Sarcomatoid carcinoma of the urinary bladder: a case report with immunohistochemical and molecular genetic analysis

Clear cell variant, urothelial carcinoma of ureter: A rare entity

Clear cell variants of transitional cell carcinoma of upper urinary tract is extremely rare. Although clear cell of urinary bladder has been reported, its occurrence in the upper tract has not been reported readily in literature.

We present a case of 77 year old female who was suspected with TCC of the ureter, but was found to have clear cell variant on histology post radical nephroureterectomy.

This was the first such case in our institution.

Establishment and antitumor effects of dasatinib and PKI-587 in BD-138T, a patient-derived muscle invasive bladder cancer preclinical platform with concomitant EGFR amplification and PTEN deletion

Muscle-invasive bladder cancer (MIBC) consists of a heterogeneous group of tumors with a high rate of metastasis and mortality. To facilitate the in-depth investigation and validation of tailored strategies for MIBC treatment, we have developed an integrated approach using advanced high-throughput drug screening and a clinically relevant patient-derived preclinical platform. We isolated patient-derived tumor cells (PDCs) from a rare MIBC case (BD-138T) that harbors concomitant epidermal growth factor receptor (EGFR) amplification and phosphatase and tensin homolog (PTEN) deletion. High-throughput in vitro drug screening demonstrated that dasatinib, a SRC inhibitor, and PKI-587, a dual PI3K/mTOR inhibitor, exhibited targeted anti-proliferative and pro-apoptotic effects against BD-138T PDCs. Using established patient-derived xenograft models that successfully retain the genomic and molecular characteristics of the parental tumor, we confirmed that these anti-tumor responses occurred through the inhibition of SRC and PI3K/AKT/mTOR signaling pathways. Taken together, these experimental results demonstrate that dasatinib and PKI-587 might serve as promising anticancer drug candidates for treating MIBC with combined EGFR gene amplification and PTEN deletion.

Scattered sarcomatoid urothelial carcinoma cells within MALT lymphoma of the urinary bladder

Recently the author encountered a peculiar tumour of the bladder consisting of the following three components: MALT lymphoma, scattered poorly cohesive sarcomatoid urothelial carcinoma within MALT lymphoma, and surface non-invasive, low-grade conventional urothelial carcinoma (UC) occurring in a 65-year-old female. A low-power view showed MALT. Meticulous observations revealed a small amount of non-invasive, low-grade conventional UC at the surface area. In addition, meticulous observations identified a small number of cytokeratin-positive, poorly cohesive sarcomatoid UC cells scattered within the MALT lymphoma. The MALT lymphoma was typical. Immunohistochemically, the scattered sarcomatoid cells within the MALT lymphoma were positive for various types of CK, EMA, p53 and Ki-67 (LI = 70%). The MALT lymphoma was composed mainly of B-cells (CD10, CD20, CD23, CD79α, κ-chains and λ-chain), but T-cells positive for CD3, CD4, CD5, CD43 or CD45RO were seen in a very small number. This scattering sarcomatoid UC within MALT lymphoma of bladder has not been reported.

Primary Sarcomatoid Tumor of the Bladder: A Different Entity but the Same Approach?

Bladder cancer remains a frequent cancer worldwide, and most tumors are diagnosed at localized stages. Urothelial carcinoma (UC) accounts for 90% of bladder cancer cases. Sarcomatoid carcinoma (SaC) of the bladder is a rare variant (0.5% of total bladder cancers) characterized by 2 components based on histology; the epithelial and mesenchymal phenotypes, which can be easily differentiated by immunohistochemistry. SaC has similar epidemiologic features to UC but different behavior, aggressiveness, and prognosis. In this review, we summarize the main differences between UC bladder cancers and SaC subtypes. The therapeutic strategies used in SaC today do not differ much from those used for the urothelial variant. However, there is still no standard treatment--the result of a lack of clinical trials for the sarcomatoid variant. Further multicenter comparative studies are needed to devise a better treatment strategy for patients with this rare histologic tumor subtype.

Discovery of potential bladder cancer biomarkers by comparative urine proteomics and analysis

OBJECTIVE

We searched for bladder tumor markers by analyzing urine samples from patients with bladder cancer and from normal controls.

METHODS

Proteins in urine samples of patients with bladder cancer and with normal controls were systematically examined by 2-dimensional electrophoresis combined with matrix-assisted laser desorption ionization time-of-flight mass spectrometry. The expression of the protein apolipoprotein A-I (apoA-I) was confirmed by Western blot analysis and further evaluated.

RESULTS

We successfully obtained the 2-dimensional electrophoresis gel maps of urinary proteins in patients with bladder cancer and in normal controls. Thirty differentially expressed protein spots were successfully matched by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Combined with the SWISS-PROT database, only 14 proteins (beta-2-microglobulin, fatty acid-binding protein adipocyte, gelsolin, isoform 1 of gelsolin, myoglobin, isoform 2 of fibrinogen alpha chain, apoA-I, prostaglandin D(2) synthase 21 kDa [brain], protein AMBP, transthyretin, keratin type II cytoskeletal 1, type II cytoskeletal 8, putative uncharacterized protein ALB, putative uncharacterized protein MASP2 [fragment]) were identified, including 2 putative proteins. Furthermore, apoA-I was confirmed by Western blot analysis, and the high level of apoA-I was found in urine samples from patients with bladder tumors compared with normal controls.

CONCLUSIONS

Analysis of urinary proteome may be a feasible, noninvasive, and efficient strategy for searching for potential bladder tumor biomarkers. A significant relationship of expressed apoA-I was established between bladder cancer and normal controls. We concluded that 14 differential spots included the apoA-I and would be potential urinary biomarkers for the diagnosis and surveillance of bladder cancer.

Solitary skin metastasis from sarcomatoid carcinoma of the bladder: a case report

INTRODUCTION

Cutaneous metastases from carcinomas of the bladder are very rare. They are related to advanced stages of the disease and have poor prognosis with low survival rates. The common treatment modality of cutaneous metastases from a primary bladder cancer is wide local excision followed by chemotherapy.

CASE PRESENTATION

We report a case of solitary skin metastasis from a rare type of urinary bladder carcinoma in a 68 year-old Caucasian man. Urinary bladder carcinoma metastasizing to the skin is an uncommon finding despite the high incidence of this tumor. Skin metastasis generally presents in the late stages of this disease and indicates a poor outcome.

CONCLUSIONS

Because of the extremely aggressive malignant potential of sarcomatoid carcinomas, the indications for a transurethral resection of the bladder should be carefully assessed and suitable therapeutic strategies should be examined further.