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Gulinac M, Velikova T, Dikov D. Multinucleated giant cells of bladder mucosa are modified telocytes: Diagnostic and immunohistochemistry algorithm and relation to PD-L1 expression score. World J Clin Cases 2023; 11:6091-6104. [PMID: 37731584 PMCID: PMC10507540 DOI: 10.12998/wjcc.v11.i26.6091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Multinucleated giant cells (MGCs) in bladder carcinomas are poorly studied. AIM To describe the function, morphogenesis, and origin of mononuclear and MGCs in urothelial carcinoma (UC) of the bladder in Bulgarian and French patients. METHODS Urothelial bladder carcinomas (n = 104) from 2016-2020 were analyzed retrospectively using immunohistochemical (IHC) and histochemical stain examination. Giant cells in the bladder stroma were found in 35.6% of cases, more often in high-grades. RESULTS We confirm that MGCs in the mucosa in UC of the bladder were positive for both mesenchymal and myofibroblast markers (vimentin, smooth muscle actin, Desmin, and CD34) and the macrophage marker CD68. Furthermore, IHC studies revealed the following profile of these cells: Positive for p16; negative for epithelial (CK AE1/AE3 and GATA-3), vascular (CD31), neural (PS100 and C-KIT), cambial, blastic (CD34-blasts and C-KIT), and immune markers (IG G, immunoglobulin G4, and PD-L1); no proliferative activity, possess no specific immune function, and cannot be used to calculate the Combined Positive Score scale. CONCLUSION In conclusion, the giant stromal cells in non-tumor and tumor bladder can be used as a characteristic and relatively constant, although nonspecific, histological marker for chronic bladder damage, reflecting the chronic irritation or inflammation. Likewise, according to the morphological and IHC of the mono- and multinucleated giant cells in the bladder, they are most likely represent telocytes capable of adapting their morphology to the pathology of the organ.
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Affiliation(s)
- Milena Gulinac
- General and Clinical Pathology, Medical University of Plovdiv, Plovdiv 4002, Bulgaria
- Medical Faculty, Sofia University, St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University, St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Dorian Dikov
- Pathology, Grand Hospital de l’Este Francilien, Jossigny 1000, France
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2
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Schwarzova L, Varchulova Novakova Z, Danisovic L, Ziaran S. Molecular classification of urothelial bladder carcinoma. Mol Biol Rep 2023; 50:7867-7877. [PMID: 37525073 PMCID: PMC10460735 DOI: 10.1007/s11033-023-08689-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
Urothelial bladder carcinoma (UC) ranks among the top ten most commonly diagnosed cancers worldwide on an annual basis. The standardized classification system for urothelial bladder tumors is the Tumor, Node, Metastasis classification, which reflects differences between non-muscle-invasive bladder carcinoma (NMIBC) and muscle-invasive bladder carcinoma (MIBC) and it depends on the extent to which tumor has infiltrated the bladder wall and other tissues and organs. NMIBC and MIBC exhibit great intrinsic heterogeneity regarding different prognoses, survival, progression, and treatment outcomes. In recent years, studies based on mRNA expression profiling revealed the existence of biologically relevant molecular subtypes of UC, which show variant molecular features that can provide more precise stratification of UC patients. Here, we present a complex classification of UC based on mRNA expression studies and molecular subtypes of NMIBC and MIBC in detail with regard to different mRNA expression profiles, mutational signatures, and infiltration by non-tumor cells. The possible impact of molecular subtyping on treatment decisions and patients' outcomes is outlined, too.
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Affiliation(s)
- Lucia Schwarzova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zuzana Varchulova Novakova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lubos Danisovic
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
| | - Stanislav Ziaran
- Department of Urology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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3
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Abol-Elnazer HF, Awadalla A, Ahmed AE, Abol-Enein H, Al Ganzouri MA, Elsawy AA. Novel urine-based DNA methylation biomarkers for urothelial bladder carcinoma detection in patients with hematuria. Arab J Urol 2023; 21:248-257. [PMID: 38178946 PMCID: PMC10763582 DOI: 10.1080/2090598x.2023.2208492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/25/2023] [Indexed: 01/06/2024] Open
Abstract
Background Urothelial bladder carcinoma (UBC) is usually detected during work-up for hematuria. Cystoscopy and/or contrast-enhanced imaging are the gold standard tools for UBC diagnosis, despite limited by being invasive, expensive and low yield in small flat tumors. Objectives To assess the diagnostic performance of urine-based DNA methylation of six genes (GATA4, P16, P14, APC, CDH1 and CD99) for UBC detection in patients with hematuria. Patients and methods Voided urine was collected from consecutive patients presented with hematuria for urine cytology and DNA methylation assay of the assigned genes using methylation-specific Polymerase Chain Reaction (PCR). Further assessment by office cystoscopy and imaging with subsequent inpatient cystoscopic biopsy for positive findings was done. The diagnostic characteristics of DNA methylation and urine cytology were assessed based on its capability to predict UBC. Results We included 246 patients in the study with identified macroscopic hematuria in 204 (82.9%) patients. Positive cytology was found in 78 (31.7%) patients. DNA methylation of GATA4, P16, P14, APC, CDH1 and CD99 genes was identified in 127 (51.6%), 52 (21.1%), 117 (47.6%), 106 (43.1%), 90 (36.6%) and 71 (28.9%) patients, respectively. The sensitivity of the assigned genes for UBC detection ranges from 35% (95%CI: 31-39) to 83% (95%CI: 79-87). Optimal specificity (SP) (100%) was noted for P16, APC and CDH1 genes. While for the other genes (GATA4, P14 and CD99), the SP was 95% (95%CI: 92-98), 96% (95%CI: 92-99) and 97% (95%CI: 93-99), respectively. On multivariate logistic regression analysis, all genes exclusively demonstrated independent prediction of UBC. On receiver operator characteristic (ROC) analysis, all tested genes methylation showed superior area under the curve (AUC) when compared to urine cytology. Conclusions We have developed a novel urine-based DNA methylation assay for detection of UBC in patients with hematuria with superior diagnostic performance and independent predictive capacity over urine cytology.
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Affiliation(s)
| | - Amira Awadalla
- Center of Excellent for Genome and Cancer Research (CEG-CR), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Asmaa E. Ahmed
- Center of Excellent for Genome and Cancer Research (CEG-CR), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hassan Abol-Enein
- Center of Excellent for Genome and Cancer Research (CEG-CR), Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Amr A. Elsawy
- Urology department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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4
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Syed S, Rahman M, Israr A, Anwar M, Khatroth S, Safi D, Kamran A. A systematic review on the available treatment modalities for Bacillus Calmette-Guérin-unresponsive carcinoma in situ and tumors in patients who are ineligible for or decline radical cystectomy. SAGE Open Med 2023; 11:20503121231160408. [PMID: 36949824 PMCID: PMC10026116 DOI: 10.1177/20503121231160408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/10/2023] [Indexed: 03/18/2023] Open
Abstract
Introduction Globally, urothelial bladder carcinoma is a disease which carries a poor prognosis. There are various treatment modalities for urothelial bladder carcinoma with intravesical Bacillus Calmette-Guérin immunotherapy being the most efficacious intravesical therapy and the treatment of choice for patients with carcinoma in situ. A number of chemotherapeutic drugs are also available for the management of Ta/T1 tumors such as mitomycin C and epirubicin. However, relapse and progression is quite common. The optimal management of patients with Bacillus Calmette-Guérin-unresponsive disease remains to be a challenge. The purpose of this study was to conduct a systematic review on the treatment modalities available for the management of Bacillus Calmette-Guérin-unresponsive carcinoma in situ and urothelial bladder carcinoma in patients who are ineligible or decline radical cystectomy. Methods Two authors independently searched three databases on the treatment modalities available for the management of Bacillus Calmette-Guérin-unresponsive carcinoma in situ and Bacillus Calmette-Guérin-unresponsive urothelial bladder carcinoma. Results The systematic search resulted in 15 studies. We recommend the use of intravesical CG0070 adenovirus or hyperthermic intravesical chemotherapy mitomycin C in patients with carcinoma in situ only disease. In patients with carcinoma in situ ± Ta/T1 disease, we recommend the use of intravesical radiofrequency-induced chemohyperthermia or electromotive drug administration of mitomycin C. In patients who have Ta/T1 disease, we recommend the use of either hyperthermic intravesical chemotherapy epirubicin or electromotive drug administration mitomycin C followed by chemohyperthermia mitomycin C. If any of these second line therapies fail, an alternative regimen would be a combination of gemcitabine, cabazitaxel, and cisplatin. Conclusion This recommendation is subject to the available resources and clinical expertise available in different hospitals. More studies using study designs such as randomized controlled trials comparing multiple drugs with larger sample sizes and regular follow-up intervals should be performed to accurately assess the different medications and aid in designing guidelines to guide the management of Bacillus Calmette-Guérin-unresponsive non-muscle invasive intravesical bladder cancer.
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Affiliation(s)
- Saad Syed
- Mohammed Bin Rashid University of
Medicine and Health Sciences, Dubai, UAE
- Saad Syed, Mohammed Bin Rashid University
of Medicine and Health Sciences, Building 14, DHCC, Dubai, UAE.
| | | | - Aisha Israr
- Khyber Girls Medical College, Peshawar,
Pakistan
| | | | | | - Danish Safi
- West Virginia University, Morgantown,
West Virginia, USA
| | - Amir Kamran
- Charleston Area Medical Center,
Charleston, West Virginia, USA
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5
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Taherkhani R, Farshadpour F. BK and JC polyomaviruses and risk of urothelial bladder carcinoma: a preliminary study in the northern shores of Persian Gulf, Iran. Infect Agent Cancer 2022; 17:50. [PMID: 36123699 PMCID: PMC9487020 DOI: 10.1186/s13027-022-00463-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Bladder cancer is a challenging public health concern in South of Iran because of its high prevalence and the related medical expenses. Although the exact etiology of bladder cancer remains unknown, given the cell transforming ability and oncogenic potential of the members of Polyomaviridae families, this study was conducted to evaluate the magnitude of BK polyomavirus (BKPyV) and John Cunningham polyomavirus (JCPyV) among patients with bladder cancer residents in the northern shores of the Persian Gulf, South of Iran. Methods Totally 211 patients with bladder cancer were enrolled in this study. Bladder biopsy samples of these patients and patients with interstitial cystitis as well as autoptic samples of healthy bladder were tested for detection of BKPyV and JCPyV by semi-nested PCR–RFLP followed by sequencing. Results BKPyV and JCPyV were detected in 1.7% and 6.1% of bladder cancer samples, respectively. These samples were infected with JCPyV genotypes 2, 3 and 6 and BKPyV genotypes I and IV. BKPyV and JCPyV coinfection was detected in 2 samples. Moreover, one of the healthy bladder samples was positive for BKPyV, and one of the interstitial cystitis samples was positive for JCPyV. Although the majority of infected patients were in the age group 70–79 years, male, residents in Tangestan, stage Ta–T1, and low-grade and high-grade papillary urothelial carcinoma, the prevalence of BKPyV and JCPyV among patients with bladder cancer was not statistically associated with age, gender, place of residency, and stage and grade of the tumor. Conclusion Despite identifying BKPyV and JCPyV in a number of bladder cancer biopsy specimens and the high prevalence of bladder cancer among people resident in South of Iran, it is suggested that these viruses are unlikely to be effective causative factors in bladder carcinogenesis in this region. Therefore, environmental risk factors and genetic backgrounds may have a more prominent role than human polyomaviruses in the development of bladder cancer in South of Iran.
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Affiliation(s)
- Reza Taherkhani
- Department of Virology, School of Medicine, Bushehr University of Medical Sciences, Moallem Street, Bushehr, 751463334, Iran
| | - Fatemeh Farshadpour
- Department of Virology, School of Medicine, Bushehr University of Medical Sciences, Moallem Street, Bushehr, 751463334, Iran.
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Mohanad M, Yousef HF, Bahnassy AA. Epigenetic inactivation of DNA repair genes as promising prognostic and predictive biomarkers in urothelial bladder carcinoma patients. Mol Genet Genomics 2022; 297:1671-1687. [PMID: 36076047 PMCID: PMC9596572 DOI: 10.1007/s00438-022-01950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/27/2022] [Indexed: 11/29/2022]
Abstract
We sought to examine epigenetic inactivation of DNA damage repair (DDR) genes as prognostic and predictive biomarkers for urothelial bladder cancer (UBC) as there are currently no reliable prognostic biomarkers that identify UBC patients who would benefit from chemotherapy. Genome-wide DNA methylome using the cancer genome atlas-bladder cancer (TCGA-BLCA) datasets (primary tumors = 374 and normal tissues = 37) was performed for 154 DDR genes. The most two significant differentially methylated genes, Retinoblastoma binding protein 8 (RBBP8) and MutS homologue 4 (MSH4), between primary tumors and normal tissues of TCGA–BLCA were validated by methylation-specific PCR (MSP) in UBC (n = 70) compared to normal tissues (n = 30). RBBP8 and MSH4 expression was measured using qRT-PCR. We developed a predictive model for therapeutic response based on the RBBP8- and MSH4-methylation along with patients’ clinical features. Then, we assessed the prognostic significance of RBBP8 and MSH4. RBBP8- and MSH4 methylation and corresponding gene downregulation significantly associated with muscle-invasive phenotype, prolonged progression-free survival (PFS) and increased susceptibility to cisplatin chemotherapy in UBC. Promoter methylation of RBBP8 and MSH4 was positively correlated with each other and with their corresponding gene repression. The best machine-learning classification model predicted UBC patients’ response to cisplatin-based chemotherapy with an accuracy of 90.05 ± 4.5%. Epigenetic inactivation of RBBP8 and MSH4 in UBC could sensitize patients to DNA-damaging agents. A predictive machine-learning modeling approach based on the clinical features along with RBBP8- and MSH4-methylation might be a promising tool for stratification of UBC responders from nonresponders to chemotherapy.
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Affiliation(s)
- Marwa Mohanad
- Biochemistry Department, College of Pharmaceutical Sciences and Drug Manufacturing, Misr University for Science and Technology, 6th of October, Giza, Egypt.
| | - Hend F Yousef
- Tissue Culture and Cytogenetics Unit, Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Abeer A Bahnassy
- Tissue Culture and Cytogenetics Unit, Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
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7
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Li X, Li S, Chi Z, Cui C, Si L, Yan X, Mao L, Lian B, Tang B, Wang X, Bai X, Zhou L, Kong Y, Dai J, Guo J, Sheng X. Clinicopathological characteristics, prognosis, and chemosensitivity in patients with metastatic upper tract urothelial carcinoma. Urol Oncol 2020; 39:75.e1-75.e8. [PMID: 32654950 DOI: 10.1016/j.urolonc.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/23/2020] [Accepted: 06/13/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the clinical characteristics, chemosensitivity, and outcome of metastatic upper tract urothelial carcinoma (UTUC). PATIENTS AND METHODS Records of patients with metastatic UTUC since January 2005 were retrieved from a database that included clinical and survival data. Statistical analyses including survival and multivariate analyses of factors were respectively performed by the Kaplan-Meier method and Cox proportional hazard model. RESULTS A total of 250 consecutive UTUC cases were evaluated. There were 56 patients (22.4%) with initially diagnosed stage IV disease. The most common metastatic sites were lung (39.6%), distant lymph nodes (39.2%), bone (19.6%), liver (18.0%), and adrenal gland (7.2%), respectively, and the local recurrence rate was 10.4%. Two hundred thirteen patients received first-line chemotherapy. The overall response rate was only 28.7% and the median progression-free survival time was only 5.0 months. The overall survival time of the cohort was 18.0 months. Multivariate analyses showed that initially diagnosed stage IV disease, number of metastatic organs ≥3, no response to chemotherapy and cycles of chemotherapy ≤2 were adverse prognosticators for overall survival. CONCLUSION UTUC presented to be more prone to metastasize than locally recur and thought to have low chemosensitivity. Stage IV disease at initial diagnosis, number of metastatic organs, response and cycles of chemotherapy were independent prognosticators for metastatic UTUC.
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Affiliation(s)
- Xu Li
- Department of Oncology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Siming Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Zhihong Chi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Chuanliang Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Xieqiao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Bin Lian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Bixia Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Xue Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Li Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Yan Kong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Jie Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China.
| | - Xinan Sheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, PR China.
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Jiang Q, Xie MX, Zhang XC. Complete response to trastuzumab and chemotherapy in recurrent urothelial bladder carcinoma with HER2 gene amplification: A case report. World J Clin Cases 2020; 8:594-599. [PMID: 32110671 PMCID: PMC7031824 DOI: 10.12998/wjcc.v8.i3.594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/31/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Targeted treatments may greatly affect the natural history of urothelial carcinoma based on their pharmacokinetics. A phase II trial has explored the combination of cytotoxic chemotherapy with the anti-HER-2 monoclonal antibody trastuzumab in selected patients with metastatic bladder cancer, but it failed.
CASE SUMMARY Here, we report a case of recurrent urothelial bladder carcinoma (UBC) in a patient who has undergone three operations, and further illuminate its diagnosis and treatment. The diagnosis of UBC was rendered according to the pathological indices. Next-generation sequencing on formalin fixed paraffin-embedded (FFPE) tissue was also performed and suggested HER2 gene amplification in the FFPE tissue. Based on HER2 gene amplification in FFPE, the patient was treated with chemotherapy in combination with trastuzumab after his third surgery. Fortunately, the patient got a clinically complete remission to trastuzumab for 34 mo.
CONCLUSION There is not enough clinical evidence for incorporating trastuzumab in routine treatment of UBC. This case hinted that recurrent UBC patients with HER2 gene amplification may benefit from targeted trastuzumab. Further studies are needed to further investigate the status of HER2 gene and better determine trastuzumab in the management of UBC.
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Affiliation(s)
- Qi Jiang
- Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Mi-Xue Xie
- Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Xiao-Chen Zhang
- Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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Taktak T, Boussaffa H, Ouanes Y, Zaghbib S, Sellami A, Ghorbel Z, Chelly I, Rhouma SB, Nouira Y. Unexpected skin lesions secondary to metastasis of urothelial carcinoma. Int J Surg Case Rep 2019; 64:177-179. [PMID: 31670145 PMCID: PMC6831817 DOI: 10.1016/j.ijscr.2019.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 11/28/2022] Open
Abstract
Skin metastases of urothelial bladder carcinoma are rare. The inflammatory presentation, as seen in our case, is exceptional. Diagnosis requires immunohistochemical study of a skin biopsy. The prognosis after the appearance of cutaneous metastasis is poor.
Introduction Metastatic spread of urothelial bladder carcinoma (UBC) rarely involves the skin which is associated with a poor prognosis. We present a rare case of UBC with cutaneous metastases which is exceptional by its inflammatory clinical form. Presentation of case A 62-year-old male was diagnosed with a non-metastatic muscle invasive transitional cell bladder carcinoma invading the anterior wall of the rectum. Cisplatin-based chemotherapy was indicated but refused by the patient. Three months later, he developed cutaneous lesions in the left axilla and the right inguinal fold. These lesions were budding, nodular and inflammatory corresponding to carcinomatous metastasis on skin biopsy which urothelial origin was confirmed by immunohistochemical analysis. The patient died four weeks later after multi-organ failure. Discussion Skin metastasis of transitional cell carcinoma of the bladder are uncommon, representing 0.84% of all cutaneous metastases. The inflammatory presentation, as seen in our case, is rarer than the other types and is usually due to a lymphatic extension. The clinical appearance of cutaneous metastases might mimic other common dermatologic disorders; Thus, diagnosis requires histological confirmation by microscopic examination and immunohistochemical study of a skin biopsy. The prognosis after the appearance of cutaneous metastases is generally poor with a median disease-specific survival of less than 12 months Treatment is palliative and is principally based on chemotherapy, analgesics and psychological support. Conclusion Cutaneous metastases secondary to urothelial bladder carcinoma are exceptional especially in its inflammatory presentation. Diagnosis is based on immunohistochemical study. Treatment is based on chemotherapy and the prognosis is poor.
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Affiliation(s)
- Tarek Taktak
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Hamza Boussaffa
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Yassine Ouanes
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Selim Zaghbib
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ahmed Sellami
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Zinet Ghorbel
- Department of Anatomopathology, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ines Chelly
- Department of Anatomopathology, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sami Ben Rhouma
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Yassine Nouira
- Urology Department, La Rabta Teaching Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
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Carneiro BA, Meeks JJ, Kuzel TM, Scaranti M, Abdulkadir SA, Giles FJ. Emerging therapeutic targets in bladder cancer. Cancer Treat Rev 2015; 41:170-8. [PMID: 25498841 DOI: 10.1016/j.ctrv.2014.11.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 11/14/2014] [Accepted: 11/15/2014] [Indexed: 12/11/2022]
Abstract
Treatment of muscle invasive urothelial bladder carcinoma (BCa) remains a major challenge. Comprehensive genomic profiling of tumors and identification of driver mutations may reveal new therapeutic targets. This manuscript discusses relevant molecular drivers of the malignant phenotype and agents with therapeutic potential in BCa. Small molecule pan-FGFR inhibitors have shown encouraging efficacy and safety results especially among patients with activating FGFR mutations or translocations. mTOR inhibitors for patients with TSC1 mutations and concomitant targeting of PI3K and MEK represent strategies to block PI3K/AKT/mTOR pathway. Encouraging preclinical results with ado-trastuzumab emtansine (T-DM1) exemplifies a new potential treatment for HER2-positive BCa along with innovative bispecific antibodies. Inhibitors of cell cycle regulators (aurora kinase, polo-like kinase 1, and cyclin-dependent kinase 4) are being investigated in combination with chemotherapy. Early results of clinical studies with anti-CTLA4 and anti-PDL1 are propelling immune modulating drugs to the forefront of emerging treatments for BCa. Collectively, these novel therapeutic targets and treatment strategies hold promise to improve the outcome of patients afflicted with this malignancy.
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MESH Headings
- Ado-Trastuzumab Emtansine
- Antibodies, Monoclonal, Humanized/pharmacology
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/therapeutic use
- Aurora Kinases/metabolism
- B7-H1 Antigen/antagonists & inhibitors
- Biomarkers, Tumor/metabolism
- CTLA-4 Antigen/antagonists & inhibitors
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/pathology
- Cell Cycle Proteins/antagonists & inhibitors
- Cell Cycle Proteins/metabolism
- Clinical Trials as Topic
- Cyclin D1/metabolism
- Cyclin-Dependent Kinase 4/metabolism
- Heat-Shock Proteins/metabolism
- Humans
- Immunotherapy/methods
- Maytansine/analogs & derivatives
- Maytansine/pharmacology
- Molecular Targeted Therapy/methods
- Mutation
- Neoplasm Invasiveness
- Phosphatidylinositol 3-Kinases/metabolism
- Protein Serine-Threonine Kinases/metabolism
- Proto-Oncogene Proteins/metabolism
- Proto-Oncogene Proteins c-akt/metabolism
- Receptor, ErbB-2/metabolism
- Receptor, Fibroblast Growth Factor, Type 1/genetics
- Signal Transduction/drug effects
- TOR Serine-Threonine Kinases/metabolism
- Translocation, Genetic
- Trastuzumab
- Tuberous Sclerosis Complex 1 Protein
- Tumor Suppressor Proteins/genetics
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/metabolism
- Urinary Bladder Neoplasms/pathology
- Polo-Like Kinase 1
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Affiliation(s)
- Benedito A Carneiro
- Northwestern Medicine Developmental Therapeutics Institute, Feinberg School of Medicine, Northwestern University, United States; Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, United States; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States.
| | - Joshua J Meeks
- Department of Urology, Feinberg School of Medicine, Northwestern University, United States; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
| | - Timothy M Kuzel
- Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, United States; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
| | - Mariana Scaranti
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Brazil
| | - Sarki A Abdulkadir
- Department of Urology, Feinberg School of Medicine, Northwestern University, United States; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
| | - Francis J Giles
- Northwestern Medicine Developmental Therapeutics Institute, Feinberg School of Medicine, Northwestern University, United States; Division of Hematology and Oncology, Feinberg School of Medicine, Northwestern University, United States; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
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11
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Erhamamcı S, Reyhan M, Altinkaya N. A case of brain and leptomeningeal metastases from urothelial carcinoma of the bladder. Rev Esp Med Nucl Imagen Mol 2014; 33:290-2. [PMID: 25043771 DOI: 10.1016/j.remn.2013.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 09/23/2013] [Accepted: 10/07/2013] [Indexed: 10/25/2022]
Abstract
Brain metastases are unusual from urethelial carcinoma of bladder and particularly the occurrence of leptomeningeal metastases is extremely rare, with few cases described in the literature. We present a case of a 45-year-old man with a rare brain metastases as the first metastatic manifestation secondary to urethelial carcinoma of bladder followed by leptomeningeal metastases without any other organ involvement. Eleven months after the diagnosis of high-grade urethelial carcinoma of bladder (T2N0M0), the patient was detected having brain metastases by MRI. FDG PET/CT images for the metastatic evaluation showed no abnormal FDG uptake elsewhere in the body except the brain. Histopathology examination from brain lesion demonstrated the cerebral lesion to be a metastatic urothelial carcinoma. Two months later, the patient was diagnosed to have leptomeningeal metastases by MRI. Our patient's condition gradually worsened, and he died 3 months after the diagnosis of leptomeningeal metastases.
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Affiliation(s)
- S Erhamamcı
- Department of Nuclear Medicine, Faculty of Medicine, Baskent University, Ankara, Turkey.
| | - M Reyhan
- Department of Nuclear Medicine, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - N Altinkaya
- Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey
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12
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Otto W, Denzinger S, Fritsche HM, Burger M, Rößler W, Bertz S, May M, Hartmann A, Hofstädter F, Wieland WF, Eder F. Introduction and first clinical application of a simplified immunohistochemical validation system confirms prognostic impact of KI-67 and CK20 for stage T1 urothelial bladder carcinoma: single-center analysis of eight biomarkers in a series of three hundred six patients. Clin Genitourin Cancer 2013; 11:537-44. [PMID: 23850551 DOI: 10.1016/j.clgc.2013.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 05/01/2013] [Accepted: 05/14/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Biomarkers could help to estimate the prognosis of solid tumors. One of the reasons that many immunohistochemical (IHC) markers are not used routinely is the high interobserver variability and various cutoff values. In the present study, we used a simplified IHC method with a group of 8 biomarkers in stage pT1 urothelial bladder carcinoma (UBC). PATIENTS AND METHODS IHC expression of CK20, KI-67, STK15, MUC7, periostin, fibronectin, survivin, and CXCR4 was assessed independently by 2 reviewers in a series of 306 stage pT1 UBC specimens from a single center in 10% steps from < 10% up to > 90%. A general center < 10% vs. ≥ 10% was set for further analysis for all markers. All patients initially underwent a bladder-sparing approach. Kaplan-Meier analyses and multivariate Cox regression analyses of recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS) were performed. RESULTS A cutoff point ≥ 10% was shown to be valid and reliable for marker expression, with 96% interobserver agreement. Of the studied marker expressions, ≥ 10% for Ki-67 showed a statistically significant worse RFS (54% vs. 64%; P = .004), PFS (66% vs. 73%; P = .001), and CSS (71% vs. 77%; P = .015); ≥ 10% for CK20 showed a worse RFS (57% vs. 58%; P = .009). Multivariate Cox regression analysis revealed CK20 to be an independent prognostic factor for recurrence (hazard ratio [HR], 2.08; confidence interval [95% CI]; 1.21-3.57; P = .008) and Ki-67 for progression (HR, 2.11; CI, 1.02-4.37; P = .045). CONCLUSION We proposed and applied a simplified IHC evaluation that increases interobserver agreement and confirms the prognostic role of Ki-67 and CK20 for stage T1 UBC.
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Affiliation(s)
- Wolfgang Otto
- St. Josef Medical Centre, Department of Urology of Regensburg University, Regensburg, Germany.
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