Emerging biomarkers in metastatic urothelial carcinoma: tumour mutational burden, PD-L1 expression and APOBEC polypeptide-like signature in a patient with complete response to anti-programmed cell death protein-1 inhibitor.

Immunotherapy has recently been incorporated into the treatment guidelines for metastatic urothelial carcinoma. Nevertheless, the role of prognostic and predictive biomarkers in this setting is not completely defined. To date, PD-L1 expression and a high tumour mutational burden (TMB) seem to predict better responses to immune checkpoint inhibitors, but patients without these biomarkers may still respond to immunotherapy. There are some caveats regarding these biomarkers, such as lack of standardisation of techniques, tumour heterogeneity and other factors influencing the tumour microenvironment. Genomic signatures are other promising emerging strategies. We hereby discuss the management of a 70-year-old man with a metastatic recurrence of urothelial carcinoma within 1 year after neoadjuvant chemotherapy and radical cystectomy. Tumour next-generation sequencing showed a high TMB and a CD274 (PD-L1) amplification. The patient was treated with pembrolizumab and achieved a complete response.

The influence of testosterone suppression on HER2 immunoexpression in prostatic neoplastic tissue.

During initial risk assessments, the metastatic potential of prostate cancer (PCa) may not be fully considered. The tumor's multicentric origin, which is associated with genetic mutations, may explain existing treatment limitations. Investigating human epidermal growth factor receptor 2 (HER2) expression in patients with different stages of PCa may therefore increase understanding of the mechanisms associated with the development of castration resistance. The present study examined the association between HER2 expression and the histologic features of PCa subjected to radical prostatectomy (RP) and evaluated the role of testosterone suppression in HER2 expression. In group 1, specimens from individuals who underwent RP without prior neoadjuvant androgen deprivation therapy (ADT) were included (n=42). In group 2 (PCa with ADT), specimens from individuals who underwent RP and received neoadjuvant cyproterone acetate during distinct periods (200 mg daily for 1-24 months) were included (n=150; cohort derived from a previous study). Immunohistochemical expression of HER2 was associated with prognostic factors such as perineural invasion, extra-prostatic disease, T stage, serum prostate-specific antigen (PSA), angiolymphatic invasion and surgical margins. Univariate regression analysis indicated that perineural invasion, PSA, International Society of Urological Pathology, angiolymphatic invasion, margin, T stage and neoadjuvant ADT was associated with HER2 expression. Ordinal regression analysis indicated a significant effect of neoadjuvant ADT alone on HER2 expression (P<0.001). In addition, regression analysis indicated a significant effect of neoadjuvant ADT alone on HER2 expression (odd ratio=0.01; 95% CI, 0.00, 0.02; P<0.001). HER2 was expressed in PCa samples but was not associated with known prognostic factors. The use of short-acting ADT and the consequent blockage of testosterone effect may suppress the expression of HER2 in PCa cells.

Is possible to rule out clinically significant prostate cancer using PI-RADS v2 for the assessment of prostate MRI?

ABSTRACT Objectives To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2. Materials and Methods In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa). Results Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density. Conclusions Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

Is possible to rule out clinically significant prostate cancer using PI-RADS v2 for the assessment of prostate MRI?

OBJECTIVES: To evaluate the diagnostic performance and interobserver agreement of PI-RADS v2. MATERIALS AND METHODS: In this Institutional Review Board approved single-center retrospective study, 98 patients with clinically suspected PCa who underwent 3-T multiparametric MRI followed by MRI/TRUS fusion-guided prostate biopsy were included from June 2013 to February 2015. Two radiologists (R1 and R2) with 8 and 1 years of experience in abdominal radiology reviewed the MRI scans and assigned PI-RADS v2 scores in all prostate zones. PI-RADS v2 were compared to MRI/TRUS fusion-guided biopsy results, which were classified as negative, PCa, and significant PCa (sPCa). RESULTS: Sensitivity, specificity, NPV, PPV and accuracy for PCa was 85.7% (same for all metrics) for R1 and 81.6%, 79.6%, 81.2%, 80.0% and 80.6% for R2. For detecting sPCa, the corresponding values were 95.3%, 85.4%, 95.9%, 83.7% and 89.8% for R1 and 93.0%, 81.8%, 93.7%, 86.7% and 86.7% for R2. There was substantial interobserver agreement in assigning PI-RADS v2 score as negative (1, 2, 3) or positive (4, 5) (Kappa=0.78). On multivariate analysis, PI-RADS v2 (p <0.001) was the only independent predictor of sPCa compared with age, abnormal DRE, prostate volume, PSA and PSA density. CONCLUSIONS: Our study population demonstrated that PI-RADS v2 had high diagnostic accuracy, substantial interobserver agreement, and it was the only independent predictor of sPCa.

MiR-9 and miR-21 as prognostic biomarkers for recurrence in papillary thyroid cancer.

Despite low mortality rates, nodal recurrence in papillary thyroid carcinoma occurs in up to 20 % of patients. Emerging evidences indicate that dysregulated microRNAs are implicated in the process of metastasis. In the present study, we investigated whether miR-9, miR-10b, miR-21 and miR-146b levels are predictive of papillary thyroid carcinoma recurrence. Using macro-dissection followed by quantitative real-time PCR, we measured miR-9, miR-10b, miR-21 and miR-146b expression levels in formalin-fixed, paraffin-embedded samples of 66 patients with papillary thyroid carcinoma categorized into two groups: the recurrent group (n = 19) and the non-recurrent group (n = 47). All patients underwent total thyroidectomy and were followed for at least 120 months after surgery to be considered recurrence-free. Univariate and multivariate analysis were performed using the Cox proportional hazard model in order to identify associations between multiple clinical variables and microRNA expression levels and papillary thyroid carcinoma recurrence. MiR-9 and miR-21 expression levels were found to be significant prognostic factors for recurrence in patients with papillary thyroid carcinoma (HR = 1.48; 95 % CI 1.24-1.77, p < 0.001; and HR = 1.52; 95 % CI 1.18-1.94, p = 0.001; respectively). Multivariate analysis involving the expression level of miR-9 and miR-21 and various clinical parameters identified the expression of these microRNAs as independent prognostic factors for papillary thyroid cancer patients. In conclusion, our results support the potential clinical value of miR-9 and miR-21 as prognostic biomarkers for recurrence in papillary thyroid carcinoma.

Hyaluronan-mediated motility receptor (RHAMM) immunohistochemical expression and androgen deprivation in normal peritumoral, hyperplasic and neoplastic prostate tissue.

OBJECTIVES: To evaluate hyaluronan-mediated motility receptor (RHAMM) expression in normal, hyperplasic and neoplastic prostate tissue after various types and durations of androgen-deprivation therapy (ADT). Clinical and oncological data from men with localised prostate adenocarcinoma were also assessed and compared with RHAMM expression data. PATIENTS AND METHODS: Data from 367 men who underwent histological evaluation of the prostate were retrospectively evaluated under six conditions: (i) benign prostatic hyperplasia (BPH), (ii) BPH treated with finasteride, (iii) prostate cancer without ADT, (iv) prostate cancer treated with neoadjuvant ADT before prostatectomy (cyproterone 200 mg/day), (v) castration-resistant prostate cancer (CRPC), and (vi) normal peritumoral prostate tissue. Tissue microarrays were constructed and 1354 cores were evaluated for immunohistochemical RHAMM expression. RESULTS: There was no RHAMM expression in any tissue from normal patients or those with BPH or prostate cancer without ADT. There was RHAMM expression in 39.4% of prostate cancer tissues treated with ADT and in 46.2% of CRPC samples (P = 0.001). There was a significant increase in RHAMM expression with increased ADT duration in group 4, with a marked increase in RHAMM expression after 6-12 months of ADT (P = 0.04). No prognostic or clinical factors related to prostate cancer were associated with RHAMM expression. CONCLUSIONS: RHAMM expression in prostate cancer is directly associated with ADT. Significant RHAMM expression occurs as early as after 1 month of ADT and progressively increases with ADT duration. When prostate cancer becomes CRPC, RHAMM expression is higher. RHAMM expression was not associated with prostate cancer prognostic factors. RHAMM overexpression may contribute to the development of hormonal resistance in prostate cancer.

Associação entre o consumo de tabaco e a progressão do câncer superficial da bexiga / Amount of tobacco consumption is associated with superficial bladder cancer progression

Objective: To evaluate the association between smoking habits and outcome of patients with superficial bladder cancer. Methods: A retrospective study was performed evaluating 99 patients (67.0 ± 13.2 years, ranging from 31.4-93.4 years, 72.7% males and 27.3% females) treated at our institution with non muscle-invasive bladder cancer, between 1994 and 2000, with a mean follow-up of 49.3 months (range 4.0-177.9 months). Patients were divided according to smoking status, and the main measured outcome was progression to invasive disease. Additional cohort analysis was performed dividing patients according to previous tobacco exposure: smokers and non-smokers. Smokers were stratified into former smokers, early-quitters, late quitters and continued smokers. Results: Smoking habit was significantly more common in males (p = 0.03). Cancer also occurred at an earlier age among smokers (70.8 versus 64.8 years, p = 0.030). Tobacco consumption was present in 62.7% of the patients with bladder cancer. There was a significant higher progression rate to muscle-invasive disease in patients that had more than 60 pack-years of exposure (52.9 versus 26.2%, p = 0.037). These patients had a mean progression time of 59.3 months, whereas patients who had smoked less than 60 pack-years progressed after a mean time of 131.8 months. Conclusions: A direct association between the amount of tobacco consumed and disease progression is observed in patients with bladder cancer, as suggested by the present study. Tobacco consumption has a direct association with progression of superficial bladder cancer to invasive disease and also shortens the period of time for muscle invasion. Larger and prospective studies are still necessary to bring further definitive conclusions about reproducibility of our data and to better understand how smoking cessation affects progression of superficial bladder cancer.

Objetivo: Avaliar a relação entre os hábitos tabágicos e a evolução de pacientes com carcinoma urotelial de bexiga superficial. Métodos: Foi realizado um estudo retrospectivo com 99 pacientes (67,0 ± 13,2 anos, variando de 31,4-93,4 anos, 72,7% homens e 27,3% mulheres) tratados de carcinoma urotelial de bexiga não-invasivo entre 1994 e 2000, com seguimento médio de 49,3 meses (4,0-177,9 meses). Os pacientes foram divididos em tabagistas e não-tabagistas, e os tabagistas foram subestratificados entre ex-tabagistas, interruptores precoces, interruptores tardios e tabagistas persistentes. O principal desfecho avaliado foi a progressão para doença invasiva. Resultados: O tabagismo foi mais comum entre os homens (p = 0,03), sendo que 62,6% do total de pacientes avaliados eram tabagistas. O diagnóstico do câncer ocorreu em uma idade mais precoce entre os tabagistas (70,8 versus 64,8 anos, p = 0,03). Observou-se uma progressão significativamente maior para doença invasiva entre os pacientes com carga tabágica acima de 60 maços/ano (52,9 versus 26,2%, p = 0,037). Estes pacientes tiveram um tempo de progressão de 59,3 versus 131,8 meses para aqueles com menor carga tabágica. Conclusões: Há associação direta entre a carga tabágica e progressão do carcinoma urotelial de bexiga para doença músculo-invasiva em um curto intervalo de tempo. Estudos prospectivos e com maior número de pacientes são necessários para entender como a interrupção do tabagismo afeta a progressão do carcinoma superficial de bexiga.

Amount of tobacco consumption is associated with superficial bladder cancer progression.

OBJECTIVE: To evaluate the association between smoking habits and outcome of patients with superficial bladder cancer. METHODS: A retrospective study was performed evaluating 99 patients (67.0 ± 13.2 years, ranging from 31.4-93.4 years, 72.7% males and 27.3% females) treated at our institution with non muscle-invasive bladder cancer, between 1994 and 2000, with a mean follow-up of 49.3 months (range 4.0-177.9 months). Patients were divided according to smoking status, and the main measured outcome was progression to invasive disease. Additional cohort analysis was performed dividing patients according to previous tobacco exposure: smokers and non-smokers. Smokers were stratified into former smokers, early-quitters, late quitters and continued smokers. RESULTS: Smoking habit was significantly more common in males (p = 0.03). Cancer also occurred at an earlier age among smokers (70.8 versus 64.8 years, p = 0.030). Tobacco consumption was present in 62.7% of the patients with bladder cancer. There was a significant higher progression rate to muscle-invasive disease in patients that had more than 60 pack-years of exposure (52.9 versus 26.2%, p = 0.037). These patients had a mean progression time of 59.3 months, whereas patients who had smoked less than 60 pack-years progressed after a mean time of 131.8 months. CONCLUSIONS: A direct association between the amount of tobacco consumed and disease progression is observed in patients with bladder cancer, as suggested by the present study. Tobacco consumption has a direct association with progression of superficial bladder cancer to invasive disease and also shortens the period of time for muscle invasion. Larger and prospective studies are still necessary to bring further definitive conclusions about reproducibility of our data and to better understand how smoking cessation affects progression of superficial bladder cancer.

Experimental study of the tissue reaction caused by the presence of cellulose produced by Acetobacter xylinum in the nasal dorsum of rabbits.

UNLABELLED: Several materials have been proposed for nasal reconstruction. There is no consensus on which is the best. The cellulose blanket produced by bacteria may be a possible cartilaginous addition element to the nose. AIM: to study tissue reaction to cellulose in the dorsal nose of rabbits. MATERIALS AND METHODS: 22 New Zealand rabbits were used. In 20 a cellulose blanket was implanted in the nasal dorsum and 2 served as controls. They were followed up through a period of three and six months, after which their nostrils and nasal dorsums were removed and histological studies were carried out on them, considering defined parameters of inflammation such as vascular congestion, intensity of the inflammatory process and presence of purulent exudate. RESULTS: The inflammatory process remained stable, showing its relationship with the surgical procedure and not with the presence of the cellulose blanket. There were no statistical differences in the other parameters. CONCLUSION: The cellulose blanket produced by Acetobacter xylinum presented good biocompatibility, remained stable during the entire study period, and could be considered a good material for elevating the nasal dorsum.

Estudo experimental da resposta tecidual à presença de celulose produzida por Acetobacter xylinum no dorso nasal de coelhos / Experimental study of the tissue reaction caused by the presence of cellulose produced by Acetobacter Xylinum in the nasal dorsum of rabbits

Vários materiais são propostos para reconstrução nasal, não havendo consenso sobre qual o melhor. A manta de celulose produzida por bactéria pode ser mais um elemento para adição cartilaginosa. Não há estudos deste material no dorso nasal. OBJETIVO: Avaliar a resposta tecidual à presença da celulose bacteriana no dorso nasal de coelhos. MATERIAL E MÉTODO: Foram utilizados 22 coelhos Nova Zelândia, sendo que em 20 deles foi implantada a manta de celulose no dorso nasal e em 2 controles nada foi feito. Foram acompanhados por um período de três e seis meses, sendo então retirados as regiões do dorso nasal e narinas dos coelhos e realizado estudo histopatológico levando em consideração parâmetros definidos de condição inflamatória como congestão vascular, intensidade do processo inflamatório e presença de exsudato purulento. RESULTADOS: O processo inflamatório manteve-se estável, demonstrando sua relação com o procedimento cirúrgico, e não com a presença da manta de celulose. Nos demais parâmetros estudados não houve diferença estatisticamente significante. CONCLUSÃO: A manta de celulose de Acetobacter xylinum mostrou boa biocompatibilidade e manteve-se estável no decorrer do tempo de estudo, podendo ser considerada um bom material para uso na elevação do dorso nasal.

Several materials have been proposed for nasal reconstruction. There is no consensus on which is the best. The cellulose blanket produced by bacteria may be a possible cartilaginous addition element to the nose. AIM: to study tissue reaction to cellulose in the dorsal nose of rabbits. MATERIALS AND METHODS: 22 New Zealand rabbits were used. In 20 a cellulose blanket was implanted in the nasal dorsum and 2 served as controls. They were followed up through a period of three and six months, after which their nostrils and nasal dorsums were removed and histological studies were carried out on them, considering defined parameters of inflammation such as vascular congestion, intensity of the inflammatory process and presence of purulent exudate. RESULTS: The inflammatory process remained stable, showing its relationship with the surgical procedure and not with the presence of the cellulose blanket. There were no statistical differences in the other parameters. CONCLUSION: The cellulose blanket produced by Acetobacter xylinum presented good biocompatibility, remained stable during the entire study period, and could be considered a good material for elevating the nasal dorsum.

Testicular metastases: a poor prognostic factor in patients with advanced prostate cancer.

PURPOSE: Prostate cancer is the most frequently diagnosed neoplasm in men. In some patients, however, the disease pursues a clearly more aggressive course. Testicular metastases from prostate cancer are rare events that have been previously reported; however, its frequency and clinical meaning are not well established. The aim of the present study was, therefore, to evaluate its occurrence and clinical meaning. PATIENTS AND METHODS: A review of patients who underwent androgen deprivation orchidectomy for prostate cancer between 1995 and 2007 was undertaken. On the period evaluated, 1,693 orchidectomies were performed at our institution. Since, the population of patients treated at our institution does not have access to the expensive androgen-deprivation drugs, the vast majority is treated through surgical castration. In such context, evaluation of testicular parenchyma of patients with advanced prostate cancer could be assessed. Clinical and histological data were reviewed, and patients with testicular metastases were identified. RESULTS: Of the 1,693 orchidectomies performed during the period analysed, three cases of testicular metastases of prostate cancer (range 58-76 years) were diagnosed (0.18%). All patients had very atypical neoplasm's behaviour and poor prognosis, dying within the first year. CONCLUSION: In conclusion, testicular metastases from prostate cancer are a rare event, observed in 1.8 per 1,000 cases. As other visceral metastases, testicular metastases might also be considered as an unusual additional factor of poor prognosis.

Prostate biopsies containing prostate intraepithelial neoplasia and atypical small acinar proliferation: what to do? / Biópsias prostáticas contendo neoplasia intraepitelial e proliferação acinar atípica: o que fazer?

Objective: The aim of the study was to assess the frequency of high-grade prostate intraepithelial neoplasia and atypical small acinar proliferations on a contemporary series, and their relation to posterior diagnosis of prostate cancer. Methods: A retrospective study was conducted with 6,490 consecutive men submitted to extended prostate biopsies between 2000 and 2005 at a single institution. Of these, 400 men (6.16%) had atypical small acinar proliferation or high-grade prostatic intraepithelial neoplasia, and 43 had at least one follow-up biopsy. Results: The overall incidence of high-grade prostatic intraepithelial neoplasia was 4.6% and 1.4% for atypical small acinar proliferation. High-grade prostatic intraepithelial neoplasia plus atypical small acinar proliferation occurred in 0.11% of men. The detection rates of prostate cancer on repeated biopsies were of 38.5 and 53.6% for high-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation, respectively. All patients with high- grade prostatic intraepithelial neoplasia plus atypical small acinar proliferation who had a repeated biopsy were diagnosed with prostate cancer. There was a higher risk of diagnosing prostate cancer in a site close to previous atypical small acinar proliferation (OR = 5.93; p = 0.015). Conclusions: After high-grade prostatic intraepithelial neoplasia or atypical small acinar proliferation finding on extended biopsies, close follow-up is recommended, and repeated biopsies should be done according to clinical data as well. Rebiopsies should be strongly recommended when the association high- grade prostatic intraepithelial neoplasia plus atypical small acinar proliferation is present, or when atypical small acinar proliferation is found only after the second biopsy. Repeated biopsies after an atypical small acinar proliferation finding should be always randomized, but sites of atypical small acinar proliferation should be more extensively sampled.

Objetivo: O objetivo do estudo foi avaliar a frequência de neoplasia intraepitelial prostática de alto grau e de proliferações atípicas de pequenos ácinos em uma série atual, e sua relação com o diagnóstico de câncer de próstata. Métodos: Foi realizado estudo retrospectivo com 6.490 homens submetidos consecutivamente a biópsia estendida de próstata entre 2000 e 2005. Destes, 400 (6,16%) apresentaram proliferações atípicas de pequenos ácinos ou neoplasia intraepitelial prostática de alto grau, e 43 foram submetidos à rebiópsias. Resultados: A incidência de neoplasia intraepitelial prostática de alto grau foi de 4,6% e, de proliferações atípicas de pequenos ácinos, 1,4%. Neoplasia intraepitelial prostática de alto grau mais proliferações atípicas de pequenos ácinos ocorreu em 0,11% dos homens. Detecção de câncer de próstata em rebiópsias ocorreu em 38,5 e 53,6% dos homens com neoplasia intraepitelial prostática de alto grau e proliferações atípicas de pequenos ácinos, respectivamente. Todos os homens com neoplasia intraepitelial prostática de alto grau mais proliferações atípicas de pequenos ácinos apresentaram câncer de próstata em rebiópsias. Observou-se um risco elevado de detecção de câncer de próstata próximo ao local onde ocorreram proliferações atípicas de pequenos ácinos previamente (OR = 5,93; p = 0,015). Conclusões: Após o achado de neoplasia intraepitelial prostática de alto grau ou proliferações atípicas de pequenos ácinos em biópsias estendidas, seguimento cauteloso é recomendado, e rebiópsias devem ser realizadas de acordo com dados clínicos. Rebiópsias são fortemente recomendadas quando há associação da neoplasia intraepitelial prostática de alto grau mais proliferações atípicas de pequenos ácinos, ou quando proliferações atípicas de pequenos ácinos são encontradas a partir da segunda biópsia repetida. Rebiópsias após proliferações atípicas de pequenos ácinos devem ser randomizadas, porém locais onde ocorreu o achado de proliferações atípicas de pequenos ácinos devem ser mais extensivamente representados.

Long-term follow-up of advanced bladder adenocarcinoma / Seguimento a longo prazo do adenocarcinoma avançado da bexiga

Objective: to evaluate patients treated with primary bladder adenocarcinoma at our institution. Methods: A review of 30 patients diagnosed with bladder adenocarcinoma at a single institution from 1994 of 2005 was undertaken. Cases of primary bladder adenocarcinoma were retrospectively evaluated. Results: Out of 490 patients with bladder carcinoma, 30 had bladder adenocarcinoma: 22 metastatic tumors, eight (1.6%) primary adenocarcinoma. Of these, three (0.6%) were primary non-urachal and five (1.0%) were urachal adenocarcinoma. All patients were men with mean age of 55.8 years (range 37-83). Dysuria and hematuria were the main symptoms reported. Of the total, four patients had cancer-related mortality. Conclusion: Primary bladder adenocarcinoma is a rare neoplasm, observed in 1.6% patients with bladder malignancies. Late diagnosis limits therapeutic possibilities. Partial cystectomy seems to have unsatisfactory results and radical cystectomy, although remains as the gold standard, have no proven efficacy. New methods of adjuvant treatment must be studied to improve treatment outcomes, as high mortality is observed despite treatment.

Objetivo: avaliar pacientes com adenocarcinoma primário da bexiga tratados em uma instituição. Métodos: foi realizada uma revisão em 30 pacientes diagnosticados com adenocarcinoma da bexiga, em uma única instituição, no período de 1994 a 2005. Os casos de adenocarcinoma primário da bexiga foram avaliados retrospectivamente. Resultados: dos 490 pacientes tratados com carcinoma da bexiga, 30 tinham adenocarcinoma da bexiga: 22 eram tumores metastáticos, oito (1,6%) tinham adenocarcinoma primário. Destes, três (0,6%) eram não-úraco primários e cinco (1,0%) do úraco. Todos os pacientes eram homens com média de idade de 55,8 anos (entre 37-83). Disúria e hematúria foram os sintomas predominantes. Do total, quatro pacientes tiveram mortalidade relacionada ao câncer. Conclusões: adenocarcinoma da bexiga é um tumor raro, observado em 1,6% dos pacientes com neoplasias da bexiga. O diagnóstico tardio limita as possibilidades terapêuticas. A cistectomia parcial parece ter resultados pouco satisfatórios e a cistectomia radical, embora permaneça o padrão ouro, não provou eficácia. Novos métodos de tratamentos adjuvantes devem ser estudados para melhorar os resultados terapêuticos, pois alta mortalidade é observada mesmo após o tratamento.

Adenocarcinoma of persistent müllerian duct remnants: case report and differential diagnosis.

Persistent müllerian duct syndrome is an unusual disorder characterized by cryptorchidism and retention of müllerian derivatives (uterus, fallopian tubes, and upper vagina). We report the case of a 39-year-old man with this syndrome in association with adenocarcinoma from the retained müllerian remnants of probable endocervical origin. To our knowledge, this is the first report of an endocervical adenocarcinoma associated with persistent müllerian duct syndrome.