Use of CT-guided percutaneous bone biopsy in staging of genitourinary tumors

CT-guided needle aspiration biopsy has been used for staging of genitourinary tumors. The display of structures provided by CT is particularly suited for complex anatomic sites such as spine, pelvis, thorax, permitting selection of the shortest and safest route for the needle, away from the aorta, vena cava, and pleural surface. Another advantage of CT is its ability to detect soft tissue components of the tumors and the presence of central necrosis therefore targetting the biopsy toward the part of the lesion with the greatest diagnostic yield.

Prostatic recurrences in the management of superficial bladder tumors

Mitomycin C has proved to be useful as prophylaxis against superficial bladder tumor recurrences. However, there is a significant incidence of prostatic urethral recurrences. Careful followup with urine cytology and cystoscopy, and bladder and prostatic urethral biopsies should be done at regular intervals.

Transitional cell carcinoma of bladder originating from transitional cell carcinoma of anus

A unique case of transitional cell carcinoma of the bladder with the primary being in the anus is reported. The patient presented with acute urinary retention from a large bladder tumor, which was thought to be primary to the bladder. Biopsy of the bladder revealed transitional cell carcinoma, microscopically indistinguishable from the primary cloacogenic carcinoma diagnosed seven years previously.

Brain metastasis from prostatic cancer

Four cases of prostatic carcinoma with metastasis to brain are described. Two of those cases are diagnosed antemortem. Our experience from postmortem case studies and review of the literature point to the fact that metastasis to brain from a prostatic cancer remains a rare occurrence.

A comparative study of the intravesical MTP and BCG treatment of transplantable bladder cancer

We induced transitional cell cancer of the urinary bladder in Fischer rats by feeding them N-[4(5-nitro-2-furyl)-2-thiazolyl] formamide (FANFT). Tumors were subsequently transplanted orthotopically in the bladder submucosa of Fischer rats. This animal model was used to compare the therapeutic effects of maltose tetrapalmitate (MTP), and bacillus Calmette Guérin (BCG). The routes of administration compared were intravesical alone or intravesical and oral for MTP, and intravesical alone or intravesical and subcutaneous for BCG. The intravesical and oral MTP treatment was more effective than the intravesical and subcutaneous BCG as regards the tumor size, incidence of tumor metastasis and the immunologic status of the tumor bearing host.

[Increased risk of tumor development in the upper urinary tract following multicentric papillary bladder tumors]

Two theories of pathogenesis of multifocal transitional cell carcinoma are discussed: 1. Theory of cellular implantation; 2. multifocal tumor growth. The increased incidence of tumors in the upper urinary tract after urinary diversion for bladder cancer supports the multifocal theory. After treatment of papillary bladder cancer the risk of developing a second tumor in the kidney or ureter is much higher. Therefore we emphasize the continuous follow-up with radiological control of the upper urinary tract.

Identical genetic profiles in primary and metastatic bladder tumors

Transitional cell carcinoma of the bladder has been shown repeatedly to possess abnormal genetic profiles. During long periods recurrent tumors in the bladder consistently show the same type of genetic profile with each recurrence. We report on a patient with metastatic bladder cancer who had similar genetic profiles of the primary lesion and thoracocentesis fluid from the metastatic site. The significance of these findings is discussed.

Acquired renal cysts and multiple renal cell and urothelial tumors

This paper reports two cases of acquired renal cysts and multiple renal cell tumors in end-stage kidneys with a discussion of the pathogenesis of these lesions. The first patient had been on maintenance dialysis for approximately three years when he was found to have multiple renal cysts and renal cell tumors. He subsequently developed multifocal urothelial carcinomas of the lower urinary tract. The second patient had progressive renal failure due to hypertensive vascular disease when he underwent left nephrectomy because of multiple renal cysts and renal cell carcinoma. He later developed terminal renal failure and was maintained on chronic dialysis. He expired three years later. At autopsy, the right kidney also demonstrated multiple cysts and renal cell tumors.

Transient global amnesia associated with a single metastasis in the non-dominant hemisphere. Case report

A patient in whom transient global amnesia (TGA) led to the diagnosis of a metastasis of a transition-cell carcinoma of the bladder to the non-dominant hemisphere is described. In previously reported cases of TGA associated with brain tumors, the tumors involved either the dominant or both hemispheres. The etiology of TGA associated with a brain tumor is most likely vascular, as suggested by the sudden development and the transitory character of the event. In contrast to the "common" form of TGA (where both temporal lobes suffer temporary ischemia), in these patients only one side of the limbic system is affected, because a brain tumor has already compromised the other limbic area. Therefore, the dominance of the hemisphere with the tumor is of no consequence, as both hemispheres have been involved. It is concluded that the TGA in these patients is not due to, but is rather associated with, a unilateral brain tumor.

Prognostic factors in non-infiltrating carcinoma of the bladder: a preliminary report

We have reviewed 111 patients with papillary transitional cell carcinoma of the bladder, category Ta and T1, admitted between 1975 and 1980. Histological grade and the presence of multiple tumours at presentation were the most useful prognostic features in terms of recurrence and mortality from either locally invasive or metastatic disease.

Cost-effective analysis of pre-cystectomy radioisotope scans

To evaluate the cost-effectiveness of liver and bone isotope scans results were reviewed in 114 patients with invasive transitional cell carcinoma of the bladder. In 100 patients cystectomy was performed. In no patient has the results of the scans influenced or changed treatment. Routine use of isotope scans is not warranted for the preoperative evaluation of bladder cancer patients.

Choroid metastases from transitional cell carcinoma of the bladder: a case report and a review of the literature

A case of choroidal metastases as the initial manifestation of disseminated bladder cancer is presented. Ocular metastases are an extremely rare manifestation of bladder cancer and when present, usually are a late manifestation. The pathophysiology of ocular metastases is discussed and literature is surveyed.

Metastases in the oral cavity. Case reports

4 cases of metastases in the oral cavity are described. They were seen in patients with carcinoma of the renal pelvis, renal carcinoma, breast carcinoma and malignant melanoma. In 3 of the cases, the metastases were situated distally to the canines in the mandible, where Roentgen examination had revealed a radiolucent area, and in the 4th case, in the soft tissue in the upper jaw. The initial symptoms in all 4 cases were swelling, pain or decreased sensitivity. The metastases were diagnosed, on average, 7 years after diagnosis of the primary tumour.

Metastatic tumors of the foot: case report and literature review

Metastatic lesions to the bones of the foot occurred in three elderly patients. Biopsy established the diagnosis in a 90-year-old woman. In a 72-year-old man and a 79-year-old man, the diagnosis was possible from roentgenographic features. In the latter, biopsy of an additional osseous metastatic site established the diagnosis. A thorough review of the literature has yielded 72 previously reported cases of metastasis to the foot. Only 38 of these cases were histologically confirmed. Primary tumors of the colon, kidney, and lung are the most common sources of metastasis to the bones of the foot. Metastatic disease should be considered in elderly patients presenting with foot pain and osteolytic lesions, especially when there is a history of a previously diagnosed malignancy. The generally poor prognosis indicates that treatment should be clearly designed to relieve pain.

Xenografts of human bladder cancer in immune-deprived mice

Human bladder cancer from cystoscopic biopsies and from established cell lines was transplanted into mice that were immune suppressed by thymectomy plus sequential treatment with 1-beta-D-arabinofuranosylcytosine and whole-body irradiation. Each of four established human bladder cancer cell lines generated transplantable tumors in these mice, and some of the mice developed pulmonary metastases. Eight of 33 cystoscopically obtained biopsies of transitional cell carcinoma and one from a metastatic site led to xenografts that grew progressively, and some of these have been transplanted and/or have generated cell lines in vitro. Xenografts grew after a lag period of 0 to 32 weeks and had doubling times of 9 to 30 days. All of those examined histologically were consistent with transitional cell carcinoma, but some of the xenografts became more or less well differentiated in first and subsequent passages. The immune-deprived mouse is an alternative host to the nude mouse for generation of human tumor xenografts and may be a useful model for study of biological properties and therapeutic response of human bladder cancer.

Distant metastasis of urothelial tumors of the renal pelvis and ureter

Autopsy reports on urothelial tumors of the renal pelvis and ureter in 602 cases were analyzed to investigate the mode of metastasis. Seventy one cases, or 12%, showed no metastasis. Metastasis-free cases occurred with significantly high frequencies in cases of tumors of the ureter and papillomatosis, and less frequently in squamous cell carcinoma cases and in females. Lymph nodes were the most frequent site of dissemination, especially the retroperitoneal and para-aortic lymph nodes. Metastases to the lungs, peritoneum and ipsilateral adrenal were significantly more frequent in cases of tumors of the renal pelvis than in those of tumors of the ureter. Metastases to the retroperitoneal lymph nodes and peritoneum were frequent in cases with metastasis to one organ. Radical nephrectomy with regional lymphadenectomy and/or radiation therapy is indicated for tumors of the renal pelvis. Palliative surgery or nephroureterectomy with a cuff of bladder wall is indicated for tumors of the ureter or papillomatosis, and radical nephroureterectomy with regional lymphadenectomy and/or radiation therapy in cases where a pronounced tendency of down-growth invasion is suspected.

Endobronchial metastatic disease

Between 1969 and 1979, 90 patients of the Thoracic Surgical Unit at Harefield Hospital were found to have pulmonary metastatic disease. In 25 instances (28%) the diagnosis was established by bronchial biopsy. Twenty-four patients had endobronchial metastatic carcinoma and in one metastatic sarcoma was diagnosed. All but one had a past history of malignancy, the interval between treatment of the primary and appearance of the endobronchial metastasis ranging from a few months to 17 years. Primary sites in these patients included large intestine, breast, cervix, uterus, and bladder. There were four instances of metastatic malignant melanoma. The pulmonary secondaries were resectable in 10 patients and in one a second resection was done for a further metastasis three years after the first. Three patients are still alive two, four, and 10 years later.

Cerebrospinal fluid and metastasis of transitional cell carcinoma of the bladder

Two cases are presented of cerebrospinal fluid with tumor cells metastatic from transitional cell carcinomas of the bladder. They demonstrate that in spite of the rarity of transitional cell carcinoma's metastasizing to the central nervous system (0.4% to 0.6%), it is necessary to consider the bladder as the primary site and to obtain urinary cytology in such cases when the primary tumor is still unknown.

Response of metastatic cloacogenic carcinoma to treatment with semustine

A case of cloacogenic carcinoma of the anorectal junction with pulmonary metastases is presented. Treatment with Semustine (Methyl-CCNU) resulted in a partial response lasting 15 months. Cloacogenic carcinoma is an uncommon neoplasm against which only a few chemotherapeutic agents have been tried. Semustine should be considered in the treatment of metastatic cloacogenic carcinoma.

[Frequency of recurrences and tumor progression on superficial bladder carcinoma (author's transl)]

A retrospective study with an adequate follow-up of three years or longer of 315 superficial transitional cell carcinomas (Ta--T2) is reported. Patients had transurethral resection in 80% and open excision or resection in 20% for cure or control. It is demonstrated, that in addition to the grade and the stage of the tumor, multifocal tumor growth and whether it is a primary or recurrent tumor influence the frequency of recurrences and the tumor progression. The overall percentage of recurrences after resection of Ta, T1 and T2 tumors within three years is 60%. A primary tumor recurs in 45%, the first recurrence in 84%, solitary tumors in 46% and multifocal tumors in 73%. Tumor progression is observed in solitary tumors in 24%, in multifocal tumors in 44%, in primary and recurrent Ta and primary T1 tumors in 20 to 25%, in recurrent T1 tumors in 56%. Therefore, when planning therapy, stage, grade, multifocal tumor growth and whether it is a primary or recurrent tumor should be considered. Ta tumors can be treated sufficiently by transurethral resection, even in case of several recurrences; more aggressive therapy should be considered, when multifocal or recurrent T1 or T2 tumors recur again as invasive carcinomas.

Bone formation associated with osseous metastases from bladder carcinoma

Twenty-four cases of carcinoma of the urinary bladder, involving bone, have been reviewed. Eighteen of these were distant metastases beyond the pelvis. The lesions were predominantly osteolytic. Ossification in the soft tissues adjacent to the bone metastasis was observed in three cases, all involving the left tibia. The reason for this site of predilection remains obscure.

Use of CT in evaluation of postcystectomy patients

Twenty-one patients with prior cystectomy for transitional cell carcinoma of the bladder were evaluated by computed tomography. In eight patients who developed local pelvic recurrence, CT diagnosis was correct in seven. CT also detected distant metastasis in five patients and local pelvic abscesses in two additional patients. Our data show CT to be a more sensitive means than conventional radiologic methods including gray scale sonography in the detection of local recurrence and postoperative complications. Examples of normal postcystectomy changes in the pelvis as well as recurrent disease and surgical complications are illustrated. The pitfalls and the proper role of CT in these patients are also discussed.

Recurrent transitional cell carcinoma in an ileal conduit

A patient with recurrent transitional cell carcinoma involving an ileal conduit is reported. This case is unusual for the following reasons: the malignancy was located in an area where there was no transitional epithelium; a "napkin ring" deformity was present; there was a 6-year interval between the initial cystectomy and the recurrence of the malignancy.

Extensive cutaneous metastases from urinary bladder carcinoma

Herein we present an update of the literature and a report of a recent case of cutaneous metastases from transitional cell carcinoma of the urinary bladder. Cutaneous metastases from bladder carcinoma more commonly affect middle-aged or elderly men and generally herald a rapid demise. Our case is unusual because of the rather extensive area of skin involvement, rapidity of development, and occurrence in a woman.

Cutaneous manifestation of carcinoma of urinary bladder: carcinoma erysipelatodes

Cutaneous metastases from carcinoma of the urinary bladder is an uncommon finding. We present a patient with carcinoma of the bladder whose first manifestation of disseminated disease was a nodular erythematous skin rash diagnosed as carcinoma erysipelatodes. The presentation, diagnosis, and hospital course is given.

Spontaneous regression of pulmonary metastases from transitional cell carcinoma

Spontaneous regression of metastatic cancers occurs rarely and has been reported only once for pulmonary metastases from transitional cell carcinoma. Two cases of spontaneous complete regression of lung metastases from transitional cell carcinoma are presented. In one case, regression occurred after a course of radiation to the primary bladder cancer, but in the other patient, lung lesions disappeared without treatment to the primary or metastatic cancers. The factors that alter the tumor-host relationship to allow spontaneous regression of cancers are unknown, but observation of these phenomena may help reveal parameters that influence tumor progression in the majority of cancer patients.

Metastases from transitional cell carcinoma of urinary bladder

In 107 patients who died of metastatic transitional cell carcinoma, the most common sites for metastases at necropsy were the lymph nodes, liver, lung, bone, and adrenal gland. Metastases first were documented clinically in multiple-organ sites in one third of the patients; solitary metastases were present in only 9 patients at necropsy. The mean duration of survival for patients was thirteen months from the diagnosis of the primary tumor. The metastatic lesion(s) generally were evident clinically within eleven months of the primary diagnosis; death ensued usually within three months. Our finding that the majority of patients presented initially with high-grade tumors suggests that a high-grade lesion, regardless of its clinical stage, warrants early aggressive therapy.

Metastases from transitional cell carcinoma of the bladder masquerading as psoas abscess

Metastases from transitional cell carcinoma of the bladder usually progress in a stepwise fashion. We report that first case of metastasis to the body of the psoas muscle. No evidence of retroperitoneal lymphatic involvement or direct extension was identified. Furthermore, the original tumor was superficial but the history was complicated by perforation of the bladder during resection.

Cis-diamminedichloroplatinum as a therapeutic agent in metastatic transitional cell carcinoma

Cis-platinum as single agent therapy was investigated in 8 patients with stage D transitional cell carcinoma of the bladder. Dramatic responses were obtained in some patients and the quality of life was improved for as long as 8 months but no cures were obtained. Also noted was an occasional marked loss of renal function as measured by creatinine clearance despite a carefully managed protocol to avert this known side effect of cis-platinum (nephrotoxicity). No auditory problems were noted in these 8 patients.

Pagetoid lesions associated with carcinoma of the bladder

Three cases of pagetoid infiltrations by a transitional cell carcinoma are reported. The theories of histogenesis of extramammary Paget's disease are reviewed and discussed. Evidence from these cases suggests that the lesion develops because of the intraepithelial migration of cells.

Primary carcinoma of the ureteral stump: a case report and a review of the literature

A case is reported of primary carcinoma of the ureteral stump with metastases following nephrectomy for benign disease. The occurrence of disseminated tumor at the time of diagnosis is uncommon, having been reported in only 3 previous cases. The autopsy findings are discussed and the literature is reviewed.