Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2005 / Cilt: 31 - Sayı: 4
Non-transitional cell carcinoma of the bladder
- Pages
- 469–473
- DOI
- —
Abstract
Introduction: Transitional cell carcinoma is the most common histopathologic type of bladder tumors. But bladder cancer is a heterogenous disease with an unpredictable clinical course. Non-transitional cell carcinomas of the bladder are uncommon and aggressive tumors. It is necessary to distinguish histopathologic type of tumors because squamous or glandular differentiation can be found with transitional cell carcinoma. In this study, we examined pathologic diagnosis, treatment and prognosis of 34 patients with non-transitional cell carcinoma. Materials and Methods: A total of 1150 patients with bladder tumors operated in our clinic between August 1994 and November 2002 were retrospectively evaluated. 34 (3%) bladder tumors of non-transitional type were pathologically diagnosed. All patients were treated with transurethral resection of bladder tumor. After the histological diagnosis of the tumor, radiologic tests (abdominal and chest CT, radionuclide bone scan) were obtained for accurate staging. Of these tumors, there were 10 (34.5%) squamous cell carcinoma, 9 (31%) adenocarcinoma, 3 (10.3%) sarcomatous carcinoma, 2 (7%) lymphepithelioma, 2 (7%) small cell carcinoma, 1 (3.4%) clear cell carcinoma, 1 (3.4%) choriocarcinoma and 1 (3.4%) sarcoma. Totally 54 specimens of 34 cases were examined histopathologically (37 TUR-BT, 14 radical cystectomy, 3 consultation material). In histopathologic examination; development pattern, depth of invasion, angiogenesis, necrosis, mitosis, immunologic staining, differentiation patterns and superficial epithelium changes, neural and vascular invasion were evaluated. Results: Patients were followed-up minimum 6 months to maximum 39 months (mean follow- up 17 months). There were 31 (91.2%) men and 3 (8.8%) women with a mean age of 62.3 (ranging 47 to 76) years. We could not reach to 5 (14.7%) patients with different histologic types and these patients were excluded from study. Pathological stages were T2NoMo in 4 (13.8%) patients, T2N+Mo in 4 (13.8%), T2N+M1 in 4 (13.8%), T3NoMo in 5 (17.2%), T3N+Mo in 5 (17.2%), T3N+M1 in 3 (10.4%), T4N+M1 in 4 (13.8%). Tumor behavior was very aggressive in all histological types. Of 29 patients, 19 patients (65.5%) had local invasive disease and 10 (34.5%) had metastatic disease at pathologic examination. Fourteen (48.3%) patients were treated with radical cystectomy and pelvic lymphadenectomy and 12 (41.4%) patients with systemic chemotherapy and/or radiotherapy. Three patients could not take any therapy because of their clinical status. After a mean followup of 17 months, 10 (34.5%) patients were alive and 19 (65.5%) died. Conclusion: Prognosis of urinary bladder tumors were directly related to histologic grade and stage of the tumor. Non-transitional cell carcinomas are typically deep invasive and advanced tumors indicating that they are highly aggressive neoplasms and have poor survival rates. Chemotherapy or radiotherapy has limited response rates. Early radical cystectomy should be done to improve prognosis.
Özet
Mesane kanseri klinik gidişi öngörülemeyen heterojen bir hastalıktır. Mesanenin non-transisyonel hücreli kanserleri ender ve agresif seyirli tümörlerdir. Transisyonel hücreli kanserlerde glandüler veya skuamöz hücre diferansiyasyonu bulunabilir ve bunların non-transisyonel hücreli kanserlerden ayırıcı tanısı uygun tedavinin seçilmesi ve hastalığın seyri açısından önemlidir. Bu çalışmamızda mesanenin non-transisyonel hücreli kanseri olan 34 hasta retrospektif olarak incelendi. Ağustos 1994-Kasım 2002 yılları arasında kliniğimizde ameliyat edilen 1150 mesane tümörlü hasta retrospektif olarak değerlendirildi. 34 (%3) hastada non-transisyonel hücreli kanser saptandı. Tüm hastalara histolojik tanı için transüretral rezeksiyon uygulandı ve evrelendirme için radyolojik incelemeler yapıldı. Toplam 34 mesane tümörlü olguya ait 37 TUR,14 radikal sistektomi ve 3 konsültasyon bloğu olmak üzere toplam 54 spesimen incelendi. Hastalar en az 6 ay - en çok 39 ay (ortalama 17 ay) takip edildi. Hastaların yaş ortalamaları 62.3 idi (47-76 yıl). Tümör davranışı tüm histolojik tiplerde agresif seyirli idi. Toplam 29 hastanın 19'unda (%65.5) lokal ilerlemiş hastalık ve 10'unda (%34.5) metastatik hastalık mevcuttu. Kontrol dışı 5 hasta çalışmadan çıkarıldı.14 (%48.3) hastaya radikal sistektomi yapılırken 12 hastaya kemoterapi ve/veya radyoterapi uygulandı. 3 hastaya herhangi bir tedavi verilemedi. Ortalama 17 aylık takip sonunda 10 (%34.5) hasta sağ idi. Non-transisyonel hücreli mesane tümörleri tanı konulduğunda ileri evre tümörlerdir ve yapılan tedaviye karşın sağ kalım oranları düşüktür. Kemoterapi veya radyoterapiye cevap sınırlıdır. Hastalığın seyrini iyileştirmek için erken radikal sistektomi ideal tedavidir.