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Kimura K, Yamamoto T, Tsuchiya J, Yoshida S, Yanai S, Onishi I, Fujii Y, Tateishi U. A diagnostic approach of various urethral diseases using multimodal imaging findings: comprehensive overview. Abdom Radiol (NY) 2024:10.1007/s00261-024-04435-0. [PMID: 38896251 DOI: 10.1007/s00261-024-04435-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
In clinical practice, urethral diseases are not as frequent as conditions affecting other components of the urinary system. Radiological imaging tests, such as retrograde urethrography, CT, MRI, and PET/CT, along with patient history, are crucial for accurately assessing relatively rare urethral lesions. This article aimed to provide a comprehensive overview of urethral lesions, from traumatic changes to neoplasms, and discuss the multimodal imaging findings of various urethral lesions that radiologists should know. To this end, the normal imaging anatomy of the urethra and a step-by-step approach that can be used in clinical practice have been presented to help in the systematic understanding of urethral lesions.
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Affiliation(s)
- Koichiro Kimura
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Tatsuya Yamamoto
- Department of Diagnostic Imaging, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuichi Yanai
- Department of Radiology, Fraternity Memorial Hospital, Tokyo, Japan
| | - Iichiro Onishi
- Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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2
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Ji X, Dong A, Zhu Y. Intraureteral Metastasis From Colon Cancer Mimicking Primary Ureteral Carcinoma on FDG PET/CT. Clin Nucl Med 2024:00003072-990000000-01160. [PMID: 38861423 DOI: 10.1097/rlu.0000000000005314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
ABSTRACT Hematogenous or lymphatic intraureteral metastasis from distant primary cancer is very rare. We present contrast-enhanced CT and FDG PET/CT findings in a case of intraureteral metastasis from colonic adenocarcinoma 3 years after colectomy. The intraureteral showed moderate enhancement on contrast-enhanced CT and increased FDG uptake on PET/CT mimicking a primary ureteral carcinoma. This case suggests that metastatic tumor of the ureter should be considered in the differential diagnosis in patients with hypermetabolic ureteral lesion and known malignancy.
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Affiliation(s)
- Xia Ji
- From the Department of Gastroenterology, The Second Affiliated Hospital, Jiaxing University, Jiaxing, Zhejiang Province, China
| | - Aisheng Dong
- Department of Nuclear Medicine, The First Affiliated Hospital of Naval Medical University, and
| | - Yan Zhu
- Department of Pathology, No. 905 Hospital of People's Liberation Army Navy and The First Affiliated Hospital of Naval Medical University, Shanghai, China
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3
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Zhou H, Liu D, Chen L, Zhang Y, Zhao X, Ge Y, Liu M, Kong T. Metastasis to the bladder from primary breast cancer: A case report and literature review. Oncol Lett 2024; 27:249. [PMID: 38638844 PMCID: PMC11024766 DOI: 10.3892/ol.2024.14382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 01/11/2024] [Indexed: 04/20/2024] Open
Abstract
Breast cancer is the most prevalent malignant tumor affecting women and represents the leading cause of female cancer-related mortality worldwide. Although distant organ metastasis accounts for the majority of breast cancer-related deaths, reports on bladder metastasis are limited in the existing literature. The present study describes the case of a patient with bladder metastasis originating from breast cancer. In addition, the present study also provides a review of 54 cases of similar disease that have been documented in the currently available literature. The literature review aims to elucidate the clinicopathological characteristics and therapeutic approaches for such conditions. The median time from breast cancer diagnosis to bladder metastasis was found to be 5.6 years (range, 0-28 years). The origin of the bladder metastases was predominantly invasive ductal carcinoma (IDC) accounting for 52.3% of cases, followed by invasive lobular carcinoma, accounting for 40.9% of cases. The pathology in the primary tumor was the same as the pathology of the bladder metastases in all cases. There was an 88.9% concordance rate for estrogen receptor status, while the progesterone receptor status was 83.3% and the human epidermal growth factor receptor 2 expression status was 100%. The primary initial symptoms included urinary system manifestations, such as increased frequency, urgency, dysuria, urinary incontinence, nocturia and gross hematuria. For the cystoscopic examination, the predominant findings were bladder wall thickening or masses, along with ureteral orifice masses. Overall, the present study demonstrated that the occurrence of bladder metastasis often follows the metastasis of other organs, with IDC being the most prevalent subtype. The pathological characteristics between the primary tumor and bladder metastasis exhibit a high degree of concordance.
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Affiliation(s)
- Hanli Zhou
- Department of Oncology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Danna Liu
- Department of Pharmacy, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Lu Chen
- Department of Oncology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Yujie Zhang
- Department of Oncology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Xiaoli Zhao
- Department of Oncology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Yongchao Ge
- Department of Urology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Mengmeng Liu
- Department of Pathology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
| | - Tiandong Kong
- Department of Oncology, Cancer Hospital of Henan University, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, P.R. China
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4
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Oka S, Hara T, Ito S, Hayashida M, Sakaguchi K, Urakami S. Metastatic Sites in Rare Genitourinary Malignancies and Primary Cancer Sites in Genitourinary Organ Metastases: A Secondary Analysis Using the Japanese Pathological Autopsy Registry Database. EUR UROL SUPPL 2024; 59:78-89. [PMID: 38298769 PMCID: PMC10829604 DOI: 10.1016/j.euros.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 02/02/2024] Open
Abstract
Background The epidemiology of metastases from rare genitourinary cancer and metastases to genitourinary organs from other primary neoplasms remains poorly understood. Objective To investigate the epidemiology of rare genitourinary metastases from rare genitourinary organ-type cancer and to genitourinary organs using data from a large national autopsy registry in Japan. Design setting and participants A secondary analysis of the data reported in the Annual of the Pathological Autopsy Cases in Japan and the Japanese Mortality Database from 1993 to 2020 was performed. Outcome measurements and statistical analysis Via a retrospective epidemiologic analysis, we evaluated the frequency (probability of occurrence [number per person]) and proportion (percentage) of metastases from upper urinary tract, adrenal, testicular, urethral, and penile cancers. Moreover, the sites of primary tumors metastasizing to genitourinary organs were examined. Results and limitations In Japan, the mortality rate of upper urinary tract cancer is increasing rapidly. In the integrated database with 365 099 autopsies and 835 959 metastatic organs, the major metastatic sites (range of frequency ratios) of rare genitourinary organ-type cancers were the lungs (0.38-0.47), liver (0.21-0.56), bone (0.16-0.33), adrenal gland (0.10-0.20), peritoneum (0.0-0.16), and kidneys (0.07-0.22). The major primary sites (range of proportions) of genitourinary organ metastases were the respiratory tract (5.6-34.0%), stomach (4.7-27.0%), hematologic site (0.9-24.9%), lymphoid (2.4-22.2%), bladder (0.8-20.0%), prostate (0.7-14.1%), rectal (2.0-11.7%), and pancreas (2.6-11.0%). The cancers with a high likelihood of genitourinary metastasis were respiratory and stomach cancers. However, the study lacked individual-level information, and there might be a concomitant selection bias in this autopsy study. Conclusions This large-scale autopsy database analysis identified the epidemiology of metastasis from rare genitourinary organ-type cancer and the origins of metastasis to genitourinary organs. Patient summary This study provides valuable metastatic epidemiologic data and clinical information that are fundamental to the mechanisms of genitourinary metastasis.
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Affiliation(s)
- Suguru Oka
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | - Tomohiko Hara
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | - Shinji Ito
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
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5
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Kawaguchi Y, Naritomi K, Kawagoe N, Matsunaga Y, Ogasawara N, Igawa T. A metastatic ureteral tumor successfully treated with multidisciplinary therapy including radiotherapy. IJU Case Rep 2023; 6:173-176. [PMID: 37144082 PMCID: PMC10151199 DOI: 10.1002/iju5.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/09/2023] [Indexed: 03/07/2023] Open
Abstract
Introduction Metastatic ureteral tumors are difficult to diagnose pathologically. Treatment is only available for the primary disease, and prognosis is generally poor. Case presentation A 63-year-old patient with a history of gastric cancer presented with asymptomatic right-sided hydronephrosis. Ureteroscopic examination revealed tissue in the ureter consistent with gastric cancer. The lesion was localized, and the patient was treated with chemotherapy and radiotherapy as part of a multidisciplinary treatment. The prognosis was better than in other reports. To the best of our knowledge, this is the first case of a patient with metastatic gastric cancer who received multidisciplinary treatment including radiotherapy and had a good prognosis. Conclusion In cases where a localized metastatic ureteral tumor cannot be ruled out, ureteroscopy is an effective therapeutic strategy.
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Affiliation(s)
- Yoshihiro Kawaguchi
- Department of Urology Saiseikai Futsukaichi Hospital Chikushino‐shi Fukuoka Japan
| | - Kazuya Naritomi
- Department of Surgery Saiseikai Futsukaichi Hospital Chikushino‐shi Fukuoka Japan
| | | | - Yoshihiro Matsunaga
- Department of Urology Kurume University School of Medicine Kurume Fukuoka Japan
| | - Naoyuki Ogasawara
- Department of Urology Kurume University School of Medicine Kurume Fukuoka Japan
| | - Tsukasa Igawa
- Department of Urology Kurume University School of Medicine Kurume Fukuoka Japan
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Liu B, Su J, Fan B, Ni X, Jin T. High expression of KIF20A in bladder cancer as a potential prognostic target for poor survival of renal cell carcinoma. Medicine (Baltimore) 2023; 102:e32667. [PMID: 36637953 PMCID: PMC9839245 DOI: 10.1097/md.0000000000032667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Urinary system tumors are malignant tumors, including renal cancer and bladder cancer. however, molecular target of them remains unclear. GSE14762 and GSE53757 were downloaded from GEO database to screen differentially expressed genes (DEGs). Weighted gene co-expression network analysis was performed. Gene Ontology (GO) and Kyoto encyclopedia of genes and genomes were used for enrichment analysis. Gene ontology and Kyoto encyclopedia of genes and genomes analyses were performed on whole genome, as formulated by gene set enrichment analysis. Survival analysis was also performed. Comparative toxicogenomics database was used to identify diseases most associated with hub genes. A total of 1517 DEGs were identified. DEGs were mainly enriched in cancer pathway, HIF-1 signaling pathway, organic acid metabolism, glyoxylate and dicarboxylate metabolism, and protein homodimerization activity. Ten hub genes (TPX2, ASPM, NUSAP1, RAD51AP1, CCNA2, TTK, PBK, MELK, DTL, kinesin family member 20A [KIF20A]) were obtained, which were up-regulated in tumor tissue. The expression of KIF20A was related with the overall survival of renal and bladder cancer. KIF20A was up-regulated in the tumor tissue, and might worsen the overall survival of bladder and kidney cancer. KIF20A could be a novel biomarker of bladder and kidney cancer.
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Affiliation(s)
- Bin Liu
- Department of Urology Surgery, The Fourth Hospital of Hebei Medical University, Hebei, PR China
- * Correspondence: Bin Liu, Department of Urology Surgery, The Fourth Hospital of Hebei Medical University, No.12 Jiankang Road, Hebei 050000, PR China (e-mail: )
| | - Jianzhi Su
- Department of Urology Surgery, The Fourth Hospital of Hebei Medical University, Hebei, PR China
| | - Bo Fan
- Department of Urology Surgery, The Fourth Hospital of Hebei Medical University, Hebei, PR China
| | - Xiaochen Ni
- Department of Urology Surgery, The Fourth Hospital of Hebei Medical University, Hebei, PR China
| | - Tingting Jin
- Department of Urology Surgery, The Fourth Hospital of Hebei Medical University, Hebei, PR China
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7
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Kitashiro S, Kuno I, Sugano T, Yamano Y, Shigeoka Y, Inaba M. Urethral metastasis from esophageal cancer: symptoms of dysuria and cystoscopic diagnosis. Oxf Med Case Reports 2022; 2022:omac099. [PMID: 36176944 PMCID: PMC9514107 DOI: 10.1093/omcr/omac099] [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: 04/26/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Urethral malignant tumors are rare and can lead to stenosis, causing dysuria. We report a case of urethral metastasis secondary to esophageal cancer. At the time of diagnosis, a patient with esophageal squamous cell carcinoma presented with voiding difficulties, feeble stream, terminal dribbling and incomplete voiding. The urethral tumor was diagnosed using cystoscopy, and biopsy was thereafter performed. Histopathology of the urethral tumor microscopically resembled to that of esophageal cancer. On immunohistochemistry, the urothelium markers uroplakin 2 and GATA3 were negative in the carcinomatous component; however, GATA3 was detected on the lesion’s surface. This case demonstrated that esophageal cancer metastasized to the urethra. Medical oncologists should consider this diagnosis in patients with cancer presenting with dysuria.
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Affiliation(s)
- Saya Kitashiro
- Yodogawa Christian Hospital Department of Medical Oncology, , Osaka, Japan
| | - Ikumi Kuno
- Yodogawa Christian Hospital Department of Medical Oncology, , Osaka, Japan
| | - Tenyu Sugano
- Yodogawa Christian Hospital Department of Diagnostic Pathology, , Osaka, Japan
| | - Yukimasa Yamano
- Yodogawa Christian Hospital Department of Urology, , Osaka, Japan
| | - Yasushi Shigeoka
- Yodogawa Christian Hospital Department of Medical Oncology, , Osaka, Japan
| | - Mayumi Inaba
- Yodogawa Christian Hospital Department of Diagnostic Pathology, , Osaka, Japan
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Saranti G, Zolota V, Kalogeropoulou C, Papathanasiou N, Katsila T, Kitsou K, Haliassos I, Kardamakis D. Diagnostic and Therapeutic Challenges in a Patient with Ureteral Metastases from a Triple Negative Breast Cancer. Curr Oncol 2022; 29:4791-4798. [PMID: 35877240 PMCID: PMC9323522 DOI: 10.3390/curroncol29070380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/27/2022] Open
Abstract
Metastatic ureteral tumors arising from a primary breast carcinoma are extremely rare. They present with hematuria and radiological findings compatible with obstructive ureteral phenomena. We present a case of an 87-year-old woman with a history of lymphoma and triple negative breast cancer (TNBC), during an emergency admission for peptic ulcer, developed macroscopic hematuria. Radiologic and endoscopic investigations revealed a remarkable stenosis at the lower segment of the right ureter, attributed to metastases from her breast carcinoma. We report this case with the aim to make both oncologists and urologists aware of this rare condition.
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Affiliation(s)
- Georgia Saranti
- Department of Radiation Oncology, University Hospital of Patras, University Campus, 26504 Patras, Greece; (G.S.); (I.H.)
| | - Vasiliki Zolota
- Department of Histopathology, University Hospital of Patras, University Campus, 26504 Patras, Greece;
| | - Christina Kalogeropoulou
- Department of Radiology, University Hospital of Patras, University Campus, 26504 Patras, Greece;
| | - Nikolaos Papathanasiou
- Department of Nuclear Medicine, University Hospital of Patras, University Campus, 26504 Patras, Greece;
| | - Theodora Katsila
- Institute of Chemical Biology, National Hellenic Research Foundation, 11635 Athens, Greece;
| | - Konstantina Kitsou
- Department of Hygiene and Epidemiology, University of Patras Medical School, 26504 Patras, Greece;
| | - Ilias Haliassos
- Department of Radiation Oncology, University Hospital of Patras, University Campus, 26504 Patras, Greece; (G.S.); (I.H.)
| | - Dimitrios Kardamakis
- Department of Radiation Oncology, University Hospital of Patras, University Campus, 26504 Patras, Greece; (G.S.); (I.H.)
- Correspondence: ; Tel.: +30-6999-424273
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Huai TZ, Ramely R, Daud MAM, Mokhtar MF, Mohammad H, Omar SZ. Isolated Renal and Ureter Metastasis as the First Manifestation of Rectal Adenocarcinoma. Middle East J Dig Dis 2022; 14:254-257. [PMID: 36619144 PMCID: PMC9489311 DOI: 10.34172/mejdd.2022.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 01/10/2022] [Indexed: 01/11/2023] Open
Abstract
Colorectal carcinoma (CRC) rarely metastasizes to the urinary system in isolated form. It usually spreads through direct invasion with intra-ureteric growth or local ureter mucosal metastasis without involving the muscular layer. We present a case of a 63-year-old man who came with uraemic symptoms and a ballotable right kidney. Laboratory and imaging showed acute renal failure with right renal mass suspicious of malignancy and left ureteric stricture causing hydronephrosis. He underwent right radical nephrectomy and left open ureteric stenting plus biopsy sampling. Adenocarcinoma was detected through the evaluation of the specimen. In view that adenocarcinoma rarely occurs in the urinary system, an investigation was carried out to search for the primary source. Colonoscopy was performed, which later showed adenocarcinoma of the rectum. Adenocarcinoma in the renal system should always raise the suspicion of another primary source of malignancy, especially colorectal origin. The advanced stage of this cancer should be managed with the best palliative treatment rather than aggressive surgical intervention.
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Affiliation(s)
- Teoh Zhan Huai
- Department of Surgery, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia,Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Rosnelifaizur Ramely
- Department of Surgery, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia,Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia,Corresponding Author: Rosnelifaizur Ramely, MD, MMed (Surgery) Department of Surgery, Universiti Sains Malaysia, Kubang Kerian,16150 Kota Bharu, Kelantan, Malaysia. Tel: + 609 7676758 Fax: + 609 7653370
| | - Mohamed Ashraf Mohamed Daud
- Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia,Urology Unit, Department of Surgery, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | | | - Hussain Mohammad
- Department of Surgery, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
| | - Siti Zarqah Omar
- Department of Pathology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Malaysia
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10
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Abdel-Razeq R, AlMasri R, Abunasser M, Edaily S, Jaber O, Khader O, Ghanem R, Abdel-Razeq H. Urinary bladder metastasis from primary breast cancer, a rare and challenging diagnosis. A case report and literature review. Ann Med Surg (Lond) 2022; 76:103455. [PMID: 35308426 PMCID: PMC8927793 DOI: 10.1016/j.amsu.2022.103455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 10/26/2022] Open
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11
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Pennisi I, Giordano G, Lentini V, Meo D, Piana S, Falsaperla M, Lio VMS. Ureteral metastasis from gastric cancer after two years of subtotal gastrectomy: a case report. Radiol Case Rep 2022; 17:875-877. [PMID: 35059091 PMCID: PMC8760388 DOI: 10.1016/j.radcr.2021.12.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/05/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022] Open
Abstract
True ureteral metastases from gastric cancer are extremely rare. Only a few cases of this condition have been reported. CT is the first-line imaging technique and may aid the diagnosis, even if the definitive diagnosis is histologic. We report a case of a 45-year-old female with a history of gastric cancer who underwent subtotal gastrectomy and presented 2 years later with ureteral metastasis and subsequently renal pelvis metastasis in absence of peritoneal involvement. A biopsy was required to rule out primary urothelial carcinoma and make a well-timed and proper diagnosis. We describe the pathologic and radiological features of this case, followed by a brief review of the literature included in the discussion.
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Affiliation(s)
- Isabella Pennisi
- Department of Medical-Surgical Sciences and Advanced Technologies - University Hospital "Policlinico-Vittorio Emanuele", Radiology Unit 1, University of Catania, Catania CAP 95125, Italy
| | - Giuseppe Giordano
- Unit of Diagnostic and Interventional Radiology ARNAS "Garibaldi-Nesima", Catania, Italy
| | - Viviana Lentini
- Unit of Diagnostic and Interventional Radiology ARNAS "Garibaldi-Nesima", Catania, Italy
| | - Diego Meo
- Unit of Diagnostic and Interventional Radiology ARNAS "Garibaldi-Nesima", Catania, Italy
| | - Sebastiano Piana
- Unit of Diagnostic and Interventional Radiology ARNAS "Garibaldi-Nesima", Catania, Italy
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12
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Takagawa Y, Izumi S, Okano T, Takahashi E, Wakamatsu Y, Takahara M, Okada H, Kita M. External Urethral Orifice Metastasis of Cervical Cancer Treated With Intraluminal Urethral Brachytherapy Using a Lumencath Applicator: The First Case Report. Adv Radiat Oncol 2022; 7:100828. [PMID: 35079663 PMCID: PMC8777246 DOI: 10.1016/j.adro.2021.100828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/01/2021] [Accepted: 09/28/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Yoshiaki Takagawa
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
- Departments of Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
- Corresponding author: Yoshiaki Takagawa, MD
| | - Sachiko Izumi
- Departments of Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Tomoyuki Okano
- Departments of Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Eiichi Takahashi
- Departments of Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yuki Wakamatsu
- Departments of Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Megumi Takahara
- Departments of Obstetrics and Gynecology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Haruka Okada
- Departments of Pathology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Midori Kita
- Departments of Radiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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13
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Jaouani L, Zaimi A, Al Jarroudi O, Brahmi SA, Afqir S. Unusual Metastasis From Breast Cancer: Case Report. Cureus 2021; 13:e18737. [PMID: 34796050 PMCID: PMC8589340 DOI: 10.7759/cureus.18737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/05/2022] Open
Abstract
Metastatic breast cancer among young women represents a serious public health issue. The most frequent sites of dissemination are bone, liver, lung, lymph nodes and brain. Bladder location is extremely unusual. We present the case of a 33-year-old female who was receiving palliative chemotherapy for bilateral metastatic invasive lobular cancer. Following episodes of macroscopic hematuria, a CT scan was performed, which revealed a suspicious thickening of the bladder wall. After an endoscopic resection with immunohistological analysis, the diagnosis was confirmed. Voiding symptoms in a woman with a history of breast cancer should be evaluated to rule out a secondary urinary tract lesion. As soon as the diagnosis is determined, appropriate therapy should be initiated.
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Affiliation(s)
- Laila Jaouani
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
| | - Adil Zaimi
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
| | | | | | - Said Afqir
- Medical Oncology, Mohammed VI University Hospital, Oujda, MAR
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14
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Fejes Z, Király IE, Fehér ÁM, Kovács PG, Gyuris Z, Sükösd F, Torday L, Kuthi L. Multifocal Urinary Tract Metastasis of Colorectal Carcinoma. Pathobiology 2021; 89:56-62. [PMID: 34525471 DOI: 10.1159/000518967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/01/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Secondary urinary tract tumors are uncommon findings and mainly evolve by direct invasion from adjacent organs. Actual metastatic involvement often develops in the urinary bladder, while the upper urinary tract is infrequently affected. In addition, the lungs, breast, and prostate gland are the usual primary sites. Colorectal carcinoma (CRC) may spread to the ureter directly or seeds via vascular or lymphatic channels. It may pose struggles in the differential diagnosis because CRC shares standard pathologic features with the primary adenocarcinoma of the urinary tract. CASE PRESENTATION We describe the case of an 81-year-old man who was referred to our hospital with a distal ureteral tumor that was treated by a ureteronephrectomy. The histopathological and genetic analysis established the diagnosis of metastatic CRC along with 3 metastases in the renal pelvis. CONCLUSION This rare case highlights the limitations of conventional histological processing, including immunohistochemistry, and it underlines the role of molecular investigations in certain circumstances.
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Affiliation(s)
- Zsuzsanna Fejes
- Department of Radiology, University of Szeged, Szeged, Hungary
| | | | | | | | | | - Farkas Sükösd
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - László Torday
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Levente Kuthi
- Department of Pathology, University of Szeged, Szeged, Hungary
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15
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Hadhri A, Abidi R, Mahjoub N, Mousli A, Mahjoubi K, Boujelbene N, Nasr C. Metastasis of breast cancer to bladder. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00224-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Breast cancer is the leading cause of cancer death in women, and most breast cancer related deaths are due to metastasis. Urinary bladder metastasis from breast cancer is rarely reported in the literature.
Case presentation
We report a case of a 77-year-old female with history of left breast cancer, who presented a thickening of the bladder wall at pelvic ultrasound. Biopsy confirmed that the origin was lobular carcinoma of breast origin. The patient received chemotherapy, but the clinical course of the patient was very aggressive and she died one year later.
Conclusion
Bladder metastasis from breast cancer is rare, but the literature reveals an increase in such occurrence over the last few years. Pathologic diagnosis relies on immunohistochemical studies. Chemotherapy and hormonal treatment represent the standard therapy, with radiotherapy being used only to control bladder bleeding. The prognosis is usually poor.
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16
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Chahin M, Chhatrala H, Krishnan N, Brow D, Zuberi L. Triple-Negative Lobular Breast Cancer Causing Hydronephrosis. J Investig Med High Impact Case Rep 2021; 8:2324709620905954. [PMID: 32043897 PMCID: PMC7013110 DOI: 10.1177/2324709620905954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Breast cancer is the leading malignancy and the second most common cause of
mortality in women. Although there have been advances in identifying biomarkers
as potential targets for therapy, triple-negative breast cancer (TNBC) continues
to have a poorer prognosis than the other receptor subtypes. The most common
sites of metastasis are bone, liver, lung, and brain. We present a patient with
known TNBC presenting with nausea and vomiting in whom computed tomography
revealed a right-side pelvic mass causing hydronephrosis. Biopsy was consistent
with TNBC of the ureter, an unusual site for breast cancer involvement. She
required ureteral stent placement to relieve obstruction and has had good
response to paclitaxel. Hydronephrosis due to malignancy presents significant
risk of morbidity and mortality due to compromised renal function and must be
resolved promptly to avoid compromise of renal function.
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Affiliation(s)
| | | | | | - Darren Brow
- University of Florida, Jacksonville, FL, USA
| | - Lara Zuberi
- University of Florida, Jacksonville, FL, USA
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17
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Huang Y, He H, Wei W, Li Q, Long X, Li Y, Chen R, Yi X. 18F-FDG PET/CT features of ureteral metastases from breast cancer: a case report. J Int Med Res 2021; 49:3000605211014090. [PMID: 33990152 PMCID: PMC8127773 DOI: 10.1177/03000605211014090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Breast cancer metastasis to the ureter is rare. Fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/computed tomography (CT) is widely used to identify primary lesions of metastatic tumours, however, 18F-FDG PET/CT imaging features of ureteral metastasis from breast cancer are rarely reported. Herein, the case of a 46-year-old woman with recurrent left flank pain for 5 months, who was admitted to the Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, is described. She had undergone right radical mastectomy 5 years previously and had received tamoxifen treatment for 5 years. Assessment by 18F-FDG PET/CT revealed tumours on the ureter presenting as a long segmental lesion, radioactive concentrations, and a low maximum standardized uptake value (SUVmax), with no radioactive concentrations in the urine and no significant change in the ureteral contour. The severity of the ureteral lesion was not consistent with the severity of hydronephrosis. A tumour biopsy was performed laparoscopically, and postoperative pathological examination confirmed a primary breast cancer tumour. The patient did not consent to treatment and was lost to follow-up.
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Affiliation(s)
- Yuanbi Huang
- Department of Urology, Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, China
| | - Huajie He
- Department of Urology, Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, China
| | - Wei Wei
- Department of Radiology, Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, China
| | - Qiguang Li
- Department of Urology, Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, China
| | - Xian Long
- Department of Urology, Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, China
| | - Yongpeng Li
- Department of Urology, Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, China
| | - Rongchao Chen
- Department of Urology, Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, China
| | - Xianlin Yi
- Department of Urology, Cancer Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, China
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18
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Liew ALF, Yu EY, Chotai N. A Case Series of Unusual or Infrequent Locations of Breast Cancer Metastases. Indian J Radiol Imaging 2021; 31:366-372. [PMID: 34556920 PMCID: PMC8448236 DOI: 10.1055/s-0041-1734338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Breast cancer metastasis to unusual locations may present as a diagnostic challenge. Recognizing the different manifestations of metastatic breast disease can help to guide patient treatment and assist in disease prognosis. The purpose of this article is to illustrate the imaging findings of some of the unusual or infrequent locations of breast metastases through a series of interesting cases and to revisit this uncommon clinical issue.
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Affiliation(s)
- Amanda Ling Fung Liew
- Division of Oncologic Imaging, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore
| | - Ern Yu Yu
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), 61 Biopolis Dr, Singapore
| | - Niketa Chotai
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore
- RadLink Diagnostic Imaging, Singapore, 08-08, 290 Orchard Road, Singapore
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19
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Santos SF, Santos PO, Doutel D, Venancio J. Metastasis of renal cell carcinoma to the ure-thra: a rare scenario. Int Braz J Urol 2021; 47:674-677. [PMID: 33621022 PMCID: PMC7993951 DOI: 10.1590/s1677-5538.ibju.2020.0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/29/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sofia Frade Santos
- Instituto Português de Oncologia de Lisboa Francisco Gentil - IPOLFG, Lisboa, Portugal
| | - Pedro Oliveira Santos
- Instituto Português de Oncologia de Lisboa Francisco Gentil - IPOLFG, Lisboa, Portugal
| | - Delfim Doutel
- Instituto Português de Oncologia de Lisboa Francisco Gentil - IPOLFG, Lisboa, Portugal
| | - Jose Venancio
- Instituto Português de Oncologia de Lisboa Francisco Gentil - IPOLFG, Lisboa, Portugal
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20
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Causa Andrieu PI, Golia Pernicka JS, Faria E Silva Costa G, Chesnut GT, Shandu JS, Ying-Bei C, Petkovska I. Isolated urethral metastasis from appendiceal mucinous adenocarcinoma. Clin Imaging 2020; 67:68-71. [PMID: 32526660 DOI: 10.1016/j.clinimag.2020.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/11/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
We are presenting a compelling case of a 61-year-old female with a history of appendiceal mucinous adenocarcinoma (AMA) with a new complaint of irritative lower urinary tract symptoms. Magnetic resonance imaging (MRI) showed a semi-circumferential, T2 hyperintense, rim enhancing, and lacking restricted diffusion lesion involving the urethra and infiltrating the right perineal and internal obturator muscles. The suspected differential diagnosis was urethral malignancy, based on her cancer history and MRI findings. After interdisciplinary consensus, the patient underwent excision of the lesion, and pathology was consistent with metastasis from the primary tumor. The urethra is a rare site of primary malignancy and metastatic disease. In particular, a non-contiguous metastatic disease involving the urethra is exceedingly rare. To the best of our knowledge, this is the first report of an AMA metastasizing to the urethra.
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Affiliation(s)
- Pamela I Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States.
| | | | | | - Gregory T Chesnut
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Jaspreet S Shandu
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Chen Ying-Bei
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
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21
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Karjol U, Jonnada P, Cherukuru S, Chandranath A. Bladder Metastasis from Breast Cancer: A Systematic Review. Cureus 2020; 12:e7408. [PMID: 32257726 PMCID: PMC7117603 DOI: 10.7759/cureus.7408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Breast cancer is the leading cause of cancer death in women, and most breast cancer related deaths are due to metastasis. Urinary bladder metastasis from breast cancer is rarely reported in the literature. In this review, we examined the reported cases of breast cancer metastasizing to the urinary bladder, with the objective of identifying clues that could help physicians in diagnosing and planning further treatment. We performed a systematic review of the literature to analyze the clinical and pathological profile of this disease. We thoroughly examined and systematically reported data regarding epidemiology, the pattern of spread, signs and symptoms, pathology and hormonal status, diagnostic workup, management, and outcomes. Urinary bladder metastases from breast cancers are more common in invasive lobular carcinoma. In addition to asymptomatic presentations, most cases present with hematuria and voiding dysfunction. This review summarizes the insights into the incidence, clinical presentation, diagnostic workup, management, and prognosis of urinary bladder metastasis in patients with breast cancer.
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Affiliation(s)
- Uday Karjol
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, IND
| | - Pavan Jonnada
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, IND
| | | | - Ajay Chandranath
- Surgical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, IND
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22
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Levitske C, Gollapudi K, Pak S, Liang L. Repair of iatrogenic ureteral injury secondary to breast cancer metastasis. Urol Case Rep 2020; 28:101024. [PMID: 31641604 PMCID: PMC6796656 DOI: 10.1016/j.eucr.2019.101024] [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: 08/16/2019] [Accepted: 09/18/2019] [Indexed: 12/02/2022] Open
Abstract
We present a case of unforeseen ureteral metastasis from a primary breast cancer. A ureteral injury leak was postoperatively recognized after a hysterectomy and bilateral oophorectomy were performed. Subsequent repair with a psoas hitch ureteral re-implant was performed and breast cancer metastasis was discovered in the ureteral stump specimen.
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Affiliation(s)
- Cassandra Levitske
- Ross University School of Medicine, 2300 SW 145th Ave #200, Miramar, FL, 33027, USA
- Corresponding author.
| | - Kiran Gollapudi
- Habor UCLA Medical Center, Urology Department, 1000 West Carson Street, Torrance, CA, 90509, USA
| | - Sophia Pak
- Keck School of Medicine of University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA
| | - Leonard Liang
- Habor UCLA Medical Center, Urology Department, 1000 West Carson Street, Torrance, CA, 90509, USA
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23
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Ma HL, Yu SJ, Chen J, Ding XF, Chen G, Liang Y, Pan JL. CA8 promotes RCC proliferation and migration though its expression level is lower in tumor compared to adjacent normal tissue. Biomed Pharmacother 2019; 121:109578. [PMID: 31715371 DOI: 10.1016/j.biopha.2019.109578] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/17/2019] [Accepted: 10/24/2019] [Indexed: 12/24/2022] Open
Abstract
Chemotherapy and radiotherapy are not as successful in the case of renal cell carcinoma (RCC) although some targeted drugs were approved for RCC therapy recently. Analysis of whole genomic data will lead to improvements in understanding RCC and identifying novel anticancer targets. Here, we found the differential mRNA expression and copy number variation (CNV) of Carbonic anhydrase-related protein VIII (CA8) gene in RCC through integrated bioinformatics analysis of TCGA database, which was confirmed in 5 cases of samples collected from RCC patients who underwent radical nephrectomy by analysis of CA8 mRNA and protein levels using RT-PCR immunohistochemical assay. However, we got a completely opposite result that CA8 promoted RCC progression, those are CA8 overexpression promoted the proliferative and migratory ability of Caki-1 and 769-P cells in vitro as determined with MTT and transwell assay, and CA8 overexpression could also promote Caki-1 xenograft growth in BALB/C‑nu/nu mice. On the contrary, CA8-knockdown reduced Caki-1 and 769-P cell proliferation and migration. Moreover, knockdown of CA8 decreased pAKT and MMP2 protein levels in Caki-1 cells while overexpressing CA8 increased pAKT and MMP2. In conclusion, we showed that CA8 promoted RCC cell proliferation and migration, but it was down-regulated in RCC, which requires an additional mechanism study.
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Affiliation(s)
- Huai-Lu Ma
- Department of Pharmacology, School of Clinical Medicine, Taizhou University, Taizhou, Zhejiang 318000, China; Graduate School of Medicine, Hebei North University, Zhangjiakou, Hebei 075000, China; School of Medicine, Taizhou University, Taizhou, Zhejiang 318000, China
| | - Sheng-Jian Yu
- Department of Pharmacology, School of Clinical Medicine, Taizhou University, Taizhou, Zhejiang 318000, China
| | - Jie Chen
- School of Medicine, Taizhou University, Taizhou, Zhejiang 318000, China
| | - Xiao-Fei Ding
- School of Medicine, Taizhou University, Taizhou, Zhejiang 318000, China
| | - Guang Chen
- Department of Pharmacology, School of Clinical Medicine, Taizhou University, Taizhou, Zhejiang 318000, China; School of Medicine, Taizhou University, Taizhou, Zhejiang 318000, China.
| | - Yong Liang
- Institute of Tumor, Taizhou University, School of Medicine, 1139 Shi-Fu Avenue, Taizhou, Zhejiang 318000, China.
| | - Jian-Li Pan
- Pharmacy Department, Eye Hospital of Wenzhou Medical University, NO. 618, Fengqi East Road, Hangzhou, Zhejiang 310000, China.
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24
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Gabsi A, Yahiaoui Y, Zenhani A, Herbegue K, Meddeb K, Mokrani A, Letaief F, Ayadi M, Rais H, Chraiet N, Haouet S, Mezlini A. Ureteral metastasis in carcinoma of the breast. Urol Case Rep 2018; 21:38-40. [PMID: 30202731 PMCID: PMC6128026 DOI: 10.1016/j.eucr.2018.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/15/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Azza Gabsi
- Medical Oncology Department, Salah Azaiez Institute, Tunis, Tunisia
| | - Yosra Yahiaoui
- Medical Oncology Department, Salah Azaiez Institute, Tunis, Tunisia
| | - Alia Zenhani
- Department of Pathology, Rabta Hospital, Faculty of Medicine, Tunis, Tunisia
| | | | - Khedija Meddeb
- Medical Oncology Department, Salah Azaiez Institute, Tunis, Tunisia
| | - Amina Mokrani
- Medical Oncology Department, Salah Azaiez Institute, Tunis, Tunisia
| | - Feryel Letaief
- Medical Oncology Department, Salah Azaiez Institute, Tunis, Tunisia
| | - Mouna Ayadi
- Medical Oncology Department, Salah Azaiez Institute, Tunis, Tunisia
| | - Henda Rais
- Medical Oncology Department, Salah Azaiez Institute, Tunis, Tunisia
| | - Nesrine Chraiet
- Medical Oncology Department, Salah Azaiez Institute, Tunis, Tunisia
| | - Slim Haouet
- Department of Pathology, Rabta Hospital, Faculty of Medicine, Tunis, Tunisia
| | - Amel Mezlini
- Medical Oncology Department, Salah Azaiez Institute, Tunis, Tunisia
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