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Djatisoesanto W, Yatindra IBGTY, Rahaju AS. Ureteral small cell neuroendocrine carcinoma: A case report and short review. Int J Surg Case Rep 2023; 111:108708. [PMID: 37703696 PMCID: PMC10502330 DOI: 10.1016/j.ijscr.2023.108708] [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: 07/23/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary small cell neuroendocrine carcinoma (SCNEC) in the urinary tract represents less than 0.5 % of urinary tract cancers, and bladder or prostate are the most common sites. Early diagnosis and treatment of ureteral SCNECs are challenging due to nonspecific clinical symptoms and radiographic findings. CASE PRESENTATION Here, we described a diagnostic and therapeutic challenge of a 56-yearold male with recurrent right flank pain that did not relieve with analgesics alone. The patient underwent several non-invasive to invasive procedures revealing nonspecific inflammation pathology of the ureter that later developed into protruded papillary mucosa resembling polypoid cystitis. Later, an abdominal multi-slice computed tomography examination suggested a malignant mass and was confirmed as SCNEC from the pathological analysis. After several successful chemotherapy cycles and surgical procedures, cancer reoccurred, and the patient's general condition deteriorated. He passed away a year after a radical cystoprostatectomy and nephroureterectomy on his right side. CLINICAL DISCUSSIONS The occurrence of primary SCNEC is a highly uncommon phenomenon. As SCNEC arises from pluripotent stem cells that have differentiated into neuroendocrine cells, some patients may exhibit paraneoplastic syndrome. The patient's prognosis of this tumor is poor, even for patients in the earliest phases, because SCNEC is characterized by highly aggressive local invasion and distant metastases. CONCLUSIONS This case highlights the importance of accurate early diagnosis and treatment of recurrent flank pain and considering the possibility of a malignant tumor as the cause of obstruction.
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Affiliation(s)
- Wahjoe Djatisoesanto
- Department of Urology, Faculty of Medicine Airlangga University, Surabaya, Indonesia; Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
| | - Ida Bagus Gde Tirta Yoga Yatindra
- Department of Urology, Faculty of Medicine Airlangga University, Surabaya, Indonesia; Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Anny Setijo Rahaju
- Department of Pathology Anatomy, Faculty of Medicine, Airlangga University, Surabaya, Indonesia; Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
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2
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Neuroendocrine Neoplasms of the Female Genitourinary Tract: A Comprehensive Overview. Cancers (Basel) 2022; 14:cancers14133218. [PMID: 35804996 PMCID: PMC9264819 DOI: 10.3390/cancers14133218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Primary neuroendocrine neoplasms (NENs) are a rare, heterogeneous group of tumors that include well-differentiated neuroendocrine tumors, poorly differentiated neuroendocrine carcinoma, and paraganglioma. NENs in the urinary tract are observed in <0.05% of individuals, in whom the bladder is the most common site. In this review, we described the epidemiology, pathogenesis, imaging, staging, and management of the genitourinary NENs. Abstract Primary neuroendocrine neoplasms are a rare heterogeneous group of tumors that include well-differentiated neuroendocrine tumors, poorly differentiated neuroendocrine carcinoma, and paraganglioma. An extensive literature search was used to compile the data regarding epidemiology, pathogenesis, imaging features, and management of the urinary system NENs. We also included the updated staging of the NENs at various locations of the urinary system.
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3
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Farooq M, Daniel S, Joel A, Thampi John N. Successful management of small cell neuroendocrine carcinoma of the ureter with neoadjuvant chemotherapy and adjuvant chemoradiation: case report and literature review. BMJ Case Rep 2021; 14:e240613. [PMID: 34404642 PMCID: PMC8375734 DOI: 10.1136/bcr-2020-240613] [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] [Accepted: 07/31/2021] [Indexed: 11/04/2022] Open
Abstract
Neuroendocrine tumours (NETs) of the urinary tract are rare, and the urinary bladder is the the most common primary site. Primary ureteric NET is rarer with under 80 cases reported in the literature thus far. Most of these tumours are of the high-grade small cell neuroendocrine carcinoma subtype, which has a worse prognosis. Neoadjuvant chemotherapy has a proven role in the management of NET of the bladder as it downstages the tumour, which may add to significant recurrence-free survival and overall survival. We report the successful management of a patient with locally advanced small cell neuroendocrine carcinoma of the ureter, who had a pathological complete response after neoadjuvant chemotherapy with etoposide and cisplatin. He subsequently received adjuvant chemotherapy followed by radiation and is recurrence-free at a follow-up of 1 year.
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Affiliation(s)
- Mudasir Farooq
- Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
- Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sherin Daniel
- Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anjana Joel
- Medical oncology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Nirmal Thampi John
- Urology, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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4
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Obi-Njoku O, Bell C, Menon PR, Shergill I. Incidental finding of a small cell neuroendocrine carcinoma of the ureter. BMJ Case Rep 2019; 12:12/7/e229290. [PMID: 31371331 DOI: 10.1136/bcr-2019-229290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The ureter is an extremely rare site for small cell neuroendocrine carcinoma. We present a case of this disease in a patient who presented without urological symptoms. The multidisciplinary team proposed nephroureterectomy (if fit) or watchful waiting as management. After discussion with the patient a decision in favour of watchful waiting was made. We report her case including a review of the literature, and emphasise that although small cell neuroendocrine carcinomas can be very aggressive, they can remain asymptomatic.
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Affiliation(s)
- Obinna Obi-Njoku
- Urology, Wrexham Maelor Hospital, Wrexham, UK.,Urology, Whittington Hospital, London, UK
| | - Chris Bell
- Urology, Wrexham Maelor Hospital, Wrexham, UK
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5
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Jiang N, Tian D, Shen Z, Wu P, Hou Y, Xie L, Li Y, Zhang X, Tang X, Hu H, Pei Q, Wu C. Small cell carcinoma of the upper urinary tract and factors associated with progress survival: a systematic review and pooled analysis. MINERVA UROL NEFROL 2018; 72:115-122. [PMID: 30421591 DOI: 10.23736/s0393-2249.18.03212-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Little is known about small cell carcinoma of the upper urinary tract (UUT-SCC), the aim of this study is to identify the risk factors in relation to survival of patients with UUT-SCC. EVIDENCE ACQUISITION Literature search on UUT-SCC was performed in databases including MEDLINE, EMBASE, Wangfang, and CNKI. Studies were eligible for inclusion if outcomes of patients with histopathologically confirmed UUT-SCC were reported. The relevant data on clinic, pathology, and therapy were collected. Progress survival was evaluated using the Cox regression model with the robust sandwich estimates of the covariance matrix. EVIDENCE SYNTHESIS There were 55 eligible publications identified, contributing 76 patients in total. The median of overall survival (OS) was 14 months. In univariable analyses, pathological stage and platinum-based chemotherapy regimen were associated with OS (pT3-pT4 versus pT1-pT2, HR=3.228, P=0.005; other chemotherapies versus platinum-based, HR=6.249, P=0.035). The median of cancer-specific survival (CSS) was 15 months. In univariable analyses, pathological stage and platinum-based chemotherapy regimen were associated with CCS (pT3-pT4 versus pT1-pT2, HR=3.332, P=0.004; non-platinum based versus platinum-based, HR=7.784, P=0.025). CONCLUSIONS In multivariable analyses, no variables were associated with OS and CSS. UUT-SCC is a rare tumor characterized by an aggressive clinical course. Pathological stage and platinum-based chemotherapy regimen are the most important factors related to OS and CSS.
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Affiliation(s)
- Ning Jiang
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Tianjin, China
| | - Dawei Tian
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhonghua Shen
- Department of Urology, Tangshan Gongren Hospital, Tangshan, China
| | - Peikang Wu
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Tianjin, China
| | - Yuwei Hou
- Department of Magnetic Resonance, Tangshan Gongren Hospital, Tangshan, China
| | - Linguo Xie
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yuzhu Li
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Tianjin, China
| | - Xiang Zhang
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaogang Tang
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Hailong Hu
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Tianjin, China
| | - Qiong Pei
- Department of Urology, Tangshan Gongren Hospital, Tangshan, China
| | - Changli Wu
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin, China - .,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Tianjin, China
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6
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Yuen HS, Rix GH, Sen S, Kusuma VRM. Atypical Carcinoid Neuroendocrine Tumor of the Ureter: A Case Report and Literature Review. Surg J (N Y) 2018; 4:e171-e175. [PMID: 30306137 PMCID: PMC6177337 DOI: 10.1055/s-0038-1673331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022] Open
Abstract
Neuroendocrine tumors (NETs) of the ureter are rare, with less than 40 cases described in the literature. A majority of tumors described are poorly differentiated tumors with a poor prognosis. We present the case of a moderately differentiated atypical carcinoid NET of the ureter with a good postoperative outcome. A literature review was also performed to identify similar cases to compare their management and postoperative outcomes.
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Affiliation(s)
- Huay Shan Yuen
- Department of Urology, Colchester Hospital University NHS Foundation Trust, Colchester, United Kingdom
| | - Gerald Henner Rix
- Department of Urology, Colchester Hospital University NHS Foundation Trust, Colchester, United Kingdom
| | - Soumadri Sen
- Department of Pathology, Colchester Hospital University NHS Foundation Trust, Colchester, United Kingdom
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7
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Systematic review and two new cases of primary upper urinary tract neuroendocrine carcinomas. Cancer Treat Res Commun 2018; 17:23-30. [PMID: 30326420 DOI: 10.1016/j.ctarc.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/11/2018] [Accepted: 10/08/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Upper urinary tract neuroendocrine carcinoma (UUT-NEC) is extremely rare and has a poor prognosis. Although a few cases of successful treatment have been reported, no treatment has shown established efficacy. PATIENTS AND METHODS We analyzed 70 UUT-NEC patients, including 68 with small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC) reported between 1985 and 2017 and 2 treated at our hospital. RESULTS Median patient age was 66 years, 58.6% were men, and 60% were of Asian descent. Most UUT-NECs were SCNEC (68; 95.7%), whereas LCNEC was very rare (2; 2.9%). More than half of the patients had accompanying other histological components, the most common being urothelial carcinoma (51.5%), whereas 41.4% had NEC alone. Of the 70 patients, 27 underwent additional therapy (e.g., chemotherapy and radiotherapy) along with surgery. Median survival was 15 months. In univariate analysis, stages T1-2 disease showed better prognosis than stages T3-4 (P < 0.001). Additional treatment (e.g., chemotherapy and radiotherapy) significantly improved prognosis (P = 0.014). Moreover, platinum-based chemotherapy also was associated with improved prognosis (P = 0.017). For platinum-based chemotherapy, multicollinearity with additional treatments was strong, and, thus, these data were not included in the analysis. Multivariate analysis revealed pathological stage (T1-2 vs. T3-4; P = 0.003) and additional treatment (P = 0.028) to be independent predictors of improved prognosis. CONCLUSION Although UUT-NEC has a poor prognosis, additional treatment along with surgery and therapeutic intervention and stage T1-2 disease are independent factors to improve prognosis.
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8
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Farci F, Manassero F, Baldesi R, Bartolucci A, Boldrini L, Selli C, Faviana P. Primary small cell carcinoma of the ureter: Case report and review of the literature. Medicine (Baltimore) 2018; 97:e11113. [PMID: 29901633 PMCID: PMC6023684 DOI: 10.1097/md.0000000000011113] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Primitive small cell carcinoma of the ureter is extremely rare, in this case report is meticulously described its aggressive clinical course and the pathological clues that help with the diagnosis. Also, a detailed table with the clinico-pathological features of analogous case reports in literature is provided. PATIENT CONCERNS A 79-year-old female presented with gross hematuria and flank pain. DIAGNOSES Small cell carcinoma of the ureter. The surgical specimen showed a mixed histology of small cell carcinoma and transitional cell carcinoma; the common neuroendocrine markers (chromogranin A, synaptophysin, CD56) were positive, and vimentin and thyroid transcription factor 1 were negative. The patient had an advanced stage at presentation with regional nodes involvement (pT3N1). INTERVENTIONS Segmental ureterectomy was performed but it was only possible to administer 1 cycle of platinum-based adjuvant chemotherapy due to the rapid decline of her clinical parameters. OUTCOMES The disease rapidly spread locally and metastasized. LESSON The clinicians must be aware of this aggressive tumor with silent clinical course and advanced stages at presentation.
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Affiliation(s)
- Fabiola Farci
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa
| | - Francesca Manassero
- Unit of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, Pisa, Italy
| | - Ramona Baldesi
- Unit of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, Pisa, Italy
| | - Annamaria Bartolucci
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa
| | - Laura Boldrini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa
| | - Cesare Selli
- Unit of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Roma, Pisa, Italy
| | - Pinuccia Faviana
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa
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9
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Zhong W, Lin R, Zhang L, Jin C, Li X, He Q, Gong K, He Z, Zhou L. Clinicopathologic characteristics, therapy and outcomes of patients with primary ureteral small cell carcinoma: a case series and systematic review of the literature. Onco Targets Ther 2017; 10:4105-4111. [PMID: 28860819 PMCID: PMC5566501 DOI: 10.2147/ott.s138769] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose The aim of this case series was to review the standard diagnosis and treatment procedures of primary small cell carcinoma (SCC) in our institution and discuss the clinicopathologic characteristics, treatments and outcomes of patients with primary ureteral SCC. Patients and methods Patients diagnosed with ureteral SCC in Peking University First Hospital, Beijing, China, from January 2007 to December 2016 were included. In addition, we performed a systematic literature review, in October 2016, on case reports and case series of ureteral SCC. The clinicopathologic characteristics, treatments and outcomes of this rare disease were analyzed. Results A total of 32 patients were included in our analysis (4 cases from our institution and 28 cases from the literature). Most patients (71.0%) were male with an average age of 66.6 years (range 48–80 years). The most common symptoms were hematuria (n=14, 48.3%) and flank pain (n=14, 48.3%). All patients underwent surgery, with 12 (37.5%) patients undergoing multimodality therapy. Regional or distant recurrences developed in 11 patients, among which only 1 patient had bladder recurrence. The overall median survival of the patients was 17 months, with 1- and 3-year survival rates of 51.9% and 30.3%, respectively. In a univariate analysis, female (P=0.009), pure SCC (P=0.03) and advanced T stage (P=0.04) were associated with worse overall survival. Conclusion Ureteral SCCs are extremely rare neoplasms with aggressive natural history and poor prognosis. T stage, tumor components and gender may be important factors influencing prognosis. A multimodality treatment is recommended for management. However, further studies are needed to improve the treatment strategy.
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Affiliation(s)
- Wenlong Zhong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People's Republic of China
| | - Rongcheng Lin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People's Republic of China
| | - Lei Zhang
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People's Republic of China
| | - Chengyue Jin
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People's Republic of China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People's Republic of China
| | - Qun He
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People's Republic of China
| | - Kan Gong
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People's Republic of China
| | - Zhisong He
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People's Republic of China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, People's Republic of China
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10
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Acosta AM, Kajdacsy-Balla A. Primary Neuroendocrine Tumors of the Ureter: A Short Review. Arch Pathol Lab Med 2017; 140:714-7. [PMID: 27362572 DOI: 10.5858/arpa.2015-0106-rs] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neuroendocrine tumors represent 0.05% of urinary tract malignancies, and most originate in the bladder. Their pathogenesis is debated, since ureters are thought to lack neuroendocrine cells. Morphologically, most ureteral neuroendocrine tumors demonstrate the typical small cell neuroendocrine appearance, are immunohistochemically positive for synaptophysin/chromogranin A/CD56, and show electron-dense granules by electron microscopy. Clinical presentation is similar to that of other more common ureteral neoplasms. Prognosis is usually dismal, but a multimodal treatment approach including platinum-based adjuvant or neoadjuvant chemotherapy seems to be beneficial.
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Affiliation(s)
- Andres M Acosta
- From Anatomic/Clinical Pathology (Dr Acosta) and Transdisciplinary Pathology (Dr Kajdacsy-Balla), University of Illinois at Chicago Hospital and Health Sciences System, Chicago
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11
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Wang W, Liu G, Li Y, Siriwardane U, Ma H. Neuroendocrine carcinoma of the ureter: A case report and literature review. Oncol Lett 2015; 11:257-260. [PMID: 26870199 DOI: 10.3892/ol.2015.3899] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 07/21/2015] [Indexed: 12/14/2022] Open
Abstract
Primary neuroendocrine carcinoma (NEC) of the ureter is a rare entity, with few cases reported in the literature. These tumors are usually locally aggressive and are associated with a poor prognosis due to the thin walls of the ureter. This is the case report of a 69-year-old male patient who presented with left flank pain and gross hematuria. Following diagnosis of ureteral carcinoma, nephroureterectomy was performed. Postoperatively, the patient refused chemotherapy and radiotherapy, and succumbed to extensive metastases after 12 months of follow-up. The aim of the present study was to provide a literature review of NEC and its clinical and pathological characteristics, diagnostic methods and latest modifications in therapy.
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Affiliation(s)
- Wei Wang
- Department of Urology, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Guangming Liu
- Department of Urology, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Yanmin Li
- Department of Pathology, Tianjin First Central Hospital, Tianjin 300192, P.R. China
| | - Udeshika Siriwardane
- International Medical School, Tianjin Medical University, Tianjin 300070, P.R. China
| | - Hongshun Ma
- Department of Urology, Tianjin First Central Hospital, Tianjin 300192, P.R. China
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12
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Acosta AM, Hamedani FS, Meeks JJ, Wu S. Primary Ureteral Thyroid Transcription Factor 1-Positive Small Cell Neuroendocrine Carcinoma: Case Report and Review of the Literature. Int J Surg Pathol 2015; 23:472-7. [PMID: 26162396 DOI: 10.1177/1066896915594882] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Upper urinary tract neoplasms comprise only 5% of urinary malignancies overall, the overwhelming majority showing an urothelial histology. Nonurothelial lesions represent 1.9% of upper tract neoplasms, and small cell carcinomas (SmCCs) only account for a minute fraction of them, with few cases reported in the literature to date. In the genitourinary tract, these lesions are most frequently found in the urinary bladder, where they tend to show a mixed histology with a characteristic small cell neuroendocrine component that is positive for chromogranin A, synaptophysin, and CD56 immunostains. Urinary SmCCs are almost invariably aggressive, with a propensity to infiltrate surrounding tissues and vascular structures. Unfortunately, clinical stage at presentation is often advanced, with early dissemination to lymph nodes or distant organs in a significant proportion of patients. For the most part, prognosis is dismal and can be predicted by the pathologic stage at diagnosis. Recently, new chemotherapeutic regimens have shown some potential benefit for the treatment of urinary SmCC, albeit not achieving curative results. Here we present the case of a 71-year-old male patient with a history of treated bladder urothelial carcinoma that presented with subacute flank pain and was diagnosed with a primary pure SmCC of the ureter. Besides the usual neuroendocrine immunomarkers, this tumor showed intense positivity for TTF-1 (thyroid transcription factor-1), a phenomenon that has been described for extrapulmonary SmCC of other locations.
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Affiliation(s)
- Andrés Martin Acosta
- University of Illinois at Chicago Hospital and Health Sciences System, Chicago, IL, USA
| | - Farid Saei Hamedani
- University of Illinois at Chicago Hospital and Health Sciences System, Chicago, IL, USA
| | - Joshua James Meeks
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Jesse Brown VAMC, Chicago, IL, USA
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13
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Ping JH, Chen ZX, Jiong Q, Han YQ, Nong X. Small cell neuroendocrine carcinoma of the ureter: A case report and literature review. Oncol Lett 2013; 7:728-730. [PMID: 24520292 PMCID: PMC3919792 DOI: 10.3892/ol.2013.1757] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 11/25/2013] [Indexed: 12/11/2022] Open
Abstract
Small cell neuroendocrine carcinoma arising in the ureter is extremely rare; only a few cases have been previously reported in the literature. The current study reports the case of a 65-year-old female who presented with right-sided back pain. A mass was identified in the right ureter, and a nephroureterectomy was performed. The microscopic examination revealed that the mass was composed of a monotonous population of small cells and that the cells of the carcinoma were positive for cluster of differentiation 56, chromogranin A and synaptophysin. The tumor was diagnosed as a ureteral neuroendocrine small cell carcinoma. The patient returned 4 months later with recurrences in the retroperitoneum. Chemotherapy was administered and following 80 mg/m2 intravenous irinotecan on days 1 and 8 and 25 mg/m2 cisplatin on days 1–3, every 21 days for 4 cycles, the tumor was considerably smaller. During the regular follow-up examinations, the tumor remained stable.
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Affiliation(s)
- Jiang Hai Ping
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Zhang Xiao Chen
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Qian Jiong
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - You Qi Han
- Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Xu Nong
- Department of Medical Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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14
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Miller RJ, Holmäng S, Johansson SL, Lele SM. Small cell carcinoma of the renal pelvis and ureter: clinicopathologic and immunohistochemical features. Arch Pathol Lab Med 2012; 135:1565-9. [PMID: 22129185 DOI: 10.5858/arpa.2010-0690-oa] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Small cell carcinoma (SCC) of the renal pelvis and/or ureter is very rare, with only case reports published in the literature. OBJECTIVE To describe the clinicopathologic and immunohistochemical findings in the largest series to date. DESIGN A review of a regional cancer registry identified 10 cases diagnosed as SCC from 930 patients with renal pelvic and/or ureteral cancer from 1971 to 1998. The original slides, demographics, treatment, and clinical outcome were reviewed. Representative sections were immunostained for AE1/AE3, cytokeratin 7, cytokeratin 20, CD56, synaptophysin, chromogranin, and thyroid transcription factor 1. RESULTS Of the 10 cases, 5 were pure SCC, 2 were mixed (SCC and urothelial carcinoma), 2 were reclassified as poorly differentiated squamous carcinoma, and 1 was reclassified as urothelial carcinoma. The patients with SCC had an age range of 50 to 80 years (median, 72 years) with a female to male ratio of 2.5:1. All patients had non-organ confined disease. Five of 7 patients died of disease; 4 of those 5 had been clinically followed (median survival, 23 months) and 1 was diagnosed at autopsy. The SCC cases revealed positive staining of the SCC component as follows: AE1/AE3 (7 of 7), CD56 (7 of 7), synaptophysin (6 of 7), thyroid transcription factor 1 (5 of 7), chromogranin (4 of 7), and cytokeratin 7 (1 of 7). None were positive for cytokeratin 20 (0 of 7). CONCLUSIONS SCC of the renal pelvis/ureter is seen in a predominately female population in Sweden, is clinically aggressive, and has poor survival when presenting at an advanced stage in patients only treated by surgery. An immunostain panel serves as a useful adjunct in classifying these tumors.
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Affiliation(s)
- Ross J Miller
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, 68198-3135, USA
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Patil S, Kaza RCM, Kakkar AK, Chamberlain RS. Small cell carcinoma of the renal pelvis: a case report and review of the literature. ISRN UROLOGY 2011; 2011:786505. [PMID: 22084805 PMCID: PMC3195810 DOI: 10.5402/2011/786505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/12/2011] [Indexed: 12/18/2022]
Abstract
Extrapulmonary small cell carcinoma occurs in nearly all organs except the central nervous system and the liver. We are presenting a case of renal small cell carcinoma (SCC) with two unique characters. A 75-year-old patient was evaluated for back pain with no other complaints. Magnetic Resonance (MR) imaging of the abdomen revealed homogeneous tumor in the left renal pelvis extending beyond the kidney. Metastatic workup was negative. A left nephroureterectomy was performed. Histopathology and immunohistochemistry revealed a small cell carcinoma of the renal pelvis. The patient declined adjuvant therapy and died 2 months after surgery due to unrelated causes. After comprehensive worldwide literature search, we found 13 cases of SCC of the renal pelvis, including the current case. The mean age was 61.6 years (37–83), with a M : F ratio of 1 : 1.8. The average duration of symptoms was 71.4 days (21–168). Gross hematuria was the most common symptom (69.2%) followed by pain (61.5%). Adjuvant chemotherapy was provided to 4 patients (30.7%), and neoadjuvant to 1 patient. The median survival of patients who did and did not receive chemotherapy was 5.5 months (3–8) and 6 months (2–31), respectively, P < .50. In conclusion, renal SCC (both parenchymal and pelvic SCC) is a rapidly fatal disease with a median survival of ≤8 months.
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Affiliation(s)
- Sachin Patil
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA
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Small cell carcinoma of the upper urinary tract (UUT-SCC): report of a rare entity and systematic review of the literature. Cancer Treat Rev 2011; 37:366-72. [PMID: 21257269 DOI: 10.1016/j.ctrv.2010.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/12/2010] [Accepted: 12/18/2010] [Indexed: 12/11/2022]
Abstract
BACKGROUND Primary small cell carcinoma of the upper urinary tract (UUT-SCC) is an extremely uncommon disease. The current knowledge of these rare tumors is mainly based on case reports or small series. METHODS We reported two cases and performed a systematic literature search from 1970 to 2010 for articles on UUT-SCC. Overall, 40 patients with UUT-SCC were reviewed, a database was generated to analyze clinical characteristics, pathological features and therapy outcomes and to attempt in identifying prognostic factors. RESULTS For the 39 cases with available data, median age was 66.5 years and male-female ratio was 2:1. An Asian ethnic background was more common (59%). Surgery was the standard treatment given to all patients. In 67% of cases, SCC coexisted with another malignant component, including urothelial carcinoma in 62% of patients. Overall median survival was 15 months and the 1-, 2- and 3-year survival rates were 58.4%, 38.1% and 23.8%, respectively. Of all cases, 53.8% developed detectable metastasis in a median delay of 13 months. Pathological stage was the only significant prognostic factor found (p=0.01). Patients who received adjuvant chemotherapy seem to have a higher median survival comparatively to those who did not receive chemotherapy but this was not statistically significant (24 vs. 12 months, p=0.56). CONCLUSIONS UUT-SCC is an extremely rare tumor characterized by an aggressive clinical course. Local or distant metastases are frequent and survival is poor. Pathological stage appeared to be a prognostic factor for overall survival.
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Wronski S, Marszalek A. Diagnostic pitfalls of rare urinary bladder tumors: differential diagnosis of lymphoma-like carcinoma of the bladder--a clinicopathologic study and literature review. J Clin Oncol 2010; 29:e196-9. [PMID: 21189383 DOI: 10.1200/jco.2010.32.3121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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