Small Cell Cancer of the Bladder and Prostate: A Retrospective Review from a Tertiary Cancer Center

Primary Small Cell Carcinoma of the Kidney: Disease Characteristics and Treatment Outcomes

Background: Primary small cell carcinoma of the kidney (PSCCK) is exceedingly rare and data on disease characteristics and outcomes are sparse. This study examines a nationally-representative cancer registry to better characterize PSCCK. Methods: We queried the National Cancer Database to identify patients with histology-confirmed PSCCK from 2004 to 2015. Adjusted Cox proportional hazards regression and Kaplan–Meier analyses were employed to assess predictors of mortality and estimate median survival time, respectively. Results: A total of 110 patients were included (47:53% female:male, 77% ≥60 years of age, 86% Caucasian). Significant predictors of mortality included female sex, age 60–69 years, treatment at an Integrated Network Cancer Program, stage cM1, and lack of surgical and chemoradiotherapy treatment. Independent protective factors were high socioeconomic status and treatment at an Academic Research Program. The estimated median overall survival time was 9.31 (95% CI 7.28–10.98) months for all patients. No differences in estimated survival time were observed across individual treatment modalities among those patients who underwent treatment (p = 0.214). Conclusions: PSCCK is an aggressive malignancy with a median survival time of less than one year. Future studies that correlate clinical tumor staging with specific treatment modalities are needed to optimize and individualize management.

Unusual Cushing's Syndrome and Hypercalcitoninaemia due to a Small Cell Prostate Carcinoma

A 75-year-old man was hospitalized because of severe hypokalaemia due to ACTH dependent Cushing's syndrome. Total body computed tomography (TBCT) and 68 Gallium DOTATATE PET/CT localized a voluminous prostate tumour. A subsequent transurethral prostate biopsy documented a small cell carcinoma positive for ACTH and calcitonin and negative for prostatic specific antigen (PSA) at immunocytochemical study; serum prostatic specific antigen (PSA) was normal. Despite medical treatments, Cushing's syndrome was not controlled and the patient's clinical condition progressively worsened. Surgical resection was excluded; the patient underwent a cycle of chemotherapy followed by febrile neutropenia and fatal intestinal perforation. This case report describes a rare case of Cushing's syndrome and hypercalcitoninaemia due to a small cell carcinoma of the prostate, a rare tumour with very few therapeutic options and negative prognosis.

Small-Cell Carcinoma of the Bladder: 20-Year Single-Institution Retrospective Review

INTRODUCTION

Small-cell carcinoma of the bladder is a poorly differentiated neoplasm with aggressive behavior. We analyzed clinical outcomes of patients who were treated at our institution to identify an optimal treatment strategy.

MATERIALS AND METHODS

Retrospective chart analysis was performed for patients who were treated for small-cell carcinoma of the bladder at Fox Chase Cancer Center between 1995 and 2015. Survival was compared between different treatment periods (before January 2010 vs. after January 2010) and different treatment modalities (surgery vs. neoadjuvant chemotherapy vs. radiation).

RESULTS

Thirty-eight patients were treated for small-cell carcinoma of the bladder at our institution during the 20-year study period. Median survival was 11.8 months and overall survival rates after 1, 3, and 5 years were 46.6%, 26.2%, and 14%, respectively. Survival analysis adjusted for age, histology, and stage showed that no single treatment strategy was significantly superior (95% confidence interval [CI], 0.26-3.03; P = .860 for surgery; 95% CI, 0.31-2.87; P = .928 for neoadjuvant chemotherapy; 95% CI, 0.65-5.49; P = .238 for radiation). In separate analyses of long-term survivors, we found that most received platinum-based neoadjuvant chemotherapy followed by radical cystectomy. Among the 20 patients who received neoadjuvant chemotherapy, downstaging occurred in 9 (45%).

CONCLUSION

Although none of the treatment options were found to be significantly superior with respect to survival, neoadjuvant chemotherapy might halt the progression of the disease until cystectomy and lead to downstaging. At our institution, the best outcomes were observed in patients who received neoadjuvant platinum-based chemotherapy combined with radical cystectomy.

Neuroendocrine Tumors of the Urinary Bladder According to the 2016 World Health Organization Classification: Molecular and Clinical Characteristics

Neuroendocrine neoplasms of the urinary bladder are a rare type of tumor that account for a small percentage of urinary bladder neoplasms. These tumors of the urinary bladder range from well-differentiated neuroendocrine neoplasms (carcinoids) to the more aggressive subtypes such as small cell carcinoma. Despite the rarity of the neuroendocrine tumors of the bladder, there has been substantial investigation into the underlying genomic, molecular, and the cellular alterations within this group of neoplasms. Accordingly, these findings are increasingly incorporated into the understanding of clinical aspects of these neoplasms. In this review, we provide an overview of recent literature related to the 2016 World Health Organization Classification of Neuroendocrine Tumors of the Urinary Bladder. Particular emphasis is placed on molecular alterations and recently described gene expression. The neuroendocrine tumors of the urinary bladder are subdivided into four subtypes. Similar to their pulmonary and other extrapulmonary site counterparts, these have different degrees of neuroendocrine differentiation and morphological features. The clinical aspects of four subtypes of neuroendocrine tumor are discussed with emphasis of the most recent developments in diagnosis, treatment, and prognosis. An understanding of molecular basis of neuroendocrine tumors will provide a base of knowledge for future investigations into this group of unusual bladder neoplasms.