Stages of transformation in the development of N-butyl-N-(4-hydroxybutyl)-nitrosamine-induced transitional cell carcinomas in the urinary bladder of rats

Gene Expression and DNA Methylation Status of Glutathione S-Transferase Mu1 and Mu5 in Urothelial Carcinoma

Bladder cancer is highly recurrent after therapy, which has an enormous impact on the health and financial condition of the patient. It is worth developing diagnostic tools for bladder cancer. In our previous study, we found that the bladder carcinogen BBN increased urothelial global DNA CpG methylation and decreased GSTM1 protein expression in mice. Here, the correlation of BBN-decreased GSTM1 and GSTM gene CpG methylation status was analyzed in mice bladders. BBN treatment decreased the protein and mRNA expression of GSTM1, and the CpG methylation ratio of GSTM1 gene promoter was slightly increased in mice bladders. Unlike mouse GSTM1, the human GSTM1 gene tends to be deleted in bladder cancers. Among 7 human bladder cancer cell lines, GSTM1 gene is really null in 6 cell lines except one, T24 cells. The CpG methylation level of GSTM1 was 9.9% and 5-aza-dC did not significantly increase GSTM1 protein and mRNA expression in T24 cells; however, the GSTM5 gene was CpG hypermethylated (65.4%) and 5-aza-dC also did not affect the methylation ratio and mRNA expression. However, in other cell lines without GSTM1, 5-aza-dC increased GSTM5 expression and decreased its CpG DNA methylation ratio from 84.6% to 61.5% in 5637, and from 97.4% to 75% in J82 cells. In summary, two biomarkers of bladder tumor were provided. One is the GSTM1 gene which is down-regulated in mice bladder carcinogenesis and is usually deleted in human urothelial carcinoma, while the other is the GSTM5 gene, which is inactivated by DNA CpG methylation.

[Karyometry of BBN-induced precancerosis of the urothelium : An experimental analysis]

BACKGROUND

The morphology of experimental precancerous lesions of the urinary bladder has been interpreted quite differently by various authors.

OBJECTIVES

The aim of this investigation was to quantify these lesions by karyometry and, thus, to gain a more reliable understanding of the process.

MATERIALS AND METHODS

A total of 60 Wistar rats were fed with N‑butyl-N-(4-hydroxybutyl)nitrosamine (BBN) at a concentration of 0.05 % in their drinking water to induce preneoplastic changes of the urothelium. After the second week of BBN exposition, 6 animals were killed every 2 weeks up to week 20. Smears of the scraped off urothelium of 3 urinary bladders of each group were analyzed cytologically and karyometrically.

RESULTS

BBN exposition led to statistically significant changes of the karyometric values using the χ² test to differentiate the control animals from the ones that had ingested BBN and the 2‑week groups from each other. These changes consisted mainly in significant deviations of the size of the nuclear area within the different groups.

CONCLUSION

Morphological and karyometrical analysis showed that biologically relevant stages in the development of chemically induced urothelial precancerous lesions could be realized much earlier than had been assumed in recent publications. Karyometric analysis offered a valid basis to describe the early morphologic alterations of carcinogenesis.

DNA cytophotometric and histological analysis of N-butyl-N-(4-hydroxybutyl)nitrosamine-induced precancerous lesions of the bladder urothelium

Purpose

The morphology of experimentally induced urinary bladder precancerous lesions has been differentially interpreted in the literature. Here, we aimed to describe the development of precancerous lesions of the urothelium histologically and by DNA cytophotometric analysis.

Methods

We induced precancerous lesions of the urothelium in 60 Wistar rats with 0.05 % N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) solution as drinking water. After exposure for 2–20 weeks, each animal received tap water for 2 weeks. Subsequently, six animals were killed every 2 weeks, and urothelia of three urinary bladders per time point were examined by DNA cytophotometry of smear preparations. An additional three urinary bladders were processed for histological analysis.

Results

Over 20 weeks, BBN exposure led to a significant difference between the control group and most of the BBN-exposed 2-week groups and to differences between most of these time point groups. After week 4, this difference included a higher proportion of cells with increased nuclear DNA content. At the end of the experiment, DNA cytophotometric values of the urothelium in experimental rats corresponded to those of poorly differentiated urothelial carcinomas.

Conclusions

Biologically significant stages of precancerous lesions were already detectable after 4 weeks of BBN exposure, considerably earlier than previously described in the literature.

Downregulation of glutathione S-transferase M1 protein in N-butyl-N-(4-hydroxybutyl)nitrosamine-induced mouse bladder carcinogenesis

Bladder cancer is highly recurrent following specific transurethral resection and intravesical chemotherapy, which has prompted continuing efforts to develop novel therapeutic agents and early-stage diagnostic tools. Specific changes in protein expression can provide a diagnostic marker. In our present study, we investigated changes in protein expression during urothelial carcinogenesis. The carcinogen BBN was used to induce mouse bladder tumor formation. Mouse bladder mucosa proteins were collected and analyzed by 2D electrophoresis from 6 to 20 weeks after commencing continuous BBN treatment. By histological examination, the connective layer of the submucosa showed gradual thickening and the number of submucosal capillaries gradually increased after BBN treatment. At 12-weeks after the start of BBN treatment, the urothelia became moderately dysplastic and tumors arose after 20-weeks of treatment. These induced bladder lesions included carcinoma in situ and connective tissue invasive cancer. In protein 2D analysis, the sequentially downregulated proteins from 6 to 20 weeks included GSTM1, L-lactate dehydrogenase B chain, keratin 8, keratin 18 and major urinary proteins 2 and 11/8. In contrast, the sequentially upregulated proteins identified were GSTO1, keratin 15 and myosin light polypeptide 6. Western blotting confirmed that GSTM1 and NQO-1 were decreased, while GSTO1 and Sp1 were increased, after BBN treatment. In human bladder cancer cells, 5-aza-2'-deoxycytidine increased the GSTM1 mRNA and protein expression. These data suggest that the downregulation of GSTM1 in the urothelia is a biomarker of bladder carcinogenesis and that this may be mediated by DNA CpG methylation.

Vascular endothelial growth factor mRNA levels as a biomarker for short-term N-butyl-N-(4-hydroxybutyl) nitrosamine-induced rat bladder carcinogenesis bioassay

Generically, carcinogenic effects of chemicals in bladder carcinogenesis are judged by induction of papillary or nodular (PN) hyperplasia in rats given N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) for 4 weeks and the test chemical for 22-28 weeks. However, upregulation of vascular endothelial growth factor (VEGF) begins early in rat BBN bladder carcinogenesis. To establish a short-term rat bladder carcinogenic bioassay, we analyzed the correlations between VEGF, VEGF mRNA and bladder lesions inductions at 10 and 26 weeks after BBN treatment. Six-week-old male Wistar (slc) rats were given 0.05% BBN for 4, 10 or 26 weeks. To avoid individual rat bias, the bladders were investigated by partial cystectomy at 10 weeks and total cystectomy at 26 weeks. After induction, PN hyperplasia and carcinoma in rats increased with the length of BBN treatment and immunohistochemical VEGF expression also increased following carcinogenesis, but the immunoreactivity of individual lesions was quite variable. Moreover, induction of PN hyperplasia at 10 weeks' BBN treatment was not significantly correlated with that at 26 weeks' treatment; thus, it was not possible to predict the carcinogenic effect due to the induction of PN hyperplasia at 26 weeks' BBN treatment by that at 10 weeks' treatment. However, VEGF mRNA levels of rat bladders at 10 weeks' BBN treatment revealed a strong significant correlation with the incidence of bladder lesions at 26 weeks' treatment. Here, we suggest that quantitative VEGF mRNA levels are a good biomarker for a short-term BBN-induced bioassay for rat bladder carcinogenesis.

Induction of invasive transitional cell bladder carcinoma in immune intact human MUC1 transgenic mice: a model for immunotherapy development

A preclinical model of invasive bladder cancer was developed in human mucin 1 (MUC1) transgenic (MUC1.Tg) mice for the purpose of evaluating immunotherapy and/or cytotoxic chemotherapy. To induce bladder cancer, C57BL/6 mice (MUC1.Tg and wild type) were treated orally with the carcinogen N-butyl-N-(4-hydroxybutyl)nitrosamine (OH-BBN) at 3.0 mg/day, 5 days/week for 12 weeks. To assess the effects of OH-BBN on serum cytokine profile during tumor development, whole blood was collected via submandibular bleeds prior to treatment and every four weeks. In addition, a MUC1-targeted peptide vaccine and placebo were administered to groups of mice weekly for eight weeks. Multiplex fluorometric microbead immunoanalyses of serum cytokines during tumor development and following vaccination were performed. At termination, interferon gamma (IFN-γ)/interleukin-4 (IL-4) ELISpot analysis for MUC1 specific T-cell immune response and histopathological evaluations of tumor type and grade were performed. The results showed that: (1) the incidence of bladder cancer in both MUC1.Tg and wild type mice was 67%; (2) transitional cell carcinomas (TCC) developed at a 2:1 ratio compared to squamous cell carcinomas (SCC); (3) inflammatory cytokines increased with time during tumor development; and (4) administration of the peptide vaccine induces a Th1-polarized serum cytokine profile and a MUC1 specific T-cell response. All tumors in MUC1.Tg mice were positive for MUC1 expression, and half of all tumors in MUC1.Tg and wild type mice were invasive. In conclusion, using a team approach through the coordination of the efforts of pharmacologists, immunologists, pathologists and molecular biologists, we have developed an immune intact transgenic mouse model of bladder cancer that expresses hMUC1.

Omega-3 fatty acids inhibit tumor growth in a rat model of bladder cancer

Omega-3 (ω-3) fatty acids have been tested on prevention and treatment of several cancer types, but the efficacy on “in vivo” bladder cancer has not been analyzed yet. This study aimed at evaluating the chemopreventive efficacy of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) mixture in an animal model of bladder cancer. Forty-four male Wistar rats were divided into 4 groups during a 20-week protocol: control; carcinogen—N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN); ω-3 (DHA + EPA); and ω-3 + BBN. BBN and ω-3 were given during the initial 8 weeks. At week 20 blood and bladder were collected and checked for the presence of urothelium lesions and tumors, markers of inflammation, proliferation, and redox status. Incidence of bladder carcinoma was, control (0%), ω-3 (0%), BBN (65%), and ω-3 + BBN (62.5%). The ω-3 + BBN group had no infiltrative tumors or carcinoma in situ, and tumor volume was significantly reduced compared to the BBN (0.9 ± 0.1 mm³ versus 112.5 ± 6.4 mm³). Also, it showed a reduced MDA/TAS ratio and BBN-induced serum CRP, TGF-β1, and CD31 were prevented. In conclusion, omega-3 fatty acids inhibit the development of premalignant and malignant lesions in a rat model of bladder cancer, which might be due to anti-inflammatory, antioxidant, anti-proliferative, and anti-angiogenic properties.

Development and characterization of a bladder cancer xenograft model using patient-derived tumor tissue

Most of the cancer xenograft models are derived from tumor cell lines, but they do not sufficiently represent clinical cancer characteristics. Our objective was to develop xenograft models of bladder cancer derived from human tumor tissue and characterize them molecularly as well as histologically. A total of 65 bladder cancer tissues were transplanted to immunodeficient mice. Passagable six cases with clinico-pathologically heterogeneous bladder cancer were selected and their tumor tissues were collected (012T, 025T, 033T, 043T, 048T, and 052T). Xenografts were removed and processed for the following analyses: (i) histologic examination, (ii) short tandem repeat (STR) genotyping, (iii) mutational analysis, and (iv) array-based comparative genomic hybridization (array-CGH). The original tumor tissues (P 0) and xenografts of passage 2 or higher (≥P2) were analyzed and compared. As a result, hematoxylin and eosin staining revealed the same histologic architecture and degree of differentiation in the primary and xenograft tumors in all six cases. Xenograft models 043T_P2 and 048T_P2 had completely identical STR profiles to the original samples for all STR loci. The other models had nearly identical STR profiles. On mutational analysis, four out of six xenografts had mutations identical to the original samples for TP53, HRAS, BRAF, and CTNNB1. Array-CGH analysis revealed that all six xenograft models had genomic alterations similar to the original tumor samples. In conclusion, our xenograft bladder cancer model derived from patient tumor tissue is expected to be useful for studying the heterogeneity of the tumor populations in bladder cancer and for evaluating new treatments.

Chemopreventive efficacy of Atorvastatin against nitrosamine-induced rat bladder cancer: antioxidant, anti-proliferative and anti-inflammatory properties

To investigate the anti-carcinogenic effects of Atorvastatin (Atorva) on a rat bladder carcinogenesis model with N-butyl-N-(4-hydroxibutil)nitrosamine (BBN), four male Wistar rat groups were studied: (1) Control: vehicle; (2) Atorva: 3 mg/kg bw/day; (3) Carcinogen: BBN (0.05%); (4) Preventive Atorva: 3 mg/kg bw/day Atorva + BBN. A two phase protocol was used, in which the drug and the carcinogen were given between week 1 and 8 and tumor development or chemoprevention were expressed between week 9 and 20, when the bladders were collected for macroscopic, histological and immunohistochemical (p53, ki67, CD31) evaluation. Serum was assessed for markers of inflammation, proliferation and redox status. The incidence of bladder carcinoma was: control 0/8 (0%); Atorva 0/8 (0%); BBN 13/20 (65%) and Atorva + BBN 1/8 (12.5%). The number and volume of tumors were significantly lower in the Atorva + BBN group, with a marked reduction in hyperplasia, dysplasia and carcinoma in situ lesions. An anti-proliferative, anti-inflammatory and antioxidant profile was also observed in the preventive Atorva group. p53 and ki67 immunostaining were significantly increased in the BBN-treated rats, which was prevented in the Atorva + BBN group. No differences were found for CD31 expression. In conclusion, Atorvastatin had a clear inhibitory effect on bladder cancer development, probably due to its antioxidant, anti-proliferative and anti-inflammatory properties.

Exploring molecular genetics of bladder cancer: lessons learned from mouse models

Urothelial cell carcinoma (UCC) of the bladder is one of the most common malignancies worldwide, causing considerable morbidity and mortality. It is unusual among the epithelial carcinomas because tumorigenesis can occur by two distinct pathways: low-grade, recurring papillary tumours usually contain oncogenic mutations in FGFR3 or HRAS, whereas high-grade, muscle-invasive tumours with metastatic potential generally have defects in the pathways controlled by the tumour suppressors p53 and retinoblastoma (RB). Over the past 20 years, a plethora of genetically engineered mouse (GEM) models of UCC have been developed, containing deletions or mutations of key tumour suppressor genes or oncogenes. In this review, we provide an up-to-date summary of these GEM models, analyse their flaws and weaknesses, discuss how they have advanced our understanding of UCC at the molecular level, and comment on their translational potential. We also highlight recent studies supporting a role for dysregulated Wnt signalling in UCC and the development of mouse models that recapitulate this dysregulation.

Pathobiology and chemoprevention of bladder cancer

Our understanding of the pathogenesis of bladder cancer has improved considerably over the past decade. Translating these novel pathobiological discoveries into therapies, prevention, or strategies to manage patients who are suspected to have or who have been diagnosed with bladder cancer is the ultimate goal. In particular, the chemoprevention of bladder cancer development is important, since urothelial cancer frequently recurs, even if the primary cancer is completely removed. The numerous alterations of both oncogenes and tumor suppressor genes that have been implicated in bladder carcinogenesis represent novel targets for therapy and prevention. In addition, knowledge about these genetic alterations will help provide a better understanding of the biological significance of preneoplastic lesions of bladder cancer. Animal models for investigating bladder cancer development and prevention can also be developed based on these alterations. This paper summarizes the results of recent preclinical and clinical chemoprevention studies and discusses screening for bladder cancer.

Biological similarities between murine chemical-induced and natural human bladder carcinogenesis

The present study investigated the similarities between rodent and human urothelial carcinogenesis models using DNA content, p53 and Ki-67 immunoexpression as surrogate markers of bladder carcinogenesis. Following N-butyl-N-(4-hydroxybutyl)-nitrosamine exposure, 49 human cystectomy specimens of bladder cancer and 53 rat bladder specimens were studied. All of the tumours and adjacent mucosa present in each specimen were evaluated. High similarities were observed between the rodent urothelium carcinogenesis process and the corresponding process in humans, in regards to the histopathological features and biological alteration profile: DNA aneuploidy, p53 overexpression and high proliferative index measured by Ki-67 immunoexpression. Despite these similarities, a higher frequency of alterations was observed in earlier stages in the rat chemical-induced carcinogenesis, namely in 5c aneuploid cells, p53 overexpression and higher Ki-67 labelling index. These results confirm that this experimental animal model is a suitable and reproducible model of bladder carcinogenesis, particularly in regards to high-risk non-invasive and invasive urothelial carcinomas. These features mandate its use in the identification of new molecular targets and evaluation of tumour response to new cytotoxic drugs or drug combinations in bladder cancer therapeutic intervention.

Molecular credentialing of rodent bladder carcinogenesis models

Cancer of the urinary bladder is often a result of exposure to chemical carcinogens. Models of this disease have been developed by exposing rodents to N-butyl-N-(4-hydroxybutyl)-nitrosamine (OH-BBN). The resultant tumors are histologically similar to human disease, but little is known about genetic similarities to the latter. Such knowledge would help identify or corroborate genes found important in human bladder cancer and suggest biologically appropriate mechanistic studies. We address this need by comparing gene expression profiles associated with urothelial carcinoma for three different species: mouse, rat, and human. We find that many human genes homologous to those differentially expressed in carcinogen-induced rodent tumors are also differentially expressed in human disease and are preferentially associated with progression from non-muscle-invasive to muscle-invasive disease. We also find that overall gene expression profiles of rodent tumors correspond more closely with those of invasive human tumors rather than non-muscle-invasive tumors. Finally, we provide a list of genes that are likely candidates for driving this disease process by virtue of their concordant regulation in tumors of all three species.

Comparative pathology of proliferative lesions of the urinary bladder

Bladder neoplasia in humans consists of 2 diseases, a low-grade papillary tumor that does not invade or metastasize, and a high-grade lesion that usually invades and metastasizes. Bladder carcinogenesis in rats is most like the low-grade, papillary tumor, although it eventually does progress and invade. In the mouse, models are available that mimic each of these disease processes. Preneoplastic lesions in humans and rodents include various types of hyperplasia, proliferative cystitis, and dysplasia. These preneoplastic and neoplastic lesions arise throughout the urothelium, from the renal pelvis to the urethra, although most commonly in the bladder. Rarely, benign and malignant mesenchymal lesions occur in rats and mice, with a unique submucosal mesenchymal lesion present in some strains of mice. In addition, eosinophilic and clear inclusions in the superficial layer of urothelium in mice, which do not appear to be associated with toxicity or carcinogenesis, have been reported. An approach to evaluation of carcinogenic mechanisms involved in the urothelium is presented. It focuses on distinguishing between DNA reactive carcinogens vs those that act by increasing cell proliferation. Although rodent models do not precisely mimic the human disease, they have provided useful models for furthering our understanding of the carcinogenic process in the urothelium as it pertains to human diseases.

Histogenesis of nonurothelial carcinomas in the human and rat urinary bladder

The histogenesis of nonurothelial carcinomas (squamous cell carcinoma, common adenocarcinoma, clear cell adenocarcinoma, signet ring cell adenocarcinoma and undifferentiated carcinomas) of the urinary bladder is difficult to understand, since the bladder is normally lined exclusively by transitional cell epithelium and contains no otherwise specified epithelia. In the present study we analysed the morphology and development of nontransitional cell carcinomas of the human and comparatively of the rat urinary bladder in an attempt to elucidate their histogenetic derivation. There is strong evidence that the underlying histogenetic principle consists in the well-known pluripotent metaplastic potency (squamous, columnar, goblet and signet ring cell, glandular and so-called nephrogenic metaplasia) of the normal and neoplastic urothelium as well, due to the complex embryologic origin of the bladder. Our findings indicate that squamous cell carcinomas, common and clear cell adenocarcinomas, and signet ring cell adenocarcinomas mainly arise secondarily from preexisting, predominantly solid transitional cell carcinomas by focally beginning and diffusely progressing metaplastic changes of various types. The second histogenetic pathway consists in the formation from primary metaplasias of the transitional cell epithelium in situ. Undifferentiated carcinomas (small, large and sarcomatoid subtypes) develop from preexistent solid urothelial carcinomas by a cellular dedifferentiation. Recognition of transitional cell carcinomas characterised by focal metaplastic processes or cellular dedifferentiation seems to be important from a clinical point of view, because of their probably more malignant biologic behaviour compared with uniformly differentiated pure urothelial carcinomas. Our comparative morphologic analysis of nonurothelial carcinomas and their histogenesis has demonstrated that the findings in the human and rat urinary bladder are largely identical. The experimental models used permit reliable extrapolation of the results obtained to the situation in man.

Lack of an antitumoral effect of immunomodulatory galactoside-specific mistletoe lectin on N-methyl-N-nitrosourea-induced urinary bladder carcinogenesis in rats

The aim of the present animal experiment was to study the effect of galactoside-specific lectin or agglutinin (VAA) from mistletoe (Viscum album L.) on chemically induced tumor development in the urinary bladder of rats. Since VAA has been shown to exert a remarkable immunomodulating effect, any change in tumor formation would indicate a lectin-triggered immune control of urothelial carcinogenesis in the used model. To produce vesical neoplasms the direct-acting urothelial carcinogen N-methyl-N-nitrosourea (MNU) was administered at a single intravesical dose (7.5 mg/kg body weight). Highly purified VAA was given subcutaneously twice a week at the immunomodulatory dose of 1 ng/kg body weight over a period of 6 months during the critical phases of tumor development. After a total experimental time of 15 months the incidence of epithelial bladder tumors was 29.3% in controls versus 27.9% in rats additionally receiving the lectin and thus not significantly different in both experimental groups. There were, moreover, no substantial differences in the histopathologic spectrum of epithelial tumors induced, their patterns of growth, grades of cellular malignancy and local extension. The frequency and histopathology of mesenchymal bladder tumors as well as the incidence and morphology of carcinomas of the ureters and renal pelves also proved to be similar in controls and in rats treated with VAA. In conclusion, the present data provide no evidence for a modifying or even inhibitory effect of the immunomodulatory galactoside-specific mistletoe lectin on experimental urothelial carcinogenesis.

Modification of N-methyl-N-nitrosourea-induced urinary bladder carcinogenesis in rats following stimulation of urothelial proliferation by a partial cystectomy

The present experiments are concerned with the question whether stimulation of urothelial proliferation modifies tumor development in the urinary bladder. To induce proliferative activity of the urothelium a partial cystectomy (one-third resection of the bladder) was performed in female Wistar rats. N-Methyl-N-nitrosourea (MNU) was used as a carcinogen which acts directly on the urothelium without requiring metabolic activation. MNU was given as a single intravesicular dose of 5 mg/kg body weight via a urethral catheter. After an experimental period of 15 months rats with an intact quiescent bladder showed a tumor incidence of 32.6%. Rats having received MNU 45 h following partial cystectomy - when proliferative activity reached its peak - had developed bladder tumors with a frequency of 17.9%. Initial administration of MNU followed 24 h later by a one-third resection of the bladder resulted in a tumor incidence of only 8.8%. The histologic types of tumors induced proved to be similar to those found with other carcinogens. However, by contrast the majority of urothelial tumors were characterized by a squamous metaplasia. There was no substantial difference between the various histologic tumor types found in the resting and regenerating bladder. The mechanisms responsible for the observed inhibition of tumor development in the regenerating bladder are unknown. It is assumed that an increased capacity of the proliferating urothelial cells to repair carcinogen-induced DNA damage may play an important role.

Carcinogenesis in mammalian urothelium: changes induced by non-carcinogenic substances and chronic indwelling catheters

Carcinogenesis in urinary bladders may not be represented by a continuum of pathological lesions beginning with papillary tumors or flat dysplasias/atypias. In a previous experiment, sterile water and saline continuously infused via catheters connected to ALZA mini-pumps were shown to induce papillary urothelial lesions indistinguishable from tumors considered to be carcinomas in most histological classification schemes. The animals in the initial experiment were followed for relatively brief periods which did not allow for determination of potential reversibility of the process and did not distinguish the effects of the catheters versus those of the infused substances. The present study was designed to control for these variables. Rats were divided into seven groups to examine the urothelial changes after: surgery alone, continuous infusion of the sterile water and mitomycin C, and chronic indwelling catheters with and without infusion. The results indicated that chronic irritation with indwelling catheters was a strong stimulus for the induction of urothelial neoplasms and that continuous infusion of certain substances, even sterile water, might play a small role in the process of carcinogenesis. Comparing the frequencies of papillary urothelial tumors appearing after brief exposure to sterile water and catheters in the initial experiment (75 per cent) and papillary lesions appearing long after removal of the sterile water and catheters in the current study (0 per cent) indicates that these lesions are reversible and probably not neoplastic.

Epithelial abnormalities in the renal pelvis in experimental hydronephrosis and pyelonephritis

Unilateral hydronephrosis was induced by temporary ligature of the left ureter in 29 rabbits. In 21 animals so treated, chronic pyelonephritis was simultaneously induced by intravenous application of a suspension of E. coli. Histologic examination of renal pelvic epithelia in animals killed four weeks after the surgical intervention, revealed the following features: 1. Simple hyperplasia of urothelium in 12 cases, 2. atypical hyperplasia - (dysplasia) of urothelium in 10 cases, 3. v. Brunn's nests in 20 renal pelvises; 11 cases of cystic pyelitis, all combined with Brunn's nests, 4. metaplastic transformation of visceral mono- or bilayered epithelium into multi-layered urothelium-like structures in 19 renal pelvises. These changes are observed almost exclusively in the left renal pelvis of animals subjected to temporary ureteral ligature. Atypical urothelial hyperplasia is found only together with chronic pyelonephritis. Hyperplastic and dysplastic epithelial changes in the renal pelvis, the formation of Brunn's nests, and cystic pyelitis are interpreted as sequelae of postrenal obstruction or concomitant chronic inflammation.

Histology and histogenesis of two different types of inverted urothelial papillomas

Inverted papillomas are rare tumors of the lower urinary tract. Among 1829 reclassified tumors of the urinary bladder, renal pelves, ureters, and urethra, there were 40 (2.2%) inverted papillomas. The great majority of these were localized in the bladder. Because of distinctive histologic features and patterns of growth it is possible to differentiate between two basic types of inverted papillomas which were termed "trabecular" and "glandular." The trabecular type consists of widely branched, anastomosing cords of urothelial cells originating directly from the overlying transitional epithelium. The trabeculae are arranged horizontally or perpendicularly to the surface epithelium and occasionally exhibit peripheral palisading of the cells. The glandular type is characterized by multiple round to oval islands of proliferated urothelial cells together with pseudoglandular and true glandular structures which are often still connected with the surface urothelium. The gland-like structures are lined by stratified urothelium, the true glands by mucus secreting columnar epithelium. Sometimes glandular metaplasia of an intestinal type with goblet cell formation could be observed. Inverted papillomas of the trabecular type arise histogenetically from a proliferation of the basal cells of the urothelium. The glandular type develops apparently from a proliferative cystitis cystica and glandularis which, therefore, should be considered a potentially preneoplastic lesion. The predominant view of the biological behavior of inverted papillomas is that of a benign neoplastic lesion. Morphologic findings supplied some arguments in favor of a low grade malignant potential of these tumors. However, their malignant transformation seemed to be much lower than that of exophytic papillomas.

The origin of invasive carcinoma of the bladder

One-hundred and four consecutive cases of invasive bladder carcinoma were studied. Twenty of the 104 cases had a history of papillary neoplasms of the bladder while the remaining 84 cases did not. Further, 22 of the 104 cases had cystoscopies, months to years prior to the diagnosis of invasive bladder carcinoma, which documented the absence of previous papillary neoplasms of the bladder. Therefore, this study suggests that papillary neoplasms of the bladder may not be the most common precursor of invasive bladder carcinoma. Consequently, vigorously attacking the highly visible papillary neoplasms of the bladder may not be as fruitful in preventing invasive bladder carcinoma as attempting to identify the presence of other less visible nonpapillary lesions which may be the most frequent precursors of invasive bladder carcinoma.

Induction of bladder cancer in rats by fractionated intravesicular doses of N-methyl-N-nitrosourea

Experiments were conducted to determine the dose response of rat bladder urothelium to a range of different single and fractionated intravesicular doses of the carcinogen, N-methyl-N-nitrosourea (MNU). A dose-related response of bladder-tumour incidence to single graded doses of MNU was found, and a threshold does suitable for use of multistage carcinogenesis experiments was derived from these data. For any given total dose of MNU, the tumour incidence was greater if the MNU had been administered in several small fractions than if it had been administered in fewer larger ones. Extending the interval between doses did not reduce the tumour incidence. It is argued that these results support the multistage theory of carcinogenesis. The histopathology and cell-surface alterations which characterize the development of MNU-induced bladder cancer are described and the contribution of hyperplasia and calculi are discussed.

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 cellular features of developing carcinoma in murine urinary bladder

Bladder cancer often results from a widespread reaction of urothelial cells to carcinogenic stimuli. Although developing carcinoma is widely considered to progress through various grades of epithelial atypia, well-controlled prospective studies detailing the morphologic features of these lesions at the cellular level have not appeared in the literature. This study was designed to document the cellular features of developing urothelial carcinoma in experimental animals using the BHBN model system. Developing lesions were monitored by periodic collection of urine and tissue. The specimens were coded and examined by cytology and histology using multiple discriminators. The morphologic changes in the treated bladders were statistically different from those in control tissue. They could be divided into three stages: 1) The earliest abnormalities were an increase in the number of cell layers, loss of polarity, and slight crowding of nuclei in the tissue sections. Among the cellular features, there were increased nuclear size and sharply angulated indentations (notches) in the nuclear borders. A few nuclei exhibited a finely granular pattern, but dusty chromatin predominated. 2) In the intermediate stage, nuclear crowding became more prominent, and there were numerous areas with finely granular, regularly distributed chromatin. A few nucleoli were identified. Mitoses were prominent in the tissue sections. 3) In the late stage, as papillary tumors developed elsewhere, the urothelium of the flat areas changed significantly. Nuclear crowding and notching remained constant but were overshadowed by the appearance of nucleoli and irregularly distributed chromatin. The pattern was finely granular in some cases but coarsely granular in most. Nuclear size decreased markedly as the cells became smaller and more numerous. Cytologically, it was not possible to distinguish these cells from neoplastic cells emanating from the papillary areas. This experimental study tends to confirm deductions made from clinical material that urothelial carcinoma develops through an orderly sequence of morphologic severity. It further indicates that invasive carcinoma can arise from neoplastic cells that neither occupy the full thickness of the epithelium nor represent lateral migration from an adjacent full thickness lesion. The detailed cellular features documented can be used to identify atypical cells in correlative cytologic preparations. Studies such as this could provide an experimental basis for future evaluations of the cytologic characteristics of human urothelial atypia.

Ortho-toluene sulphonamide and saccharin in the promotion of bladder cancer in the rat

The importance of the contaminant OTS in the promoting activity of commercial saccharin on rat bladder neoplasia was investigated. OTS, OTS-free and OTS-contaminated saccharin were administered in the drinking water or diet for 2 years to groups of rats pretreated with an intravesical instillation of MNU; OTS alone and OTS-free saccharin were also given to groups of rats not pretreated with MNU. Administration of OTS was not associated with changes in urinary pH, crystalluria or calculus formation, had no effect on the histology of normal rat bladder, and did not increase the incidence of bladder hyperplasia or neoplasia elicited by pretreatment with MNU. No differences could be found between the effect of OTS-free or OTS-contaminated saccharin on bladders of rats pretreated with MNU. These results indicate that OTS contamination played no part in the reported promoting activity of saccharin on the rat bladder. Administration of saccharin did not increase urinary pH, crystalluria or calculus formation, and failed to promote bladder neoplasia after a carcinogenic dose of MNU, though the numbers of proliferative lesions in the bladder were increased.

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

The inhibitory effect of thio-TEPA on both developing and established mammalian bladder cancer was tested in the FANFT model system using female C3H/He mice. This model allows the histologic evaluation of the entire target organ, a major advantage over clinical trials, which have relied largely on endoscopic appearance for determination of response. A powerful carcinogen, FANFT is known to cause bladder carcinoma in at least 90% of these animals within 12 months. The tumors develop through a spectrum of morphologic changes including hyperplasia, dysplasia, and carcinoma in situ. Animals were divided into equally sized control and test groups and either thio-TEPA or saline was administered on a schedule designed to correspond to that used in clinical trials. Bladders from 159 mice were evaluated grossly, microscopically and in some instances, ultrastructurally, for the presence of tumor or other intraepithelial lesions. When compared to controls, thio-TEPA had no statistically significant inhibitory effect on either developing or established bladder tumors. The drug did, however, cause a statistically significant decrease in the frequency of high-grade, high-stage lesions when given during tumor development and may retard the evolution of such neoplasms from low-grade noninvasive carcinomas. The correlation of these experimental findings with the reportedly beneficial results of clinical trials is discussed.