The effect of thio-TEPA on developing and established mammalian bladder tumors

The effect of intravesical instillations of thiotepa, mitomycin C, and adriamycin on normal urothelium: an experimental study in rats

The effects of intravesical instillations of thiotepa, mitomycin C and adriamycin on the normal urothelium were studied in rats. Changes in the bladder wall in the form of fibroblastic atypia and submucous fibrous plaques were significant in the mitomycin C treated group. In 46% of mitomycin C treated animals there was urothelial atypia and in one animal, the atypia was severe enough to resemble carcinoma in situ. None of the rats treated with thiotepa showed intramural fibrous plaques or fibroblastic atypia and only 8% showed urothelial atypia. In the group treated by adriamycin instillation, 17% showed intramural fibrous plaques, but none showed urothelial atypia or fibroblastic atypia. The fibroblastic atypia and submucosal fibrous plaques seen in the mitomycin treated group may explain the reduced bladder capacity seen in the clinical setting.

Difficulties in evaluating urinary specimens after local mitomycin therapy of bladder cancer

In order to describe the cytological changes induced by mitomycin in urinary specimens, we re-examined cytological specimens from patients with recurring bladder cancer treated by long-term intravesical mitomycin therapy after transurethral resection. Local mitomycin therapy causes an increase of leukocytes and urothelial cells, especially of the umbrella-cell type, in urinary specimens. During and after the application of mitomycin, the nucleus and the cytoplasm of urothelial cells are enlarged, usually proportionally. Urothelial cells frequently show a giant nucleus, multiple prominent nucleoli, and an enlarged foamy cytoplasm of the umbrella-cell type. Anisokaryosis is also seen. Such cytological changes are more remarkable later in the course of therapy and after the end of therapy, and they often confuse cytological interpretation. However, the nuclei of urothelial cells are usually translucent and not hyperchromatic, and there is rarely a coarse chromatin pattern. On the other hand, in positive specimens during or after local mitomycin therapy, usually a number of tumor cells showing nuclear enlargement, hyperchromatic nuclei, coarse chromatin pattern, and/or increased nuclear-cytoplasmic ratio are found beside the atypical cells changed by mitomycin.

Flow cytometry versus urinary cytology in the evaluation of patients with bladder cancer

We compared the roles of urinary cytology and flow cytometry in the evaluation of patients with bladder cancer in clinical practice situations at a large general hospital. Specimens included 105 bladder washings from patients being followed for urothelial carcinomas and 28 control washings from individuals undergoing cytoscopy for other reasons. Flow cytometry and cytology were performed on aliquots of the same specimen in all bladder cancer samples. When carcinoma was present at the time of specimen collection it was detected by positive cytology in 75 per cent and deoxyribonucleic acid aneuploidy in 78 per cent of the cases. Combination of flow cytometry and urinary cytology increased the diagnostic yield to 95 per cent. Flow cytometry was slightly more sensitive than urinary cytology for detection of abnormalities in specimens from noninvasive and untreated tumors but the only statistically significant difference between the 2 procedures occurred among specimens from treated invasive cancers in which flow cytometry was a less sensitive method than cytology. Abnormal deoxyribonucleic acid ploidy was documented in a few specimens from noncancer-bearing patients having diseases associated with high urothelial cell turnover rates but the concomitant urinary cytology was negative for neoplasia. When used in conjunction with urinary cytology, flow cytometry was a valuable procedure in the followup of patients with bladder cancer. The diagnostic yield with this combination was such that flow cytometry and cytology may be used to reduce the frequency of cystoscopy and biopsy during clinical management in selected situations.

Histological parameters and pitfalls in the interpretation of bladder biopsies in bacillus Calmette-Guerin treatment of superficial bladder cancer

We report the morphological effects of intravesical bacillus Calmette-Guerin therapy on early post-treatment biopsies of the bladder in 39 patients with superficial transitional cell carcinoma (stage Ta, T1 or Tis) of the bladder. Although submucosal granulomatous inflammation in bladder biopsies of patients receiving intravesical bacillus Calmette-Guerin treatment has been described previously, a complete morphological description of the early effects of bacillus Calmette-Guerin on all bladder layers and the prostatic urethra has not been reported. In the majority of cases the superficial epithelium was eroded and the edematous submucosa contained noncaseating granulomas with a surrounding lymphoplasmocytic and eosinophilic infiltrate. Langhans' giant cells occasionally were found, and acid-fast bacilli were demonstrated only rarely by special stains in the 6-week post-treatment biopsy. In some cases the prostatic urethra and muscle bundles contained noncaseating granulomas. Features distinguishing epithelial atypia resulting from bacillus Calmette-Guerin treatment and superficial cancer include the presence of epithelial maturation, preserved nuclear/cytoplasmic ratio, smooth nuclear contours and lack of nuclear pleomorphism, nucleoli or cytomegaly.

Effects of intravesical instillation of antitumor chemotherapeutic agents on bladder carcinogenesis in rats treated with N-butyl-N-(4-hydroxybutyl)nitrosamine

The effects of intravesical instillation of Adriamycin (doxorubicin) (ADR), and mitomycin C (MMC), as inhibitors of development of rat bladder tumors, were examined in rats treated with N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN). Intravesical instillation of ADR or MMC once a week for 12 weeks into rats pretreated with BBN for 4 weeks markedly enhanced development of bladder tumors. That is, one week after the end of intravesical instillation of these compounds the incidence of papillary or nodular hyperplasias, namely preneoplastic lesions, was significantly increased, and at the end of the experiment the incidence of not only papillary or nodular hyperplasias but also of papillomas and cancers was significantly increased. These results indicate that the intravesical instillation of ADR or MMC promotes two-stage bladder carcinogenesis in rats.

Urinary cytology and bladder cancer. The cellular features of transitional cell neoplasms

Urinary cytology is increasingly accepted as a diagnostic tool in the detection and follow-up of patients with bladder cancer. Its potential value has been reduced, however, by the relative inexperience of most pathologists in the examination of urinary specimens, and by the lack of cellular criteria specifically reflecting the morphology of low-grade papillary and flat lesions of bladder epithelium. The cytologic features of urothelial lesions, including papillary transitional cell carcinomas and flat urothelial dysplasias have been studied in both experimental systems and clinical situations and their application to a selected patient population is presented. Overall, the cytohistologic correlation for patients with bladder cancer was 92%. Positive cells reflecting the morphology of the tumor occurred in 62% of patients with grade I transitional cell carcinomas, and cells suspicious for malignancy were identified in an additional 14% of these individuals. Using the criteria presented, a positive cytology can correlate with a papillary grade I bladder tumor, and should not necessarily indicate the presence of another neoplasm. Dysplastic cells in cytologic specimens are often identified in patients having urothelial dysplasia as the most serious bladder lesion, but the cytologic diagnosis of dysplasia may represent an under-interpretation of a low-grade papillary bladder tumor. The cells of urothelial neoplasms, including low-grade transitional cell carcinomas and dysplasias, differ morphologically both from normal and reactive/reparative elements, and can be detected in cytologic samples. The changes are often subtle and require experience and a cautious approach for accurate interpretation.

Early multiple-dose adjuvant thiotepa in the control of multiple and rapid T1 tumour neogenesis

In 45 patients each with a well established and constant pattern of widespread tumor neogenesis following cystodiathermy, early multiple dose adjuvant thiotepa was used in an effort to control the tumours. The response was good in 32 patients as judged by the reduction in the number of new tumours and by the downgrading and downstaging of new lesions when compared with pre-thiotepa histology. Continuing maintenance therapy was required in the majority but, with the passage of time, the dosage could be progressively reduced, suggesting a cumulative effect of treatment. Of 13 non-responders, 7 showed evidence of higher than average malignant potential against which thiotepa appears ineffective. The timing of administration is probably a key factor in success and one which accounts for much of the variation in reported results.

Pathological changes associated with topical chemotherapy for superficial bladder cancer

With use of previous observations in experimental animals as a basis for comparison the cytologic and histologic changes in human patients who underwent topical chemotherapy for superficial bladder cancer were documented. Despite the potential for inhibition of deoxyribonucleic acid replication these drugs apparently act in vivo as toxic substances, causing increased exfoliation with denudation of papillary and/or flat urothelium. Multinucleation was common but confined to superficial cells. Atypical cells, such as those observed after systemic chemotherapy with cyclophosphamide, rarely were present and could be distinguished readily from neoplastic elements. Although topical chemotherapy may suppress tumor growth and progression it apparently does not eradicate the neoplastic process.

Evaluation of cystography for detection of bladder carcinoma in mice: comparison with urinary cytology

Cystography was compared to urinary cytology in an effort to determine whether or not this modality might be useful in the detection of FANFT-induced bladder tumors in mice. Compared to gross examination of the bladders in 24 mice, cystography had the same degree of accuracy as urinary cytology--79.2 per cent. Comparison of the cystographic and cytologic diagnoses with histology revealed that cytology was more accurate, 79.2 vs 66.6 per cent. Cystography was especially helpful in detecting papillary tumors while cytology was more accurate in the detection of high-grade, high-stage tumors or carcinoma in situ (CIS). Cystography in mice can complement cytology as an additional useful technique for detection of bladder carcinoma.

The morphologic effects of mitomycin C in mammalian urinary bladder

This investigation was intended to determine the morphologic changes of mitomycin C. It is part of a series of experiments designed to evaluate the cytologic and histologic effects of topical chemotherapeutic agents using the FANFT experimental model system in mice. The results for mitomycin C are very similar to those previously reported for thio-tepa. The indicate that these chemicals produce few, if any, drug-specific light microscopic alterations. Rather, mitomycin C and thio-tepa apparently act as toxic substances, causing increased exfoliation, degeneration, and necrosis of urothelial cells. The implications of these findings and suggestions for future investigations are discussed.

The effect of mitomycin C on superficial bladder cancer

A course of intravesical mitomycin C, consisting of 8 weekly doses of 30 or 40 mg., was evaluated in 16 patients with superficial bladder cancer (stages O and A). Cystoscopically documented tumor was destroyed completely in 11 patients (69 per cent), while 3 patients exhibited partial tumor regression. Two patients had only multifocal, grade 3 carcinoma in situ and both had a complete response with negative biopsies and cytology at the 12-week evaluation. Toxicity was minimal. Further data, including longer followup, are needed to define the potentially promising role of this agent in the over-all management of superficial bladder cancer.