Malignant change in enterocystoplasty: a histochemical assessment

Tubular adenoma with high-grade dysplasia in the ileal segment 34 years after augmentation ileocystoplasty: report of a first case

Neoplasms of the urinary bladder following augmentation ileocystoplasty are rare. We present the case of a 39-year-old male with a tubular adenoma with high-grade dysplasia in the ileal segment 34 years after augmentation ileocystoplasty to enlarge a post-chemoradiation-induced shrunken bladder. He presented with gross hematuria. Cystoscopy revealed a papillary tumor at the site of ileovesical anastomosis, and transurethral resection was performed. Histologic examination revealed a tubular adenoma with high-grade dysplasia. There are only two previous reports of tubulovillous adenoma in ileal segment after ileocystoplasty, both without high-grade dysplasia. Our observation supports the hypothesis that an ileal neobladder may undergo all the morphologic and molecular changes observed in the development of gastrointestinal adenocarcinoma. Therefore, patients who had an ileal neobladder created should be closely followed.

Comparative genomic hybridization (CGH) of augmentation cystoplasties

OBJECTIVE

Tumors arising within augmentation cystoplasties are aggressive, have poor prognosis and the majority are not detected at follow-up cystoscopy. Genetic changes in tumors precede morphological abnormalities. Therefore, the aim of this study was to investigate whether genetic abnormalities detected by comparative genomic hybridization (CGH) could be used to identify those patients with augmentation cystoplasties at increased risk of tumorigenesis.

METHODS

Bladder biopsy samples were obtained from 16 augmentation cystoplasty patients both distant from and near to the enterovesical anastomosis. CGH was used to detect genetic abnormalities in DNA extracted from the biopsies, archival specimens of two augmentation cystoplasties and two de novo bladder adenocarcinomas.

RESULTS

A greater number of amplifications on 2p, 3q, 8q, 9p, 17p, 18pq and 20pq, were observed in bladder biopsies obtained near to the enterovesical anastomosis compared to those taken distant to the suture line. CGH of archival augmentation cystoplasty tumor DNA indicated abnormalities at several loci with amplifications at 2q, 5q, 10p and 21pq, while deletions occurred at 5p and 16p.

CONCLUSIONS

The results of this study suggest that the urothelium adjacent to the bladder and/or bowel anastomosis in augmentation cystoplasties is genetically unstable. Furthermore, longitudinal studies are required to establish whether or not patients exhibiting genetic instability following augmentation cystoplasty are at greater risk of developing tumors than those with genetically stable epithelia.

Tumour formation within intestinal segments transposed to the urinary tract

Patients and their urologists are quite rightly concerned about the possibility of neoplastic change within intestinal segments transposed to the lower urinary tract. This fear arises from the occurrence of latent adenocarcinoma arising from the urocolic anastomosis in approximately 10% of patients who underwent ureterosigmoidostomy in childhood. The present text provides an update of previous reviews and details work published since 1990 on epidemiological, experimental and clinical studies. Consideration of the collected evidence confirms the increased risk of colonic neoplasia following mixing of the faecal and urinary stream by ureterosigmoidostomy or its more recent variants. In contrast, the occurrence of tumours within transposed intestinal segments appears more likely to be related to the underlying urinary tract disease for which the surgery was performed rather than exposure of the intestinal mucosa to urine. This conclusion is, however, based on low level evidence and, despite the reassuring findings, caution is advised until more robust data are available to provide a confident risk assessment.