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Alhamar M, Al-Ahmadie HA, Feratovic R, Lin O. Sensitivity of urine cytology in detecting high-grade urothelial carcinoma in patients with neoplastic urinary bladder diverticula: A major cancer center experience. Cancer Cytopathol 2024; 132:144-151. [PMID: 38054371 DOI: 10.1002/cncy.22782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/28/2023] [Accepted: 10/18/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Bladder diverticula are herniations of bladder urothelium and mucosa through the muscularis propria. The reported incidence of neoplasia arising in bladder diverticula is widely variable. The authors' objective was to study the characteristics and sensitivity of urine cytology in these patients with emphasis on primary intradiverticular bladder cancer (IDBC). METHODS A 17-year, retrospective review of all resected bladder diverticula associated with bladder carcinoma was performed. Cases that had complete diverticular resections and preresection urine samples were included in this study. The cases were divided into either primary IDBC or primary extradiverticular bladder cancer (EDBC). Demographic data and urine cytology characteristics were recorded, and sensitivity was calculated. For IDBC, a comparison between voided and cystoscopic urines was done for cases that had both collection methods performed. RESULTS Of 70 patients with IDBC, 47 patients had urine cytology results that were either positive for high grade-urothelial carcinoma (HG-UC) or suspicious for HG-UC. The sensitivity for HG-UC in IDBC samples was 80%, compared with 82% in EDBC samples (p > .05). Also, 28 patients in the IDBC group had both voided and cystoscopic urine samples for comparisons; in seven patients, the voided urine sample yielded a more definitive diagnosis; in 10 patients, the cystoscopic urine sample yielded a more definitive diagnosis; and, in 11 patients, both samples were equally diagnostic (p > .05). CONCLUSIONS The characteristics and sensitivity of urine cytology in bladder diverticula were investigated in association with neoplasia, with an emphasis on primary intradiverticular bladder cancer. The results indicated that urine cytology remains a reliable screening and diagnostic test for detecting IDBC, with sensitivity similar to that for detecting EDBC, and no significant difference was noted between voided and cystoscopic samples.
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Affiliation(s)
- Mohamed Alhamar
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering, New York, New York, USA
| | - Hikmat A Al-Ahmadie
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering, New York, New York, USA
| | - Rusmir Feratovic
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering, New York, New York, USA
| | - Oscar Lin
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering, New York, New York, USA
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2
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Tashiro Y, Teishima J, Sakata H, Mita Y, Yao A, Nakamura I. Ureteral obstruction following transurethral resection of bladder cancer within the Hutch's diverticulum. Int Cancer Conf J 2024; 13:45-48. [PMID: 38187182 PMCID: PMC10764662 DOI: 10.1007/s13691-023-00634-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/07/2023] [Indexed: 01/09/2024] Open
Abstract
Here, we report a rare case of bladder cancer within the left congenital periureteral diverticulum, termed the Hutch's diverticulum. Following transurethral resection of the bladder tumor, repeated pyelonephritis was caused by stricture of the diverticulum orifice and ureter. We attempted transurethral dilation and ureteral stenting, but the obstruction did not improve. The patient's renal dysfunction showed gradual progression due to recurrent left pyelonephritis as well as the ureteral obstruction. Therefore, we finally performed a partial cystectomy, involving stricture and ureteral reimplantation. No tumor recurrence was observed over 39 months, and renal dysfunction did not progress following partial cystectomy.
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Affiliation(s)
- Yuki Tashiro
- Department of Urology, Kobe City Hospital Organization Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
| | - Jun Teishima
- Department of Urology, Kobe City Hospital Organization Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
- Division of Urology, Department of Surgery Related, Kobe University Graduated School of Medicine, Kobe, Japan
| | - Hiroyuki Sakata
- Department of Urology, Kobe City Hospital Organization Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
| | - Yoshie Mita
- Department of Urology, Kobe City Hospital Organization Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
| | - Akihisa Yao
- Department of Urology, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | - Ichiro Nakamura
- Department of Urology, Kobe City Hospital Organization Kobe City Medical Center West Hospital, 2-4 Ichibancho, Nagata-ku, Kobe, 653-0013 Japan
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3
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Kwentoh I, Henry T. Look Beyond Syncope: A Positive Outcome in the Management of Multiple Bladder Diverticuli-Associated Enterococcus faecium Urinary Tract Infection. Cureus 2023; 15:e42361. [PMID: 37525864 PMCID: PMC10387183 DOI: 10.7759/cureus.42361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/02/2023] Open
Abstract
Enterococcus faecium is a Gram-positive flora bacterium home to the gastrointestinal tracts of humans. A true ubiquitous pathogen and a member of the intestinal microbiome, formerly known as group D streptococci, this pathogen has been around for over 10 centuries. Enterococcus faecium thrives in the presence of stool and sewage. The ability to cause endocarditis and urinary tract infections (UTIs) has led to morbidity and mortality in the adult population. We report a case of an elderly woman who presented with multiple falls to our trauma bay area. She was initially managed as trauma during multiple visits with superficial scalp lacerations. However, with multiple falls, she was subsequently transferred to medicine to rule out cardiogenic versus neurogenic syncope. She was admitted to the telemetry unit, and a cardiologist was consulted. Orthostatic vitals were negative, and she had no fever or leukocytosis. Abdominal computed tomography (CT) done as part of the standard trauma workup revealed an interesting finding of multiple bladder diverticula.
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Affiliation(s)
- Ifeoma Kwentoh
- Medicine, Columbia University, New York, USA
- Internal Medicine, Harlem Hospital Center, New York, USA
| | - Terrence Henry
- Internal Medicine, Harlem Hospital Center, New York, USA
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4
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Aron M, Zhou M. Urothelial Carcinoma: Update on Staging and Reporting, and Pathologic Changes Following Neoadjuvant Chemotherapies. Surg Pathol Clin 2022; 15:661-679. [PMID: 36344182 DOI: 10.1016/j.path.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Staging and reporting of cancers of the urinary tract have undergone major changes in the past decade to meet the needs for improved patient management. Substantial progress has been made. There, however, remain issues that require further clarity, including the substaging of pT1 tumors, grading and reporting of tumors with grade heterogeneity, and following NAC. Multi-institutional collaborative studies with prospective data will further inform the accurate diagnosis, staging, and reporting of these tumors, and in conjunction with genomic data will ultimately contribute to precision and personalized patient management.
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Affiliation(s)
- Manju Aron
- Department of Pathology, Keck School of Medicine, University of Southern California; Department of Urology, Keck School of Medicine, University of Southern California.
| | - Ming Zhou
- Department of Anatomic and Clinical Pathology, Tufts University School of Medicine and Tufts Medical Center, 800 Washington St., Box 802, Boston, MA 02111
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5
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Huan J, Grivas P, Birch J, Hansel DE. Emerging Roles for Mammalian Target of Rapamycin (mTOR) Complexes in Bladder Cancer Progression and Therapy. Cancers (Basel) 2022; 14:1555. [PMID: 35326708 PMCID: PMC8946148 DOI: 10.3390/cancers14061555] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 12/15/2022] Open
Abstract
The mammalian target of rapamycin (mTOR) pathway regulates important cellular functions. Aberrant activation of this pathway, either through upstream activation by growth factors, loss of inhibitory controls, or molecular alterations, can enhance cancer growth and progression. Bladder cancer shows high levels of mTOR activity in approximately 70% of urothelial carcinomas, suggesting a key role for this pathway in this cancer. mTOR signaling initiates through upstream activation of phosphatidylinositol 3 kinase (PI3K) and protein kinase B (AKT) and results in activation of either mTOR complex 1 (mTORC1) or mTOR complex 2 (mTORC2). While these complexes share several key protein components, unique differences in their complex composition dramatically alter the function and downstream cellular targets of mTOR activity. While significant work has gone into analysis of molecular alterations of the mTOR pathway in bladder cancer, this has not yielded significant benefit in mTOR-targeted therapy approaches in urothelial carcinoma to date. New discoveries regarding signaling convergence onto mTOR complexes in bladder cancer could yield unique insights the biology and targeting of this aggressive disease. In this review, we highlight the functional significance of mTOR signaling in urothelial carcinoma and its potential impact on future therapy implications.
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Affiliation(s)
- Jianya Huan
- Department of Pathology & Laboratory Medicine, Oregon Health & Science University, Portland, OR 97239, USA; (J.H.); (J.B.)
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA 98195, USA;
| | - Jasmine Birch
- Department of Pathology & Laboratory Medicine, Oregon Health & Science University, Portland, OR 97239, USA; (J.H.); (J.B.)
| | - Donna E. Hansel
- Department of Pathology & Laboratory Medicine, Oregon Health & Science University, Portland, OR 97239, USA; (J.H.); (J.B.)
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Niimi F, Danno T, Iwata S, Honda S, Itagaki S, Azuma T. Submucosal urothelial bladder cancer: A case report. Mol Clin Oncol 2021; 14:77. [PMID: 33680465 DOI: 10.3892/mco.2021.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 02/09/2021] [Indexed: 11/06/2022] Open
Abstract
Bladder tumors can be broadly divided into those of epithelial or mesodermal origin. Furthermore, 90% of bladder tumors arise from the epithelium of the bladder, and most cases of bladder cancer are histologically urothelial carcinomas. Mesodermal tumors are exceptionally rare and often benign. Of the mesenchymal tumors of the bladder, leiomyomas are the most common, and their prognosis depends on their histology. The present report describes a case of submucosal urothelial cancer in a patient with no past history of bladder cancer. To the best of our knowledge, there are no previous reports of urothelial cancer occurring in the submucosa. The present report was the first to document a case of submucosal urothelial cancer, whose diagnosis was made possible only by transurethral resection of bladder tumor. Although the precise pathomechanism of the present case was unclear, two hypotheses were considered. First, the urothelial cancer developed within a diverticulum, then the entrance of the diverticulum closed, sealing in the cancer. Second, the bladder cancer stemmed from aberrant urothelium in the submucosal tissue. If submucosal urothelial bladder carcinoma develops within the diverticular environment, its prognosis can be as poor as that of invasive bladder cancer due to the features of the diverticular environment. Even in a patient with a submucosal bladder tumor but no previous history of bladder cancer, bladder cancer should be considered in the differential diagnosis.
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Affiliation(s)
- Fusako Niimi
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo 183-0042, Japan
| | - Tetsuya Danno
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo 183-0042, Japan
| | - Shohei Iwata
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo 183-0042, Japan
| | - Sachi Honda
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo 183-0042, Japan
| | - Shingo Itagaki
- Department of Pathology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo 183-0042, Japan
| | - Takeshi Azuma
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo 183-0042, Japan
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7
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Voskuilen CS, Seiler R, Rink M, Poyet C, Noon AP, Roghmann F, Necchi A, Aziz A, Lavollé A, Young MJ, Marks P, Saba K, van Rhijn BW, Fransen van de Putte EE, Ablat J, Black PC, Sosnowski R, Dobruch J, Kumar P, Jallad S, Catto JW, Xylinas E, Hendricksen K. Urothelial Carcinoma in Bladder Diverticula: A Multicenter Analysis of Characteristics and Clinical Outcomes. Eur Urol Focus 2020; 6:1226-1232. [DOI: 10.1016/j.euf.2018.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/27/2018] [Accepted: 12/04/2018] [Indexed: 02/07/2023]
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8
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Tan MO, Yam WL, Tan YK, Chia SJ, Ng KS. A Rare Case of Acute Urinary Bladder Diverticulitis Mimicking Acute Appendicitis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925236. [PMID: 32780730 PMCID: PMC7440753 DOI: 10.12659/ajcr.925236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patient: Male, 52-year-old Final Diagnosis: Urinary bladder diverticulitis Symptoms: Right iliac fossa pain Medication: — Clinical Procedure: Computed tomography • cystoscopy Specialty: Urology
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Affiliation(s)
- Min-On Tan
- Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - Wai Loon Yam
- Department of Urology, Changi General Hospital, Singapore, Singapore
| | - Yung Khan Tan
- Urohealth Medical Clinic, Mount Elizabeth Novena Specialist Centre, Singapore, Singapore
| | - Sing Joo Chia
- ML've Urocare Center, Mount Elizabeth Novena Hospital, Singapore, Singapore
| | - Keng Sin Ng
- Department of Radiology, Mount Alvernia Hospital, Singapore, Singapore
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9
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Cornejo KM, Rice-Stitt T, Wu CL. Updates in Staging and Reporting of Genitourinary Malignancies. Arch Pathol Lab Med 2020; 144:305-319. [PMID: 32101056 DOI: 10.5858/arpa.2019-0544-ra] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The 8th edition of the American Joint Committee on Cancer (AJCC) staging manual changed the tumor, node, metastasis (TNM) classification systems of genitourinary malignancies in 2017. However, some of the changes appear not well appreciated or recognized by practicing pathologists. OBJECTIVE.— To review the major changes compared with the 7th edition in cancers of the prostate, penis, testis, bladder, urethra, renal pelvis/ureter, and kidney and discuss the challenges that pathologists may encounter. DATA SOURCES.— Peer-reviewed publications and the 8th and 7th editions of the AJCC Cancer Staging Manual. CONCLUSIONS.— This article summarizes the updated staging of genitourinary malignancies, specifically highlighting changes from the 7th edition that are relevant to the pathologic staging system. Pathologists should be aware of the updates made in hopes of providing clarification and the remaining diagnostic challenges associated with these changes.
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Affiliation(s)
- Kristine M Cornejo
- From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Travis Rice-Stitt
- From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chin-Lee Wu
- From the Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Kang Q, Kang B, Yu Y, Yang B. Transurethral enucleation of the prostate combined with laparoscopic bladder diverticulectomy. MINIM INVASIV THER 2020; 31:144-148. [PMID: 32432482 DOI: 10.1080/13645706.2020.1768123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: We present a one-session procedure for treating bladder diverticula combined with benign prostatic hyperplasia (BPH).Material and methods: Between January 2015 and April 2019, transurethral plasmakinetic enucleation of the prostate (TUEP) followed by laparoscopic bladder diverticulectomy (LD) were performed in 12 patients at our institution, in four of them combined with bladder stone(s) and in one patient combined with diverticular tumor. Clinical data were retrospectively collected.Results: The mean size of the prostate was 137.3 ± 96.3 (65.5-403.3) ml. The mean maximal diameter of the diverticulum was 8.0 ± 2.7 (3.2-12.0) cm. The mean total operation time was 214.2 ± 69.0 (120-300) min, and the mean enucleation time was 23.2 ± 6.4 (12-35) min. The mean intraoperative blood loss was 52.1 ± 14.9 (30-80) ml. The average pre- and post-operative maximum flow rate was 5.1 ± 1.4 (2.4-8.5) ml/s and 12.8 ± 2.3 (9.6-17.1) ml/s. Except for urinary infection in one patient, no other severe peri- or postoperative complications were observed.Conclusions: TUEP accompanied by LD in one session provides an effective and minimally invasive surgical treatment for bladder diverticula combined with BPH, with or without bladder stones, and permits reasonable operation time and rapid discharge.
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Affiliation(s)
- Qianyu Kang
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Bin Kang
- Department of General Surgery, the Third People's Hospital of Ningxia, Yinchuan, China
| | - Yang Yu
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Bo Yang
- Department of Urology, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
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11
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Dataset for the reporting of carcinoma of the bladder-cystectomy, cystoprostatectomy and diverticulectomy specimens: recommendations from the International Collaboration on Cancer Reporting (ICCR). Virchows Arch 2020; 476:521-534. [PMID: 31915958 DOI: 10.1007/s00428-019-02727-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022]
Abstract
The International Collaboration on Cancer Reporting (ICCR) is a not for profit organisation whose goal is to produce standardised internationally agreed and evidence-based datasets for pathology reporting. With input from pathologists worldwide, the datasets are intended to be uniform and structured. They include all items necessary for an objective and accurate pathology report which enables clinicians to apply the best treatment for the patient. This dataset has had input from a multidisciplinary ICCR expert panel. The rationale for some items being required and others recommended is explained, based on the latest literature. The dataset incorporates data from the World Health Organization (WHO) 2016, and also from the latest (8th edition) TNM staging system of the American Joint Committee on Cancer (AJCC). Fifteen required elements and eight recommended items are described. This dataset provides all the details for a precise and valuable pathology report required for patient management and prognostication. This dataset is intended for worldwide use, and should facilitate the collection of standardised comparable data on bladder carcinoma at an international level.
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12
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Park S, Reuter VE, Hansel DE. Non-urothelial carcinomas of the bladder. Histopathology 2019; 74:97-111. [PMID: 30565306 DOI: 10.1111/his.13719] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 07/30/2018] [Indexed: 12/29/2022]
Abstract
Non-urothelial carcinomas involving the bladder are uncommon and often diagnostically challenging. These carcinomas may show squamous, adenocarcinomatous or neuroendocrine features, with immunohistochemical stains aiding the diagnosis in only a subset of cases. The clinical history in non-urothelial bladder carcinomas is important, given that the differential diagnosis often includes secondary involvement of the bladder by direct extension or metastasis from carcinomas at other sites. This paper will review non-urothelial carcinomas in each of these three morphological categories, emphasising recent changes in diagnostic grouping and challenges in the histopathological diagnosis. Review of bladder cancers with squamous morphology will include discussion of conventional squamous cell carcinoma and verrucous carcinoma and their distinction from urothelial carcinoma with extensive squamous differentiation. Bladder carcinomas with adenocarcinomatous change will include primary bladder adenocarcinoma, urachal adenocarcinoma and tumours of Müllerian type. Finally, neuroendocrine neoplasms of the bladder, including well-differentiated neuroendocrine tumour and neuroendocrine carcinomas, will be discussed. Associated surface findings, risk factors and prognostic features will be described.
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Affiliation(s)
- Sanghui Park
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Institute, New York, NY
| | - Donna E Hansel
- Department of Pathology, University of California at San Diego, La Jolla, CA, USA
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13
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Magers MJ, Lopez-Beltran A, Montironi R, Williamson SR, Kaimakliotis HZ, Cheng L. Staging of bladder cancer. Histopathology 2019; 74:112-134. [PMID: 30565300 DOI: 10.1111/his.13734] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Abstract
Urothelial carcinoma of the urinary bladder is a heterogeneous disease with multiple possible treatment modalities and a wide spectrum of clinical outcome. Treatment decisions and prognostic expectations hinge on accurate and precise staging, and the recently published American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition, should be the basis for staging of urinary bladder tumours. It is unfortunate that the International Union Against Cancer (UICC) 8th edition failed to incorporate new data which is considered in the AJCC 8th edition. Thus, the AJCC 8th edition is the focus of this review. Several critical changes and clarifications are made by the AJCC 8th edition relative to the 7th edition. Although the most obvious changes in the 8th edition are in the N (i.e. perivesical lymph node involvement now classified as N1) and M (i.e. M1 is subdivided into M1a and M1b) categories, several points are clarified in the T category (e.g. substaging of pT1 should be attempted). Further optimisation, however, is required. No particular method of substaging pT1 is formally recommended. In this review, these modifications are discussed, as well as points, which require further study and optimisation.
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Affiliation(s)
- Martin J Magers
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Antonio Lopez-Beltran
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Cordoba, Spain
| | - Rodolfo Montironi
- Faculty of Medicine, Department of Surgery, Unit of Anatomical Pathology, Cordoba, Spain.,Champalimaud Clinical Center, Lisbon, Portugal
| | - Sean R Williamson
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy.,Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
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14
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Gallan AJ, Choy B, Paner GP. Contemporary Grading and Staging of Urothelial Neoplasms of the Urinary Bladder: New Concepts and Approaches to Challenging Scenarios. Surg Pathol Clin 2018; 11:775-795. [PMID: 30447841 DOI: 10.1016/j.path.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Grading and staging of urothelial neoplasm are the most crucial factors in risk stratification and management; both necessitate optimal accuracy and consistency. Several updates and recommendations have been provided though recent publications of the 4th edition of the World Health Organization classification, the 8th edition of the American Joint Committee on Cancer staging system, and the International Consultation on Urological Diseases-European Association of Urology updates on bladder cancer. Updates and recent studies have provided better insights into and approaches to the challenging scenarios in grading and staging of urothelial neoplasm; however, there remain aspects that need further investigation and refinement.
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Affiliation(s)
- Alexander J Gallan
- Department of Pathology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA
| | - Bonnie Choy
- Department of Pathology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA
| | - Gladell P Paner
- Department of Pathology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA; Department of Surgery, Section of Urology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA.
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15
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Wang G, McKenney JK. Urinary Bladder Pathology: World Health Organization Classification and American Joint Committee on Cancer Staging Update. Arch Pathol Lab Med 2018; 143:571-577. [DOI: 10.5858/arpa.2017-0539-ra] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Since the publication of the previous World Health Organization (WHO) Classification of Tumours on the Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs in 2004, significant new knowledge has been generated regarding the pathology and genetics of bladder neoplasia. Publication of the 2016 WHO “Blue Book” has codified that new data into updated recommendations for classification and prognostication. Similarly, the recent release of the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, which was implemented in January 2018, has also addressed staging criteria for bladder cancer in several unique settings to clarify their application.
Objective.—
To highlight subtle changes within the recent WHO and AJCC publications that may affect daily surgical pathology practice.
Data Sources.—
Peer-reviewed published literature, the 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs, and the 8th edition of the AJCC Cancer Staging Manual were reviewed.
Conclusions.—
Selected changes and/or clarifications are discussed and include classification of flat and papillary urothelial neoplasia, select variant patterns of invasive urothelial carcinoma, staging of invasive carcinoma in bladder diverticula, and staging of carcinomas involving the prostate gland.
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Affiliation(s)
- Gang Wang
- From the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Wang); and the Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio (Dr McKenney)
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16
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Paner GP, Stadler WM, Hansel DE, Montironi R, Lin DW, Amin MB. Updates in the Eighth Edition of the Tumor-Node-Metastasis Staging Classification for Urologic Cancers. Eur Urol 2018; 73:560-569. [DOI: 10.1016/j.eururo.2017.12.018] [Citation(s) in RCA: 285] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/14/2017] [Indexed: 12/23/2022]
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Wang G, Huang H, Kamat AM, Siefker-Radtke A, Dinney CP, Troncoso P, Czerniak B, Guo CC. High-grade neuroendocrine carcinoma of the urachus-report of 3 cases. Hum Pathol 2017; 67:126-133. [PMID: 28823575 DOI: 10.1016/j.humpath.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/24/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
Abstract
Most urachal malignancies are composed of pure adenocarcinoma with mucin production. Urachal neuroendocrine carcinoma (NEC) is extremely rare, with only a few cases reported in the literature. Here we report 3 cases of urachal NEC, the largest series of this rare disease from a single institution. The patients were young, with a mean age of 27 years (range, 23-34). The urachal tumors showed 2 distinct components: high-grade NEC and enteric-type adenocarcinoma. The urachal NECs were composed of small cell carcinoma (n=2) or large cell NEC (n=1). The subsequent resection specimens showed that all the tumors were at advanced Sheldon stages. All 3 patients developed metastases, which were composed of NEC exclusively. Two patients died from disease in 10 and 31 months, respectively, and the third patient was alive with widespread metastases at 21 months. Our findings suggest that urachal NEC is an aggressive variant with an overwhelming growth advantage over conventional adenocarcinoma. The presence of high-grade NEC in the urachus is associated with poor prognosis.
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Affiliation(s)
- Gang Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - He Huang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Arlene Siefker-Radtke
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Colin P Dinney
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Patricia Troncoso
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Bogdan Czerniak
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Charles C Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Challenges in Pathologic Staging of Bladder Cancer: Proposals for Fresh Approaches of Assessing Pathologic Stage in Light of Recent Studies and Observations Pertaining to Bladder Histoanatomic Variances. Adv Anat Pathol 2017; 24:113-127. [PMID: 28398951 DOI: 10.1097/pap.0000000000000152] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The paradigm of pathologic stage (pT) categorization in bladder cancer remains the depth of invasion into the different histologic layers of the bladder wall. However, the approaches to assigning pT stage category toward an enhanced outcome stratification have been marked by challenges and innovations, due in part to our growing appreciation of the surprisingly perplexing bladder histoanatomy. Upstaging of pT1 tumors after radical cystectomy is substantial and underscores the potential value of pT1 substaging in transurethral resection (TUR) specimens. The 2017 American Joint Committee on Cancer tumor-node-metastasis system recommends pT1 substaging but recognizes the need to optimize the approach. Over the years, the cut-off for microinvasion has been significantly lowered to 0.5 mm and is now a promising scheme for pT1 (micrometric) substaging. Unlike the micrometric approach, histoanatomic substaging using muscularis mucosae (MM) and vascular plexus as landmarks is less feasible in TUR specimens and inconsistent in stratifying the outcome of pT1 tumors. The lamina propria possesses inherent variations in depth, MM, and vascular plexus dispositions that should be factored in future pT1 substaging proposals. Histoanatomic variations among the bladder regions also occur, and studies suggest that trigone and bladder neck cancers may have more adverse outcomes. The muscularis propria (MP), besides being the essential histologic landmark for assigning pT2 stage category, is also considered a surrogate for the adequacy of TUR, furthering the importance of identifying its presence in TUR specimens. MP, however, may be mimicked by hyperplastic or isolated MP-like MM muscle bundles in the lamina propria with overstaging implications, and caution should be exercised in distinguishing these 2 muscle types morphologically and immunohistochemically. Presence of additional superficial MP unique from the detrusor muscle proper may also complicate staging at the trigone and ureter insertion sites. With regard to the depth of MP invasion, large and multicenter studies have reaffirmed the prognostic significance of pT2a/b subcategories. It is revealed that there are at least 3 ways used to demarcate the irregular MP to perivesical soft tissue junction, and use of a common criterion indicates improvement in pT2b/pT3a staging reproducibility. Although studies have shown significantly poorer outcome in pT3b compared with pT3a tumors, this designation has a substantial reliance on the prosector's gross assessment of perivesical soft tissue invasion which if performed incorrectly may lead to staging inaccuracy of pT3 tumors. The 8th edition of the American Joint Committee on Cancer has updated the staging schema for bladder cancers with concomitant prostatic stromal invasion and cancers within bladder diverticula. Because of 2 possible pT designations, prostatic stromal invasion in TUR specimens should not be automatically staged as either pT4a or pT2 (urethral). Recent data support that bladder cancer invading into the seminal vesicle has comparable outcome to pT4b tumors. Interestingly, several studies in pT4a tumors, which are staged based on sex-specific organs, have shown poorer outcome in females than males after radical cystectomy, and while there are possibly several reasons, they may also include anatomic factors. Despite the progress has been made, work remains to be done to inform future bladder cancer pT category definitions and their reproducibility in application and prognostication.
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Diverticulectomy in the Management of Intradiverticular Bladder Tumors: A Twelve-Year Experience at a Single Institution. Adv Urol 2016; 2016:2345306. [PMID: 27066072 PMCID: PMC4811051 DOI: 10.1155/2016/2345306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/28/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose. In this retrospective case review we analyze the outcomes of patients treated for intradiverticular bladder tumors (IDT). Materials and Methods. A retrospective case review was done between January 2002 and May 2014 in Hotel-Dieu de France hospital. The series included 17 patients diagnosed with IDT, all males with a mean age of 49.8 years. Results. One patient was treated with tumor resection and adjuvant BCG instillation with no recurrence on follow-up cystoscopies and urine cytologies. 64% of patients were treated by diverticulectomy. Mean follow-up time was 38.7 months. At the end of the follow-up, 81% were disease-free. One patient had a radical cystectomy 6 months after diverticulectomy for recurrent high grade tumor; another one had a nodal metastasis 10 months after diverticulectomy and was managed with chemotherapy. 29% of patients were treated with radical cystectomy. Mean follow-up time was 28.4 months. No recurrence was documented on annual CT scans. Conclusions. Our data support a conservative approach for tumors confined to the bladder diverticulum, even in high grade or in the presence of CIS provided complete removal is feasible and close follow-up is ensured.
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Legros L, Revencu N, Nassogne MC, Wese FX, Feyaerts A. [Multiple bladder diverticula caused by occipital horn syndrome]. Arch Pediatr 2015; 22:1147-50. [PMID: 26386812 DOI: 10.1016/j.arcped.2015.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 11/18/2014] [Accepted: 07/30/2015] [Indexed: 12/17/2022]
Abstract
We report on the case of a child who presented with recurrent, multiple, and voluminous bladder diverticula. Bladder diverticula are defined as a herniation of the mucosa through the bladder muscle or the detrusor. Causes are numerous and diverticula can be classified into primary congenital diverticula (para-ureteral - or Hutch diverticula - and posterolateral diverticula); secondary diverticula (resulting from chronic mechanical obstruction or from neurological disease; and diverticula secondary to connective tissue or muscle fragility. The latter is seen in disease entities such as prune belly syndrome, Ehlers-Danlos syndrome, cutis laxa syndrome, OHS (occipital horn syndrome), Menkes disease, and Williams-Beuren syndrome. In this patient, the cause of these diverticula was OHS, a genetic, recessive X-chromosome-linked syndrome, responsible for abnormal tissue caused by a disorder in copper metabolism. This case reminds us of the importance of pushing the diagnostic workup when presented with multiple and/or large bladder diverticula, and in particular to search for rare malformation syndromes after exclusion of an obstacle.
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Affiliation(s)
- L Legros
- Service d'urologie, cliniques universitaires Saint-Luc, Bruxelles, Belgique
| | - N Revencu
- Centre de génétique humaine, cliniques universitaires Saint-Luc, Bruxelles, Belgique
| | - M-C Nassogne
- Service de neurologie pédiatrique, cliniques universitaires Saint-Luc, Bruxelles, Belgique
| | - F-X Wese
- Service d'urologie, cliniques universitaires Saint-Luc, Bruxelles, Belgique
| | - A Feyaerts
- Service d'urologie, cliniques universitaires Saint-Luc, Bruxelles, Belgique.
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Elands S, Vasdev N, Tay A, Adshead JM. Robot-Assisted Laparoscopic Bladder Diverticulectomy and Ureteral Re-Implantation for a Diverticulum Containing High Grade Transitional Cell Carcinoma. Curr Urol 2015; 8:104-8. [PMID: 26889127 DOI: 10.1159/000365699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 10/23/2014] [Indexed: 12/30/2022] Open
Abstract
We present a case of an 84-year-old man presenting with painless visible hematuria. Further investigation revealed a primary G3pT1 transitional cell carcinoma confined to a bladder diverticulum. In view of bladder-sparing therapy, he underwent a robot-assisted laparoscopic bladder diverticulectomy with ureteral re-implantation. This report demonstrates a minimally invasive approach offering radical treatment without having to recur to partial or radical cystectomy. We discuss the operative steps, the significance of this case with a review of the literature, and the future potential this may represent for the treatment of tumor-containing bladder diverticula.
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Affiliation(s)
- Sophie Elands
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Nikhil Vasdev
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - Andrea Tay
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
| | - James M Adshead
- Hertfordshire and South Bedfordshire Robotic Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK
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Hu B, Satkunasivam R, Schuckman A, Miranda G, Cai J, Daneshmand S. Urothelial carcinoma in bladder diverticula: outcomes after radical cystectomy. World J Urol 2014; 33:1397-402. [DOI: 10.1007/s00345-014-1472-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022] Open
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Zhong H, George S, Kauffman E, Guru K, Azabdaftari G, Xu B. Clinicopathologic characterization of intradiverticular carcinoma of urinary bladder - a study of 22 cases from a single cancer center. Diagn Pathol 2014; 9:222. [PMID: 25425482 PMCID: PMC4254201 DOI: 10.1186/s13000-014-0222-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 11/10/2014] [Indexed: 12/12/2022] Open
Abstract
Background To examine histopathologic features and clinical outcomes of intradiverticular bladder carcinomas. Methods Twenty-two consecutive patients with intradiverticular bladder carcinoma treated with either endoscopic transurethral resection or partial or radical cystectomy at a single institution between years of 1995 to 2011. Clinicopathologic characteristics and oncologic outcomes of patients were retrospectively analyzed, including tissue histology re-review by genitourinary pathologists. Results Histologically, 9 cases (41%) were non-invasive papillary urothelial carcinoma, 13 cases (59%) were invasive urothelial carcinoma, including three cases of small cell carcinoma. Final pathology revealed synchronous extradiverticular urothelial carcinomas in 6 out of 9 cases (67%) of non-invasive and 2 out of 10 cases (20%) invasive intradiverticular urothelial carcinoma, respectively. More than half of cases (13/22, 59%) showed a distinctive hypertrophic layer of muscularis mucosae. There was no statistical difference in disease free survival or overall survival between non-invasive and invasive tumors within approximately 3 years of follow up (mean 38 months, median 32 months). While stage T3 patients generally did poorly, oncologic outcomes for stage T1 patients were no different than those of stage Ta. Conclusion Intradiverticular carcinomas are often associated with a hypertrophic layer of muscularis mucosae that can potentially confound tumor staging. Non-invasive intradiverticular urothelial carcinomas are more likely to have coexisting synchronous extradiverticular lesions. The absence of a muscularis propria layer may not necessarily predispose T1 tumors to more aggressive disease. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_222
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Affiliation(s)
- Hua Zhong
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA. .,Current address: Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School, UMDNJ, One Robert Wood Johnson Place - MEB 212, New Brunswick, NJ, 08901, USA.
| | - Saby George
- Department of Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | - Eric Kauffman
- Department of Urology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | - Khurshid Guru
- Department of Urology, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | - Gissou Azabdaftari
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | - Bo Xu
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
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Intradiverticular bladder cancer: CT imaging features and their association with clinical outcomes. Clin Imaging 2014; 39:94-8. [PMID: 25457532 DOI: 10.1016/j.clinimag.2014.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 09/12/2014] [Accepted: 10/09/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate if computed tomographic (CT) features of intradiverticular bladder cancer can predict clinical outcome. METHODS Retrospective study of 34 patients with intradiverticular bladder cancer. Two radiologists independently evaluated all CT exams. RESULTS CT tumor length and width were significantly associated with survival for both readers [hazard ratios (HRs) 1.31-1.62, P<.001-.043]. No other tumor features were significantly associated with survival. The interreader agreement for the assessment of CT features was fair to substantial (k=0.34-0.78, concordance correlation coefficient=0.56-0.66). There was no association between transurethral resection pathology stage and survival (HR 2.10, P=.21). CONCLUSIONS In patients with intradiverticular bladder cancer, the tumor length and width measured on the pretreatment CT predicted survival.
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26
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Tudor J, Cantley RL, Jain S. Primary small cell carcinoma arising from a bladder diverticulum. J Urol 2014; 192:236-7. [PMID: 24747653 DOI: 10.1016/j.juro.2014.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- James Tudor
- University of Toledo School of Medicine, Toledo, Ohio
| | - Richard L Cantley
- Department of Pathology, University of Toledo Medical Center, Toledo, Ohio
| | - Samay Jain
- Department of Urology, University of Toledo Medical Center, Toledo, Ohio
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28
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The spectrum of histopathologic findings in vesical diverticulum: implications for pathogenesis and staging. Hum Pathol 2013; 44:1223-32. [DOI: 10.1016/j.humpath.2012.11.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 11/19/2012] [Accepted: 11/21/2012] [Indexed: 11/19/2022]
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29
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Kong MX, Zhao X, Kheterpal E, Lee P, Taneja S, Lepor H, Melamed J, Deng FM. Histopathologic and Clinical Features of Vesical Diverticula. Urology 2013; 82:142-7. [DOI: 10.1016/j.urology.2013.02.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 01/28/2013] [Accepted: 02/09/2013] [Indexed: 10/27/2022]
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Transitional Cell Carcinoma within a Portion of Inguinally Herniated Bladder. Case Rep Urol 2013; 2013:610312. [PMID: 23781387 PMCID: PMC3676974 DOI: 10.1155/2013/610312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 05/15/2013] [Indexed: 11/18/2022] Open
Abstract
Bladder herniation within the inguinal canal is a relatively uncommon finding. We report an even less-common occurrence of transitional cell carcinoma located within a portion of inguinally herniated bladder. Fewer than 20 reports exist in the literature describing this scenario.
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Gran divertículo vesical como quiste de ovario en la anciana. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2013. [DOI: 10.1016/j.gine.2012.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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32
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Tumeurs de vessie intradiverticulaires : revue du Comité de cancérologie de l’Association française d’urologie. Prog Urol 2012; 22:495-502. [DOI: 10.1016/j.purol.2012.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/02/2012] [Accepted: 03/26/2012] [Indexed: 11/23/2022]
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Alexander RE, Kum JB, Idrees M. Bladder diverticulum: clinicopathologic spectrum in pediatric patients. Pediatr Dev Pathol 2012; 15:281-5. [PMID: 22416946 DOI: 10.2350/12-02-1154-oa.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Urinary bladder diverticula are a relatively rare finding in both the adult and pediatric population. Their presence in the adult population has long been associated with the development of urothelial carcinoma within the lesion. Our goal is to analyze a relatively large pediatric patient population with urinary bladder diverticula to expand the body of knowledge on the associated clinical symptomatology, congenital syndromes associated with the entity, and treatment methods and to further investigate if there is any reason to suspect malignant transformation within the pediatric population. A search for pediatric patients (0-19 years of age) from 1990 to 2011 revealed 47 patients with 60 diverticula within the specified age range. Clinical records and histologic slides for all cases were pulled for review, and statistical analysis was performed on the results. The most common findings were vesicoureteral reflux (68%), recurrent urinary tract infection (55%), and hydronephrosis (40%). Fourteen of 47 (30%) patients had an associated congenital syndrome/malformation. Diverticular size range was 0.5-10 cm with a mean of 2.56 cm. No patient was found to have overt malignancy or dysplastic changes within the diverticula or bladder at the time of pathologic evaluation. High association with recognizable clinical symptoms and additional urinary tract abnormalities leads to early identification and treatment. A sizable percentage of those found to have bladder diverticula within the pediatric population will have a congenital syndrome. No association with malignancy is seen within pediatric bladder diverticula; it is an extremely unlikely event in these young patients.
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Affiliation(s)
- Riley E Alexander
- Indiana University School of Medicine, Department of Pathology and Laboratory Medicine, Indianapolis, IN, USA.
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Boscolo-Berto R, Lamon C, Gardi M, Vezzaro R, Gardiman M. Recurrent nephrogenic adenoma in bladder diverticulum: Case report and literature review. Can Urol Assoc J 2012; 6:E34-7. [PMID: 22511428 DOI: 10.5489/cuaj.10140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Nephrogenic adenoma is an uncommon benign lesion of the urinary tract induced by chronic irritation of the vesical mucosa, due to infection, trauma, surgery, calculi, foreign bodies and chemical agents. A 68-year-old male was admitted to our linic for a periodical cystoscopic evaluation as part of a follow-up initiated due to a past transitional cell carcinoma. The scheduled cystoscopy revealed, within a bladder diverticulum, an unexpected and completely asymptomatic nephrogenic adenoma that we removed by transurethral resection. We followed up the patient at 24 months, then later we made the diagnosis of nephrogenic adenoma. During this time, the patient experienced three relapses within the same diverticulum, always involving a nephrogenic adenoma we persistently treated by transurethral resections. As the nephrogenic adenoma is considered a benign lesion without any direct evidence of a possible evolution to an overt cancer, we successful attempted a half-yearly cystoscopic follow-up to control the growth of a highly recurrent benign entity, interposing between controls a periodical imaging. This paper represents the second report of a nephrogenic adenoma within a bladder diverticulum, but the first case of a nephrogenic adenoma highly recurrent within the same diverticulum and managed conservatively by regular transurethral resection scheduled over the time.
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Affiliation(s)
- Rafael Boscolo-Berto
- Department of Environmental Medicine and Public Health, Section of Legal Medicine and Forensic Pathology, University of Padova, Italy; Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Italy
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35
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Urothelial carcinoma associated with a blind-ending bifid ureter. Int Cancer Conf J 2012. [DOI: 10.1007/s13691-012-0028-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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37
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Hansel DE, Paner GP, Nese N, Amin MB. Limited smoothelin expression within the muscularis mucosae: validation in bladder diverticula. Hum Pathol 2011; 42:1770-6. [DOI: 10.1016/j.humpath.2011.02.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 02/03/2011] [Accepted: 02/11/2011] [Indexed: 11/30/2022]
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38
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Cauliflower Urinary Bladder Caused by Multiple Diverticula. Am J Med Sci 2011; 341:410. [DOI: 10.1097/maj.0b013e3181e9559d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Grubišić I, Leniček T, Tomas D, Džombeta T, Trnski D, Tomašković I, Krušlin B. Primary osteosarcoma of bladder diverticulum mimicking intradiverticular calculus: a case report. Diagn Pathol 2011; 6:37. [PMID: 21496355 PMCID: PMC3086856 DOI: 10.1186/1746-1596-6-37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 04/18/2011] [Indexed: 11/30/2022] Open
Abstract
There is a well-documented relationship between urinary bladder diverticula and intradiverticular neoplasms. The great majorities of these tumors are urothelial carcinomas, but may also be of glandular or squamous type. Sarcomas occurring within bladder diverticula are exceptionally rare and highly malignant lesions, with only 20 well documented cases published in the literature to date (including carcinosarcomas). We report a case of osteosarcoma of the bladder diverticulum in a 68-year old man, which clinically mimicked intradiverticular calculus. To our knowledge, this is the second case described in the literature to date, and the first in English literature.
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Affiliation(s)
- Igor Grubišić
- Ljudevit Jurak Department of Pathology, Sestre milosrdnice University Hospital, Zagreb, Croatia
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40
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Tortorelli AP, Rosa F, Papa V, Alfieri S, Doglietto GB. Giant bladder diverticulum. Updates Surg 2011; 63:63-6. [PMID: 21229344 DOI: 10.1007/s13304-010-0042-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 12/30/2010] [Indexed: 11/25/2022]
Abstract
We present the case of a 73-year-old man affected by progressive and painful abdominal distension and paresthesia/hypoesthesia at the left leg. US and CT-scan revealed the presence in the left retroperitoneum of a large cystic mass without parietal thickening or enhancement after contrast injection. This mass disappeared after positioning a vesical Foley's catheter and a retrograde cystography confirmed the suspected diagnosis of a large bladder diverticulum due to a severe prostatic hypertrophy; the patient underwent an open diverticulectomy and endoscopic prostatic resection. Bladder diverticula can occasionally appear as complex pelvic masses not obviously connected to the bladder, eventually leading to diagnostic confusion; while small size diverticulum resolves with relief of bladder outlet obstruction, open or laparoscopic diverticulectomy is needed in large size diverticulum if symptomatic, even considering the possible tumor harboring.
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Affiliation(s)
- Antonio Pio Tortorelli
- Digestive Surgery, "A. Gemelli" Hospital, Catholic University, Largo A. Gemelli, Rome, Italy
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41
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Lang EK, Rudman E, Hanano A, Jaworsky J. Computerized tomography reveals variable aggressiveness of transitional cell carcinoma of the bladder and bladder diverticulum. J Urol 2010; 183:1190. [PMID: 20096876 DOI: 10.1016/j.juro.2009.12.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Erich K Lang
- Department of Radiology, SUNY Downstate Medical School, Brooklyn, New York, USA
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