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AlHariry NS, El Saftawy EA, Aboulhoda BE, Abozamel AH, Alghamdi MA, Hamoud AE, Khalil Ghanam WAE. Comparison of tissue biomarkers between non-schistosoma and schistosoma-associated urothelial carcinoma. Tissue Cell 2024; 88:102416. [PMID: 38796863 DOI: 10.1016/j.tice.2024.102416] [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: 01/03/2024] [Revised: 04/15/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND High-grade urothelial carcinoma either non-Schistosoma (NS-UBC) or Schistosoma (S-UBC)-associated is the tenth cause of death worldwide and represents a serious therapeutic problem. AIM Evaluation of the immmunohistochemical expression of tumor necrosis factor-alpha (TNFα), epidermal growth factor receptor (EGFR), programmed cell death protein-1 (PDL1), estrogen receptor-alpha (ERα) and UroplakinIII, in the high-grade in NS-UBC and S-UBC as potential prognostic and therapeutic targets analyzed through estimation of area percentage, optical density and international pathological scoring system for each marker. MATERIAL AND METHODS Sixty high grade urothelial carcinoma cases were enrolled in the study (30 cases of NS-UBC and 30 cases of S-UBC). The cases were immunohistochemically-assessed for TNFα, EGFR, PDL1, ERα and Uroplakin III expression. In S-UBC, parasite load was also evaluated for correlation with the immunohistochemical markers' expression in S-UBC. RESULTS The area percentage of immune-expression of TNFα and EGFR was higher in S-UBC compared to NS-UBC. On the other hand, the NS-UBC displayed statistically-higher expression of PDL1 and uroplakinIII (p-value <0.001). ERα revealed higher, yet, non-significant expressions in S-UBC compared to NS-UBC (p-value =0.459). PDL1 expression showed the most superior record regarding area percentage (64.6± 34.5). Regarding optical density, TNF-α showed the highest transmittance expression (2.4 ± 0.9). EGFR positively correlated with PDL1 in S-UBC (r= 0.578, p-value =0.001) whereas in NS-UBC, TNFα and PDL1 (r=0.382, p-value=0.037) had positive correlation. Schistosoma eggs in tissues oppose uroplakin III expression and trigger immunomodulation via PDL1. CONCLUSION Due to lower UroplakinIII expression, S-UBC is supposed to have a poorer prognosis. Hormonal therapy is not hypothesized due to a very minimal ERα expression in both NS-UBC and S-UBC. Regarding immunotherapy, anti-TNF-α is suggested for S-UBC whilst in NS-UBC, blockading PDL1 might be useful. Targeted EGFR therapy seems to carry emphasized outcomes in S-UBC. Correlations encourage combined immune therapy in NS-UBC; nevertheless, in S-UBC, combined anti-EGFR and PDL1 seem to be of benefit.
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Affiliation(s)
| | - Enas A El Saftawy
- Department of Medical Parasitology, Faculty of Medicine, Cairo University, Egypt; Department of Medical Parasitology, Armed Forces College of Medicine, Cairo, Egypt
| | - Basma Emad Aboulhoda
- Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Ahmed H Abozamel
- Department of Urology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mansour A Alghamdi
- Department of Anatomy, College of Medicine, King Khalid University, Abha 62529, Saudi Arabia; Genomics and Personalized Medicine Unit, The Center for Medical and Health Research, King Khalid University, Abha 62529, Saudi Arabia
| | - Amany E Hamoud
- Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Wakui S, Takahashi H, Muto T. In Utero Exposure to 3,3',4,4', 5-Pentachlorobiphenyl Dose-Dependently Induces N-butyl-4-(hydroxybutyl) Nitrosamine in Rats With Urinary Bladder Carcinoma. Toxicol Pathol 2022; 50:366-380. [PMID: 35045775 DOI: 10.1177/01926233211064180] [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: 11/16/2022]
Abstract
Polychlorinated biphenyls (PCBs) are fat-soluble environmental pollutants that can accumulate in adipose tissue or be secreted in milk. N-butyl-4-(hydroxy butyl) (BBN), a rat bladder carcinogen, recruits the host metabolism to yield its ultimate carcinogenic form via CYP1s. Since estrogen receptors (ERs) mediate biological responses important for the growth of bladder carcinoma, we investigated PCNA, Cyclin D1, ERs, CYP1s, and AhR expression in BBN rat bladder carcinomas with prenatal PCB exposure. Female SD rats were treated with 7.5 μg, 250 ng, and 2.5 ng of 3,3',4,4',5-pentachlorobiphenyl (PCB126)/kg or vehicle on days 13 to 19 post-pregnancy. Six-week-old male offspring were treated with 0.05% BBN for 10 weeks before being anesthetized and the urinary bladder wall incised to expose the bladder carcinomas. N-butyl-4-(hydroxybutyl) bladder carcinoma incidence increased with prenatal PCB exposure dose-dependently. In bladder carcinoma, PCB126 exposure significantly increased PCNA, D1, ERα, CYPIA1, CYP1B1, and AhR expression dose-dependently, and increased ERα expression was particularly prominent. However, the expression of ERβ was low, independent of the volume of PCB126 given, indicating similarity to the Vehicle group. We conclude that prenatal PCB126 exposure in rats can induce PCB126 to dose-dependently metabolize BBN via CYP1A1, and contribute to bladder carcinogenesis with upregulation of ERα expression.
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Affiliation(s)
- Shin Wakui
- Laboratory of Toxicology, Azabu University School of Veterinary Medicine, Kanagawa, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan. Muto is now with Kumiai Chemical Industry Co., Ltd. Japan
| | - Tomoko Muto
- Laboratory of Toxicology, Azabu University School of Veterinary Medicine, Kanagawa, Japan
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Hyldgaard JM, Jensen JB. The Inequality of Females in Bladder Cancer. APMIS 2021; 129:694-699. [PMID: 34582047 DOI: 10.1111/apm.13183] [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] [Received: 06/24/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022]
Abstract
Urinary bladder cancer is worldwide one of the most diagnosed and costly types of cancer. One puzzle in the bladder cancer diagnosis is the disproportional relationship between genders. Males are more likely to be diagnosed with bladder cancer whereas females typically are diagnosed with more adverse disease and worse prognosis, which has led to speculation of the potential role of sex hormones and their receptors in this disease. Estrogen receptors are present in the human bladder, and their role in bladder cancer oncogenesis is increasingly becoming a focus for researchers around the world. This mini-review aims to give a brief overview of the status of female bladder cancer, and to which extend the sex hormones receptors play a role in this. A literature search was performed and included all female original studies on bladder cancer and hormone receptors. Estrogen-receptor alpha seems to be anti-oncogenic whereas estrogen-receptor beta is exhibiting its function pro-oncogenic. The receptor functions may be exercised through mRNA transcriptions and enzymes. Epidemiological studies indicate a potential increase in incidence of bladder cancer for females with earlier age at menopause, and clinical trials are investigating Tamoxifen as a potential treatment in bladder cancer. Increasing evidence supports the theory of bladder cancer development and progression as being partly hormone-dependent. This can lead to a change in conceptual background of bladder cancer etiology and development in the future. Further studies are required to more precise map the use of anti-hormonal drugs in the treatment of this cancer.
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Ide H, Miyamoto H. Sex Hormone Receptor Signaling in Bladder Cancer: A Potential Target for Enhancing the Efficacy of Conventional Non-Surgical Therapy. Cells 2021; 10:1169. [PMID: 34064926 PMCID: PMC8150801 DOI: 10.3390/cells10051169] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022] Open
Abstract
There have been critical problems in the non-surgical treatment for bladder cancer, especially residence to intravesical pharmacotherapy, including BCG immunotherapy, cisplatin-based chemotherapy, and radiotherapy. Recent preclinical and clinical evidence has suggested a vital role of sex steroid hormone-mediated signaling in the progression of urothelial cancer. Moreover, activation of the androgen receptor and estrogen receptor pathways has been implicated in modulating sensitivity to conventional non-surgical therapy for bladder cancer. This may indicate the possibility of anti-androgenic and anti-estrogenic drugs, apart from their direct anti-tumor activity, to function as sensitizers of such conventional treatment. This article summarizes available data suggesting the involvement of sex hormone receptors, such as androgen receptor, estrogen receptor-α, and estrogen receptor-β, in the progression of urothelial cancer, focusing on their modulation for the efficacy of conventional therapy, and discusses their potential of overcoming therapeutic resistance.
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Affiliation(s)
- Hiroki Ide
- Department of Urology, Keio University School of Medicine, Tokyo 160-8582, Japan;
| | - Hiroshi Miyamoto
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
- Department of Urology, University of Rochester Medical Center, Rochester, NY 14642, USA
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY 14642, USA
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Goto T, Miyamoto H. The Role of Estrogen Receptors in Urothelial Cancer. Front Endocrinol (Lausanne) 2021; 12:643870. [PMID: 33796076 PMCID: PMC8008958 DOI: 10.3389/fendo.2021.643870] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 02/26/2021] [Indexed: 12/14/2022] Open
Abstract
Epidemiological data have indicated that there are some sex-related differences in bladder cancer. Indeed, the incidence of bladder cancer in men has been substantially higher than that in women throughout the world, while women tend to have higher stage disease and poorer prognosis. These gender disparities have prompted to investigate sex hormones and their cognitive receptors in bladder cancer. Specifically, estrogen receptors, including estrogen receptor-α and estrogen receptor-β, have been shown to contribute to urothelial carcinogenesis and cancer progression, as well as to modulating chemosensitivity in bladder cancer, although conflicting findings exist. Meanwhile, immunohistochemical studies in surgical specimens have assessed the expression of estrogen receptors and related proteins as well as its associations with clinicopathologic features of bladder cancer and patient outcomes. This review article summarizes and discusses available data indicating that estrogen receptor signaling plays an important role in urothelial cancer.
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Affiliation(s)
- Takuro Goto
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
| | - Hiroshi Miyamoto
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, United States
- Department of Urology, University of Rochester Medical Center, Rochester, NY, United States
- *Correspondence: Hiroshi Miyamoto,
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Bernardo C, Monteiro FL, Direito I, Amado F, Afreixo V, Santos LL, Helguero LA. Association Between Estrogen Receptors and GATA3 in Bladder Cancer: A Systematic Review and Meta-Analysis of Their Clinicopathological Significance. Front Endocrinol (Lausanne) 2021; 12:684140. [PMID: 34690921 PMCID: PMC8531553 DOI: 10.3389/fendo.2021.684140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/03/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Estrogen receptors alpha (ERα) and beta (ERβ) and the cooperating protein GATA-binding factor 3 (GATA3) have been implicated in bladder carcinogenesis and tumour progression. GATA3 and ER have been functionally linked in the establishment of luminal fate in breast tissue, but to date their relationship in bladder cancer has not been established. This information will be useful to advance diagnostic and prognostic markers. AIM To determine the relationship between the expression of ERα, ERβ and GATA3 in bladder cancer, disclose their prognostic and diagnostic value and their association with clinicopathological characteristics. METHODS A comprehensive literature search in PubMed database was performed for all immunohistochemical studies of ERα, ERβ and/or GATA3 in bladder cancer patients. We selected eligible studies in accordance with the PRISMA guidelines and evaluated methodological quality and risk of bias based on quality criteria from the reporting recommendations for tumour MARKer (REMARK) prognostic studies. Risk of bias assessment was performed using Review Manager 5. R software was used for all statistical analysis, the packages used were meta and dmetar for the standard meta-analysis, and netmeta for the network meta-analysis. RESULTS Thirteen studies were eligible for ERα, 5 for ERβ and 58 for GATA3 meta-analysis. Low grade tumours showed significantly lower ERα expression. GATA3 was widely expressed in bladder tumours, especially urothelial carcinomas, with higher expression of GATA3 in low grade and low stage tumours. Data was insufficient to determine the prognostic value of either ERα or ERβ, but GATA3-positivity was associated with higher recurrence free survival. A negative correlation between ERα or ERβ positivity and GATA3 expression was disclosed. Additionally, several sources of heterogeneity were identified, which can be used to improve future studies. CONCLUSION The clinicopathological value of ERα and ERβ was inconclusive due to low availability of studies using validated antibodies. Still, this meta-analysis supports GATA3 as good prognostic marker. On the contrary, ERα-positivity was associated to higher grade tumours; while ERα and ERβ were inversely correlated with GATA3 expression. Considering that it has previously been shown that bladder cancer cell lines have functional ERs, this suggests that ERα could be activated in less differentiated cells and independently of GATA3. Therefore, a comprehensive analysis of ERα and ERβ expression in BlaCa supported by complete patient clinical history is required for the identification of BlaCa subtypes and subgroups of patients expressing ERα, to investigate if they could benefit from treatment with hormonal therapy. SYSTEMATIC REVIEW REGISTRATION Prospero, CRD42021226836.
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Affiliation(s)
- Carina Bernardo
- Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute – Porto, Porto, Portugal
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Fátima L. Monteiro
- Institute of Biomedicine – iBiMED, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Inês Direito
- Institute of Biomedicine – iBiMED, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Francisco Amado
- Mass Spectrometry Group, Associated Laboratory for Green Chemistry (LAQV) of the Network of Chemistry and Technology (REQUIMTE), Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Vera Afreixo
- Center for Research and Development in Mathematics and Applications –CIDMA, Department of Mathematics, University of Aveiro, Aveiro, Portugal
- *Correspondence: Luisa A. Helguero, ; Vera Afreixo,
| | - Lúcio L. Santos
- Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute – Porto, Porto, Portugal
- Department of Surgical Oncology, Portuguese Oncology Institute - Porto, Porto, Portugal
| | - Luisa A. Helguero
- Institute of Biomedicine – iBiMED, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
- *Correspondence: Luisa A. Helguero, ; Vera Afreixo,
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Bernardo C, Santos J, Costa C, Tavares A, Amaro T, Marques I, Gouveia MJ, Félix V, Afreixo V, Brindley PJ, Costa JM, Amado F, Helguero L, Santos LL. Estrogen receptors in urogenital schistosomiasis and bladder cancer: Estrogen receptor alpha-mediated cell proliferation. Urol Oncol 2020; 38:738.e23-738.e35. [PMID: 32507545 DOI: 10.1016/j.urolonc.2020.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/30/2020] [Accepted: 04/21/2020] [Indexed: 01/22/2023]
Abstract
Estrogen-like metabolites have been identified in S. haematobium, the helminth parasite that causes urogenital schistosomiasis (UGS) and in patients´ blood and urine during UGS. Estrogen receptor (ER) activation is enriched in the luminal molecular subtype bladder cancer (BlaCa). To date, the significance of ER to these diseases remains elusive. We evaluated ERα and ERβ expression in UGS-related BlaCa (n = 27), UGS-related non-malignant lesions (n = 35), and noninfected BlaCa (n = 80). We investigated the potential of ERα to recognize S. haematobium-derived metabolites by docking and molecular dynamics simulations and studied ERα modulation in vitro using 3 BlaCa cell lines, T24, 5637 and HT1376. ERα was expressed in tumor and stromal cells in approximately 20% noninfected cases and in 30% of UGS-related BlaCa, predominantly in the epithelial cells. Overall, ERα expression was associated with features of tumor aggressiveness such as high proliferation and p53 positive expression. ERα expression correlated with presence of schistosome eggs. ERβ was widely expressed in both cohorts but weaker in UGS-related cases. molecular dynamics simulations of the 4 most abundant S. haematobium-derived metabolites revealed that smaller metabolites have comparable affinity for the ERα active state than 17β-estradiol, while the larger metabolites present higher affinity. Our in vitro findings suggested that ERα activation promotes proliferation in ERα expressing BlaCa cells and that this can be reverted with anti-estrogenic therapy. In summary, we report differential ER expression between UGS-related BlaCa and noninfected BlaCa and provide evidence supporting a role of active ERα during UGS and UGS-induced carcinogenesis.
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Affiliation(s)
- Carina Bernardo
- Hormones and Cancer Lab, Department of Medical Sciences, Institute of Biomedicine, iBiMED, University of Aveiro, Aveiro, Portugal; Experimental Pathology and Therapeutics, Research Center, Portuguese Oncology Institute - Porto (IPO-Porto), Porto, Portugal
| | - Júlio Santos
- Urology Department, Hospital Américo Boavida, Luanda, Angola; Center for the Study of Animal Science, CECA/ICETA, University of Porto, Porto, Portugal
| | - Céu Costa
- Fernando Pessoa Energy, Environment and Health Research Unit/Biomedical Research Center (FP-ENAS/CEBIMED), Faculty of Health Sciences, Fernando Pessoa University, Porto, Portugal
| | - Ana Tavares
- Experimental Pathology and Therapeutics, Research Center, Portuguese Oncology Institute - Porto (IPO-Porto), Porto, Portugal
| | - Teresina Amaro
- Department of Pathology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Igor Marques
- Department of Chemistry, CICECO - Aveiro Institute of Materials, University of Aveiro, Aveiro, Portugal
| | - Maria João Gouveia
- Center for the Study of Animal Science, CECA/ICETA, University of Porto, Porto, Portugal; Department of Infectious Diseases, R&D Unit, INSA-National Health Institute Dr. Ricardo Jorge, Porto, Portugal
| | - Vítor Félix
- Department of Chemistry, CICECO - Aveiro Institute of Materials, University of Aveiro, Aveiro, Portugal
| | - Vera Afreixo
- Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics, Aveiro, Portugal
| | - Paul J Brindley
- Department of Microbiology, Immunology & Tropical Medicine, and Research Center for Neglected Diseases of Poverty, School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
| | - José Manuel Costa
- Center for the Study of Animal Science, CECA/ICETA, University of Porto, Porto, Portugal; Department of Infectious Diseases, R&D Unit, INSA-National Health Institute Dr. Ricardo Jorge, Porto, Portugal
| | - Francisco Amado
- Mass Spectrometry Group, QOPNA, Department of Chemistry, University of Aveiro, Aveiro, Portugal
| | - Luisa Helguero
- Hormones and Cancer Lab, Department of Medical Sciences, Institute of Biomedicine, iBiMED, University of Aveiro, Aveiro, Portugal
| | - Lúcio L Santos
- Experimental Pathology and Therapeutics, Research Center, Portuguese Oncology Institute - Porto (IPO-Porto), Porto, Portugal; Department of Surgical Oncology, Portuguese Oncology Institute - Porto (IPO-Porto), Rua Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal.
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Yadav G, Solanki V, Bharti JN, Bharti S, Singh P, Gothwal M. Pure Transitional Cell Carcinoma of the Ovary Presenting as Bilateral Complex Cystic Masses in a Premenopausal Woman - Case Report and Review of Literature. J Midlife Health 2019; 10:156-159. [PMID: 31579161 PMCID: PMC6767955 DOI: 10.4103/jmh.jmh_66_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The understanding of ovarian malignancy pathogenesis has greatly increased with identification of varied genomic mutation profiles, which directs the clinical behavior of the tumors. The present case describes the rare subtype of pure transitional cell carcinoma which is no more included in the newer World Health Organization (WHO) classification as the WHO labels it as a type of high-grade serous ovarian cancer with transitional cell differentiation, although in our case no serous component was identified. Hence, with revised classification of ovarian malignancies, it is important to report all rare subtypes in order to understand their biology and behavior.
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Affiliation(s)
- Garima Yadav
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vrushti Solanki
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Jyotsna Naresh Bharti
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sushma Bharti
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pratibha Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Meenakshi Gothwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Tao L, Qiu J, Slavin S, Ou Z, Liu Z, Ge J, Zuo L, Guancial EA, Messing EM, Chang C, Yeh S. Recruited T cells promote the bladder cancer metastasis via up-regulation of the estrogen receptor β/IL-1/c-MET signals. Cancer Lett 2018; 430:215-223. [PMID: 29684419 DOI: 10.1016/j.canlet.2018.03.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 12/25/2022]
Abstract
Clinical data indicates that T cells can be recruited to bladder cancer (BCa), yet the impact of T cells on BCa progression remains unclear. In the present study, we found that T cells were recruited more to BCa tissues than to the surrounding normal bladder tissues. Results from an in vitro co-culture system also found that BCa recruited more CD4+ T cells than did normal bladder cells. The recruiting of T cells to BCa tissues may increase the proliferation and invasion of BCa cells. Mechanistic studies revealed that infiltrating T cells stimulate BCa estrogen receptor beta (ERβ) signaling and consequently increase the expression of MET proto-oncogene, receptor tyrosine kinase (c-MET), through either direct binding to its promoter or via modulation of IL-1 expression. Interruption of ERβ/c-MET or ERβ/IL-1/c-MET signaling via ERβ-shRNA, IL-1 antagonist, or the c-MET inhibitor, SU11274, could partially reverse the T cell-enhanced BCa cell invasion and proliferation. Finally, the mouse BCa model with xenografted BCa 5637 cells with T (HH) cells confirmed the results of in vitro co-culture studies showing that infiltrating T cells could promote BCa metastasis via modulation of the ERβ/c-MET or ERβ/IL-1/c-MET signaling pathways. These findings may provide a new therapeutic approach to better combat BCa progression via targeting these newly identified signaling pathways.
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Affiliation(s)
- Le Tao
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China; Departments of Urology and Pathology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Jianxin Qiu
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China.
| | - Spencer Slavin
- Departments of Urology and Pathology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Zhenyu Ou
- Departments of Urology and Pathology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Zhihong Liu
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China
| | - Jifu Ge
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai 200080, China
| | - Li Zuo
- Department of Urology, Changzhou No. 2 People's Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Elizabeth A Guancial
- Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Edward M Messing
- Departments of Urology and Pathology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Chawnshang Chang
- Departments of Urology and Pathology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Shuyuan Yeh
- Departments of Urology and Pathology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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10
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Ide H, Inoue S, Miyamoto H. Histopathological and prognostic significance of the expression of sex hormone receptors in bladder cancer: A meta-analysis of immunohistochemical studies. PLoS One 2017; 12:e0174746. [PMID: 28362839 PMCID: PMC5375178 DOI: 10.1371/journal.pone.0174746] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/14/2017] [Indexed: 12/26/2022] Open
Abstract
Objective Emerging preclinical evidence suggests the involvement of sex hormones and their receptor signals in the development and progression of bladder cancer. Meanwhile, previous studies have demonstrated conflicting results on the relationship between the status of sex hormone receptors in urothelial tumors and histopathological characteristics of the tumors or patient outcomes. We therefore conducted this meta-analysis to assess the clinicopathological impact of the expression of androgen receptor (AR) and estrogen receptors (ERs) in bladder cancer. Methods A comprehensive literature search in databases (i.e. PubMed, Web of Science, Cochrane) was performed for all immunohistochemical studies stained for AR, ERα, and/or ERβ in surgically resected bladder cancer specimens and analyzed for patient outcomes. We selected eligible studies in accordance with the PRISMA guidelines and analyzed data using R software. Results A total of 2,049 patients from 13 retrospective studies were included in this meta-analysis. The difference in ERα expression between non-tumors and tumors was significant [odds ratio (OR) = 0.412; P<0.001], while those of AR (OR = 3.256; P = 0.336) or ERβ (OR = 0.580; P = 0.674) were not statistically significant. AR positivity in tumors was strongly correlated with gender (male vs. female: OR = 0.658; P = 0.027) or tumor grade (low-grade vs. high-grade: OR = 0.575; P<0.001). ERβ positive rates were significantly higher in high-grade (OR = 2.169; P<0.001) and muscle-invasive (OR = 3.104; P<0.001) tumors than in low-grade and non-muscle-invasive tumors, respectively. Survival analysis in patients with non-muscle-invasive bladder cancer revealed associations between AR expression and better recurrence-free survival [hazard ration (HR) = 0.593; P = 0.006) as well as between ERβ expression and worse recurrence-free (HR = 1.573; P = 0.013) or progression-free (HR = 4.148; P = 0.089) survivals. Conclusions These data suggest down-regulation of ERα expression in bladder tumors, compared with non-neoplastic urothelial tissues. AR or ERβ expression was down- or up-regulated, respectively, in high-grade and/or muscle-invasive bladder cancers. Moreover, immunohistochemistry of AR/ERβ in surgical specimens may serve as prognosticators in patients with non-muscle-invasive bladder tumor.
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Affiliation(s)
- Hiroki Ide
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- The Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Satoshi Inoue
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- The Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, United States of America
- The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, United States of America
| | - Hiroshi Miyamoto
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- The Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, New York, United States of America
- The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, United States of America
- Department Urology, University of Rochester Medical Center, Rochester, New York, United States of America
- * E-mail:
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Kashiwagi E, Fujita K, Yamaguchi S, Fushimi H, Ide H, Inoue S, Mizushima T, Reis LO, Sharma R, Netto GJ, Nonomura N, Miyamoto H. Expression of steroid hormone receptors and its prognostic significance in urothelial carcinoma of the upper urinary tract. Cancer Biol Ther 2016; 17:1188-1196. [PMID: 27635763 DOI: 10.1080/15384047.2016.1235667] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
To assess the expression status of steroid hormone receptors in upper urinary tract urothelial carcinoma (UUTUC), we immunohistochemically stained for androgen receptor (AR), estrogen receptor-α (ERα), ERβ, glucocorticoid receptor (GR), and progesterone receptor (PR) in 99 UUTUC specimens and paired non-neoplastic urothelial tissues. AR/ERα/ERβ/GR/PR was positive in 20%/18%/62%/63%/16% of tumors, which was significantly lower (except PR) than in benign urothelial tissues [57% (P < 0.001)/40% (P = 0.001)/85% (P = 0.001)/84% (P = 0.002)/13% (P = 0.489)]. There were no significant associations between each receptor expression pattern and histopathological characteristic of the tumors including tumor grade/stage. Kaplan-Meier and log-rank tests revealed no significant prognostic value of each receptor expression in these 99 patients. However, patients with UUTUC positive for either ERα or PR had a significantly higher risk of disease-specific mortality (P = 0.025), compared with those with UUTUC negative for both. PR positivity alone in pT3 or pT4 tumors was also strongly associated with the risk of disease-specific mortality (P = 0.040). Multivariate analysis further identified the expression of ERα and/or PR as a strong predictor for disease-specific mortality in the entire cohort of the patients (hazard ratio, 2.434; P = 0.037). Thus, in accordance with previous observations in bladder specimens, significant decreases in the expression of AR/ERα/ERβ/GR in UUTUC, compared with that in non-neoplastic urothelium, were observed. Meanwhile, the negativity of both ERα and PR in UUTUC as well as the negativity of PR alone in deeply invasive tumor was suggested to serve as a prognosticator.
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Affiliation(s)
- Eiji Kashiwagi
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Urology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Kazutoshi Fujita
- c Department of Urology , Osaka University Graduate School of Medicine , Suita , Japan
| | - Seiji Yamaguchi
- d Department of Urology , Osaka General Medical Center , Osaka , Japan
| | - Hiroaki Fushimi
- e Department of Pathology , Osaka General Medical Center , Japan
| | - Hiroki Ide
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Urology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Satoshi Inoue
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Urology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,f Department of Pathology & Laboratory Medicine , University of Rochester Medical Center , Rochester , NY , USA.,g Wilmot Cancer Institute, University of Rochester Medical Center , Rochester , NY , USA
| | - Taichi Mizushima
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Urology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,f Department of Pathology & Laboratory Medicine , University of Rochester Medical Center , Rochester , NY , USA.,g Wilmot Cancer Institute, University of Rochester Medical Center , Rochester , NY , USA
| | - Leonardo O Reis
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Urology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Rajni Sharma
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - George J Netto
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Urology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Norio Nonomura
- c Department of Urology , Osaka University Graduate School of Medicine , Suita , Japan
| | - Hiroshi Miyamoto
- a Department of Pathology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,b Department of Urology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,f Department of Pathology & Laboratory Medicine , University of Rochester Medical Center , Rochester , NY , USA.,g Wilmot Cancer Institute, University of Rochester Medical Center , Rochester , NY , USA.,h Department of Urology , University of Rochester Medical Center , Rochester , NY , USA
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12
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Metastatic Breast Carcinoma to the Prostate Gland. Case Rep Oncol Med 2016; 2016:8264140. [PMID: 27429817 PMCID: PMC4939205 DOI: 10.1155/2016/8264140] [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: 05/16/2016] [Accepted: 06/12/2016] [Indexed: 11/28/2022] Open
Abstract
Cancer of the male breast is an uncommon event with metastases to the breast occurring even less frequently. Prostate carcinoma has been reported as the most frequent primary to metastasize to the breast; however, the reverse has not been previously reported. Herein, we present, for the first time, a case of breast carcinoma metastasizing to the prostate gland. Prostate needle core biopsy revealed infiltrative nests of neoplastic epithelioid cells, demonstrated by immunohistochemistry (IHC) to be positive for GATA3 and ER and negative for PSA and P501S. A prostate cocktail by IHC study demonstrated lack of basal cells (p63 and CK903) and no expression of P501S. The patient's previous breast needle core biopsy showed strong ER positivity and negative staining for PR and HER2. Similar to the prostate, the breast was negative for CK5/6, p63, and p40. This case demonstrates the importance of considering a broad differential diagnosis and comparing histology and IHC to prior known malignancies in the setting of atypical presentation or rare tumors.
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Godoy G, Gakis G, Smith CL, Fahmy O. Effects of Androgen and Estrogen Receptor Signaling Pathways on Bladder Cancer Initiation and Progression. Bladder Cancer 2016; 2:127-137. [PMID: 27376135 PMCID: PMC4927898 DOI: 10.3233/blc-160052] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Epidemiologic studies have long demonstrated clear differences in incidence and progression of bladder cancer between genders suggesting that the mechanisms of development and progression in these tumors have a strong association with steroid hormonal pathways. Such observations led to preclinical studies investigating the role of androgen and estrogen receptors, as well as their cognate hormones in bladder cancer initiation and progression. Using various in vitro cell line assays and in vivo mouse models, studies have elucidated different mechanisms and signaling pathways through which these steroid receptors may participate in this disease. More recently, RNA expression data from multiple studies revealed a luminal subtype of bladder cancer that exhibited an estrogen receptor signaling pathway, making it a strong candidate for further consideration of targeted therapies in the future. Despite the promising preclinical data demonstrating potential roles for both antiandrogen and antiestrogen strategies targeting these pathways in different stages of bladder cancer, only two clinical trials are currently active and accruing patients for such clinical studies. Targeted therapies in bladder cancer are a large unmet need and have the potential to change treatment paradigms and improve oncological outcomes of patients with bladder cancer.
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Affiliation(s)
- Guilherme Godoy
- Scott Department of Urology, Baylor College of Medicine , Houston, TX, USA
| | - Georgios Gakis
- Department of Urology, Eberhard-Karls University , Tuebingen, Germany
| | - Carolyn L Smith
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Omar Fahmy
- Department of Urology, Eberhard-Karls University , Tuebingen, Germany
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Ide H, Miyamoto H. Steroid Hormone Receptor Signals as Prognosticators for Urothelial Tumor. DISEASE MARKERS 2015; 2015:840640. [PMID: 26770009 PMCID: PMC4685115 DOI: 10.1155/2015/840640] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/18/2015] [Indexed: 12/18/2022]
Abstract
There is a substantial amount of preclinical or clinical evidence suggesting that steroid hormone receptor-mediated signals play a critical role in urothelial tumorigenesis and tumor progression. These receptors include androgen receptor, estrogen receptors, glucocorticoid receptor, progesterone receptor, vitamin D receptor, retinoid receptors, peroxisome proliferator-activated receptors, and others including orphan receptors. In particular, studies using urothelial cancer tissue specimens have demonstrated that elevated or reduced expression of these receptors as well as alterations of their upstream or downstream pathways correlates with patient outcomes. This review summarizes and discusses available data suggesting that steroid hormone receptors and related signals serve as biomarkers for urothelial carcinoma and are able to predict tumor recurrence or progression.
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Affiliation(s)
- Hiroki Ide
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Hiroshi Miyamoto
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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The Estrogen Pathway: Estrogen Receptor-α, Progesterone Receptor, and Estrogen Receptor-β Expression in Radical Cystectomy Urothelial Cell Carcinoma Specimens. Clin Genitourin Cancer 2015; 13:476-84. [PMID: 25981333 DOI: 10.1016/j.clgc.2015.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Bladder cancer has the sixth highest incidence in the United States. Treatment of metastatic bladder cancer is difficult, and mortality is certain. There are certain pathways in cancer growth and progression that are important in bladder cancer development. Recently, the estrogen pathway has been found to be a potential target for therapy. METHODS We identified 410 patients treated with radical cystectomy for urothelial cell carcinoma between 1990 and 1994. We obtained representative paraffin-embedded tissue blocks for 336 (82.0%) of these cases and evaluated the expression and intensity of estrogen receptor (ER)-α, ER-β, and progesterone receptor by immunohistochemistry. RESULTS Among the 12 ER-α-positive cases, median tumor ER-α expression was 10% (range, 10%-50%). In contrast to ER-α, all cases were ER-β-positive. Median tumor ER-β expression was 90% (range, 20%-100%). Nearly all cases had ER-β expression of ≥ 90% (175 [55.9%] with 90% and 103 [32.9%] with 100%). However, the intensity of ER-β staining varied from focal to moderate to marked in 64 (20.5%), 167 (53.4%), and 82 (26.2%) cases, respectively. Progesterone receptor expression was noted to be negative in all cases. CONCLUSIONS ER-β is highly expressed in bladder cancer. Prospective validation of these data might further elucidate the utility of ER-β as a marker for prognosis or possible target for therapy.
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Ingin RJ, Andola SK, Zubair AA. Transitional cell carcinoma of the ovary: case series and review of literature. J Clin Diagn Res 2014; 8:FD07-8. [PMID: 25302204 DOI: 10.7860/jcdr/2014/9104.4733] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 07/01/2014] [Indexed: 11/24/2022]
Abstract
Transitional cell carcinoma (TCC) of the ovary is a recently recognized, subtype of ovarian surface epithelial cancer; the pure form accounting for only 1% of surface epithelial tumors. It has been described as a primary ovarian carcinoma with definite urothelial features but no benign, metaplastic and/or proliferating Brenner tumor (BT) identified. Recognition of such tumours is important because of its rarity, favorable response to chemotherapy and an improved patient survival. A case series of primary TCC of the ovary (3 cases) with brief review of literature is being presented.
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Affiliation(s)
- Rajashree J Ingin
- Professor, Department of Pathology, M. R. Medical College , Gulbarga, India
| | - Sainath K Andola
- Professor & HOD, Department of Pathology, M. R. Medical College , Gulbarga, India
| | - Ashraf Ahmed Zubair
- Post-Graduate, Department of Pathology, M. R. Medical College , Gulbarga, India
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Abstract
PURPOSE We investigated sex-hormone receptor expression as predicting factor of recurrence and progression in patients with non-muscle invasive bladder cancer. MATERIALS AND METHODS We retrospectively evaluated tumor specimens from patients treated for transitional cell carcinoma of the bladder at our institution between January 2006 and January 2011. Performing immunohistochemistry using a monoclonal androgen receptor antibody and monoclonal estrogen receptor-beta antibody on paraffin-embedded tissue sections, we assessed the relationship of immunohistochemistry results and prognostic factors such as recurrence and progression. RESULTS A total of 169 patients with bladder cancer were evaluated in this study. Sixty-threepatients had expressed androgen receptors and 52 patients had estrogen receptor beta. On univariable analysis, androgen receptor expression was significant lower in recurrence rates (p=0.001), and estrogen receptor beta expression was significant higher in progression rates (p=0.004). On multivariable analysis, significant association was found between androgen receptor expression and lower recurrence rates (hazard ratio=0.500; 95% confidence interval, 0.294 to 0.852; p=0.011), but estrogen receptor beta expression was not significantly associated with progression rates. CONCLUSION We concluded that the possibility of recurrence was low when the androgen receptor was expressed in the bladder cancer specimen and it could be the predicting factor of the stage, number of tumors, carcinoma in situ lesion and recurrence.
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Affiliation(s)
- Jong Kil Nam
- Department of Urology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
| | - Sung Woo Park
- Department of Urology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Don Lee
- Department of Urology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Moon Kee Chung
- Department of Urology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Chemoprevention of BBN-Induced Bladder Carcinogenesis by the Selective Estrogen Receptor Modulator Tamoxifen. Transl Oncol 2013; 6:244-55. [PMID: 23730403 DOI: 10.1593/tlo.13247] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 03/02/2013] [Accepted: 03/04/2013] [Indexed: 12/31/2022] Open
Abstract
Bladder cancer is the fifth most frequent tumor in men and ninth in women in the United States. Due to a high likelihood of recurrence, effective chemoprevention is a significant unmet need. Estrogen receptors (ERs), primarily ERβ, are expressed in normal urothelium and urothelial carcinoma, and blocking ER function with selective ER modulators such as tamoxifen inhibits bladder cancer cell proliferation in vitro. Herein, the chemoprotective potential of tamoxifen was evaluated in female mice exposed to the bladder-specific carcinogen, N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN). Carcinogen treatment resulted in a 76% tumor incidence and increased mean bladder weights in comparison to controls. In contrast, mice receiving tamoxifen concurrent (8-20 weeks) or concurrent and subsequent (8-32 weeks) to BBN administration had no change in bladder weight and only 10% to 14% incidence of tumors. Non-muscle-invasive disease was present in animals treated with tamoxifen before (5-8 weeks) or after (20-32 weeks) BBN exposure, while incidence of muscle-invasive bladder carcinoma was reduced. ERβ was present in all mice and thus is a potential mediator of the tamoxifen chemoprotective effect. Surprisingly, ERα expression, which was detected in 74% of the mice exposed to BBN alone but not in any controlmice, was correlated with tumor incidence, indicating a possible role for this receptor in carcinogen-induced urothelial tumorigenesis. Thus, these data argue that both ERα and ERβ play a role in modulating carcinogen-induced bladder tumorigenesis. Administration of tamoxifen should be tested as a chemopreventive strategy for patients at high risk for bladder cancer recurrence.
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Hsu I, Vitkus S, Da J, Yeh S. Role of oestrogen receptors in bladder cancer development. Nat Rev Urol 2013; 10:317-26. [PMID: 23588401 DOI: 10.1038/nrurol.2013.53] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Early studies documented the existence of sexual dimorphism in bladder cancer occurrence and progression, with a greater bladder cancer incidence in males than females. However, the progression of bladder cancer after diagnosis is much quicker in females than males. These findings can be explained by the effects of female hormones (predominantly oestrogens) and their binding receptors, including oestrogen receptor 1 (ESR1; also known as ERα), oestrogen receptor 2 (ESR2; also known as ERβ), and GPR30 protein on bladder cancer incidence and progression. Results from studies using various in vitro cell lines and in vivo mouse models demonstrate differential roles of oestrogen receptors in cancer initiation and progression. ERα suppresses bladder cancer initiation and invasion, whereas ERβ promotes bladder cancer initiation and progression. Mechanistic studies suggest that ERα and ERβ exert these effects via modulation of the AKT pathway and DNA replication complex, respectively. Targeting these signalling pathways--for example, with ERα agonists, ERβ antagonists, or selective oestrogen receptor modulators such as 4-[2-phenyl-5,7-bis(trifluoromethyl)pyrazolo[1,5-a]pyrimidin-3-yl]phenol (also known as PHTPP)--could lead to the development of new therapeutic approaches for controlling bladder cancer progression.
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Affiliation(s)
- Iawen Hsu
- Department of Urology, George Whipple Lab for Cancer Research, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA
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Xu Y, Zhang NZ, Chen J, Yuan HQ. Biomarkers in urothelial carcinoma of the bladder: the potential cross-talk between transforming growth factor-β1 and estrogen receptor β/androgen receptor pathways. Med Hypotheses 2013; 80:716-8. [PMID: 23490202 DOI: 10.1016/j.mehy.2013.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 02/08/2013] [Accepted: 02/16/2013] [Indexed: 01/17/2023]
Abstract
Urothelial carcinoma of the bladder is nearly three times more common in men than in women. Although it has been primarily attributed to differences in exposure to smoking and industrial chemicals, it is evident now that hormonal factors also play a role. One of the explanations for the differential biologic aggressiveness of urothelial carcinoma of the bladder between genders has focused on sex steroid hormones and their receptors. Recent studies indicated that both estrogen receptor β and androgen receptor have a role within urothelial carcinoma of the bladder and their expression and activity are altered in the carcinogenesis and progression. Moreover, expression of transforming growth factor-β1 is a strong predictor of recurrence and specific mortality. We conjecture about the potential cross-talk between transforming growth factor-β1 and estrogen receptor β/androgen receptor pathways. Clinical significance of expression of transforming growth factor-β1 could be improved, when they are related with the determination of estrogen receptor β/androgen receptor status. Further subgrouping of transforming growth factor-β1 level combined with estrogen receptor β/androgen receptor status, would be more accurately determine the prognosis of patients. This hypothesis could be easily verified in corresponding clinical research, and combined analysis of expression of TGF-β1 and ERβ/AR signaling proteins may provide clinicians useful information regarding tumor initiation and progression, and guide patient prognosis and management with specific therapies.
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Affiliation(s)
- Yang Xu
- Department of Urology, Qilu Hospital, Shandong University, Jinan, PR China
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Izumi K, Li Y, Ishiguro H, Zheng Y, Yao JL, Netto GJ, Miyamoto H. Expression of UDP-glucuronosyltransferase 1A in bladder cancer: association with prognosis and regulation by estrogen. Mol Carcinog 2012; 53:314-24. [PMID: 23143693 DOI: 10.1002/mc.21978] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 09/25/2012] [Accepted: 10/12/2012] [Indexed: 12/27/2022]
Abstract
Although UDP-glucuronosyltransferase 1A (UGT1A) plays an important role in preventing bladder cancer initiation by detoxifying carcinogenic compounds, its contribution to bladder cancer progression is poorly understood. We immunohistochemically stained for UGT1A in bladder specimens. UGT1A was positive in 130/145 (90%; 28 [19%] weak, 53 [37%] moderate, and 49 [34%] strong) urothelial neoplasms, which was significantly weaker than in matched non-neoplastic urothelial tissues (100/101 [99%]; 2 [2%] weak, 17 [17%] moderate, and 81 [80%] strong). Fifty (98%) of 51 low-grade/79 (99%) of 80 non-muscle-invasive tumors were immunoreactive to UGT1A, whereas 80 (85%) of 94 high-grade/51 (78%) of 65 muscle-invasive tumors were UGT1A-positive. Kaplan-Meier analysis showed strong associations between lower UGT1A expression versus the risk of recurrence in high-grade non-muscle-invasive tumors (P = 0.038) or disease-specific mortality in muscle-invasive tumors (P = 0.016). Multivariate analysis further revealed UGT1A loss as an independent prognosticator for disease-specific mortality in patients with muscle-invasive tumor (P = 0.010). Additionally, the expression of UGT1A was positively and negatively correlated with those of estrogen receptor-α and estrogen receptor-β, respectively. We then assessed UGT1A/Ugt1a levels in human cell lines/mouse tissues. 17β-Estradiol increased and decreased UGT1A expression in normal urothelium and bladder cancer lines, respectively, and an anti-estrogen abolished these effects. Ovariectomy in mice resulted in down-regulation of Ugt1a subtypes. These results suggest the involvement of UGT1A in not only bladder carcinogenesis but tumor progression. Moreover, UGT1A is likely regulated by estrogens in non-neoplastic urothelium versus bladder tumor in opposite manners, which could be underlying mechanisms of gender-specific differences in bladder cancer incidence and progression.
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Affiliation(s)
- Koji Izumi
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York
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Transitional Cell Carcinoma of the Ovary is Related to High-grade Serous Carcinoma and is Distinct From Malignant Brenner Tumor. Int J Gynecol Pathol 2012; 31:499-506. [DOI: 10.1097/pgp.0b013e31824d7445] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Agarwal R, Sehgal S, Singh S, Pant L, Kumar VJ, Fotedar S. Transitional Cell Carcinoma of the Ovary: A Case Report. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2011.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Reena Agarwal
- Department of Pathology, Swami Dayanand Hospital, Shahdara, New Delhi, India
| | - Shelly Sehgal
- Department of Pathology, Swami Dayanand Hospital, Shahdara, New Delhi, India
| | - Sompal Singh
- Department of Pathology, Swami Dayanand Hospital, Shahdara, New Delhi, India
| | - Leela Pant
- Department of Pathology, Swami Dayanand Hospital, Shahdara, New Delhi, India
| | - Vinita Jaggi Kumar
- Department of Gynaecologic Oncology, Delhi State Cancer Institute, New Delhi, India
| | - Sunita Fotedar
- Department of Gynaecology and Obstetrics, Swami Dayanand Hospital, Shahdara, New Delhi, India
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Miyamoto H, Yao JL, Chaux A, Zheng Y, Hsu I, Izumi K, Chang C, Messing EM, Netto GJ, Yeh S. Expression of androgen and oestrogen receptors and its prognostic significance in urothelial neoplasm of the urinary bladder. BJU Int 2012; 109:1716-26. [PMID: 22221549 DOI: 10.1111/j.1464-410x.2011.10706.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? Steroid hormone receptor signals have been implicated in bladder tumourigenesis and tumour progression. The expression of androgen and/or oestrogen receptors has been assessed in bladder cancer, leading to conflicting data of expression levels and their relationship to histopathological characteristics of the tumours. We simultaneously analyze three receptors in non-neoplastic bladder tissues as well as in primary and metastatic bladder tumour specimens. Our data demonstrate that the expression status correlates with tumour grades/stages and patients' outcomes. OBJECTIVE To assess the expression of the androgen receptor (AR) and oestrogen receptors (ERs) in bladder tumours because recent studies have shown conflicting results and the prognostic significance of their expression remains unclear. PATIENTS AND METHODS We investigated the expression of AR, ERα and ERβ in 188 bladder tumour specimens, as well as matched 141 non-neoplastic bladder and 14 lymph node metastasis tissues, by immunohistochemistry. We then evaluated the relationships between their expression and the clinicopathological features available for the present patient cohort. RESULTS AR/ERα/ERβ was positive in 80%/50%/89% of benign urothelium, 50%/67%/41% of benign stroma, 42%/27%/49% of primary tumours and 71%/64%/71% of metastatic tumours. Significantly lower expression of AR/ERα was found in high-grade tumours (36%/23%) and tumours invading muscularis propria (33%/19%) compared to low-grade tumours (55%; P= 0.0232/38%; P= 0.0483) and tumours not invading muscularis propria (51%; P= 0.0181/35%; P= 0.0139), respectively. Significantly higher expression of ERβ was found in high-grade tumours (58%) and tumours invading muscularis propria (67%) compared to low-grade tumours (29%; P= 0.0002) and tumours not invading muscularis propria (34%; P < 0.0001), respectively. Kaplan-Meier and log-rank tests further showed that positivity of ERβ (but not AR or ERα) was associated with the recurrence of low-grade tumours (P= 0.0072); the progression of low-grade tumours (P= 0.0005), high-grade tumours not invading muscularis propria (P= 0.0020) and tumours invading muscularis propria (P= 0.0010); or disease-specific mortality in patients with tumours invading muscularis propria (P= 0.0073). CONCLUSIONS Compared to benign bladders, a significant decrease in the expression of AR, ERα or ERβ in bladder cancer was seen. Loss of AR or ERα was strongly associated with higher grade/more invasive tumours, whereas ERβ expression was increased in high-grade/invasive tumours and predicted a worse prognosis.
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Affiliation(s)
- Hiroshi Miyamoto
- Department of Pathology Urology, University of Rochester Medical Center, Rochester, NY, USA
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Tazi EM, Lalya I, Tazi MF, Ahellal Y, M'rabti H, Errihani H. Transitional cell carcinoma of the ovary: a rare case and review of literature. World J Surg Oncol 2010; 8:98. [PMID: 21073751 PMCID: PMC2996384 DOI: 10.1186/1477-7819-8-98] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 11/14/2010] [Indexed: 11/16/2022] Open
Abstract
Introduction Transitional cell carcinoma (TCC) of the ovary is a rare, recently recognized, subtype of ovarian surface epithelial cancer. Case presentation A 69-year-old postmenopausal woman presented with a 2-year history of progressive enlargement of an abdominal mass. Abdominal computed tomography showed a pelvic mass. CA-125 was normal. A staging operation with total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy and pelvic lymph node dissection was performed. After surgery, the pathologic report of the right ovarian tumour was TCC, grade 3, stage IC. The patient underwent 3 cycles of chemotherapy: carboplatin and paclitaxel. She is regularly followed up and has been disease free for 10 months Conclusion Transitional cell carcinoma (TCC) of the ovary is a rare subtype of epithelial ovarian cancer. Surgical resection is the primary therapeutic approach, and patient outcomes after chemotherapy are better than for other types of ovarian cancers.
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Affiliation(s)
- E M Tazi
- Departement of Medical Oncology, National Institute of Oncology, Rabat, Morocco.
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Kontos S, Kominea A, Melachrinou M, Balampani E, Sotiropoulou-Bonikou G. Inverse expression of estrogen receptor-β and nuclear factor-κB in urinary bladder carcinogenesis. Int J Urol 2010; 17:801-9. [DOI: 10.1111/j.1442-2042.2010.02603.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Wei S, Said-Al-Naief N, Hameed O. Estrogen and Progesterone Receptor Expression is not Always Specific for Mammary and Gynecologic Carcinomas. Appl Immunohistochem Mol Morphol 2009; 17:393-402. [DOI: 10.1097/pai.0b013e31819faa07] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ramos D, Abba M, López-Guerrero JA, Rubio J, Solsona E, Almenar S, Llombart-Bosch A, Aldaz CM. Low levels of WWOX protein immunoexpression correlate with tumour grade and a less favourable outcome in patients with urinary bladder tumours. Histopathology 2008; 52:831-9. [PMID: 18452537 DOI: 10.1111/j.1365-2559.2008.03033.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS To correlate the immunohistochemical detection of WWOX with histological measures and disease progression within the whole spectrum of urothelial bladder neoplasms. METHODS AND RESULTS One hundred and one patients with primary bladder tumours were retrospectively analysed. Immunohistochemically, a polyclonal antibody was utilized and the level of WWOX protein expression was analysed by using a combined score system based on intensity of the reaction and percentage of immunoreactive tumour cells. WWOX protein expression was consistently expressed in non-neoplastic urothelium, whereas a progressive loss of immunoreactivity was observed as tumour grade and stage increased (P < 0.05). Principal component analysis showed that reduced WWOX immunoexpression was significantly associated with high histological grades (P = 0.001), advanced stage (P = 0.002), tumour size (P = 0.04) and cancer progression (P = 0.028). Invasive urothelial carcinomas of the bladder with squamous metaplasia presented the lowest levels of WWOX protein. Kaplan-Meier analyses demonstrated a significant correlation between loss of WWOX expression and a shorter progression-free survival (P = 0.042), whereas the prediction of overall survival achieved borderline significance (P = 0.053). CONCLUSION Loss of WWOX immunoexpression strongly correlates with classical clinicopathological factors and appears to be a potential predictive marker of progressive disease.
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Affiliation(s)
- D Ramos
- Department of Pathology, School of Medicine, University of Valencia, Valencia, Spain.
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Giordano G, D'Adda T, Gnetti L, Merisio C, Raboni S. Transitional Cell Carcinoma of the Endometrium Associated With Benign Ovarian Brenner Tumor. Int J Gynecol Pathol 2007; 26:298-304. [PMID: 17581415 DOI: 10.1097/01.pgp.0000236943.28969.b2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transitional cell carcinoma of the endometrium (TCCE) is a subtype of endometrial carcinoma, characterized by a prominent papillary pattern, resembling the papillary carcinoma of the urothelium. This neoplasm is very rare, with only 13 cases reported in the international literature. In this paper, a new case of TCCE associated with benign ovarian Brenner tumor is described. This association is extremely rare, with only 1 other case reported. A review of the literature is performed to delineate the clinico pathologic features of this malignancy. Moreover, immunohistochemical and molecular studies are carried out in the effort to establish the phenotype and etiology of this rare neoplasm. The molecular study, by polymerase chain reaction (PCR) failing to reveal the presence of HPV DNA, demonstrates that neither the TCCE nor the ovarian Brenner tumor is caused by an HPV infection. The association of TCCE with benign ovarian Brenner tumor could be a coincidental event. Conversely, this finding could be the manifestation of a multicentric metaplastic process (neometaplasia), involving both the coelomic epithelium of the ovary and the Mullerian epithelium of the uterus, or the evidence of "field effect" that manifests differently at different anatomical sites. In our view, other cases of TCCE associated with ovarian Brenner tumor should be reported to confirm the last 2 hypotheses.
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Affiliation(s)
- Giovanna Giordano
- Department of Pathology and Medicine of Laboratory, Section of Pathology, Parma University, Parma, Italy.
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Prizment AE, Anderson KE, Harlow BL, Folsom AR. Reproductive risk factors for incident bladder cancer: Iowa Women's Health Study. Int J Cancer 2007; 120:1093-8. [PMID: 17131327 DOI: 10.1002/ijc.22418] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We studied the association between reproductive factors and bladder cancer incidence in a prospective cohort study of 37,459 Iowa women aged 55-69 years and initially free from cancer in 1986. Women reported reproductive history and were followed prospectively through 2003. After adjusting for age and smoking, there was an inverse association between age at menopause and incident bladder cancer (n = 192). Compared with menopause at age > or =48, the hazard ratio (HR) of bladder cancer was 1.32 (95% CI; 0.90-1.94) for menopause at 43-47, and 1.60 (95% CI; 1.06-2.39) for < or =42 (p-trend = 0.02). The associations were similar for ages at natural and surgical menopause. In addition, women with a history of bilateral oophorectomy had an increased risk of bladder cancer compared with those who did not undergo bilateral oophorectomy: HR = 1.58 (95% CI; 1.12, 2.22). Finally, there was an indication of a positive association between bladder cancer and shorter lifetime years of ovulation (p-trend = 0.09). There were no associations between incident bladder cancer and age at first birth, number of births, age at menarche, use of hormone replacement therapy or any other reproductive characteristics. This study provides evidence that increased risk of bladder cancer is associated with earlier age at menopause in postmenopausal women.
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Affiliation(s)
- Anna E Prizment
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN 55454-1015, USA
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Abstract
OBJECTIVE Transitional cell carcinoma (TCC) of the ovary is a rare, recently recognized, subtype of ovarian surface epithelial cancer. We present a case of TCC of the ovary, managed by staging operation and followed by postoperative chemotherapy with carboplatin and cyclophosphamide. CASE REPORT A 67-year-old postmenopausal woman presented with a 2-year history of progressive enlargement of an abdominal mass. Pelvic sonography and abdominal computed tomography showed a pelvic mass measuring 210 x 165 x 203 mm. The serum CA-125 titer was also elevated (65.01 U/mL). A staging operation with total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy and pelvic lymph node dissection was performed. After surgery, the pathologic report of the left ovarian tumor was TCC, grade 2-3, stage IA. The patient then underwent four cycles of postoperative chemotherapy with carboplatin and cyclophosphamide. CA-125 levels declined to within the normal range after the first cycle of chemotherapy. CONCLUSION TCC of the ovary is a rare subtype of epithelial ovarian cancer. It differs from malignant Brenner tumor by the absence of a benign or borderline Brenner component. Surgical resection is the primary therapeutic approach, and patient outcomes after chemotherapy are better than for other types of common epithelial ovarian cancers.
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Affiliation(s)
- Chia-Hui Lin
- Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
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Dozmorov MG, Kyker KD, Saban R, Knowlton N, Dozmorov I, Centola MB, Hurst RE. Analysis of the interaction of extracellular matrix and phenotype of bladder cancer cells. BMC Cancer 2006; 6:12. [PMID: 16412233 PMCID: PMC1360102 DOI: 10.1186/1471-2407-6-12] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 01/13/2006] [Indexed: 01/09/2023] Open
Abstract
Background The extracellular matrix has a major effect upon the malignant properties of bladder cancer cells both in vitro in 3-dimensional culture and in vivo. Comparing gene expression of several bladder cancer cells lines grown under permissive and suppressive conditions in 3-dimensional growth on cancer-derived and normal-derived basement membrane gels respectively and on plastic in conventional tissue culture provides a model system for investigating the interaction of malignancy and extracellular matrix. Understanding how the extracellular matrix affects the phenotype of bladder cancer cells may provide important clues to identify new markers or targets for therapy. Methods Five bladder cancer cell lines and one immortalized, but non-tumorigenic, urothelial line were grown on Matrigel, a cancer-derived ECM, on SISgel, a normal-derived ECM, and on plastic, where the only ECM is derived from the cells themselves. The transcriptomes were analyzed on an array of 1186 well-annotated cancer derived cDNAs containing most of the major pathways for malignancy. Hypervariable genes expressing more variability across cell lines than a set expressing technical variability were analyzed further. Expression values were clustered, and to identify genes most likely to represent biological factors, statistically over-represented ontologies and transcriptional regulatory elements were identified. Results Approximately 400 of the 1186 total genes were expressed 2 SD above background. Approximately 100 genes were hypervariable in cells grown on each ECM, but the pattern was different in each case. A core of 20 were identified as hypervariable under all 3 growth conditions, and 33 were hypervariable on both SISgel and Matrigel, but not on plastic. Clustering of the hypervariable genes showed very different patterns for the same 6 cell types on the different ECM. Even when loss of cell cycle regulation was identified, different genes were involved, depending on the ECM. Under the most permissive conditions of growth where the malignant phenotype was fully expressed, activation of AKT was noted. TGFβ1 signaling played a major role in the response of bladder cancer cells to ECM. Identification of TREs on genes that clustered together suggested some clustering was driven by specific transcription factors. Conclusion The extracellular matrix on which cancer cells are grown has a major effect on gene expression. A core of 20 malignancy-related genes were not affected by matrix, and 33 were differentially expressed on 3-dimensional culture as opposed to plastic. Other than these genes, the patterns of expression were very different in cells grown on SISgel than on Matrigel or even plastic, supporting the hypothesis that growth of bladder cancer cells on normal matrix suppresses some malignant functions. Unique underlying regulatory networks were driving gene expression and could be identified by the approach outlined here.
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Affiliation(s)
- Mikhail G Dozmorov
- Department of Urology, Oklahoma University Health Sciences Centre, Oklahoma City, OK 73104, USA
| | - Kimberly D Kyker
- Department of Urology, Oklahoma University Health Sciences Centre, Oklahoma City, OK 73104, USA
| | - Ricardo Saban
- Department of Physiology, Oklahoma University Health Sciences Centre, Oklahoma City, OK 73104, USA
| | - Nicholas Knowlton
- Microarray Core Facility, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Igor Dozmorov
- Microarray Core Facility, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Michael B Centola
- Microarray Core Facility, Oklahoma Medical Research Foundation, Oklahoma City, OK 73104, USA
| | - Robert E Hurst
- Department of Urology, Oklahoma University Health Sciences Centre, Oklahoma City, OK 73104, USA
- Department of Biochemistry and Molecular Biology, Oklahoma University Health Sciences Centre, Oklahoma City, OK 73104, USA
- Department of Occupational and Environmental Health, Oklahoma University Health Sciences Centre, Oklahoma City, OK 73104, USA
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