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Bascio LS, Chiappa V, Paolini B, Chiarello G, Leone Roberti Maggiore U, Bogani G, Raspagliesi F. Urothelial bladder carcinoma recurrence in the uterine cervix: Cytological findings on a cervical cytology test. Cytopathology 2023; 34:645-648. [PMID: 37647028 DOI: 10.1111/cyt.13297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
The authors discuss a rare case of cervical asymptomatic metastasis of a primary high‐grade poorly differentiated urothelial bladder carcinoma, diagnosed by cervical cytology test.
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Affiliation(s)
- Ludovica Spanò Bascio
- Obstetrics and Gynecology Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Biagio Paolini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giulia Chiarello
- Unit of Obstetrics and Gynecology, Department of Biomedical Sciences and Human Oncology, Policlinico Hospital "Aldo Moro" University of Bari, Bari, Italy
| | | | - Giorgio Bogani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Aron M, Zhou M. Urothelial Carcinoma: Update on Staging and Reporting, and Pathologic Changes Following Neoadjuvant Chemotherapies. Surg Pathol Clin 2022; 15:661-679. [PMID: 36344182 DOI: 10.1016/j.path.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Staging and reporting of cancers of the urinary tract have undergone major changes in the past decade to meet the needs for improved patient management. Substantial progress has been made. There, however, remain issues that require further clarity, including the substaging of pT1 tumors, grading and reporting of tumors with grade heterogeneity, and following NAC. Multi-institutional collaborative studies with prospective data will further inform the accurate diagnosis, staging, and reporting of these tumors, and in conjunction with genomic data will ultimately contribute to precision and personalized patient management.
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Affiliation(s)
- Manju Aron
- Department of Pathology, Keck School of Medicine, University of Southern California; Department of Urology, Keck School of Medicine, University of Southern California.
| | - Ming Zhou
- Department of Anatomic and Clinical Pathology, Tufts University School of Medicine and Tufts Medical Center, 800 Washington St., Box 802, Boston, MA 02111
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Secondary Involvement of the Uterine Cervix by Nongynecologic Neoplasms: A Detailed Clinicopathologic Analysis. Am J Surg Pathol 2021; 44:1699-1711. [PMID: 32910021 DOI: 10.1097/pas.0000000000001578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Secondary involvement of the uterine cervix by nongynecologic neoplasms is rare accounting for <2% of metastases to the gynecologic tract. This study aimed to analyze the clinicopathologic features of cervical involvement by nongynecologic malignancies. A total of 47 cases were identified including 39 (83%) carcinomas, 6 lymphomas (12.8%), and 2 (4.2%) cutaneous malignant melanomas. The most common primary site of origin among carcinomas was the gastrointestinal tract (27, 69.2%), followed by breast and urothelium (5 each, 12.8%), gallbladder, and lung (1 each, 2.6%). The gynecologic tract was involved at the presentation in 16 patients (34%), including 5 (10.6%) with the cervix being the first site, 7 (14.9%) with synchronous involvement of the cervix and other gynecologic sites, and 4 (8.5%) with the involvement of other gynecologic sites before the cervical presentation. Patients with lymphoma were younger compared with those with carcinoma (43.7 vs. >50.5) (P=0.01). Mean time to identification of cervical metastases was <1 year for gallbladder carcinoma, melanomas, and gastrointestinal signet ring cell carcinomas (P=0.03). Features that varied with different types of metastatic tumor included lymphovascular space invasion, depth of stromal invasion, growth pattern (glands lacking architectural complexity, cribriforming, solid), presence of goblet cells, and signet ring cells, degree of cytologic atypia, and overall findings mimicking a benign/noninvasive process (P≤0.027). Six tumors (12.8%) were initially misdiagnosed as cervical primary. Metastatic nongynecologic tumors can mimic primary in situ or invasive neoplasms in both ectocervix and endocervix. In patients with a known prior malignancy, the clinical history with ancillary studies and a high level of suspicion are crucial to ensure accurate diagnosis.
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Kalampokis N, Grivas N, Ölschläger M, Hassan FN, Gakis G. Radical Cystectomy in Female Patients - Improving Outcomes. Curr Urol Rep 2019; 20:83. [PMID: 31781877 DOI: 10.1007/s11934-019-0951-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW To review the methods of improving surgical, oncological, and functional outcomes in women with bladder cancer treated with radical cystectomy. RECENT FINDINGS Οrthotopic urinary diversion (ONB) is a safe option for well-selected women as it combines high rates of daytime and nighttime continence with exceptional oncologic outcomes. It is considered safe even for patients with limited lymph node disease and trigone involvement, as long as a preoperative biopsy of the bladder neck or an intraoperative frozen section analysis of distal urethral margin rules out malignant disease. Nerve-sparing techniques have shown promising results. For well-selected patients with early invasive disease, sparing of internal genitalia has proven to be oncologically safe. Yet, generally accepted and evidence-based oncological and functional follow-up schemes for women after radical cystectomy are still lacking. Properly designed prospective studies are needed with adequate number of participants in order to safely conclude about a broader use of pelvic organ-sparing cystectomy.
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Affiliation(s)
| | - Nikolaos Grivas
- Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Markus Ölschläger
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
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Magers MJ, Lopez-Beltran A, Montironi R, Williamson SR, Kaimakliotis HZ, Cheng L. Staging of bladder cancer. Histopathology 2019; 74:112-134. [PMID: 30565300 DOI: 10.1111/his.13734] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/13/2022]
Abstract
Urothelial carcinoma of the urinary bladder is a heterogeneous disease with multiple possible treatment modalities and a wide spectrum of clinical outcome. Treatment decisions and prognostic expectations hinge on accurate and precise staging, and the recently published American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition, should be the basis for staging of urinary bladder tumours. It is unfortunate that the International Union Against Cancer (UICC) 8th edition failed to incorporate new data which is considered in the AJCC 8th edition. Thus, the AJCC 8th edition is the focus of this review. Several critical changes and clarifications are made by the AJCC 8th edition relative to the 7th edition. Although the most obvious changes in the 8th edition are in the N (i.e. perivesical lymph node involvement now classified as N1) and M (i.e. M1 is subdivided into M1a and M1b) categories, several points are clarified in the T category (e.g. substaging of pT1 should be attempted). Further optimisation, however, is required. No particular method of substaging pT1 is formally recommended. In this review, these modifications are discussed, as well as points, which require further study and optimisation.
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Affiliation(s)
- Martin J Magers
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Antonio Lopez-Beltran
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Cordoba, Spain
| | - Rodolfo Montironi
- Faculty of Medicine, Department of Surgery, Unit of Anatomical Pathology, Cordoba, Spain.,Champalimaud Clinical Center, Lisbon, Portugal
| | - Sean R Williamson
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, Ancona, Italy.,Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
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Gynecologic Organ Involvement During Radical Cystectomy for Bladder Cancer: Is It Time to Routinely Spare the Ovaries? Clin Genitourin Cancer 2019; 17:e209-e215. [DOI: 10.1016/j.clgc.2018.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/21/2018] [Accepted: 10/21/2018] [Indexed: 01/18/2023]
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Incidental Gynecologic Tract Neoplasms in Women Undergoing Anterior Pelvic Exenteration for Urothelial Carcinoma. Int J Gynecol Pathol 2019; 38:97-102. [DOI: 10.1097/pgp.0000000000000478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moursy EES, Eldahshoursy MZ, Gamal WM, Badawy AA. Orthotopic genital sparing radical cystectomy in pre-menopausal women with muscle-invasive bladder carcinoma: A prospective study. Indian J Urol 2016; 32:65-70. [PMID: 26941498 PMCID: PMC4756555 DOI: 10.4103/0970-1591.173112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Invasive cancer bladder is a life-threatening disease that is best treated with radical cystectomy and a suitable urinary diversion. The aim of this study was to evaluate the oncological outcome, voiding and sexual functions after genital sparing radical cystectomy with orthotopic bladder reconstruction in pre-menopausal women with bladder cancer. MATERIALS AND METHODS 18 pre-menopausal women who underwent radical cystectomy and orthotopic urinary diversion with preservation of genital organs were included for this study. The patients were followed-up clinically and radiologically to assess their oncological outcome in addition to their voiding and sexual function. RESULTS Mean age of the patients was 37.8 years, and the median follow-up after surgery was 70 months. One patient was lost to follow-up at 12 months post-operatively. The surgery was completed as planned in all patients, with a mean operative time of 290 min and an average blood loss of 750 mL. 14 patients were able to void satisfactorily, being continent day and night, while four patients needed clean intermittent catheterization. Sexual life remained unchanged in 15 cases, while three patients reported dysparunea. Till the last follow-up, there was no local recurrence while distant metastases were detected in three cases, two of whom died. CONCLUSIONS Genital sparing cystectomy is a valid option for managing carefully selected women with muscle-invasive bladder cancer with good functional and sexual outcomes.
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Affiliation(s)
| | | | - Wael M Gamal
- Department of Urology, Sohag University, Sohag, Egypt
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Salem H, El-Mazny A. Primary and secondary malignant involvement of gynaecological organs at radical cystectomy for bladder cancer: review of literature and retrospective analysis of 360 cases. J OBSTET GYNAECOL 2012; 32:590-3. [PMID: 22779969 DOI: 10.3109/01443615.2012.693980] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The pathological analysis of cystectomy specimens from 360 female patients who underwent radical cystectomy for bladder cancer was retrospectively reported. The uterus was not available in 29 specimens, while one ovary was absent in 18 specimens and the two ovaries were absent in 20 specimens. Uterine involvement was observed in one case of transitional cell carcinoma, and benign uterine pathology was detected in 37 cases. All patients had normal ovaries, while the vagina was involved in 13 cases. A total of 12% of the patients had urethral involvement. None of the 29 patients, in whom the internal genitalia were totally or partially preserved, had late ovarian, vaginal or uterine recurrence at the last follow-up. Thus, the preservation of female internal genitalia in young patients undergoing radical cystectomy should be considered under strict criteria (low-grade, low-stage tumours away from the bladder neck). This will improve the quality-of-life (QoL) and the functional outcome without compromising cancer control.
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Affiliation(s)
- H Salem
- Department of Urosurgery, Faculty of Medicine, Cairo University, Egypt
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Reproductive Organ Involvement in Female Patients Undergoing Radical Cystectomy for Urothelial Bladder Cancer. J Urol 2012; 188:2134-8. [DOI: 10.1016/j.juro.2012.08.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Indexed: 11/17/2022]
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Salem H, El-Mazny A. A clinicopathologic study of gynecologic organ involvement at radical cystectomy for bladder cancer. Int J Gynaecol Obstet 2011; 115:188-90. [DOI: 10.1016/j.ijgo.2011.05.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 05/19/2011] [Accepted: 07/28/2011] [Indexed: 11/29/2022]
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Kaneko G, Kikuchi E, Hasegawa M, Miyajima A, Nakagawa K, Kameyama K, Oya M. Non-muscle invasive bladder cancer with concomitant vaginal urothelial carcinoma: a case report and review of the literature. Int J Clin Oncol 2010; 15:626-30. [PMID: 20544250 DOI: 10.1007/s10147-010-0097-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Accepted: 05/13/2010] [Indexed: 12/01/2022]
Abstract
A 74-year-old female was referred to our hospital for non-muscle invasive bladder tumors initially treated at another hospital. Preoperatively, computed tomography and magnetic resonance imaging demonstrated non-muscle invasive bladder tumors and a vaginal tumor. A second transurethral resection of the bladder tumors, transvaginal tumor resection, and systemic chemotherapy were performed. The histopathological appearances of both tumors were very similar and the diagnoses were urothelial carcinoma (UC). The pathogenesis of the vaginal UC was considered to be the primary UC or metastasis from the bladder UC. Vaginal UC is extremely rare and this is only the 15th report in the literature.
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Affiliation(s)
- Gou Kaneko
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Koie T, Hatakeyama S, Yoneyama T, Hashimoto Y, Kamimura N, Ohyama C. Uterus-, Fallopian Tube-, Ovary-, and Vagina-sparing Cystectomy Followed by U-shaped Ileal Neobladder Construction for Female Bladder Cancer Patients: Oncological and Functional Outcomes. Urology 2010; 75:1499-503. [DOI: 10.1016/j.urology.2009.08.083] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 07/30/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
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Lowentritt BH, Castle EP, Woods M, Davis R, Thomas R. Robot-Assisted Radical Cystectomy in Women: Technique and Initial Experience. J Endourol 2008; 22:709-12. [DOI: 10.1089/end.2007.9829] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Erik P. Castle
- Department of Urology, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Michael Woods
- Department of Urology, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Rodney Davis
- Department of Urology, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Raju Thomas
- Department of Urology, Tulane University Health Sciences Center, New Orleans, Louisiana
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Kulkarni JN, Rizvi SJ, Acharya UP, Kumar KSS, Tiwari P. Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder. Int Braz J Urol 2008; 34:180-7; discussion 187-90. [DOI: 10.1590/s1677-55382008000200008] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2008] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | - P. Tiwari
- Bombay Hospital Institute of Medical Sciences, India
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Varkarakis IM, Pinggera G, Antoniou N, Constantinides K, Chrisofos M, Deliveliotis C. Pathological review of internal genitalia after anterior exenteration for bladder cancer in women. Evaluating risk factors for female organ involvement. Int Urol Nephrol 2007; 39:1015-21. [PMID: 17333520 DOI: 10.1007/s11255-006-9158-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 11/13/2006] [Indexed: 10/23/2022]
Abstract
To evaluate cancer involvement of internal female genitalia of patients undergoing anterior exenteration for clinically organ confined transitional cell carcinoma of the bladder, and identify potential preoperative risk factors. Charts and anterior exenteration specimens from 54 women with clinically organ confined transitional cell bladder cancer were retrospectively reviewed. Emphasis was given to the presence of internal genitalia involvement and or primary gynecologic pathology. Unsuspected internal genitalia involvement was reported in only three patients (5.7%). The vagina was involved in two cases (3.8%) while the uterus in one (1.9%). In all cases involvement was due to direst extension from bladder tumors of the base and dome respectively. No preoperative variable could predict internal genitalia involvement in a statistical significant manner. Benign pathology of the female reproductive organs was observed in six patients and involved in all cases the uterus (11.5%). Internal genitalia involvement after radical cystectomy for TCC tumors of the bladder is rare (5.8%). Preoperative risk factors could not be identified although all involved genitalia were seen in tumors of the bladder dome and base. Therefore large multi-institutional studies are needed in order to identify preoperative risk factors for internal genitalia involvement in females with bladder cancer.
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Affiliation(s)
- Ioannis M Varkarakis
- Department of Urology, Sismanoglio Hospital, Athens Medical School, Sismanogliou 1, Athens, 15126, Greece.
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Ogiso S, Maeno A, Yamashita M, Souma T, Nakamura K, Okuno H. Micturitional disturbance due to labial adhesion as a cause of vaginal implantation of bladder urothelial carcinoma. Int J Urol 2006; 13:1454-5. [PMID: 17083404 DOI: 10.1111/j.1442-2042.2006.01565.x] [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: 10/24/2022]
Abstract
Vaginal implantation of urinary tract urothelial carcinoma is a rare finding, with few cases reported in the literature. This is the first reported case of vaginal implantation of bladder urothelial carcinoma thought to be due to micturitional disturbances secondary to labial adhesion. The authors propose that implantation via pooled urine in the vagina may have occurred, and suggest that labial adhesion be treated in patients with urinary tract urothelial carcinoma, even if asymptomatic.
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Affiliation(s)
- Satoshi Ogiso
- Department of Urology, Kyoto Medical Center, Kyoto, Japan.
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Should the uterus and ovaries be removed, and the vagina resected, routinely during radical cystectomy? ACTA ACUST UNITED AC 2005. [DOI: 10.1038/ncpuro0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gupta NP, Ansari MS, Khaitan A, Dawar R. Fertility preserving radical cystectomy in a young female with malignant mesenchymal tumour of urinary bladder. Int Urol Nephrol 2004; 35:501-2. [PMID: 15198154 DOI: 10.1023/b:urol.0000025634.15210.3c] [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] [Indexed: 11/12/2022]
Abstract
Fertility preserving radical cystectomy has been reported in young males with leiomyosarcoma and transitional cell carcinoma but not in females. We present a case of 19-year-old lady with mesenchymal tumour of urinary bladder with myogenic differentiation who was managed with fertility preserving radical cystectomy. As the patient was just 19-year-old a consensus was made to preserve the internal genitalia (both the ovaries and uterus) in order to restore the fertility. Immunohistochemistry was compatible with mesenchymal tumour with myogenic differentiation. Adjuvant chemotherapy (Ifosfamide, CDDP and Etocid) was given. Patient is doing well at a follow-up of 6 months.
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Affiliation(s)
- N P Gupta
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Abstract
Even though radical cystectomy still remains the 'gold standard' for the treatment of invasive bladder cancer, newer insights and developments are entering the urological arena: a 'tailored' surgical approach combining a less extensive procedure and a better quality of life seems feasible for selected patients without compromising the outcome; the type of urinary diversion has no impact on the risk of complications, the ability to receive postoperative salvage treatments and the natural history of the disease; the depth of extension of the tumour and the nodal involvement are the only independent 'classical' predictors of survival after radical cystectomy; pelvic node dissection is curative in patients with limited nodal involvement; the clinical application of newer molecular prognostic factors still remains controversial.
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Affiliation(s)
- P Bassi
- Department of Urology, University Medical School of Padua, Italy.
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