Urinary bladder cancer following cyclophosphamide therapy for Hodgkin's disease

Synchronous renal pelvis carcinoma associated with small lymphocytic lymphoma: A case report

BACKGROUND

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is often associated with an increased risk of developing subsequent neoplasms of epithelial and mesenchymal origin. Coincidence of CLL/SLL and urothelial carcinoma (UC) is very rare. Herein, we report a case of synchronous renal pelvis carcinoma with SLL.

CASE SUMMARY

A 78-year-old man presented with the complaint of terminal painless gross hematuria for the past 2 mo. On physical examination, enlarged lymph nodes were palpable in the cervical and axillary regions. The patient’s peripheral blood film was normal. He had a significant smoking history for the past 50 years. Cystoscopy revealed bleeding in the left upper urinary tract. Abdominal computed tomography imaging demonstrated a left renal pelvis tumor. The patient underwent laparoscopic radical nephroureterectomy. Histopathology revealed left renal pelvis high-grade invasive papillary UC and SLL involving the kidney and bone marrow. Renal pelvis lymphatic tissue and lymphocytes were positive for CD5, CD20, and CD23. In addition, the following results were obtained: CD3 (-), Ki-67 (30%+), Bcl-2 (+), Bcl-6 (+), CD10 (-), and CD79a (+). Moreover, no UC metastasis was observed in the lymph nodes.

CONCLUSION

This is the first case of coincident CLL/SLL and upper tract UC in the literature. Cancer patients with lymphadenopathies should always be investigated to rule out the possibility of synchronous or metachronous malignancy.

Treatment and prognosis of patients with urinary bladder cancer with other primary cancers: a nationwide population-based study in the Bladder Cancer Data Base Sweden (BladderBaSe)

OBJECTIVE

To study how patients with urinary bladder cancer (UBC) with previous or concomitant other primary cancers (OPCs) were treated, and to investigate their prognosis.

PATIENTS AND METHODS

Using nationwide population-based data in the Bladder Cancer Data Base Sweden (BladderBaSe), we analysed the probability of treatment with curative intent, and UBC-specific and overall survival (OS) in patients with UBC diagnosed in the period 1997-2014 with or without OPC. The analyses considered the patient's characteristics, UBC tumour stage at diagnosis, and site of OPC.

RESULTS

There were 38 689 patients, of which 9804 (25%) had OPCs. Those with synchronous OPCs more often had T2 and T3 tumours and clinically distant disease at diagnosis than those with UBC only. Patients with synchronous prostate cancer, female genital cancer and lower gastro-intestinal cancer were more often treated with curative intent than patients with UBC only. When models of survival were adjusted for age at diagnosis, marital status, education, year of diagnosis, Charlson Comorbidity Index and T-stage, UBC-specific survival was similar to patients with UBC only, but OS was lower for patients with synchronous OPC, explained mainly by deaths in OPC primaries with a bad prognosis.

CONCLUSIONS

OPC is common in patients with UBC. Treatment for UBC, after or in conjunction with an OPC, should not be neglected and carries just as high a probability of success as treatment in patients with UBC only. The needs of patients with UBC and OPC, and optimisation of their treatment considering their complicated disease trajectory are important areas of research.

The type of lymphocyte infiltration near urothelial carcinoma is diagnostic for chronic lymphocytic leukemia

T-lymphocytic infiltration near the tumor site is an expected immune response in bladder cancers. However, reports of patients with bladder cancer exhibiting small lymphocytic infiltration of the bladder tissue are very rare in the literature. Here, the patient was presented to our group with hematuria, but subsequently diagnosed as exhibiting invasive bladder cancer and chronic lymphocytic leukemia with suspicious lymphocytic infiltration in a transurethral resection specimen. This case emphasizes the importance of lymphocytic infiltration's nature near urothelial carcinoma.

Bladder Carcinoma after ABVD Chemotherapy for Hodgkin's Lymphoma: A Case Report

The treatment of lymphomas may result in the development of second malignancies, as evident by the numerous reports in the literature. Treatment with cyclophosphamide-based chemotherapy regimens may lead to bladder lesions such as haemorrhagic cystitis and also to carcinoma of the urinary bladder. Previous pelvic radiotherapy treatment is also implicated as a cause for local second cancers. We present the case of a patient treated for Hodgkin's lymphoma, who was diagnosed with transitional cell carcinoma of the bladder soon after treatment completion. On completion of 6 cycles of ABVD chemotherapy the patient was on follow-up. Two months after treatment completion the patient complained of dysuria and was investigated for a suspected urinary tract infection. Urine microscopy did not reveal any abnormality. Symptomatic treatment was prescribed and cystoscopy was arranged. The cystoscopic findings suggested an irregular growth overlying the trigone and the biopsy reported it as transitional cell carcinoma. This case report demonstrates that symptoms attributed to common medical causes in patients treated for cancer may be a sign of second malignancy. This case report also demonstrates the need for a thorough evaluation of patients’ complaints during follow-up, although the likelihood for the occurrence of a second malignancy may be low. The assumption that these symptoms were due to a commonly occurring urinary tract infection would have had serious implications leading to a delay in the treatment of the bladder cancer.

Bladder cancer in cancer patients: population-based estimates from a large Swedish study

Background:

This study quantified the risk of urinary bladder neoplasms in cancer patients taking into account the age at first diagnosis, the gender of the patients and the lead time between diagnoses.

Methods:

We used standardised incidence ratios (SIRs) to compare the incidence of bladder tumours in 967 767 cancer patients with the incidence rate in the general Swedish population. A total of 3324 male and 1560 female patients developed bladder tumours at least 1 year after first cancer diagnosis.

Results:

After bladder and renal pelvis cancers, the SIRs of bladder neoplasms were higher in female than in male patients. Men affected by lung, stomach and larynx tumours belonged to the population at high risk for bladder cancer. Treatment of breast, ovarian and cervical cancers seems to contribute to the subsequent development of bladder neoplasms. Long latencies (16–25 years) were observed after testicular, cervical and endometrial cancers. Detection bias had an important role after prostate cancer. Chemotherapy with cyclophosphamide and cisplatin, and also radiotherapy, seem to increase the risk of subsequent neoplasms in the bladder.

Conclusions:

These population-based results may help urologists to assess the risk of bladder neoplasms in cancer survivors. Our data should guide ongoing studies that investigate the effectiveness of bladder cancer screening in cancer patients.

Side effects of immunosuppressant therapies used in neurology

This article provides an overview of the clinically relevant complications of the main immunosuppressants currently used in the treatment of neurologic disorders with suspected or established immune etiology. The most serious complications are discussed in detail, including pathophysiology and preventative measures. An intimate knowledge of these complications proves helpful in the day to day practice of the neurologist supervising immunotherapy.