Carcinoma in situ spread to mucosa of sigmoid colon neobladder

Secondary tumours in orthotopic neobladder using isolated gut segment post radical cystectomy for urothelial carcinoma: a systematic review

BACKGROUND

Urothelial carcinoma recurrence of an orthotopic neobladder created from bowel segment is a rare occurrence. The usage of bowel segments to create neobladder following cystectomy for urinary diversion is growing yet there still remains a large gap in the literature about recurrence in neobladder. We carry out the first systematic review to outline current details of urothelial cancer recurrences in a neobladder, diagnostic approach, management and long term prognosis.

METHOD

We carried out a systematic review searching databases PubMed (MEDLINE), Scopus and Web of Science. Only studies reporting on urothelial carcinoma recurrence of the neobladder with or without multi-focal disease were reported. A quality assessment tool was utilized to ensure all studies met quality standards.

RESULTS

Fifteen studies were included in the systematic review meeting inclusion criteria. Fourteen of these studies were cases in men where pT3 disease was the most prevalent (29%). The most common symptomology was macroscopic haematuria seen in eight patients (53.33%). Management varied among cases and including adjuvant chemotherapy regimens and surgical interventions consisting of endoscopic resection to robotic neocystectomy and nephroureterectomy. Follow up period for these patients was up to 38 months and 55% of patients did not see a recurrence.

CONCLUSION

The nature of recurrence is hypothesised to be due to seeding of urothelial cells into the non-urothelial surfaces compatible for both implantation and growth. We present the first systematic review to report on recurrence rates and details of diagnosis and outcomes of various management regimes for urothelial carcinoma of the neobladder.

Transitional cell carcinoma recurrence impacting intestinal diversion after radical cystectomy. Oncologic outcomes of a rare site of recurrence

Introduction

Transitional cell carcinoma recurrence within an intestinal urinary diversion (TCCUD) after radical cystectomy (RC) is a rare condition with unknown origin, prognosis and treatment. The aim of this study was to describe treatment options and oncologic outcomes of this understudied site of recurrence in a multi-institutional case series.

Material and methods

TCCUD relapse cases after RC were investigated in a retrospective, multi-institutional study. Surgical approach and adjuvant chemotherapy were discussed. Early and late complications were described according to the Clavien-Dindo classification. Kaplan-Meier method was used to assess progression-free and cancer-specific survival.

Results

A total of 19 patients were selected. The most common presentation was gross hematuria. The median interval between RC and TCCUD was 51.2 months. Fifteen patients (78.9%) underwent surgical excision, and two underwent concomitant radical nephroureterectomy. In 12 (63.1%) cases the site of TCCUD was the uretero-ileal anastomosis. Tumor invading the muscularis of the intestinal diversion was described in 10 (52.6%) cases. Surgical complications occurred in 7/15 (46.6%) patients, of these two with Clavien-Dindo Grade III. Four patients (21.0%) underwent adjuvant chemotherapy and two (10.5%) both chemotherapy and radiation therapy. During follow-up 15 patients (78.9%) presented with other sites of recurrence, with lymph nodes (21.0%) and liver (15.7%) being the most common localizations. Recurrence free and overall survival rates were 36.8% and 15.8%, and 56.5% and 24.2%, respectively at 12 and 18 months.

Conclusions

Most patients with TCCUD have invasive disease and a substantial percentage experience upper tract cancer during their disease course. TCCUD is often the herald of advanced disease and systemic progression, with poor progression-free and overall survival rates.

Urothelial carcinoma in an orthotopic neobladder: an unusual pattern of recurrence and metastasis

We report a case of a 65-year-old patient with muscle invasive bladder cancer that was treated with neoadjuvant chemotherapy, followed by radical cystoprostatectomy with pelvic lymph node dissection and orthotopic neobladder according to Hautmann. Nine years later, routine follow-up showed local recurrence in the neobladder and metastatic disease of the urothelial carcinoma in the related mesenteric lymph nodes. The entire neobladder specimen was removed including the mesentery of the neobladder. Based on the anatomical lymph drainage of the ileal neobladder, we considered the metastatic disease in the mesentery lymph node as locoregional disease spread. This case shows that such locoregional lymph node metastasis may be amenable to treatment by induction chemotherapy and radical surgery.

Carcinoma in situ developing in an ileal neobladder

We report a case of carcinoma in situ of urothelial carcinoma (UC) developing in an ileal neobladder. Some cases of secondary UC in the ileal segment of a urinary diversion have been reported. However, none were cases of carcinoma in situ. After cystectomy for bladder cancer, a 73-year-old man developed UC at the left ureteral-neobladder and urethral-neobladder anastomoses. Left nephroureterectomy, resection of the neobladder, and total urethrectomy were performed. The pathologic examination revealed UC (papillary, grade 3) at these anastomoses and carcinoma in situ in the ileal neobladder.

Urothelial carcinoma recurrence in ileal orthotopic neobladder: urethrectomy and creation of ileal conduit

A patient who had previously undergone radical cystoprostatectomy and ileal neobladder with the Studer technique presented with a recurrence of urothelial carcinoma in the neobladder and urethra. Surgical treatment consisted of resection of the neobladder, urethrectomy, and creation of an ileal conduit using a separately isolated segment of ileum. Pathologic analysis revealed high-grade urothelial carcinoma implants to the Studer pouch and urethra, with spread to the mesenteric lymph nodes draining the pouch. Intraluminal tumor cell seeding appears to be an important mechanism of metachronous transitional cell carcinoma recurrence in the urethra and ileal mucosa of a neobladder.

Possibility of spontaneous seeding of transitional cell carcinoma of the ureter in renal tubules: another mechanism of transitional cell carcinoma dissemination

Cancer cell seeding inside the urinary tract always has been considered one possible mechanism of the multicentric origin of transitional cell carcinoma (TCC). However, there is still no direct clinical evidence to prove that the natural seeding of TCC is a real event. To our knowledge, we report the first case of spontaneous seeding of TCC of the ureter in the renal tubules of a hydronephrotic kidney. The TCC nature of the intratubular tumor cells has been confirmed by the morphological appearance of them after hematoxylin and eosin staining and positive p53 immunohistochemical staining.

Implants of noninvasive papillary urothelial carcinoma in peritoneum and ileocolonic neobladder: Support for “seed and soil” hypothesis of bladder recurrence

OBJECTIVES

To explore the underlying mechanism of tumor regrowth in cases of noninvasive urothelial carcinoma that recur in unusual anatomic locations.

METHODS

The pathology files of our institution and the consult service of one of us were searched for cases of noninvasive nonmetastatic urothelial carcinoma with involvement of unusual anatomic sites. Cases in which the mode of spread included direct spread to the adjacent tissue and lymphovascular metastases were excluded. Medical history, including presenting symptoms, and follow-up data were obtained.

RESULTS

Two cases of noninvasive urothelial carcinoma were identified. One had presented as an implant in the peritoneal investment of the bladder dome and the other as multiple implants growing on the benign surface of the colonic mucosa of an orthotopic neobladder distant from the anastomosis site. Both cases had initially presented as noninvasive papillary urothelial carcinoma of the renal pelvis. Although the urinary bladder was free of neoplastic changes at nephroureterectomy, both patients also developed several papillary tumors within the bladder shortly after the removal of the kidney.

CONCLUSIONS

After clinicopathologic correlation, the mode of tumor spread in these cases was best explained by the "seeding/implantation" theory. The urothelial tumor cells in each of these cases demonstrated the ability to implant themselves not only in the urothelium of the bladder but also in the colonic mucosa of a constructed neobladder and on the peritoneal surface.