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Xue J, Zhuang Z, Peng L, Chen X, Zhu H, Wang D, Zhang L. Prognostic predictive value of urothelial carcinoma of the bladder after TURBT based on multiphase CT radiomics. Abdom Radiol (NY) 2024; 49:1975-1986. [PMID: 38619611 DOI: 10.1007/s00261-024-04265-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To investigate multiphase computed tomography (CT) radiomics-based combined with clinical factors to predict overall survival (OS) in patients with bladder urothelial carcinoma (BLCA) who underwent transurethral resection of bladder tumor (TURBT). METHODS Data were retrospectively collected from 114 patients with primary BLCA from February 2016 to February 2018. The regions of interest (ROIs) of the plain, arterial, and venous phase images were manually segmented. The Cox regression algorithm was used to establish 3 basic models for the plain phase (PP), arterial phase (AP), and venous phase (VP) and 2 combination models (AP + VP and PP + AP + VP). The highest-performing radiomics model was selected to calculate the radiomics score (Rad-score), and independent risk factors affecting patients' OS were analyzed using Cox regression. The Rad-score and clinical risk factors were combined to construct a joint model and draw a visualized nomogram. RESULTS The combined model of PP + AP + VP showed the best performance with the Akaike Information Criterion (AIC) and Consistency Index (C-index) in the test group of 130.48 and 0.779, respectively. A combined model constructed with two independent risk factors (age and Ki-67 expression status) in combination with the Rad-score outperformed the radiomics model alone; AIC and C-index in the test group were 115.74 and 0.840, respectively. The calibration curves showed good agreement between the predicted probabilities of the joint model and the actual (p < 0.05). The decision curve showed that the joint model had good clinical application value within a large range of threshold probabilities. CONCLUSION This new model can be used to predict the OS of patients with BLCA who underwent TURBT.
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Affiliation(s)
- Jing Xue
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Zijian Zhuang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Lin Peng
- School of Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Xingchi Chen
- School of Medicine, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Haitao Zhu
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Dongqing Wang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
| | - Lirong Zhang
- Department of Medical Imaging, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
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Gupta RK, Wasnik P, Sharma AR. Papillary urothelial neoplasm of low malignant potential with osseous metaplasia in a 19-year-old chronic smoker: A case report with review of literature. INDIAN J PATHOL MICR 2024; 67:159-161. [PMID: 38358210 DOI: 10.4103/ijpm.ijpm_611_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Urothelial tumors characteristically occur in elderly persons, more commonly in males with typical complaints of hematuria. Although few studies attempted to describe clinic-pathological features of urothelial malignancies in young patients, due to heterogeneity in the inclusion of age groups under "young patients" no reliable conclusions can be derived. Herein, we are describing an interesting case of papillary urothelial neoplasm of low malignant potential with osseous metaplasia in a 19-year-old chronic smoker young patient presented with chief complaints of abdominal pain with a review of the literature.
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Affiliation(s)
- Rakesh K Gupta
- Department of Pathology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Poonam Wasnik
- Department of Pathology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Amit R Sharma
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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3
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Albakri M, Abu-Hijlih R, Salah S, Al-Ibraheem A, Abuhijla F, Serhan HA, Farkouh A, Obeid Z, Shahait M. Bladder cancer in young adults: Disease and treatment characteristics of patients treated at a tertiary cancer center. Urol Ann 2023; 15:207-210. [PMID: 37304510 PMCID: PMC10252776 DOI: 10.4103/ua.ua_87_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/02/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives The incidence of bladder cancer in the Middle East is increasing. Nevertheless, data on the young population with urothelial carcinoma (UC) of the urinary bladder in this region is scarce. Therefore, we evaluated clinical and tumor characteristics, in addition to treatment details in patients younger than 45 years old. Methodology We reviewed all patients presenting with UC of the urinary bladder from July 2006 to December 2019. Clinical characteristics including demographics, stage at presentation, and treatment outcomes were extracted. Results Out of 1272 new cases of bladder cancer, a total of 112 (8.8%) patients were ≤45 years old. Seven patients (6%) had nonurothelial histology and were excluded from the study. The remaining 105 eligible patients with UC had a median age at presentation of 41 years (35-43). Ninety-three patients (88.6%) were males. Tumor stage at presentation: nonmuscle invasive disease (Ta-T1), locally advanced muscle-invasive bladder cancer (MIBC) (T2-3), and metastatic disease were 84.7%, 2.8%, and 12.5%, respectively. All patients with MIBC received neoadjuvant cisplatin-based chemotherapy. Radical cystectomy was performed in 8 (7.6%) cases; three patients with MIBC and five with high-volume non-MIBC. Neobladder reconstruction was done in six patients. A total of 13 patients with metastatic disease (93%) received palliative chemotherapy (gemcitabine/cisplatin), and one (7%) was a candidate for best supportive care only. Conclusion Bladder cancer is relatively rare in the young population, although the incidence at our region is higher than other reports in the literature. Most patients present with early disease. Early diagnosis and multidisciplinary approach are paramount for the management of these patients.
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Affiliation(s)
- Mahmoud Albakri
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ramiz Abu-Hijlih
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Samer Salah
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Fawzi Abuhijla
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | | | - Ala’a Farkouh
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Zeinab Obeid
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Mohammed Shahait
- Clemenceau Medical Center, Al Jaddaf, Dubai, United Arab Emirates
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Current clinical perspective of urological oncology in the adolescent and young adult generation. Int J Clin Oncol 2023; 28:28-40. [PMID: 36527578 DOI: 10.1007/s10147-022-02251-4] [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: 04/25/2022] [Accepted: 09/29/2022] [Indexed: 12/23/2022]
Abstract
Among adolescents and young adults, hematological tumors are the most common malignancies in younger patients; however, solid tumors also increase with advancing age. The pathogenesis of some of these tumors differs from that of tumors which develop in children, or middle-aged and older adults, and special care should be taken in their treatment and management. A treatment plan that takes into consideration future fertility is necessary for testicular tumors, and an educational campaign to encourage early detection is also essential. The treatment of adolescents with advanced testicular tumors should resemble therapeutic approaches for young adults and not a pediatric regimen. Adrenal tumors often develop as part of familiar hereditary syndrome. Therefore, taking the personal and family history is very important, and genetic counseling should be also recommended. In renal tumors, the incidence of translocation renal cell carcinomas is higher. Complete resection is the only promising method for long-term prognosis because of no established treatment for translocation renal cell carcinomas with distant metastasis. Bladder tumors are often detected by symptoms of gross hematuria and are found at a relatively early stage. Along with renal tumors, oncological evaluation including cystoscopy is also considered essential for gross hematuria. Wilms tumors and rhabdomyosarcomas could be managed in accordance with pediatric protocols to improve the treatment outcomes. The dedicated cancer survivorship care for adolescents and young adults could be also indispensable to conquer cancer and maintain a better quality of life.
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Talwar HS, Panwar VK, Mittal A, Kishore S, Mandal AK. A Clinicopathological Correlation of Bladder Cancer in Young and Old Patients: Our Experience and Review of Literature. Indian J Surg Oncol 2022; 13:915-923. [PMID: 36687251 PMCID: PMC9845444 DOI: 10.1007/s13193-022-01575-x] [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: 10/31/2021] [Accepted: 06/28/2022] [Indexed: 01/25/2023] Open
Abstract
To compare the clinical, cystoscopic, and pathological characteristics of bladder cancer in patients younger than 40 years of age and those of patients older than 40 years of age. We conducted a prospective observational study at our department from September 2019 to February 2021 to compare the clinico-pathological characteristics of young and old patients with biopsy proven bladder cancer after a transurethral resection of bladder tumour. The patients were managed according to standard guidelines. Two hundred sixty-eight patients of bladder cancer were included in the analysis. Out of these, 58 patients were < 40 years of age and 210 were > 40 years. The mean age of two groups were 31.43 ± 6.30 vs 59.08 ± 9.87 years. With respect to tumour grade, 36.2% (versus 17.6%) of young patients had low grade tumour, and 58.6% had high-grade tumour (versus 82.4%). In the young population, 63.8% patients had NMIBC (versus 61.9%) and 36.2% had MIBC (versus 38.1%). Even in the NMIBC group, a large majority of young patients had high-risk disease (51.4%). The incidence of bladder cancer is on the rise in the northern belt of India, especially in the younger age group. High exposure to smoke and heavy metals in drinking water/occupation are the major risk factors. Majority of young patients aged < 40 years had a high-grade disease on presentation and a large subset had muscle invasive bladder cancer, contrary to previously reported studies.
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Affiliation(s)
- Harkirat Singh Talwar
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India 249203
| | - Vikas Kumar Panwar
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India 249203
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India 249203
| | - Sanjeev Kishore
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India 249203
| | - Arup Kumar Mandal
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India 249203
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Martin A, Woolbright BL, Umar S, Ingersoll MA, Taylor JA. Bladder cancer, inflammageing and microbiomes. Nat Rev Urol 2022; 19:495-509. [PMID: 35798831 DOI: 10.1038/s41585-022-00611-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 02/08/2023]
Abstract
Ageing is correlated with elevated bladder cancer incidence, morbidity and mortality. Advanced age is also associated with elevated markers of chronic inflammation and perturbations in gut and urinary tract microbiota. One reason for the increased incidence and mortality of bladder cancer in the elderly might be that age-associated changes in multiple microbiomes induce systemic metabolic changes that contribute to immune dysregulation with potentially tumorigenic effects. The gut and urinary microbiomes could be dysregulated in bladder cancer, although the effect of these changes is poorly understood. Each of these domains - the immune system, gut microbiome and urinary microbiome - might also influence the response of patients with bladder cancer to treatment. Improved understanding of age-related alterations to the immune system and gut and urinary microbiomes could provide possible insight into the risk of bladder cancer development and progression in the elderly. In patients with bladder cancer, improved understanding of microbiota might also provide potential targets for therapeutic intervention.
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Affiliation(s)
- Austin Martin
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Shahid Umar
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Molly A Ingersoll
- Université Paris Cité, Institut Cochin, INSERM U1016, Paris, France.,Mucosal Inflammation and Immunity group, Department of Immunology, Institut Pasteur, Paris, France
| | - John A Taylor
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA.
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7
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Mehmood S, Alothman K, Al Rumayyan M, Altaweel W, Alhussain T. Clinical behavior and survival outcome of urothelial bladder cancer in young adults. Urol Ann 2022; 14:162-166. [PMID: 35711476 PMCID: PMC9197011 DOI: 10.4103/ua.ua_15_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/22/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Bladder cancer (BC) is rare in young adults and therefore natural history of BC is still debatable. This study aimed to determine clinical behavior and prognosis of BC in patients <40 years. Materials and Methods: We reviewed patients (<40 years) managed with urothelial BC from 2003 to 2019. Patients with nonurothelial histology were excluded. Clinical behavior and prognosis such as recurrence, progression, and survival were assessed. The recurrence is defined as a newly diagnosed occurrence of BC at previous or new site(s). Cancer progression is defined as an increase in staging or grade. Results: Fifty-five patients inclusive of 45 males and 10 females with a median age of 30.0 (interquartile range [IQR] 25.0–33.0) years were included. The median follow-up was 3.5 (IQR: 1.5–7.0) years. Fifty-one (92.72%) patients were diagnosed with nonmuscle-invasive BC while four (7.27%) patients were diagnosed with muscle-invasive disease. Three out of four patients with muscle-invasive BC died of metastatic disease. According to stage and grade, there were 42 (76.36%) Ta, 9 (16.36%) T1 and 4 (7.27%) having T2 stage while 41 (74.54%) low grade and 14 (25.45%) were having high grade disease. Thirty-six (65.45%) patients remained stable, 13 (26.63%) patients progressed, and 6 (10.90%) patients regressed to lower stage and grade. Higher stage and grade (P = 0.0431) and tumor size >3 cm (P = 0.0454) were significant for recurrence, and higher stage and grade (P = 0.0012) and tumor size >3 cm (P = 0.0055) were associated with tumor progression. Conclusion: BC in younger adults is mostly low stage and low grade. We should be vigilant in patients with higher stage and grade as it is related with recurrence, progression, and metastatic disease.
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Agnihotri MA, Sathe PA. Coexistent urothelial papilloma and ureteric calculus in an 8-year-old child: A rare co-occurrence. J Postgrad Med 2021; 67:182-183. [PMID: 33380592 PMCID: PMC8445120 DOI: 10.4103/jpgm.jpgm_300_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- M A Agnihotri
- Department of Pathology, Seth G.S. Medical College, Mumbai, Maharashtra, India
| | - P A Sathe
- Department of Pathology, Seth G.S. Medical College, Mumbai, Maharashtra, India
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Incidence, Survival, and Mortality Trends of Cancers Diagnosed in Adolescents and Young Adults (15-39 Years): A Population-Based Study in The Netherlands 1990-2016. Cancers (Basel) 2020; 12:cancers12113421. [PMID: 33218178 PMCID: PMC7698904 DOI: 10.3390/cancers12113421] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Adolescents and young adults (AYAs, aged 15–39 years) with cancer form a distinct patient population within the oncology care setting that is often overlooked in favour of paediatric and older adult patients. As such, specific knowledge on AYAs and their distinct spectrum of cancers is limited. Worldwide, cancer is increasing and it is among the major causes of death among AYAs. Cancer prognosis among AYAs has also been shown to lag behind that of younger and older patients suffering from similar diseases. To address these problems, better understanding of AYA cancers is needed. This study aims to provide an overview of the specific cancer trends among AYAs and the changes that have occurred in the Netherlands since 1990 in terms of incidence, survival, and mortality. This information will provide a solid foundation from which to guide future studies upon, aimed at acquiring more detailed cancer knowledge within the AYA domain. Abstract Adolescent and young adult (AYA) cancer patients, aged 15–39 years at primary cancer diagnosis, form a distinct, understudied, and underserved group in cancer care. This study aimed to assess long-term trends in incidence, survival, and mortality of AYA cancer patients within the Netherlands. Data on all malignant AYA tumours diagnosed between 1990–2016 (n = 95,228) were obtained from the Netherlands Cancer Registry. European age-standardised incidence and mortality rates with average annual percentage change (AAPC) statistics and five-year relative survival rates were calculated. The overall cancer incidence increased from 54.6 to 70.3 per 100,000 person-years (AAPC: +1.37%) between 1990–2016, and increased for both sexes individually and for most cancer types. Five-year relative survival overall improved from 73.7% in 1990–1999 to 86.4% in 2010–2016 and improved for both sexes and most cancer types. Survival remained poor (<60%) for rhabdomyosarcoma, lung, stomach, liver, bladder, and pancreatic carcinomas, among others. Mortality rates among male AYAs overall declined from 10.8 to 6.6 (AAPC: −1.64%) and from 14.4 to 10.1 per 100,000 person-years (AAPC: −1.81%) for female AYAs since 1990. Mortality rates remained unchanged for male AYAs aged 20–24 and 25–29 years. In conclusion, over the past three decades, there has been a considerable increase in cancer incidence among AYAs in the Netherlands. Meanwhile, the survival improved and the mortality overall declined. Survival at five-years now well exceeds above 80%, but did not do so for all cancer types.
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Chehroudi AC, Lavoie JM, Black PC, Eigl BJ. Clinical characteristics and outcomes for young patients with advanced urothelial carcinoma. Can Urol Assoc J 2020; 15:E123-E126. [PMID: 32744994 DOI: 10.5489/cuaj.6405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ali Cyrus Chehroudi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Michel Lavoie
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Bernhard J Eigl
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
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de la Calle CM, Washington SL, Lonergan PE, Meng MV, Porten SP. Bladder cancer in patients younger than 40 years: outcomes from the National Cancer Database. World J Urol 2020; 39:1911-1916. [PMID: 32737581 DOI: 10.1007/s00345-020-03376-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the clinical, pathological, and survival outcomes of bladder cancer in patients aged 18-40 years. METHODS We identified 362,091 bladder cancer patients from the National Cancer Database between 2004-2013 and compared patients aged 18-40 years to those > 40 years of age with univariate analysis using Chi-square tests. A subset analysis was performed on patients who underwent cystectomy. Multivariable Cox regression was used for overall survival analysis. RESULTS Our final analysis included 314,177 patients with 3314 (1.1%) patients aged 18-40 years. Patients aged 18-40 years had a lower male-to-female ratio (2.4 versus 3.0), a greater proportion of low-grade tumors (72.7% versus 48.3%, p < 0.001), non-muscle invasive tumors (90.3% versus 81.2%, p < 0.001), and variant histology (4.0% versus 3.3%, p < 0.001). Similar trends were observed at cystectomy including lower male-to-female ratio in the 18-40 years group (1.7 versus 3.1), a greater proportion of variant histology (25.0% versus 10.0%, p < 0.001); and 53.3% of those younger patients with variant histology were women. Patients aged 18-40 years who underwent cystectomy had a higher proportion of locally advanced disease (pT4 19.2% versus 14.6%, p = 0.004). Multivariable analyses in both cohorts demonstrated that variant histology was a predictor of worse overall survival. CONCLUSION The majority of patients aged 18-40 years with bladder cancer present with low-grade, non-muscle-invasive disease associated with better survival. However, a subset of younger patients with a higher proportion of women presents with aggressive bladder cancer which may be partly explained by a higher prevalence of variant histology.
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Affiliation(s)
- Claire M de la Calle
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, 1825 4th Street, San Francisco, CA, 94158, USA.
| | - Samuel L Washington
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, 1825 4th Street, San Francisco, CA, 94158, USA
| | - Peter E Lonergan
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, 1825 4th Street, San Francisco, CA, 94158, USA
| | - Maxwell V Meng
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, 1825 4th Street, San Francisco, CA, 94158, USA
| | - Sima P Porten
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, 1825 4th Street, San Francisco, CA, 94158, USA
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Im SW, Sung CO, Kim KS, Cho NH, Kim YM, Kwon GY, Moon KC, Choi SY, Lim JS, Choi YJ, Jung SJ, Lim SD, Paick SH, Lee OJ, Kang HW, Rha SH, Hwang HS, Park JM, Yoon SY, Chae J, Choi J, Kim JI, Cho YM. Genomic Landscape of Young-Onset Bladder Cancer and Its Prognostic Implications on Adult Bladder Cancer. Cancers (Basel) 2020; 12:cancers12020307. [PMID: 32012866 PMCID: PMC7073191 DOI: 10.3390/cancers12020307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 12/30/2022] Open
Abstract
Due to the rare occurrence of young-onset bladder cancer (YBC), its genomic characteristics remain largely unknown. Twenty-nine biopsy-proven YBC cases were collected using a nation-wide search for bladder cancer diagnosed at 20 years or younger. Whole exome sequencing and RNA sequencing were carried out in 21 and 11 cases, respectively, and compared with those of adult bladder cancer (ABC) cases obtained from public databases. Almost all YBCs were low grade, non-invasive papillary tumors. YBC had a low mutation burden and less complex copy number alterations. All cases harbored putative driver mutations. Mutations were most commonly found in HRAS (10 cases), with a preference for exon 5. FGFR3 gene fusions were noted with various partner genes (7 cases). The alterations on HRAS and FGFR3 occurred in a mutually exclusive manner. Others included KRAS mutations (2 cases), chromosomes 4p and 10q arm-level deletions (1 case), and ERCC2 mutation (1 case). There were no point mutations in TP53 and FGFR3. The gene expression profiles of YBC were similar to those of the ABC group with good prognosis. None of the YBCs and ABCs with YBC-like mutations showed progression to muscle-invasive tumors. Our results suggest that bladder cancer with YBC-like mutations represents an indolent bladder tumor, regardless of age.
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Affiliation(s)
- Sun-Wha Im
- Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul 03080, Korea;
| | - Chang Ohk Sung
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.O.S.); (H.S.H.)
| | - Kun Suk Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Nam Hoon Cho
- Department of Pathology, Yonsei Medical University College of Medicine, Seoul 03722, Korea;
| | - Young Min Kim
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea;
| | - Ghee Young Kwon
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea;
| | - Song-Yi Choi
- Department of Pathology, Chungnam National University College of Medicine, Daejeon 35015, Korea;
| | - Jae Sung Lim
- Department of Urology, Chungnam National University College of Medicine, Daejeon 35015, Korea;
| | - Yeong Jin Choi
- Department of Hospital Pathology, The Catholic University of Korea, Seoul 06591, Korea;
| | - Soo Jin Jung
- Department of Pathology, Inje University Busan Paik Hospital, Busan, Seoul 47392, Korea;
| | - So Dug Lim
- Department of Pathology, School of Medicine, Konkuk University, Seoul 05029, Korea
| | - Sung Hyun Paick
- Department of Urology, School of Medicine, Konkuk University, Seoul 05029, Korea;
| | - Ok-Jun Lee
- Department of Pathology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea;
| | - Ho Won Kang
- Department of Urology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju 28644, Korea;
| | - Seo Hee Rha
- Department of Pathology, College of Medicine, Dong-A University, Busan 49201, Korea;
| | - Hee Sang Hwang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.O.S.); (H.S.H.)
| | - Ja-Min Park
- Asan Institute of Life Science, Asan Medical Center, Seoul 05505, Korea; (J.-M.P.); (S.Y.Y.)
| | - Sun Young Yoon
- Asan Institute of Life Science, Asan Medical Center, Seoul 05505, Korea; (J.-M.P.); (S.Y.Y.)
| | - Jeesoo Chae
- Department of Biomedical Science, Seoul National University Graduate School, Seoul 03080, Korea; (J.C.); (J.C.)
| | - Jaeyong Choi
- Department of Biomedical Science, Seoul National University Graduate School, Seoul 03080, Korea; (J.C.); (J.C.)
| | - Jong-Il Kim
- Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul 03080, Korea;
- Department of Biomedical Science, Seoul National University Graduate School, Seoul 03080, Korea; (J.C.); (J.C.)
- Cancer Research Institute, Seoul National University, Seoul 03080, Korea
- Correspondence: (J.-I.K.); (Y.M.C.); Tel.: +82-740-8421 (J.-I.K.); +82-2-3010-5965 (Y.M.C.)
| | - Yong Mee Cho
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (C.O.S.); (H.S.H.)
- Correspondence: (J.-I.K.); (Y.M.C.); Tel.: +82-740-8421 (J.-I.K.); +82-2-3010-5965 (Y.M.C.)
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Gadea A, Hernández-Muñoz I, Vicente A, Andrades E, García-Calvente M, Camacho L, Fernandez-Rodríguez C, Bellosillo B, Pujol R, Toll A. Molecular characterisation of oncogenic urothelial mosaic mutations in patients with extensive keratinocytic epidermal naevi. J Med Genet 2020; 57:601-604. [PMID: 31937562 DOI: 10.1136/jmedgenet-2019-106296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/16/2019] [Accepted: 12/22/2019] [Indexed: 12/20/2022]
Abstract
Background: Keratinocytic epidermal naevi (KENs) are congenital benign skin mosaic lesions that share common mutations with some subsets of urothelial carcinomas. Moreover, several patients with extensive KEN who also developed urothelial carcinomas at young ages have been reported. Thus, patients with extensive KEN may harbour mosaic urothelial oncogenic mutations that would favour the early development of urothelial carcinomas. Methods: We selected five patients with extensive KEN involving the lower part of the back and performed a molecular characterisation of urothelial and cutaneous samples using a next-generation sequencing (NGS) custom panel targeting candidate oncogenic genes. Results: Mosaic pathogenic mutations were detected in KEN in all patients. In four out of five patients, mosaic pathogenic mutations in FGFR2 or HRAS were also detected in samples from the urothelial tract. Moreover, we report a patient who developed urothelial carcinomas at age 29 and harboured an HRAS G12S mutation both in skin and urothelial tumour samples. Conclusions: We conclude that patients with extensive KEN involving the lower part of the back frequently harbour oncogenic mutations in the urothelium that may induce the development of carcinomas. NGS panels can be considered as highly sensitive tools to identify this subgroup of patients, which might permit adoption of screening measures to detect malignant transformation at early stages.
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Affiliation(s)
- Alejandra Gadea
- Group of Inflammatory and Neoplastic Dermatological Diseases, IMIM, Barcelona, Catalunya, Spain
| | | | - Asunción Vicente
- Dermatology, Sant Joan de Deu Hospital, Barcelona, Catalunya, Spain
| | - Evelyn Andrades
- Group of Inflammatory and Neoplastic Dermatological Diseases, IMIM, Barcelona, Catalunya, Spain
| | | | - Laura Camacho
- Department of Pathology, Hospital del Mar, Barcelona, Catalunya, Spain
| | | | - Beatriz Bellosillo
- Department of Pathology, Hospital del Mar, Barcelona, Catalunya, Spain.,Cancer Research Program, IMIM (Hospital del Mar Medical Research Institute), Hospital del Mar, Barcelona, Catalunya, Spain
| | - Ramon Pujol
- Group of Inflammatory and Neoplastic Dermatological Diseases, IMIM, Barcelona, Catalunya, Spain.,Dermatology, Consorci Parc de Salut MAR de Barcelona, Barcelona, Catalunya, Spain
| | - Agustín Toll
- Dermatology, Hospital Clinic de Barcelona, Barcelona, Spain
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14
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Maurizi P, Capozza MA, Triarico S, Perrotta ML, Briganti V, Ruggiero A. Relapsed papillary urothelial neoplasm of low malignant potential (PUNLMP) of the young age: a case report and a review of the literature. BMC Urol 2019; 19:36. [PMID: 31072376 PMCID: PMC6509853 DOI: 10.1186/s12894-019-0469-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 04/30/2019] [Indexed: 11/11/2022] Open
Abstract
Background Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP) are exceptionally rare in the first decade of life (mostly if multifocal) and there is a lack of standardized recommendations for the pediatric age. Case presentation We describe the case of a 9-year-old boy with a diagnosis of PUNLMP, who underwent to cystoscopic lesion removal and later to endoscopic lesion removal and intra-bladder Mitomycin-c (MMC) instillations for relapsed disease. Follow-up investigations at five years showed disease negativity. Conclusions Intra-bladder MMC instillation may allow obtaining the complete remission with bladder-sparing for paediatric patients with a high-risk relapsed PUNLMP.
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Affiliation(s)
- Palma Maurizi
- Pediatric Oncology Unit, Foundation "A. Gemelli" Hospital IRCCS - Catholic University of Sacred Hearth, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Michele Antonio Capozza
- Pediatric Oncology Unit, Foundation "A. Gemelli" Hospital IRCCS - Catholic University of Sacred Hearth, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Silvia Triarico
- Pediatric Oncology Unit, Foundation "A. Gemelli" Hospital IRCCS - Catholic University of Sacred Hearth, Largo A. Gemelli 8, 00168, Rome, Italy.
| | | | - Vito Briganti
- Pediatric Surgery Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Foundation "A. Gemelli" Hospital IRCCS - Catholic University of Sacred Hearth, Largo A. Gemelli 8, 00168, Rome, Italy
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15
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Kim SC, Park S, Song SH, Kim KS, Park S. Clinicopathological Characteristics of Urinary Bladder Tumors in Korean Patients 20 Years or Younger. J Korean Med Sci 2018; 33:e242. [PMID: 30275804 PMCID: PMC6159107 DOI: 10.3346/jkms.2018.33.e242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/20/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To investigate the clinicopathological characteristics of urinary bladder tumors, a rare malignancy, in patients 20 years or younger. METHODS Using a retrospective chart review among patients who received bladder surgery at 2 institutions between July 1996 and January 2013, we analyzed the clinicopathological characteristics of urinary bladder tumors in 21 pediatric patients (male:female = 4.25:1.00; mean age, 12.1 years). RESULTS Pathology revealed 9 urothelial tumors, 6 rhabdomyosarcomas, 1 low-grade leiomyosarcoma, 1 large cell neuroendocrine carcinoma, 1 inflammatory myofibroblastic tumor, and 3 cases of chronic inflammation without tumors (including 1 xanthogranulomatous inflammation). Urothelial tumors (mean patient age, 16.0 years) were benign or low-grade; and only transurethral resection of the bladder tumor was necessary for treatment. Patients with rhabdomyosarcomas (mean age, 5 years) underwent radiotherapy (if unresectable) or transurethral resection of the bladder tumor (if resectable), after chemotherapy. Of these patients, 2 underwent radical cystectomy, with the remaining patients not receiving a cystectomy. With the exception of one patient, all patients are currently alive and recurrence-free. CONCLUSION Urothelial tumors were the most commonly found pediatric bladder tumor, with embryonal rhabdomyosarcoma being the second most common. Urothelial tumors are common in relatively older age. Since urothelial tumors in children typically have a good prognosis and rarely recur, transurethral resection of the bladder tumor is the treatment of choice. Rhabdomyosarcomas are common in younger patients. Since rhabdomyosarcoma is generally chemosensitive, chemotherapy and radiotherapy are the treatment of choice for bladder preservation in these patients.
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Affiliation(s)
- Seong Cheol Kim
- Department of Urology, Inje University, Haeundae Paik Hospital, Busan, Korea
| | - Sejun Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sang Hoon Song
- Department of Urology, Asan Medical Center, University of Ulsan Collage of Medicine, Seoul, Korea
| | - Kun Suk Kim
- Department of Urology, Asan Medical Center, University of Ulsan Collage of Medicine, Seoul, Korea
| | - Sungchan Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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16
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Alabdulkareem AI, Al-Jahdali FH, Nazers AI, Alkhateeb SS. Characteristics of bladder neoplasms in the young population of Saudi Arabia. Urol Ann 2017; 9:343-347. [PMID: 29118536 PMCID: PMC5656959 DOI: 10.4103/ua.ua_122_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Bladder neoplasms are a well-studied subject in medicine. However, the evidence of bladder neoplasms in children and the young adult population (≤40 years), particularly in Saudi Arabia, is lacking. Aims: The aims of this study were to identify histopathological characteristics as well as clinical features, prognosis, and treatment of bladder neoplasms in this age group in a single tertiary referral center, Riyadh, Saudi Arabia. Settings and Design: A retrospective cohort study. Materials and Methods: Children and young adults (≤40 years) diagnosed with epithelial and mesenchymal bladder neoplasms from 1994 to 2017. Statistical Analysis Used: Descriptive data are presented as mean (standard deviation) or median (interquartile range) for continuous variables and n (%) for categorical variables. Statistical Package for Social Sciences version 23 was used. Results: Thirty-eight cases were identified. The majority, 71.1% (n = 27) were male. The median age of diagnosis was 33 years ranging from 1 to 40 years. Nearly 45% (n = 17) were smokers. Macroscopic hematuria was present in 57.8% (n = 22). The most common histopathology was papillary urothelial carcinoma (n = 18, 58%). All mesenchymal neoplasms accounted for 18.4% (n = 7). Of all malignancies, 63.2% (n = 24) and 44.7% (n = 17) were low stage and low grade, respectively. Transurethral resection of bladder tumor (TURBT) was conducted for 81.6% (n = 31). The mean length of follow-up was 36.05 months (±39.4 months). Recurrence occurred in 15.8% (n = 6) and 7.9% (n = 3) had progression. Distant metastasis was reported in 5.3% (n = 2). Nearly 8% (n = 3) died during their follow-up. Conclusions: Bladder malignancies at the early fourth decade of life tend to be a low stage and low grade. The most common histopathology was papillary urothelial carcinoma. Management should be based on the clinical and histopathological features. However, most of the patient underwent TURBT.
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Affiliation(s)
| | - Fares H Al-Jahdali
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmed I Nazers
- Department of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sultan S Alkhateeb
- Department of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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17
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Bladder cancer to patients younger than 30 years: a retrospective study and review of the literature. Urologia 2017; 84:231-235. [PMID: 28885656 DOI: 10.5301/uj.5000264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The aim of this report was to study the specific characteristics of bladder cancer in patients younger than 30 years. MATERIALS AND METHODS Five patients with a mean age of 24 ± 2.83 years were included in the study. All patients had painless macroscopic hematuria as the first symptom. Three patients had pTa as a first diagnosis, one had pT1 and one pT2. All the patients had smoking as a risk factor and at least one additional possible risk factor. RESULTS One patient with pTa had an aggressive course and after multiple recurrences was diagnosed with pT2 and refused to be submitted to radical cystectomy and died from the disease even though he received a multimodality treatment. The other two patients with the pTa diagnosis had no recurrence after the first TUR-BT and the patient with the pT1 diagnosis after one recurrence with a pTa histology is free of recurrence for the last 2 years. The patient diagnosed with pT2 was submitted to a radical cystectomy and an s-pouch diversion with a preservation of the genital system in order to have the ability of a future motherhood with the acceptance of course risks. CONCLUSIONS Young patients with bladder cancer is a difficult group of patients and show more reluctance to comply to the necessary strict follow-up of the repeated urinary cytology examinations, cystoscopies and CT pyelographies. Herein, we report a retrospective study of five patients younger than 30 years with bladder cancer.
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18
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Urothelial Carcinoma in a 22-Year-Old Female with Angelman Syndrome. Case Rep Urol 2017; 2017:9298565. [PMID: 28487808 PMCID: PMC5405399 DOI: 10.1155/2017/9298565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 11/17/2022] Open
Abstract
A 22-year-old nulligravid white female with Angelman syndrome was noted to have a 4-month history of premenstrual nausea, vomiting, and abdominal pain. She had an echogenic focus in her bladder noted on ultrasound. She was diagnosed with low grade urothelial carcinoma after cystoscopic evaluation with biopsy and was sent to urology for further treatment. Urothelial carcinoma is rare in individuals younger than age 40. Patients may present with gross hematuria. There is often a delay in diagnosis in younger individuals with different genetic mutations noted upon diagnosis.
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19
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Caione P, Patruno G, Pagliarulo V, Bulotta AL, Salerno A, Diomedi Camassei F, Lastilla G, Gerocarni Nappo S. Nonmuscular Invasive Urothelial Carcinoma of the Bladder in Pediatric and Young Adult Patients: Age-related Outcomes. Urology 2017; 99:215-220. [DOI: 10.1016/j.urology.2016.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/05/2016] [Accepted: 07/11/2016] [Indexed: 11/26/2022]
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20
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Grapin-Dagorno C, Peycelon M, Philippe-Chomette P, Berrebi D, El Ghoneimi A, Orbach D. [Urothelial tumors in children]. Bull Cancer 2016; 104:195-201. [PMID: 28034440 DOI: 10.1016/j.bulcan.2016.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/26/2016] [Indexed: 11/29/2022]
Abstract
Urothelial tumors are very rare in children (to date, only about 150 cases have been reported worlwide). Only 20% occur before the age of ten. The aim of this study is to specify the clinicopathologic features of urothelial tumor in young patients, which require a slightly different approach to treatment. On the basis of the WHO/ISUP (World Health Organisation/International Society of Urological Pathology) consensus classification report, these lesions are usually low-grade lesions, non invasive, and rarely recurrent. The sex ratio is three boys to one girl. These tumors are located preferentially in the low urinary tract, especially in the bladder. The main symptom is the macroscopic hematuria, which requires ultrasound examination in all cases. Cystoscopy is indicated in case of lesion of the bladder wall, or in case of persistent or recurrent hematuria, to obtain definitive diagnosis and biopsies. The tumors are mainly located on the posterior or lateral bladder wall above the trigone or near the ureteral orifices. Treatment is based on the transurethral resection of the lesion. The subsequent monitoring is sparsely codified, due to the exceptional occurrence of these tumors in the paediatric age group. These patients are likely to have better outcome than older patients, but it is due to the predominance of noninvasive papillary urothelial tumors. Tumor recurrences are not uncommon. In case of invasive, high-grade urothelial carcinomas, metastases or even lethal outcome may occur in rare cases.
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Affiliation(s)
- Christine Grapin-Dagorno
- Hôpital Robert-Debré, service de chirurgie viscérale et urologique, 48, boulevard Sérurier, 75019 Paris, France.
| | - Matthieu Peycelon
- Hôpital Robert-Debré, service de chirurgie viscérale et urologique, 48, boulevard Sérurier, 75019 Paris, France
| | - Pascale Philippe-Chomette
- Hôpital Robert-Debré, service de chirurgie viscérale et urologique, 48, boulevard Sérurier, 75019 Paris, France
| | - Dominique Berrebi
- Hôpital Robert-Debré, service d'anatomopathologie, 48, boulevard Sérurier, 75019 Paris, France
| | - Alaa El Ghoneimi
- Hôpital Robert-Debré, service de chirurgie viscérale et urologique, 48, boulevard Sérurier, 75019 Paris, France
| | - Daniel Orbach
- Institut Curie, service d'oncopédiatrie, 26, rue d'Ulm, 75005 Paris, France
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21
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Lara J, Brunson A, Keegan THM, Malogolowkin M, Pan CX, Yap S, deVere White R. Determinants of Survival for Adolescents and Young Adults with Urothelial Bladder Cancer: Results from the California Cancer Registry. J Urol 2016; 196:1378-1382. [PMID: 27208515 DOI: 10.1016/j.juro.2016.05.082] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Bladder cancer is a common malignancy often diagnosed in older adults. Previous studies have reported racial/ethnic disparities in bladder cancer survival outcomes but have not focused on younger patients. We identified whether factors influencing cause specific survival in adolescents and young adults (ages 15 to 39) differed from older adults, and defined prognostic factors specifically in adolescents and young adults using the California Cancer Registry. MATERIALS AND METHODS Patients diagnosed with bladder cancer between 1988 through 2012 were included in the study. The primary outcome measure was cause specific survival. A multivariable Cox proportional hazards regression model was used to evaluate predictors of cause specific survival in patients of all ages and in adolescents/young adults. Interactions of age and other variables between younger and older adult patients were assessed. RESULTS Of 104,974 patients with bladder cancer we identified 1,688 adolescent and young adult patients (1.6%). Compared to older patients these patients had a 58% reduced risk of bladder cancer death (HR 0.42, p <0.001). Significant age interactions were identified involving race/ethnicity and histology. Among adolescents and young adults, nonHispanic African-American patients with low socioeconomic status had poor cause specific (HR 7.1, p <0.001) and overall (HR 5.02, p <0.001) survival. CONCLUSIONS Racial/ethnic and socioeconomic disparities exist in adolescent and young adult patients with bladder cancer in California. Further studies are warranted to identify the underlying causes in order to overcome these disparities.
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Affiliation(s)
| | - Ann Brunson
- University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Theresa H M Keegan
- University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Marcio Malogolowkin
- University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Chong-Xian Pan
- University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Stanley Yap
- University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Ralph deVere White
- University of California Davis Comprehensive Cancer Center, Sacramento, California.
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22
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Castillo-Martin M, Collazo Lorduy A, Gladoun N, Hyun G, Cordon-Cardo C. H-RAS mutation is a key molecular feature of pediatric urothelial bladder cancer. A detailed report of three cases. J Pediatr Urol 2016; 12:91.e1-7. [PMID: 26522772 DOI: 10.1016/j.jpurol.2015.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 08/17/2015] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Urothelial carcinoma (UC) of the bladder is a rare entity in the pediatric population, with an incidence of less than 0.4% in patients younger than 20 years. These patients overwhelmingly present with non-muscle-invasive low-grade disease and an indolent behavior. OBJECTIVE The aim was to determine the source of the different natural history between pediatric population and adults; we hypothesized that pediatric bladder cancer may stem from different molecular pathways. Our objective with this descriptive case series was to study the main genes involved in pediatric urothelial bladder carcinoma using immunohistochemical (IHC) and mutational analysis. By studying the genetic alterations and immunophenotype of the most commonly altered genes in bladder urothelial cancer in three pediatric tumors we could gain better understanding of the molecular pathogenesis in this rare disease. STUDY DESIGN Formalin-fixed paraffin-embedded (FFPE) tissue slides of urothelial bladder tumors from three pediatric patients were retrospectively identified at Columbia University pathology archives (1990-2011) and re-evaluated. FGFR3, H-RAS, and PI3K hotspots mutational analyses were conducted by polymerase chain reaction amplification and Sanger sequencing from the FFPE tissue blocks. IHC analysis was conducted using antibodies against p53, PTEN, RB, EGFR, and HER2. Proliferative rate was assessed by Ki-67 expression. RESULTS Two patients had low-grade Ta disease, whereas the other tumor was classified as a papillary urothelial neoplasm of low malignant potential. None of the lesions recurred. Notably, all specimens showed H-RAS G12V mutation, whereas they were characterized by wild-type FGFR3 and PI3K. Nuclear p53 was not detected, whereas PTEN and RB expression were maintained. EGFR was expressed in the three cases and HER2 was negative. The proliferation rate was very low in all cases. DISCUSSION It is difficult to draw strong conclusions from the study of three tumors treated at the same institution and from the same referral population, and a multicentric study should be performed to confirm these preliminary results. However, we propose that H-RAS mutation analysis could be performed on urothelial bladder tumors of pediatric patients. The knowledge in the molecular basis of urothelial bladder tumors in children opens a promising field which could lead us to establish different guidelines for surveillance and follow-up of pediatric urothelial bladder cancer patients. CONCLUSION Pediatric tumors are characterized by a consistent H-RAS mutation status, whereas FGFR3 and p53 pathways are not involved in this tumor initiation. These results may explain the few recurrences seen in this population.
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Affiliation(s)
- Mireia Castillo-Martin
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA.
| | - Ana Collazo Lorduy
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA; Spanish Society of Medical Oncology, Spain
| | - Nataliya Gladoun
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Grace Hyun
- Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Carlos Cordon-Cardo
- Department of Pathology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA.
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23
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Khan R, Ibrahim H, Tulpule S, Iroka N. Bladder cancer in a young patient: Undiscovered risk factors. Oncol Lett 2016; 11:3202-3204. [PMID: 27123090 DOI: 10.3892/ol.2016.4355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 02/04/2016] [Indexed: 11/05/2022] Open
Abstract
Bladder cancer is one of the most common forms of malignancies involving the urinary system and multiple risk factors have been associated with its etiology. The most common of which include cigarette smoking and various occupational or chemical exposures. It is usually diagnosed in older individuals with an average age of 70. In rare cases it is observed in children as well as young adults where it usually presents as a low-grade, non-invasive disease. In the present case report a 27-year-old male patient is discussed: The patient presented with no significant risk factors and was treated for mucinous adenocarcinoma of the bladder while further investigations were performed to identify other associated factors related to this form of malignancy. Debate in the literature exists in regards to the characteristics of bladder neoplasms in younger patients compared with older patients, however there is a lack of research into the etiology or prognosis in young patients. The present case study illustrates the case of a young adult with no clear risk factors who was diagnosed with a rare case of mucinous adenocarcinoma of the bladder.
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Affiliation(s)
- Rafay Khan
- Internal Medicine Department, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
| | - Hiyam Ibrahim
- Internal Medicine Department, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
| | - Sunil Tulpule
- Internal Medicine Department, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
| | - Nneka Iroka
- Internal Medicine Department, Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
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24
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Zangari A, Zaini J, Gulìa C. Genetics of Bladder Malignant Tumors in Childhood. Curr Genomics 2016; 17:14-32. [PMID: 27013922 PMCID: PMC4780472 DOI: 10.2174/1389202916666151014221954] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/25/2015] [Accepted: 06/30/2015] [Indexed: 12/30/2022] Open
Abstract
Bladder masses are represented by either benign or malignant entities. Malignant bladder tumors are frequent causes of disease and death in western countries. However, in children they are less common. Additionally, different features are found in childhood, in which non epithelial tumors are more common than epithelial ones. Rhabdomyosarcoma is the most common pediatric bladder tumor, but many other types of lesions may be found, such as malignant rhabdoid tumor (MRT), inflammatory myofibroblastic tumor and neuroblastoma. Other rarer tumors described in literature include urothelial carcinoma and other epithelial neoplasms. Rhabdomyosarcoma is associated to a variety of genetic syndromes and many genes are involved in tumor development. PAX3-FKHR and PAX7-FKHR (P-F) fusion state has important implications in the pathogenesis and biology of RMS, and different genes alterations are involved in the pathogenesis of P-F negative and embryonal RMS, which are the subsets of tumors most frequently affecting the bladder. These genes include p53, MEF2, MYOG, Ptch1, Gli1, Gli3, Myf5, MyoD1, NF1, NRAS, KRAS, HRAS, FGFR4, PIK3CA, CTNNB1, FBXW7, IGF1R, PDGFRA, ERBB2/4, MET, BCOR. Malignant rhabdoid tumor (MRT) usually shows SMARCB1/INI1 alterations. Anaplastic lymphoma kinase (ALK) gene translocations are the most frequently associated alterations in inflammatory myofibroblastic tumor (IMT). Few genes alterations in urothelial neoplasms have been reported in the paediatric population, which are mainly related to deletion of p16/lnk4, overexpression of CK20 and overexpression of p53. Here, we reviewed available literature to identify genes associated to bladder malignancies in children and discussed their possible relationships with these tumors.
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Affiliation(s)
| | - Johan Zaini
- Università degli Studi della Tuscia, dipartimento di scienze biologiche (DEB), Viterbo, Italy
| | - Caterina Gulìa
- Università degli Studi di Roma La Sapienza, Dipartimento di Urologia, Roma, Italy
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25
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Gunlusoy B, Ceylan Y, Degirmenci T, Kozacioglu Z, Yonguc T, Bozkurt H, Aydogdu O, Sen V. Urothelial bladder cancer in young adults: Diagnosis, treatment and clinical behaviour. Can Urol Assoc J 2015; 9:E727-30. [PMID: 26664508 DOI: 10.5489/cuaj.3049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study is to reveal pathologic characteristics and clinical behaviour of patients 40 years old or younger diagnosed with and treated for urothelial bladder carcinoma. METHODS We retrospectively analyzed the clinical and pathologic data of 91 patients, initially diagnosed and treated at our institution from May 1996 to December 2014. Cancer recurrence was defined as new occurrence of bladder cancer at the same or different sites of the bladder. Cancer progression was defined as an increase in stage or grade in any of the recurrences. RESULTS The mean age was 33.8 (range: 17-40) years. The pathological examination after transurethral resection revealed 83 (91.2%) patients with non-muscle invasive urothelial bladder cancer, and 8 (8.8%) patients with muscle invasive urothelial bladder cancer. According to the distribution of grade, there were 75, 4 and 12 patients with grade 1, grade 2 and grade 3 diseases, respectively. Initial cancer staging was: pTa with 40 patients (43.9%), pT1 with 43 patients (47.2%), pT2 with 7 patients (7.6%), and pT3 with 1 patient (1.2%). While 17 (18.6%) patients recurred in the follow-up, 10 (10.9%) patients had progression. There were no differences in recurrence and progression rates in the Ta and T1 stages between groups (p = 0.233, p = 0.511, respectively). CONCLUSION The risk of progression increased as the number of relapses increased. The clinical behaviour of high-stage and high-grade disease in younger patients is similar to the older group.
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Affiliation(s)
- Bülent Gunlusoy
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Yasin Ceylan
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Tansu Degirmenci
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Zafer Kozacioglu
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Tarık Yonguc
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Halil Bozkurt
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Ozgü Aydogdu
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
| | - Volkan Sen
- Izmir Bozyaka Training and Research Hospital, Urology Clinic, Turkey
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26
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Wang QH, Ji ZG, Li HZ, Fan H, Chen ZG, Shi BB, Fang Y. Clinicopathologic Comparison of Urothelial Bladder Carcinoma in Young and Elder Patients. Pathol Oncol Res 2015; 22:67-70. [DOI: 10.1007/s12253-015-9968-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
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Koyuncuer A. Histopathological evaluation of urothelial carcinomas in transurethral resection urinary bladder tumor specimens: eight years of single center experience. Asian Pac J Cancer Prev 2015; 16:2871-7. [PMID: 25854375 DOI: 10.7314/apjcp.2015.16.7.2871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urothelial carcinoma (UC) is a malignant neoplasm that most commonly occurs in the urinary bladder. The primary aim of this study was to evaluate the clinicopathologic features, recurrence and progression in patients with bladder urothelial cancer. MATERIALS AND METHODS The medical records of patients diagnosed with UC in the state pathology laboratory between January 2006 and July 2014 were retrospectively included. Carcinomas were categorized according to age, gender, histologic grade, tumor configuration, pathologic staging, recurrence status, and progression. RESULTS A total of 125 (113 men, 12 women) patients were examined. The mean age was 65.9 years and the male-to-female urothelial cancer incidence ratio was 9.4:1. Low-grade UCs were observed in 85 (68%) and high-grade in 40 (32%). A papillary tumor pattern was observed in 67.2% of the UCs. Cases were classified with the following pathological grades: 34 (27.2%) cases of pTa, 70 (56%) of pT1, and 21 (16.8%) of pT2. Recurrence occurred in 27 (21.6%) patients. Ten progressed to a higher stage (pT1 to pT2), and three cases to higher grade (low to high). We also analyzed the results separately for 70 (56%) patients 65 years of age and older. CONCLUSIONS With early detection and diagnosis of precursor lesions in older patients, by methods such as standard urologic evaluation, urinary cytology, ultrasound scanning and contrast urography, and cystoscopy, in addition to coordinated efforts between pathologists and urologists, early diagnosis may reduce the morbidity and mortality of patients with urothelial carcinoma.
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Affiliation(s)
- Ali Koyuncuer
- Department of Pathology, State Hospital, Antakya, Hatay, Turkey E-mail :
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28
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Huang H, Sun M, Li X, Jin J. Urothelial carcinoma of the bladder in patients aged 30 years or younger: clinicopathological analysis and expression of fibroblast growth factor receptor 3 (FGFR3) of 45 cases. Med Oncol 2015; 32:137. [DOI: 10.1007/s12032-015-0581-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
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Ander H, Dönmez Mİ, Yitgin Y, Tefik T, Ziylan O, Oktar T, Özsoy M. Urothelial carcinoma of the urinary bladder in pediatric patients: a long-term follow-up. Int Urol Nephrol 2015; 47:771-4. [PMID: 25787072 DOI: 10.1007/s11255-015-0950-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 03/07/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To report our experience and long-term follow-up data on pediatric patients with urothelial carcinoma (UC) of the urinary bladder. METHODS In this retrospective study, perioperative and long-term follow-up data of nine pediatric patients with neoplasms of urothelial origin within the urinary bladder between 1980 and 2014 were analyzed. Cystoscopy was performed under general anesthesia, and transurethral resection of the bladder tumors was carried out in the same session. Adult follow-up protocols were used for all patients. RESULTS Urothelial carcinoma of the urinary bladder was histologically verified in five male (66%) and three female (33%) patients. In one patient, papillary urothelial neoplasm of low malignant potential was detected. Median patient age at the time of diagnosis was 12 years (4-18 years). Mean tumor size was 2.2 cm (1.5-4 cm). After a median follow-up of 60 months (10-121 months), no recurrence was observed among our patients. CONCLUSION Urothelial carcinoma of the urinary bladder in pediatric patients is a rare condition. Due to lack of substantial data, it is difficult to establish tailored management strategies. Most patients present with low-grade, low-stage disease. Being the most common symptom, macroscopic hematuria should be clarified with cystoscopy in pediatric age group.
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Affiliation(s)
- Haluk Ander
- Department of Urology, Istanbul Medical Faculty, Istanbul University, Capa, 34093, Istanbul, Turkey
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30
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Sheehan L, Anwar A, Kommu S. Presentation of case: Bladder cancer in an 18 year old female patient. Int J Surg Case Rep 2014; 7C:42-6. [PMID: 25574770 PMCID: PMC4347959 DOI: 10.1016/j.ijscr.2014.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Bladder cancers are not very common in the young population below 20 years of age, especially in those who have not been exposed to chemotherapy, bladder augmentation surgery and other known risk factors. By highlighting this case we hope to raise awareness in the medical community, that the symptom of visible haematuria can potentially be due to a bladder malignancy and therefore this should be thoroughly investigated. PRESENTATION OF CASE An 18-year-old female presented with intermittent macroscopic haematuria and non-specific abdominal pain. Physical examination and routine blood tests were normal. An ultrasound scan initially showed a bladder wall lesion, which a flexible cystoscopy confirmed. Histology revealed grade 2 papillary transitional cell carcinoma of the bladder with no invasion into the lamina propria (G2pTa TCCB). DISCUSSION We recognise through our literature review that paediatric bladder cancers are not commonly reported in the UK. In our paper we highlight the relevant major studies that have been carried out world-wide, the reported incidence so far and gaps in the evidence base. CONCLUSION Despite the dearth of data about paediatric bladder malignancies there is enough case-based evidence, from world-wide sources, to support that bladder cancer must be suspected in the event of macroscopic haematuria. Ultrasound and cystoscopy are the standard diagnostic tools for bladder tumours. Endoscopic resection of the tumour followed up by interval ultrasound scans and flexible cystoscopy checks remain the mainstay of treatment hitherto.
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Affiliation(s)
- Lisa Sheehan
- St Thomas' Hospital, General Surgery, Westminster Bridge Rd, London SE17EH, United Kingdom.
| | - Adeel Anwar
- St Thomas' Hospital, General Surgery, Westminster Bridge Rd, London SE17EH, United Kingdom
| | - Sashi Kommu
- St Thomas' Hospital, General Surgery, Westminster Bridge Rd, London SE17EH, United Kingdom
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Lightfoot M, Li R, Alsyouf M, Nicolay L, Chamberlin D. Transurethral needle biopsy: a novel technique for pathologic diagnosis of bladder tumors in children. J Pediatr Urol 2014; 10:1280-2. [PMID: 25082712 DOI: 10.1016/j.jpurol.2014.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
Abstract
Although rare, both benign and malignant bladder tumors are occasionally encountered in the pediatric population. In the present article, the technique of transurethral needle biopsy, which utilizes an 18-gauge core biopsy instrument inserted through a 9.5 French offset pediatric cystoscope to obtain diagnostic biopsies, is described. This technique has been used successfully in two patients, both of whom had an inflammatory myofibroblastic tumor on biopsy and on final pathology from partial cystectomy. This provides an alternative technique, which may be used when a pediatric resectoscope is not available or in patients with a small caliber urethra.
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Affiliation(s)
- Michelle Lightfoot
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA, 92354, United States.
| | - Roger Li
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA, 92354, United States.
| | - Muhannad Alsyouf
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA, 92354, United States.
| | - Lesli Nicolay
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA, 92354, United States.
| | - David Chamberlin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA, 92354, United States.
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Molecular characteristics of urothelial neoplasms in children and young adults: a subset of tumors from young patients harbors chromosomal abnormalities but not FGFR3 or TP53 gene mutations. Mod Pathol 2014; 27:1540-8. [PMID: 24743222 DOI: 10.1038/modpathol.2014.48] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/25/2014] [Accepted: 01/26/2014] [Indexed: 01/12/2023]
Abstract
Urothelial neoplasms in children and young adult patients are rare and hypothesized to have a lower rate of recurrence and progression than those of older adults. Because of their rarity, data regarding molecular abnormalities in these tumors are limited. We studied molecular characteristics of urothelial neoplasms from patients under age 30 years using UroVysion fluorescence in situ hybridization (chromosomes 3, 7, 17, and 9p21) and DNA mutational analysis for the FGFR3 and TP53 genes. Seventeen tumors were identified in patients 6-26 years of age, including low-grade papillary urothelial carcinoma (n=10), high-grade papillary urothelial carcinoma (n=5), urothelial papilloma (n=1), and papillary urothelial neoplasm of low malignant potential (n=1). No tumor demonstrated mutation of FGFR3 or TP53. Chromosomal abnormalities were detected only in patients aged ≥19 years: two low-grade urothelial carcinomas had loss of 9p21 as a sole chromosomal abnormality and three high-grade urothelial carcinomas had other or multiple chromosomal abnormalities. Under age 19 years, no tumor showed molecular abnormalities with either method (five low-grade papillary urothelial carcinomas and one each of high-grade papillary urothelial carcinoma, papillary urothelial neoplasm of low malignant potential, and urothelial papilloma). Our results support the idea that mutations of the FGFR3 and TP53 genes are rare or absent in urothelial neoplasms of young patients. In contrast, chromosomal abnormalities detected by UroVysion fluorescence in situ hybridization are sometimes present in patients above 19-20 years of age. This finding supports the recently proposed hypothesis that an age of 19-20 years separates distinct molecular pathways of urothelial carcinogenesis.
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Morales SA, Abu-Yousef MM, Tracy CR. A Rare Case of Papillary Bladder Neoplasm Detected by Sonography in a Young Male. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2014. [DOI: 10.1177/8756479314545775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bladder tumors are extremely rare in young adults and are usually linked to tobacco abuse, chronic infections, or occupational exposure to carcinogens. We present a case of a papillary urothelial neoplasm in a 19-year-old man with no significant risk factors, initially detected by sonography and later confirmed with computed tomographic urography and cystoscopy. The tumor was quickly resected and mitomycin C instilled in the bladder prophylactically. This is an atypical situation in a patient with none of the common risk factors.
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Affiliation(s)
- Steven A. Morales
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Monzer M. Abu-Yousef
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Chad R. Tracy
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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