Adenocarcinoma in an ileal conduit

Metastatic angiosarcoma in an ileal conduit: an unusual presentation

The authors in this study describe the case of a patient with a history of multiple malignancies who underwent total cystectomy with ileal loop urinary diversion and presented with a lower extremity angiosarcoma on the background of lymphedema a decade later. Shortly thereafter, she was diagnosed with metastatic ileal conduit angiosarcoma. The authors state that to their knowledge, this is the first case of ileal conduit angiosarcoma reported in the English literature.

SECONDARY MALIGNANCIES IN DIFFERENT FORMS OF URINARY DIVERSION USING ISOLATED GUT

PURPOSE

Tumor development following ureterosigmoidostomy is a worldwide accepted late complication. In contrast, tumor risk in other forms of urinary diversion with the separation of urine and feces is still unclear. We present a complete and detailed analysis of all reported tumors following urinary diversions using isolated gut segments in the literature. We estimated the tumor risk in comparison to ureterosigmoidostomies and to the general population.

MATERIALS AND METHODS

We reviewed the world literature up to April 2003 via MEDLINE for secondary tumors in urinary diversions using isolated intestinal segments.

RESULTS

We found 81 tumor case reports following urinary diversion using isolated intestinal segments. Tumors developed in 18 conduits, 45 cystoplasties, 5 rectal bladders, 3 neobladders, 6 colonic pouches and 4 ileal ureter replacements.

CONCLUSIONS

All urinary diversions using bowel with or without separation of urine and feces carry a significantly higher tumor risk for intestinal tumor development compared to the general population. The tumor spectrum and tumor location in isolated gut segments are different than tumors following ureterosigmoidostomies but the total tumor risk is probably similar. The latency period depends on the initial diagnosis with malignant diseases leading to a shorter induction time. Concerning etiology, many theories exist but the exact mechanism remains unclear. Regular endoscopic control beginning with postoperative year 3 for early detection of secondary malignancies is mandatory.

Squamous cell carcinoma in an ileal conduit

We report a patient with squamous cell carcinoma that developed at the ureteroileal anastomosis and extended into the ileal conduit 11 years after a radical cystectomy for transitional cell carcinoma of the bladder. To our knowledge, this is the first report to document the development of a squamous cell carcinoma in an ileal conduit after a radical procedure for bladder cancer.

Adenocarcinoma in a continent colonic urinary reservoir

We report the first case of an adenocarcinoma developing in a continent ileocolonic urinary reservoir. The tumor presented 7 years after the urinary diversion and more than 6 years after the resection of a Dukes' B lesion of the left colon. This report demonstrates that the colonic segment used for urinary diversion retains its malignant potential and that surveillance pouchoscopy should be performed in these patients.