ciento de las neoplasias de ovario. La mayoría son benignas, pero existe un pequeño porcentaje de casos de tumor de Brenner maligno, entre ellos el caso que se presenta. Se trata de una mujer de 41 años que presentó una tumoración ovárica cuyo resultado anatomopatológico fue de carcinoma pobremente diferenciado, con asociación de tumor tipo Brenner maligno. A pesar de ser diagnosticado en estadio precoz, este caso destaca por su mal pronóstico.

Brenner tumor is a rare neoplasia, accounting for 1-2 percent of ovarian cancer. Most of them are benign, but there are a small percentage of malignant Brenner tumors, including the case presented. This is a 41-year-old woman who presented an ovarian tumor. Definitive histological result showed a poorly differentiated carcinoma, with association of malignant Brenner tumor. Despite being diagnosed in early stages, this case stands out for its poor prognosis.

[Immunohistochemical expression of Cyclooxygenase-2 in urinary bladder transitional cell carcinomas]

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

Urinary schistosomiasis with simultaneous bladder squamous cell carcinoma and transitional cell carcinoma

This is a case report concerning a 60 years old man who lived for a short period in an endemic area of Khuzestan Province [neighboring province of Persian Gulf in Iran] for approximately 20 years ago. Recently he referred to the Urology Department of Kerman University of Medical Sciences with hematuria and dysuria. In the sonography a polypoid mass on the bladder floor was observed. In the cystoscopy and biopsy a bladder tumor [Simultaneous squamous cell carcinoma and Transitional Bladder Cell Carcinoma] and schistosomiasis [Schistosoma haematobium] was diagnosed

Patients with a negative cystoscopy and negative Nmp22® Bladderchek® test are at low risk of missed transitional cell carcinoma of the bladder: a prospective evaluation

OBJECTIVES: Urine based tumor markers have uncertain utility in diagnosis or surveillance of patients with bladder cancer while cytology is commonly used. We evaluated whether cytology provides additional diagnostic information in patients with a negative NMP22® BladderChek® test (BladderChek) and negative cystoscopy. MATERIALS AND METHODS: We performed subset analyses of 2 large prospective multi-center databases evaluating BladderChek for UCB detection and surveillance. These cohorts were analyzed for presence of cancer and result of urine cytology in setting of a negative cystoscopy and negative BladderChek. Subsequently, we prospectively performed cystoscopy, cytology and BladderChek on 434 patients at our institution being evaluated for UCB. RESULTS: In the detection database (n = 1331), 1065 patients had a negative cystoscopy and BladderChek. There were 3 cancers (stages Ta, Tis and T1) and cytology was atypical in one and reactive in two. In the surveillance cohort (n = 668) patients, 437 patients had negative cystoscopy and BladderChek. Cancer was found in 2 patients (stages Tis and Ta). The patient with Tis has dysplastic cytology and Ta tumor had reactive cytology. In our cohort of 434 patients, 288 pts had negative cystoscopy and BladderChek. One cancer was missed, a Ta ureteral urothelial carcinoma with a reactive cytology. CONCLUSIONS: In patients with negative cystoscopy and BladderChek, very few cancers are missed and cytology was not effective in detection. Use of a point-of-care test in conjunction with cystoscopy in lieu of cytology could decrease cost, provide immediate results, improve negative predictive value and reduce the uncertainty that results from inconclusive cytologic results.

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.

High-Grade Hydronephrosis Predicts Poor Outcomes After Radical Cystectomy in Patients with Bladder Cancer

We examined whether the presence and severity of preoperative hydronephrosis have prognostic significance in patients who underwent radical cystectomy for transitional cell carcinoma of the bladder. The medical records of 457 patients who underwent radical cystectomy for bladder cancer between 1986 and 2005 were retrospectively reviewed. Following the Society for Fetal Urology grading system, patients were divided into low-, and high-grade hydronephrosis groups. Clinicopathologic factors associated with preoperative hydronephrosis and survival were evaluated. Of a total of 406 patients, unilateral hydronephrosis was found in 74 (18.2%), bilateral hydronephrosis in 11 (2.7%), and no hydronephoris in 321 (79.1%). Low-grade hydronephrosis was found in 57 (12.2%) patients and high-grade hydronephrosis in 28 (6%). Preoperative hydronephrosis was related to higher pT stage and lymph node invasion. In univariate analysis, the presence of hydronephrosis, hydronephrosis grade, age, pT and pN stage, tumor grade, surgical margin, number of retrieved nodes, carcinoma in situ, and lymphovascular invasion were significant prognostic factors for cancer-specific survival. In multivariate analysis, bilateral hydronephrosis and high-grade hydronephrosis remained significant predictors for decreased survival. The presence of preoperative hydronephrosis, and high-grade hydronephrosis are significant prognostic factors in patients with bladder cancer after radical cystectomy.

Ulcerative cutaneous metastasis from primary transitional cell carcinoma of urinary bladder

Transitional cell carcinoma of urinary bladder with skin metastasis is extremely rare presentation. Skin metastases are considered as poor prognostic factors with low survival rates. We report a case of skin metastasis in patient with bladder cancer

Carcinoma transicional de vejiga en adolescentes: un diagnóstico para tener en cuenta / Transitional cell carcinoma of the bladder in adolescents: a diagnosis to bear in mind

El carcinoma transicional de vejiga es una entidad de alta incidencia en adultos pero infrecuente en niños y adolescentes. La hematuria es la forma más frecuente de presentación y la ecografía vesical es el método diagnóstico de elección. El diagnóstico y tratamiento se realiza mediante cistofibroscopia y resección endoscópica. Presentamos dos pacientes: un joven de 18 años que exhibía un tumor pediculado en cara posterior de vejiga y una joven de 15 años con una formación de 1cm delongitud, también pediculada y en cara posterior; ambas lesiones fueron resecadas bajo control endoscópico. En ambos casos el diagnóstico fue carcinoma transicional superficial yestán libres de enfermedad con 3 y 5 años de seguimiento. Se realizó una revisión de la bibliografía para clarificar si estas lesiones vesicales deben ser consideradas malignas e intentar definir cómo y cuánto tiempo deben seguirse estos pacientes.

The Utility of Fluorescence In Situ Hybridization for Detection of Bladder Urothelial Carcinoma in Routine Clinical Practice

To evaluate the ability of fluorescence in situ hybridization (FISH) in detecting bladder urothelial carcinoma (BUC), FISH and cytology were compared for the evaluation of 308 consecutive urine samples from patients suspected of having BUC. All patients underwent cystoscopy for identification of bladder lesions. The FISH results were compared with the cytology assessment. In all, 122 patients had confirmed BUC. Among them, 68 (55.7%) were FISH-positive, while only 33 (27%) were positive on cytology. According to disease stage (superficial vs. invasive) and grade (low vs. high), the sensitivities of FISH were also significantly higher than those of cytology in all categories. Moreover, in 36 patients who had no visible tumor with flat, erythematous mucosa (suspicious lesion), FISH was more sensitive than cytology for the detection of BUC (83.3% vs. 33.3%, P=0.002). The FISH was negative in 168 (90.3%) of 186 patients with no histological evidence of BUC or negative cystoscopy findings. The sensitivity of FISH for detecting BUC was superior to that of cytology, regardless of tumor stage and grade. FISH is a significant additional and complementary method for detection of BUC in patients who have suspicious lesions on cystoscopy.

Transitional Cell Carcinoma in a Remnant Ureter after Retroperitoneoscopic Simple Nephrectomy for Benign Renal Disease

A 70-yr-old man presented with painless gross hematuria. He underwent right nephrectomy for benign disease 9 yr ago. Computed tomography and cystoscopy showed a mass in the distal region of the right ureteral stump. He underwent right ureterectomy and bladder cuff resection. Pathological examination showed T1 and WHO grade 2 transitional cell carcinoma. At 6 months postoperatively, the patient is alive without any evidence of recurrence.

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