Squamous cell carcinoma-associated antigen in uroepithelial carcinoma

Intermittent self-catheterization and the risk of squamous cell cancer of the bladder: An emerging clinical entity?

There are only 7 cases reported in the literature of squamous cell cancer of the bladder in patients performing intermittent self-catheterization (ISC). We report on an eighth case, and the first case described in a patient with a Mitrofanoff continent appendicovesicostomy. A description of the case and review of the literature are presented. Risk factors for squamous cell cancer include recurrent urinary tract infections, keratinising squamous metaplasia (leukoplakia) and local mucosal trauma from intermittent self-catheterization. There is no recognized or validated monitoring program for patients performing ISC who may also have these risk factors. Reasonable protocols may include regular urinary cytology and cystoscopy with random or targeted bladder biopsies. Squamous cell cancer may present late in this cohort of patients and is associated with a dismal prognosis.

Nonurothelial cancer of the bladder

In this article, we review available evidence on the treatment of patients with nonurothelial cancer of the bladder. More than 150 published works were reviewed in preparation for this summary. Squamous cell carcinoma and adenocarcinoma are ideally treated with radical cystectomy. High-risk groups for these diseases are defined. Small cell carcinoma should be treated with multimodality therapy, including chemotherapy. Other rarer tumors of the bladder are also discussed.

Clinical usage of the squamous cell carcinoma antigen in patients with penile cancer

BACKGROUND

We present our initial experience with the use of the squamous cell carcinoma (SCC) antigen (SCCAg) in 16 men with penile SCC (SCC group), in four men with condyloma acuminatum (benign group), and in 32 blood donors (control group).

METHODS

The SCCAg levels were measured at presentation and every 6 months (upper limit was 2 ng/mL). The mean follow-up time was 4 years.

RESULTS

All non-SCC patients had normal SSCAg serum levels in contrast with the SCC patients. The presence of nodal and/or distant metastases resulted in statistically significant higher SCCAg levels, both at presentation and during the follow-up. In patients undergoing lymph node dissection with elevated SCCAg levels prior to the procedure, there was a statistically significant decrease of the SCCAg levels after the operation.

CONCLUSION

The SCCAg level could be a serum marker that holds promise for clinical use in penile SCC. Sequential monitoring of SCCAg level might indicate developing of nodal and/or distant metastases and could be useful in following the response to treatment.

Local recurrence after radical cystectomy for invasive bladder cancer: An analysis of predictive factors

OBJECTIVES

To examine which clinicopathologic parameters predict clinically detectable local recurrence after radical cystectomy. Local recurrence after radical cystectomy for invasive bladder cancer was infrequently observed until 20 years ago because of the lack of adequate diagnostic tools. The recent development and use of pelvic computed tomography has allowed us to detect local recurrence more precisely. However, only a few studies have investigated the rate and pattern of local recurrence in the computed tomography era.

METHODS

This retrospective review included 145 patients with muscle-invasive bladder cancer treated with radical cystectomy, regional pelvic lymph node dissection, and urinary diversion between January 1990 and December 2001. The development of local recurrence and/or distant metastasis was analyzed as the endpoint using univariate and multivariate analyses.

RESULTS

Local recurrence developed in 27 (18.6%) of the 145 patients at a median of 8 months after cystectomy. Of the 27 patients, 8 had local recurrence alone and 19 had concurrent distant metastasis. Distant metastasis without local recurrence developed in 34 patients (23.4%). Univariate and multivariate analyses revealed that Stage pT3-T4 and pathologic pelvic lymph node involvement were statistically significant factors predicting clinical failure, local recurrence, and/or distant metastasis. However, a concomitant squamous cell carcinoma component in the specimen was the only independent predictor of local recurrence alone in both univariate and multivariate analyses.

CONCLUSIONS

Only the finding of a concomitant squamous cell carcinoma component in the specimen was an independent predictor of local recurrence in patients treated with radical cystectomy.

Squamous cell carcinoma of the bladder: pathology, diagnosis and treatment

Squamous cell carcinoma (SCC) can occur in both nonbilharzial and bilharzial bladders; the two subtypes differ in epidemiology, pathogenesis and clinicopathological features. The nonbilharzial type occurs in Western countries and represents < 5% of all vesical tumours; it occurs most often in the seventh decade with a slight male predominance. The principal predisposing factor is prolonged indwelling urethral catheterization in patients with spinal cord injury and the main symptom is haematuria. Patients are usually diagnosed at an advanced stage and most of the tumours are of moderate and high grades. At cystoscopy tumours are predominantly ulcerative and commonly involve the trigone and lateral walls. Although distant metastasis is infrequent (8-10%) the prognosis is grave and most patients die after failure of locoregional control; radical cystectomy provides the best therapy. To avoid nonbilharzial SCC, patients with spinal cord injury should be free of catheterization if possible. The outcome can be improved by early detection with frequent cytology, cystoscopy and biopsy. Bilharzial SCC occurs commonly in the Middle East, South-east Asia and South America where schistosomiasis is endemic. In an Egyptian series SCC represented 59% of 1026 cystectomy specimens. The tumour is diagnosed in the fifth decade, and five times more common in men than women. Bladder carcinogenesis is probably related to bacterial and viral infections, commonly associated with bilharzial infestation rather than the parasite itself. The presentation is often with irritative bladder symptoms and haematuria, and many patients present at an advanced stage, although most tumours are of low and moderate grades. At cystoscopy tumours are predominantly nodular and usually arise from the upper vesical hemisphere. Lymph-node metastasis occurs in approximately 19% and significantly decreases survival; radical cystectomy remains the main treatment, giving a 5-year survival rate of 50%. Early detection improves the therapeutic yield and prevention is possible by combining snail control and mass therapy of the infested rural population by oral antibilharzial drugs.

Expression of squamous cell carcinoma-associated antigen in grade 3 pT1 transitional cell carcinoma of the bladder and prediction of its progression and intravesical recurrence

BACKGROUND

Among superficial transitional cell carcinomas (TCC) of the bladder, Grade 3 pT1 disease is associated with a higher risk of progression and intravesical recurrence. The authors determined whether or not squamous cell carcinoma-associated antigen (SCC antigen) could predict clinical behavior of Grade 3 pT1 disease.

METHODS

SCC antigen was immunohistochemically stained in Grade 3 pT1 TCC of the bladder that had been fixed in formaldehyde solution and embedded in paraffin. Patients were followed up, and disease progression and recurrence were identified. Disease progression was defined as histologically verified muscle invasion or clinically detectable distant metastasis, including pelvic lymph node metastasis.

RESULTS

SCC antigen in the cytoplasm was positively identified with immunohistochemical staining in 21 of 55 patients with the disease. Of 21 patients with positive SCC antigen in the cytoplasm, 8 experienced disease progression, whereas there was progression in 5 of 34 patients with negative antigen. The nonprogression rate of Grade 3 pT1 carcinomas with positive antigen in the cytoplasm was significantly lower than that for those with negative antigen. The disease-free rate also was clearly lower in the positive carcinoma than in the negative. Multivariate analysis confirmed that SCC antigen in the cytoplasm was the only significant variable independently affecting progression and intravesical recurrence of the disease.

CONCLUSIONS

The results suggested that immunohistochemical expression of SCC antigen in the cytoplasm is closely linked with a higher risk for progression and intravesical recurrence of Grade 3 pT1 disease. Detection of the antigen can help to more accurately predict the clinical course of the disease.