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Brocklehurst A, Varughese M, Birtle A. Bladder Preservation for Muscle-Invasive Bladder Cancer With Variant Histology. Semin Radiat Oncol 2023; 33:62-69. [PMID: 36517195 DOI: 10.1016/j.semradonc.2022.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A growing body of evidence has shown bladder-preservation with chemo-radiotherapy achieves comparable survival to Radical Cystectomy (5-year OS 50%-70%) and superior quality of life outcomes for patients with muscle-invasive urothelial carcinoma of the bladder (UC). However, up to 55% of patients harbor variant histology and in this review we aim to clarify the role of bladder-preservation for this group. We first draw the distinction between urothelial carcinoma with divergent differentiation (UCDD) and non-urothelial carcinoma (NUC). UCDD is common, increasing in prevalence, and whilst each subtype may have its own characteristics current evidence suggests comparable outcomes with radical cystectomy and bladder-preservation. Non-urothelial carcinoma is a collection of distinct pathologies each deserving of its own management strategy. However, these tumors are rare, and evidence is generated from retrospective studies with significant inherent bias. Small cell carcinoma of the bladder has good evidence for bladder-preservation; however, other pathologies such as Squamous Cell Carcinoma and Adenocarcinoma are not well supported. We recommend careful multidisciplinary appraisal of the evidence for each subtype and honest patient discussion about the limited evidence before reaching management decisions. As we look to the future molecular-profiling may help better characterize these tumors and aid in treatment selection.
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Affiliation(s)
| | - Mohini Varughese
- Royal Devon & Exeter NHS Foundation Trust, University of Exeter, United Kingdom
| | - Alison Birtle
- Rosemere Cancer Centre, Preston, Lancs; University of Manchester; University of Central Lancashire
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2
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Rahoui M, Ouanes Y, Marrak M, Chaker K, Ben Rhouma S, Nouira Y. Adult bladder rhabdomyosarcoma: A case report. Urol Case Rep 2022; 44:102134. [PMID: 35769130 PMCID: PMC9234586 DOI: 10.1016/j.eucr.2022.102134] [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: 05/01/2022] [Accepted: 06/16/2022] [Indexed: 11/19/2022] Open
Abstract
Rhabdomyosarcomas (RMS) are mesenchymal tumors that develop at the expense of striated muscle fibers. It accounts for 6% of childhood malignancies. Rhabdomyosarcomas of the genitourinary tract also occur in children but are distinctly uncommon in adults. We report a case of bladder rhabdomyosarcoma in a 72-year-old patient who presented with gross hematuria and discuss difficulties of diagnosis and treatment.
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Hart AA, Schlaepfer CH, Dhungana N, Milhem MM, Packiam VT. Surgical management for giant bladder leiomyosarcoma. Urol Case Rep 2022; 42:101995. [PMID: 35059300 PMCID: PMC8760472 DOI: 10.1016/j.eucr.2022.101995] [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: 12/05/2021] [Revised: 12/21/2021] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
While urothelial carcinoma is the most common histologic type of bladder cancer in the United States, leiomyosarcoma is a rare and aggressive variant. The rarity of bladder leiomyosarcoma results in uncertainty regarding the optimal treatment pathway. We report on a patient with a giant non-metastatic bladder leiomyosarcoma effectively managed with primary surgical intervention without chemoradiation.
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Li S, Liu X, Chen X. Development and validation of a prognostic nomogram for predicting overall survival in patients with primary bladder sarcoma: a SEER-based retrospective study. BMC Urol 2021; 21:162. [PMID: 34823525 PMCID: PMC8614032 DOI: 10.1186/s12894-021-00929-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/22/2021] [Indexed: 01/14/2023] Open
Abstract
Background Primary bladder sarcoma (PBS) is a rare malignant tumor of the bladder with a poor prognosis, and its disease course is inadequately understood. Therefore, our study aimed to establish a prognostic model to determine individualized prognosis of patients with PBS. Patients and Methods Data of 866 patients with PBS, registered from 1973 to 2015, were extracted from the surveillance, epidemiology, and end result (SEER) database. The patients included were randomly split into a training (n = 608) and a validation set (n = 258). Univariate and multivariate Cox regression analyses were employed to identify the important independent prognostic factors. A nomogram was then established to predict overall survival (OS). Using calibration curves, receiver operating characteristic curves, concordance index (C-index), decision curve analysis (DCA), net reclassification improvement (NRI) and integrated discrimination improvement (IDI), the performance of the nomogram was internally validated. We compared the nomogram with the TNM staging system. The application of the risk stratification system was tested using Kaplan–Meier survival analysis. Results Age at diagnosis, T-stage, N-stage, M-stage, and tumor size were identified as independent predictors of OS. C-index of the training cohort were 0.675, 0.670, 0.671 for 1-, 3- and 5-year OS, respectively. And that in the validation cohort were 0.701, 0.684, 0.679, respectively. Calibration curves also showed great prediction accuracy. In comparison with TNM staging system, improved net benefits in DCA, evaluated NRI and IDI were obtained. The risk stratification system can significantly distinguish the patients with different survival risk. Conclusion A prognostic nomogram was developed and validated in the present study to predict the prognosis of the PBS patients. It may assist clinicians in evaluating the risk factors of patients and formulating an optimal individualized treatment strategy. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00929-x.
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Affiliation(s)
- Shijie Li
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Xuefeng Liu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China
| | - Xiaonan Chen
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, 110004, Liaoning, People's Republic of China.
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Chou WH, McGregor B, Schmidt A, Carvalho FLF, Hirsch MS, Chang SL, Kibel A, Mossanen M. Cyclophosphamide-associated bladder cancers and considerations for survivorship care: A systematic review. Urol Oncol 2021; 39:678-685. [PMID: 34134927 DOI: 10.1016/j.urolonc.2021.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/31/2021] [Accepted: 05/09/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE We performed a systematic review to assess the clinical features of cyclophosphamide-associated bladder cancer. MATERIALS AND METHODS MEDLINE, Web of Science, and Cochrane Library were searched from inception to August 2020 according to PRISMA guidelines. Studies that associated bladder cancer with prior cyclophosphamide use on an individual level were included. RESULTS We identified 121 studies spanning over a 50-year period with 285 patients. The most common malignant indication for cyclophosphamide was lymphoma (25%), while the most common non-malignant indication was ANCA-associated vasculitides (26%). Hematuria and dysuria were the most prevalent symptoms prior to a cyclophosphamide-associated bladder cancer diagnosis, and median age at diagnosis was 55 years. Conventional urothelial carcinoma (UC) was the most common bladder-associated diagnosis (74%), although a broad range of cancer types were represented, notably leiomyosarcoma and squamous cell carcinoma. About half of bladder cancers were muscle invasive at diagnosis and median latency time was 10.0 years; 33% of patients had a bladder cancer related death. CONCLUSIONS We describe the largest pooled analysis of patients with cyclophosphamide-associated bladder cancer. These bladder cancers have a propensity for younger age at diagnosis, more advanced stage at diagnosis, and variant histology. There was a substantial number of patients with latency time of ≥20 years independent of cumulative cyclophosphamide dose. These findings support consideration of screening and long-term surveillance of cancer survivors with a history of cyclophosphamide therapy for bladder cancer.
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Affiliation(s)
- Wesley H Chou
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Bradley McGregor
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215
| | - Andrew Schmidt
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215
| | - Filipe L F Carvalho
- Division of Urologic Surgery, Brigham and Women's Hospital, 45 Francis Street, Boston, MA, 02115
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA, 02115
| | - Steven L Chang
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115; Division of Urologic Surgery, Brigham and Women's Hospital, 45 Francis Street, Boston, MA, 02115
| | - Adam Kibel
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115; Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215; Division of Urologic Surgery, Brigham and Women's Hospital, 45 Francis Street, Boston, MA, 02115
| | - Matthew Mossanen
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115; Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215; Division of Urologic Surgery, Brigham and Women's Hospital, 45 Francis Street, Boston, MA, 02115.
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6
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Grilo I, Rodrigues C, Soares A, Grande E. Facing treatment of non-urothelial bladder cancers in the immunotherapy era. Crit Rev Oncol Hematol 2020; 153:103034. [PMID: 32622321 DOI: 10.1016/j.critrevonc.2020.103034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022] Open
Abstract
Non-urothelial Bladder Cancer (BC) and variants of urothelial carcinoma account for up to 25 % of all BCs. Given their heterogeneity, these entities are not well represented in clinical trials and treatment remains challenging. Checkpoint inhibitor therapy has shown a role in the treatment of urothelial BC. By contrast, robust evidence regarding its use in other histological types is lacking. We aimed to provide a comprehensive update of non-urothelial and variant urothelial BC, exploring the evidence for immune checkpoint inhibitor therapy. A detailed analysis of the literature was conducted regarding epidemiology, aetiology, diagnosis, prognosis, treatment and outcomes of these patients in the immunotherapy era. A growing body of evidence suggests that immune checkpoint inhibition might have a role to play in non-urothelial BC, similarly to what happened with urothelial carcinomas.
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Affiliation(s)
- I Grilo
- Medical Oncology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
| | - C Rodrigues
- Medical Oncology Department, Centro Hospitalar de Entre o Douro e Vouga, EPE, Sta Maria da Feira, Portugal
| | - A Soares
- Medical Oncology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - E Grande
- Medical Oncology Department, MD Anderson Cancer Center Madrid, Madrid, Spain.
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7
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Alanee S, Alvarado-Cabrero I, Murugan P, Kumar R, Nepple KG, Paner GP, Patel MI, Raspollini MR, Lopez-Beltran A, Konety BR. Update of the International Consultation on Urological Diseases on bladder cancer 2018: non-urothelial cancers of the urinary bladder. World J Urol 2018; 37:107-114. [PMID: 30069580 DOI: 10.1007/s00345-018-2421-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/23/2018] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To provide a comprehensive update of the joint consultation of the International Consultation on Urological Diseases (ICUD) for the diagnosis and management of non-urothelial cancer of the urinary bladder. METHODS A detailed analysis of the literature was conducted reporting on the epidemiology, etiology, diagnosis, treatment and outcomes of non-urothelial cancer of the urinary bladder. An international, multidisciplinary expert committee evaluated and graded the evidence according to the Oxford System of Evidence-based Medicine modified by the ICUD. RESULTS The major non-urothelial cancers of the urinary bladder are squamous cell carcinoma, adenocarcinoma, and neuroendocrine tumors. Several other non-urothelial tumors are rare but important to identify because of their aggressive behavior when compared to urothelial bladder tumors. Radical cystectomy and urinary diversion, preceded by neoadjuvant radiation or chemotherapy in some of these tumors, is the main method or treatment for resectable disease. Adjuvant therapy is not usually successful and no novel targeted or immunotherapeutic agents have been identified to provide benefit. Patients with small cell neuroendocrine tumors of the bladder should be offered chemotherapy before surgery. Because non-urothelial cancers are usually locally advanced and/or metastatic at the time of diagnosis, 5-year survival is generally poor. CONCLUSIONS Non-urothelial cancers of the urinary bladder are rare and mostly lack established protocols for treatment. The prognosis of most of these tumors is poor because they are usually advanced at the time of diagnosis. A multimodal treatment approach should be considered to improve outcomes.
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Affiliation(s)
- Shaheen Alanee
- Urologic Oncology, Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
| | | | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Rajeev Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Kenneth G Nepple
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Gladell P Paner
- Departments of Pathology and Surgery (Urology), University of Chicago, Chicago, IL, USA
| | - Manish I Patel
- Department of Urology, Westmead Hospital and Discipline of Surgery, University of Sydney, Sydney, Australia
| | | | | | - Badrinath R Konety
- Department of Urologic Surgery, University of Minnesota, Minneapolis, MN, USA
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8
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Youssef K, Dembele ON, Idriss Z, Elsayegh H, Iken A, Benslimane L, Nouini Y. [Bladder leiomyosarcoma: about 3 cases]. Pan Afr Med J 2018; 30:19. [PMID: 30167047 PMCID: PMC6110563 DOI: 10.11604/pamj.2018.30.19.10160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 06/12/2017] [Indexed: 11/11/2022] Open
Abstract
Bladder leiomyosarcoma is a rare highly malignant tumor. It can occur in children and adults with a maximum incidence in patients over 60 years of age. It mainly affects men, with a sex ratio of 3/1. Its clinical features are non-specific and dominated by the haematuria. Endoscopic resection of the bladder associated with anatomo-pathological examination allow the diagnosis. Its treatment remains controversial due to the rarity of cases reported in the literature. Neoadjuvant chemotherapy followed by radical cystectomy is the treatment of choice, if the patient's clinical condition permit. We report 3 cases of bladder leiomyosarcoma treated by radical cystectomy and with uneventful postoperative course.
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Affiliation(s)
| | | | - Ziani Idriss
- Service d'Urologie A, CHU IBN Sina, Rabat, Maroc
| | | | - Ali Iken
- Service d'Urologie A, CHU IBN Sina, Rabat, Maroc
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9
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Zhong D, Yu F, Chen J, Lin C, Luo H. Bladder leiomyosarcoma in a patient with chronic ketamine abuse: A case report. Can Urol Assoc J 2015; 9:E514-6. [PMID: 26279728 DOI: 10.5489/cuaj.2662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Bladder leiomyosarcoma is a rare mesenchymal tumour, accounting for less than 0.5% of all primary bladder malignancies. Adult women of reproductive age have the higher incidence of bladder leiomyosarcoma. Exposure to local pelvic radiotherapy or systemic chemotherapy, especially cyclophosphamide therapy, is also a significant risk factor. We describe a case of a 31-year-old male who developed urinary bladder leiomyosarcoma. The patient had no history of radiotherapy, systemic chemotherapy, or other significant event, except a 5-year history of ketamine abuse. The tumour was found on the left bladder wall and was definitively diagnosed by transurethral resection of the bladder tumour. A partial cystectomy was performed. There are no known reports of urinary bladder leiomyosarcoma associated with chronic ketamine abuse; therefore, we speculate that chronic ketamine abuse may be a factor in the development of this infrequent bladder malignancy.
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Affiliation(s)
- Dewen Zhong
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Feng Yu
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Jiande Chen
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Chaolu Lin
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Huaijing Luo
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Longyan, China
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10
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Urinary Bladder Leiomyosarcoma: Primary Surgical Treatment. Urol Case Rep 2014; 2:137-8. [PMID: 26839792 PMCID: PMC4735486 DOI: 10.1016/j.eucr.2014.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 11/23/2022] Open
Abstract
Cases of bladder leiomyosarcoma represent 0.1% of all nonurothelial tumors. We present a case report of a 73-year-old man who underwent a radical cystoprostatectomy for a high-grade bladder leiomyosarcoma with an ileal diversion. The patient recovered uneventfully and no surgical margins were verified in final pathology. Early follow-up at 3 months shows no signs of computed tomography recurrence and adequate adaptation to ileal diversion. Although bladder sarcomas were once thought to have a grim prognosis, recent studies suggest that adequate surgical treatment is able to achieve optimal cancer control outcomes.
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Cho SY, Moon KC, Cheong MS, Kwak C, Kim HH, Ku JH. Localized resectable genitourinary sarcoma in adult Korean patients: experiences at a single center. Yonsei Med J 2011; 52:761-7. [PMID: 21786440 PMCID: PMC3159947 DOI: 10.3349/ymj.2011.52.5.761] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the clinicopathological characteristics and prognosis of localized resectable genitourinary sarcomas in adults. MATERIALS AND METHODS Between September, 1996 and November, 2008, 18 consecutive cases of adults (12 men and 6 women; median age 48.8 years) who were treated for primary genitourinary sarcomas were identified. The following variables were analyzed: patient age, gender, body mass index, American Society of Anesthesiologists (ASA) score, primary organ, tumor histology, size, necrosis, Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade, and surgical margin positivity. Recurrence- free survival and disease-specific survival were the study end-points. RESULTS The most common presenting symptom was a palpable mass (six cases, 33.3%), the most common site was the kidney (six cases, 33.3%), and the most common histological subtype was leiomyosarcoma (eight patients, 44.4%). Complete resection with negative surgical margins was achieved in 13 patients (72.2%). The median follow-up period was 49.9 months (range 6.4 to 147.6). The recurrence- free survival rates at 1, 3, and 5 years were 81.6%, 66.5%, and 66.5%, respectively. Recurrence-free survival only associated significantly with ASA score (p=0.018). The disease-specific survival rate at 1, 3, and 5 years was 88.9%, 76.2%, and 67.7%, respectively. Disease-specific survival was associated significantly only with FNCLCC grade (p=0.042). CONCLUSION Although genitourinary sarcomas in adults are a rare group of tumors with a poor prognosis, some patients may have a favorable prognosis. Our findings suggest that FNCLCC grade is the most important prognostic factor for these patients.
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Affiliation(s)
- Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Min Su Cheong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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12
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Xu YF, Wang GC, Zheng JH, Peng B. Partial cystectomy: Is it a reliable option for the treatment of bladder leiomyosarcoma? Can Urol Assoc J 2011; 5:E11-3. [PMID: 21470521 DOI: 10.5489/cuaj.10031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bladder leiomyosarcoma is a unique mesenchymal tumour, accounting for less than 0.5% of all primary bladder malignancies. Bladder leiomyosarcoma used to be treated with radical surgery in either old or young patients, often resulting in significant impact on the patients's quality of life after surgery. We report on a case of bladder leiomyosarcoma in a 31-year-old female who was treated with partial cystectomy. Fortunately, no tumour metastasis or relapse was observed during the 7-year follow-up period and the patient now has a good quality of life. We found that partial cystectomy may be an acceptable option to treat bladder leiomyosarcoma in the low MSKCC (Memorial Sloan-Kettering Cancer Center) stage.
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Affiliation(s)
- Yun-Fei Xu
- Department of Urology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, P.R. China
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13
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Lindberg MR, Fisher C, Thway K, Cao D, Cheville JC, Folpe AL. Leiomyosarcoma of the urinary bladder: a clinicopathological study of 34 cases. J Clin Pathol 2010; 63:708-13. [DOI: 10.1136/jcp.2010.077883] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BackgroundLeiomyosarcomas of the urinary bladder (LMS-UB) are rare, usually aggressive neoplasms. Owing to their rarity, only a limited number of cases with clinical follow-up information have been published. There is no current consensus on LMS-UB grading, and it is unknown whether the widely accepted Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) and National Cancer Institute (NCI) grading systems of soft-tissue sarcomas are applicable to LMS-UB.MethodsThe authors studied 34 well-characterised LMS-UB and compared the prognostic power of the FNCLCC and NCI systems with that of one published grading scheme for LMS-UB (Mayo). All available slides from 34 LMS-UB were retrieved and evaluated with regards to degree of differentiation, mitotic rate/10 high-powered fields (HPF), and % necrosis. Cases were graded using published criteria for the FNCLCC, NCI and Mayo schemes. Follow-up information was obtained.ResultsThe tumours occurred in 17 females and 17 males, ranging from 31 to 91 years (median 65), and measured 2–12 cm in size. One tumour was well differentiated, 17 tumours were moderately differentiated, and 16 tumours were poorly differentiated. Mitotic rates ranged from 1 to >30/10 HPF (median 12/10 HPF), and tumours showed 0–60% necrosis (median 25%). FNCLCC grades were 1 (3), 2 (12) and 3 (19). NCI grades were 1 (2), 2 (11) and 3 (21). Mayo grades were low (7) and high (27). FNCLCC and NCI grades were identical in 23/34 cases (68%). Four cases were FNCLCC/NCI grade 2 or 3 and Mayo low-grade. Clinical follow-up was available for 25 of 34 patients (74%). Clinical follow-up of ≥12 months was available for 17 of these 25 cases (68%) with a median follow-up duration of 52 months (range 12–120 months). Adverse outcome was seen in nine of these 17 patients (53%). Seven of the eight cases (88%) with a clinical follow-up duration of <12 months died of their disease. Overall, adverse outcome was documented in 16 of 25 (64%) cases. Metastatic disease was seen in 13 of 25 (52%) cases, with the lungs being the most common site of metastasis (62%). Adverse outcome was noted in 15 of 23 (65%) of FNCLCC grade 2 or 3 LMS-UB, as compared with zero of two (0%) FNCLCC grade 1 tumours (p=0.15), in 15 of 23 (65%) NCI grade 2 or 3 LMS-UB, versus zero of two (0%) NCI grade 1 sarcomas (p=0.17) and in 13 of 20 (65%) Mayo high grade LMS-UB, as opposed to two of five (40%) low-grade lesions (all results not statistically significant).ConclusionsThe authors conclude that LMS-UB occurs in older adults of either sex and is characterised by aggressive behaviour, with adverse outcome in >60% of cases. Certain advantages of the FNCLCC system may support its more widespread adoption for future studies.
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14
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Ricciardi E, Maniglio P, Schimberni M, Moscarini M. A case of high-grade leiomyosarcoma of the bladder with delayed onset and very poor prognosis. World J Surg Oncol 2010; 8:16. [PMID: 20302611 PMCID: PMC2847558 DOI: 10.1186/1477-7819-8-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 03/19/2010] [Indexed: 02/02/2023] Open
Abstract
Mesenchymal tumors represent a small number of bladder cancer cases. Leiomyosarcoma is the most common histology with over 100 cases reported in the whole literature. This tumor is been historically considered as highly aggressive and showing a poor prognosis. Despite very low survival rates showed in older reports, some authors indicate that some patients could have a better outcome. We report a review of the literature and a case of high-grade LMS of the bladder in a 68 years old woman. Diagnosis was delayed and disease was locally advanced. Symptoms and imaging of our case first oriented to a gynecologic condition with an adnexal or uterine origin of the mass, and, a genitourinary origin could be unveiled only intra-operatively.
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Affiliation(s)
- Enzo Ricciardi
- Department of Gynecology, Perinatology and Child Health, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00195 Rome, Italy.
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15
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Nelius T, Stevens J, Samathanam C, Filleur S. Leiomyosarcoma of the urinary bladder presenting as life threatening gross hematuria. Med Oncol 2009; 27:562-7. [DOI: 10.1007/s12032-009-9248-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Accepted: 05/28/2009] [Indexed: 02/02/2023]
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16
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Ritchey M, Ferrer F, Shearer P, Spunt SL. Late effects on the urinary bladder in patients treated for cancer in childhood: a report from the Children's Oncology Group. Pediatr Blood Cancer 2009; 52:439-46. [PMID: 18985721 PMCID: PMC2917580 DOI: 10.1002/pbc.21826] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Childhood cancer survivors who have had pelvic or central nervous system surgery or have received alkylator-containing chemotherapy or pelvic radiotherapy as part of their cancer therapy may experience urinary bladder late effects. This article reviews the medical literature on long-term bladder complications in survivors of childhood cancer and outlines the Children's Oncology Group Long-Term Follow-up (COG LTFU) Guidelines related to bladder function. An overview of the treatment of bladder late effects and recommended counseling for survivors with these complications are presented.
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Affiliation(s)
| | | | - Patricia Shearer
- Cancer Survivor Program University of Florida Shands Cancer Center Gainesville, FL
| | - Sheri L. Spunt
- Department of Oncology St. Jude Children’s Research Hospital, Memphis, TN,Department of Pediatrics University of Tennessee, Memphis, TN
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Rioja Zuazu J, Rosell Costa D, Rincón Mayans A, Saiz Sansi A, Berián Polo JM, Panizo Santos Á. Leiomiosarcoma vesical. Presentación de un nuevo caso y revisión de la literatura. Actas Urol Esp 2009; 33:816-21. [DOI: 10.1016/s0210-4806(09)74236-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Labanaris AP, Zugor V, Meyer B, Nützel R, Helmus S, Labanaris PG, Kühn R. Urinary bladder leiomyosarcoma in adults. Int Urol Nephrol 2007; 40:311-6. [PMID: 17922107 DOI: 10.1007/s11255-007-9288-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 09/04/2007] [Indexed: 02/02/2023]
Affiliation(s)
- Apostolos P Labanaris
- Department of Urology, Martha Maria Medical Center, Stadenstrasse 58, 90409 Nurnberg, Germany.
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19
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Sawhney R, Curry N, Burks T, Chaudhary UB. Locally advanced leiomyosarcoma of the urinary bladder: near-complete pathologic response to neoadjuvant gemcitabine and docetaxel. Anticancer Drugs 2007; 18:745-7. [PMID: 17762407 DOI: 10.1097/cad.0b013e32805f8f0c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Leiomyosarcoma of the urinary bladder is a rare mesenchymal tumor with distinct pathologic features. Although radical cystectomy is the standard therapy for locally invasive disease, available literature appears to support the benefit of perioperative chemotherapy, similar to that seen with the more conventional urothelial malignancies. We report on a 77-year-old gentleman with locally advanced leiomyosarcoma of the bladder achieving a near-complete pathologic response to neoadjuvant chemotherapy with a unique regimen: gemcitabine and docetaxel. Further study of this anthracycline-sparing regimen is warranted.
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Affiliation(s)
- Rishi Sawhney
- Medical University of South Carolina, Charleston, South Carolina, USA
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20
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Spiess PE, Kassouf W, Steinberg JR, Tuziak T, Hernandez M, Tibbs RF, Czerniak B, Kamat AM, Dinney CPN, Grossman HB. Review of the M.D. Anderson experience in the treatment of bladder sarcoma. Urol Oncol 2007; 25:38-45. [PMID: 17208137 DOI: 10.1016/j.urolonc.2006.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Revised: 02/06/2006] [Accepted: 02/07/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the histologic subtypes, clinical presentations, treatment approaches, and treatment-related outcomes of patients with bladder sarcoma. METHODS Between January 1985 and July 2004, 19 patients (12 men and 7 women) with primary bladder sarcoma were evaluated at the University of Texas M.D. Anderson Cancer Center. Median follow-up duration was 72 months (range 3-141). RESULTS The median age of patients at presentation was 57 years (range 22-94). The histologic subtypes of bladder sarcoma were leiomyosarcoma (N = 14), angiosarcoma (N = 3), and unclassified sarcoma (N = 2). The clinical presentation consisted of gross, painless hematuria in 79% of patients, lower urinary tract symptoms in 16%, and microhematuria in 5%. The primary treatment modalities used were surgery in 16 (84%) patients, chemotherapy in 2 (11%), and palliation in 1 (5%). The rate of local and distal recurrence was 16% and 53%, respectively. The most common sites of distant metastases were the lungs, bone, brain, and liver. The 5-year disease-specific survival rate was 59%, with a median survival duration of 6 years. There was no statistically significant difference in disease-specific survival between patients with bladder leiomyosarcoma compared to other sarcoma subtypes (P = 0.149). Lymphovascular invasion (P = 0.03) and lymphatic metastasis (P = 0.03) were associated with disease-specific survival, and surgical margin status was associated with recurrence-free (P = 0.04), disease-specific (P = 0.03), and overall survival (P = 0.005). CONCLUSIONS Bladder sarcoma is a highly aggressive malignancy, regardless of its histologic subtype. Surgical margin status is an important determinant of survival.
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Affiliation(s)
- Philippe E Spiess
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4095, USA
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21
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Matsumoto S, Shimizu N, Moriguchi N, Yagi M, Uemura H. Bladder leiomyosarcoma in a boy. Int Urol Nephrol 2006; 38:549-51. [PMID: 17115292 DOI: 10.1007/s11255-006-0072-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Accepted: 03/13/2006] [Indexed: 10/23/2022]
Abstract
Leiomyosarcoma of the urinary bladder in childhood is uncommon. We reported bladder leiomyosarcoma in a 10-year-old boy. He had underwent the extirpation of the tumor and performed adjuvant chemotherapy in combination with radiotherapy according to the Intergroup Rhabdomyosarcoma Study-4 regimens. He had no evidence of recurrence of disease after 3 years.
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Affiliation(s)
- Seiji Matsumoto
- Department of Urology, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
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22
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Brucker B, Ernst L, Meadows A, Zderic S. A second leiomyosarcoma in the urinary bladder of a child with a history of retinoblastoma 12 years following partial cystectomy. Pediatr Blood Cancer 2006; 46:811-4. [PMID: 16470582 DOI: 10.1002/pbc.20506] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This case describes a twin with bilateral retinoblastoma who developed leiomyosarcoma of the bladder at age 17 and again at 39. At 17-years of age she was diagnosed with a leiomyosarcoma of the bladder after presenting with recurrent urinary tract infections, hematuria, and dysuria. She was treated with partial cystectomy. After a 12-year disease-free interval, she was diagnosed with a second leiomyosarcoma of the bladder. This case supports the relationship between the genetic form of retinoblastoma and leiomyosarcoma and illustrates the necessity for extensive follow-up and well-defined treatment of secondary neoplasms.
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Affiliation(s)
- Benjamin Brucker
- Department of Urology, the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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23
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Abstract
MR imaging is a useful modality for evaluating diseases of the bladder. MR imaging can detect and stage bladder cancer by determining the presence and depth of muscle invasion. Direct multiplanar imaging and superb soft-tissue contrast make MR imaging an ideal modality for evaluating less common neoplastic diseases of the bladder, such as urachal carcinoma, and tumors that develop within bladder diverticula. Dynamic breath-held fast T2-weighted imaging can evaluate for cystocele and other components of pelvic floor relaxation.
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Affiliation(s)
- Gautham K Mallampati
- Hospital of the University of Pennsylvania, 3400 Spruce Street, 1st Floor Founders-MRI, Philadelphia, PA 19104-4283, USA
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24
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Abstract
OBJECTIVES Non-urothelial bladder tumors frequently present a diagnostic and therapeutic challenge. We review the peer-reviewed literature to summarize the available evidence on the etiology, diagnosis and optimal management of malignant non-urothelial bladder tumors. METHODS A comprehensive MEDLINE database search was performed. In addition, the proceedings of recent national and international urological and cancer society meetings were reviewed. RESULTS Primary non-urothelial bladder tumors are rare in Europe and North America representing less than 5% of all bladder lesions combined. A large number of risk factors have been implicated in the etiology of non-schistosomiasis-related squamous cell carcinoma, yet their exact pathomechanism remains poorly defined. Squamous cell carcinoma, adenocarcinoma, small cell carcinoma, sarcoma and carcinosarcoma/sarcomatoid tumors share an unfavorable prognosis despite aggressive surgical management that relates both to an aggressive biological behaviour as well as to an often times advanced stage at the time of diagnosis. Inflammatory pseudotumors are benign tumors of uncertain histogenesis that may mimic sarcomas. Paraganglioma, primary melanoma and lymphoma represent additional, exceedingly rare bladder tumors. CONCLUSIONS The systematic investigation of most non-urothelial bladder tumors is limited by the rarity of these lesions. A concerted effort of multiple institutions linked together in a national or international tumor registry will be necessary to advance our understanding of these tumors, evaluate treatment strategies and optimize patient outcome in the future.
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Affiliation(s)
- Philipp Dahm
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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25
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Ryan RS, Gee R, O'Connell JX, Harris AC, Munk PL. Leiomyosarcoma of the distal femur in a patient with a history of bilateral retinoblastoma: a case report and review of the literature. Skeletal Radiol 2003; 32:476-80. [PMID: 12759785 DOI: 10.1007/s00256-003-0649-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2002] [Revised: 04/01/2003] [Accepted: 04/08/2003] [Indexed: 02/02/2023]
Abstract
We report a case of primary leiomyosarcoma of the distal femoral shaft arising in a patient who had undergone bilateral orbital enucleation for bilateral retinoblastoma several years previously. Radiography demonstrated an osteolytic, expansive lesion with cortical destruction anteriorly in the distal femoral shaft, and these findings were confirmed on CT. MR imaging revealed an expansive intramedullary lesion with cortical breakthrough and soft tissue extension. The occurrence of a second malignancy in patients with a history of bilateral retinoblastoma is well documented. Many different histological types have been described, with osteosarcoma and leiomyosarcoma occurring with the greatest frequency.
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Affiliation(s)
- R S Ryan
- Department of Radiology, Vancouver General Hospital, 899 W. 12th Avenue, Vancouver, BC, V5Z 1M9, Canada
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Tanguay C, Harvey I, Houde M, Srigley JR, Têtu B. Leiomyosarcoma of urinary bladder following cyclophosphamide therapy: report of two cases. Mod Pathol 2003; 16:512-4. [PMID: 12748258 DOI: 10.1097/01.mp.0000068237.38715.d9] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Leiomyosarcoma of urinary bladder is rare, although it is the most common mesenchymal tumor in adults. We report two cases of this tumor following cyclophosphamide therapy. The first case is from a 53-year-old man with Wegener's granulomatosis treated for 6 years with cyclophosphamide. He presented with painless hematuria, and the initial biopsy of the bladder tumor revealed a malignant spindle cell neoplasm. A final diagnosis of leiomyosarcoma was made on radical cystoprostatectomy. The second example is from a 21-year-old man who had received cyclophosphamide in early infancy for a bilateral retinoblastoma. He also presented with painless hematuria, and a bladder tumor was resected transurethrally and diagnosed as leiomyosarcoma. He underwent partial cystectomy two months later. Cyclophosphamide, when used for a neoplastic or non-neoplastic condition, is associated with an increased risk of developing bladder cancer. The distribution of histologic subtypes differs from that seen in spontaneous bladder tumors. A review of the literature shows an increased proportion of squamous cell carcinomas and sarcomas, especially leiomyosarcomas in cyclophosphamide exposed patients. Acrolein, a cytotoxic metabolite of cyclophosphamide excreted in urine, is regarded as the most likely causative agent.
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Affiliation(s)
- C Tanguay
- Department of Pathology, CHUQ, Hôtel-Dieu de Québec, Laval University, Victoriaville, Quebec, Canada
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