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Comparison of the clinical and pathologic staging in patients undergoing radical cystectomy for bladder cancer
Mclaughlin, Sean;Shephard, Jon;Wallen, Eric;Maygarden, Susan;Carson, Culley C.;Pruthi, Raj S.;
International braz j urol , 2007, DOI: 10.1590/S1677-55382007000100005
Abstract: purpose: radical cystectomy (rcx) is perhaps the most effective therapeutic approach for patients with muscle-invasive bladder cancer. unfortunately, clinical staging is imprecise and the degree of understaging remains high. this study retrospectively evaluated patients undergoing rcx with regard to pathologic outcomes and degree of upstaging to better identify features that may lessen clinical understaging. materials and methods: 141 consecutive patients with urothelial bladder carcinoma who were candidates for rcx with curative intent were retrospectively evaluated. preoperative clinical and pathological (i.e. turbt) features were compared to pathological outcomes in the cystectomy specimen. patients were also evaluated as to whether cystectomy was performed as their primary (n = 91) versus secondary (n = 50) treatment for recurrent/progressive disease. date of cystectomy (< 5 years vs. > 5 years prior to study) was also analyzed. results: of the 141 patients, 54% were upstaged on operative pathology. the greatest degree of upstaging occurred in those with invasive disease preoperatively (ct2-t3). twenty-six percent of all patients had node-positive disease, and 75% of ct3 patients were node-positive. seven of 101 (7%) patients with clinical t2 disease were unresectable at the time of surgery. in the primary (vs. secondary) rcx group, more patients were upstaged (63% vs. 40%), non-organ confined (62% vs. 38%), and ln positive (31% vs. 20%). in the more modern cohort, the degree of upstaging was not improved. conclusions: pathologic findings after rcx often do not correlate with preoperative staging. over half of patients undergoing cystectomy are upstaged on their operative pathology. an improved understanding of the relative frequency of upstaging in cystectomy patients may have important implications in the decision-making and selection for neoadjuvant and adjuvant therapies for these high-risk populations.
Evaluation of Staging Accuracy of MRI in Bladder Carcinoma
Maryam Ghafoori,Azadeh Sadat Esfahani
Iranian Journal of Radiology , 2010,
Abstract: Background/Objective: The purpose of this study was to evaluate the accuracy of MRI in staging bladder cancer in a series of patients with pathologically proven bladder cancer. "nPatients and Methods: Eighty-six patients with pathologically proven bladder cancer underwent MRI in Hazrat Rasoul Akram University-Affiliated Hospital from 1387-88. Pathological staging was the golden standard for determination of superficial and invasive tumors and MRI staging was compared with pathology."nResults: MRI accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 94.2%, 97.7%, 90.7%, 91.3% and 97.5%, respectively. Overall agreement between MRI and pathology for bladder cancer staging was 82%."nConclusion: MRI shows goods reproducibility for bladder cancer staging especially in stage T4. More future studies are necessary for judgement.
Small cell carcinoma of the urinary bladder: A case report and review of the literature  [cached]
Ismaili Nabil,Ghanem Samia,Mellas Nawfel,Afqir Said
Journal of Cancer Research and Therapeutics , 2009,
Abstract: Small cell carcinoma of the bladder (SCCB) is extremely rare. In this paper, we present a case of metastatic SCCB managed by chemotherapy and we would provide a brief review of the epidemiology, clinical features, diagnosis, pathologic features, staging, treatment, and prognosis of SCCB. A 52-year-old man was admitted with signs and symptoms suggestive of a bladder cancer. Computed tomography of the pelvis and abdomen showed a large tumor at the right bladder wall, measuring 10 cm in diameter, and a multinodular liver disease. Diagnosis of small cell carcinoma was established from the histological study of the transurethral resection of the bladder tumor. The patient received 12 cycles of platinum-based chemotherapy with a good partial response of bladder tumor and liver metastasis. The patient is still alive, 18 months after diagnosis.
Current Staging Procedures in Urinary Bladder Cancer  [PDF]
Tobias Maurer,Thomas Horn,Matthias Heck,Jürgen E. Gschwend,Matthias Eiber,Ambros J. Beer
Diagnostics , 2013, DOI: 10.3390/diagnostics3030315
Abstract: Currently computed tomography (CT) represents the most widely used standard imaging modality in muscle-invasive urinary bladder cancer. Visualization of local tumor or depth of invasion as well as lymph node staging, however, is often impaired. Magnetic resonance imaging (MRI) with diffusion-weighted sequences, determination of apparent diffusion coefficient (ADC) values or utilization of superparamagnetic iron nanoparticles potentially exhibits advantages in the assessment of local tumor or lymph node involvement and therefore might play a role in routine staging of urinary bladder cancer in the future. Likewise, positron emission tomography (PET) with the currently utilized tracers 18F-FDG, 11C-choline and 11C-acetate is investigated in bladder cancer patients—mostly in combination with diagnostic CT. Although promising results could be obtained for these PET/CT examinations in smaller series, their true value cannot be determined at present.
Pathologic Pattern of Invasive Bladder Carcinoma: Impact of Bilharziasis
I Khalaf, E El-Mallah, I Elsotouhi, H Abu-Zeid, A Elmeligy
African Journal of Urology , 2008,
Abstract: Objective: To describe the pathologic pattern of invasive bladder carcinoma in cystectomy specimens in relation to bilharziasis. Patients and Methods: Between April 2002 and October 2006, 148 consecutive patients with invasive bladder cancer were subjected to radical cystectomy and orthotopic sigmoid bladder substitution at Al-Azhar Urology Department, Cairo, Egypt. A retrospective computerized data- base analysis of the pathologic features of the cystectomy specimens was done focusing on the impact of bilharziasis on the pathology of bladder carcinoma. The tumor cell type, stage, grade and gross features in addition to lymph node involvement were particularly noted. Results: Bilharzial bladder pathology (lesions or ova) was present in 105 (70.9%) of 148 cystectomy specimens. Tumor histology included transitional cell carcinoma (TCC) in 84 (56.7%), squamous cell carcinoma (SCC) in 51 (34.5%), adenocarcinoma in 9 (6.1%) and anaplastic tumor in 4 (2.7%) of these specimens. Most tumors associated with bilharziasis were bulky and appeared fungating or ulcerative. The pathologic tumor stage was pT2 in 23%, pT3 in 70.9% and pT4a involving the prostate or seminal vesicles in 6.1%. None of these pT4a tumors were SCC. The tumor grade was described as low grade in 72 (48.6%) and high grade in 76 (51.4%) specimens. Regional lymph node involvement was detected in 31 (20.9%) specimens irrespective of bilharzial infestation. Conclusion: Invasive bladder carcinoma associated with bilharzial pathology is mainly stage pT3, low-grade SCC and commonly appears as an ulcerative, bulky, fungating or verrucous mass. On the other hand, bladder carcinoma not associated with bilharziasis is mainly high-grade TCC and commonly appears as nodular or fungating lesions. Positive surgical margin and lymph node involvement are unrelated to bilharzial infestation. Africain Journal of Urology Vol. 14 (2) 2008: pp. 90-97
Comparison Of Clinical And Microbiological Effects Of Subgingival irrigation With Tetracycline As An Adjunct To Mechanical Therapy On Pathologic Periodontal Pocket Therapy  [PDF]
Ebru Ece Sar?ba?,Ahmet Da?,Arzum Güler Do?ru
Dicle Medical Journal , 2003,
Abstract: The local administration of antimicrobial agents as an adjunct to mechanical therapy in the treatment of periodontal disease gain a lot of interest in recent years. In this study, the effect of subgingival irrigation with tetracycline adjunct to scaling and root planning on clinical and microbiological parameters were evaluated. For this purpose, 40 patients which have at least 2 pathologic periodontal pockets with a probing depth greater than 5 mm have participated in this study.Initial plaque index, gingival index, gingival bleeding time index, pocket probing depth and attachment level scores were recorded and subgingival plaque sample were taken for microbiological sampling. Spirochetes, cocci and nonmotil rods were scanned by light microscope. Irrigations were performed after scaling and root planing at tetracycline group. At control group only scaling and root planing was performed. After one week, subgingival irrigations were performed again chlorhexidine group. Clinical recordings were repeated at 2. and 4. weeks and subgingival plaque sample were taken.According to our results, significant improvement were shown on all clinical parameters at all therapy groups at 2. and 4. weeks. Intergroup comparision, gingival index scores and attachment level scores were significantly reduced in tetracycline group. However no significant difference was found between groups. Positive improvements were shown on microbial flora at irrigation groups.According to our findings, subgingival irrigation as adjunct to mechanical therapy is not superior than scaling and root planing alone were determined. It suggested that subgingival irrigation may be helpful to conventional therapy at patients with poor oral hygiene
Comparison of Staging Systems of Hepatocellular Carcinoma  [PDF]
Yongyut Sirivatanauksorn,Chutwichai Tovikkai
HPB Surgery , 2011, DOI: 10.1155/2011/818217
Abstract: Many staging systems of hepatocellular carcinoma (HCC) were established; however, there is no consensus on which is proper in predicting prognosis. This study aims to evaluate various commonly used staging systems of HCC. Patients who underwent surgery during 2001–2007 were included. All patient data were retrospectively staged using six staging systems, that are American Joint Committee on Cancer (AJCC) Tumour-Node-Metastasis (TNM), Okuda staging, Cancer of the Liver Italian Program (CLIP), Barcelona Clinic Liver Cancer (BCLC), Chinese University Prognostic Index (CUPI), and Japan Integrated Staging (JIS). Child-Pugh classification was also evaluated. The staging systems were compared by mean of overall and disease-free survival. Total of 99 patient data were enrolled in the analyses. All staging systems except Okuda were significant in determining overall survival in univariate analyses. In multivariate analyses, TNM and Child-Pugh demonstrated better predictive power for overall survival. In terms of disease-free survival, univariate analyses revealed that TNM, CLIP, BCLC, CUPI, and JIS were significant, and TNM was the best predictive staging system in multivariate analyses. In our study, TNM and Child-Pugh are the representative systems in predicting survival of HCC patients who undergo surgical resection. Moreover, they are practical and easily assessable in clinical practice. 1. Background Hepatocellular carcinoma (HCC) is the most common primary malignancy of liver and one of the most common malignancies especially in Eastern and Southeastern Asia. The most important risk factors of HCC are chronic hepatitis B, C and cirrhosis. In malignancy diseases, staging system is important because it defines prognosis and is a guiding tool for treatment options and also a research tool for comparison between different groups and trials [1]. American Joint Committee on Cancer (AJCC) uses tumour-node-metastasis (TNM) system as staging system for many malignancy diseases to predict prognosis [2]. Nevertheless, in HCC, AJCC/TNM system fails to stratify patients adequately with respect to prognosis because TNM system evaluates only tumour extension. Since the remnant liver function is another important factor to prognosis of patients with HCC beside tumour burden; therefore, the staging system for HCC should include these both factors [3]. Staging systems that include liver function status were first proposed by Okuda et al. in 1985 based on study of 850 HCC patients [4]. This Okuda staging system was consisted of tumour load, ascites, albumin, and bilirubin.
CD10 expression in urothelial carcinoma of the bladder
Burak Bahadir, Kemal Behzatoglu, Sibel Bektas, Erol R Bozkurt, Sukru O Ozdamar
Diagnostic Pathology , 2009, DOI: 10.1186/1746-1596-4-38
Abstract: 371 cases of urothelial bladder carcinomas, all from transurethral resections, were included in this study. Hematoxylin-eosin (HE) stained sections from each case were reevaluated histopathologically according to WHO 2004 grading system. The TNM system was used for pathologic staging. Selected slides were also studied by IHC and a semiquantitative scoring for CD10 expression based on the percentage of positive cells was performed.157 cases (42.3%) showed immunostaining while 214 cases (57.7%) were negative for CD10. 1+ staining was seen in 65 CD10 positive cases (41.4%), and 2+ in 92 cases (58.6%). Overall CD10 expression as well as 2+ immunostaining was significantly correlated with high histologic grade. Overall CD10 expression was also significantly higher in invasive pT1 and pT2-3 tumors compared to noninvasive pTa tumors. pT1 and pT2-3 tumors were also significantly correlated with 2+ immunostaining.To date, only a few comparative IHC studies have assessed CD10 expression in urothelial carcinoma of the urinary bladder and this study represents the largest series. Our findings indicate that CD10 expression is strongly correlated with high tumor grade and stage in urothelial carcinoma of the bladder, and that CD10 may be associated with tumor progression in bladder cancer pathogenesis.Cancer of the bladder represents the ninth most common cause of cancer worldwide and the 13th most numerous cause of death from cancer with an estimated 357,000 newly diagnosed cases and 145,000 cancer-related deaths in 2002 [1]. Most patients (70-80%) with newly diagnosed urothelial carcinoma of the bladder present with well-differentiated superficial papillary tumors. Prolonged survival in most patients with superficial cancers is achieved by transurethral resection (TUR) with or without intravesical chemotherapy [2-6]. Nonetheless, these patients still have a high risk of recurrence following initial resection [7]. The major prognostic factors in carcinoma of the bladder are the
The value of mediastinoscopy in the staging of lung cancer with clinical N2 disease  [cached]
Hui ZHAO,Jun WANG,Jun LIU,Jianfeng LI
Chinese Journal of Lung Cancer , 2008,
Abstract: Background and objective To determine the value of mediastinoscopy in the mediastinal staging of lung cancer with clinical N2 disease. Methods We retrospectively reviewed 87 patients received mediastinoscopy for known or suspected lung cancer, including 83 cervical mediastinoscopies and 4 parasternal mediastinoscopies. All patients were staged clinical N2 for enlarged ipsilateral mediastinal and/or subcarinal lymph nodes (short axis > 1.0 cm)on computed tomography scan. Results Of the 87 patients, 61 cases proved N2 disease on mediastinoscopy. The other 26 mediastinoscopy-negative patients underwent thoracotomy for lung resection and mediastinal lymph node dissection in the same operative session. Final pathologic N staging were consistent for mediastinoscopic sampling and surgical dissection in 24 patients. N2 disease was found in 2 patients (false-negative of mediastinoscopy). The sensitivity, specificity, and accuracy of mediastinoscopy were 96.8%, 100%, and 97.7%, respectively. There was no mortality and only 1 complication(1.1%) for all 87 mediastinoscopic procedures. Conclusion Mediastinoscopy is a highly effective and safe procedure for the mediastinal staging of lung cancer with clinical N2 disease.
A Quantitative Proteomic Analysis Uncovers the Relevance of CUL3 in Bladder Cancer Aggressiveness  [PDF]
Laura Grau, Jose L. Luque-Garcia, Pilar González-Peramato, Dan Theodorescu, Joan Palou, Jesus M. Fernandez-Gomez, Marta Sánchez-Carbayo
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0053328
Abstract: To identify aggressiveness-associated molecular mechanisms and biomarker candidates in bladder cancer, we performed a SILAC (Stable Isotope Labelling by Amino acids in Cell culture) proteomic analysis comparing an invasive T24 and an aggressive metastatic derived T24T bladder cancer cell line. A total of 289 proteins were identified differentially expressed between these cells with high confidence. Complementary and validation analyses included comparison of protein SILAC data with mRNA expression ratios obtained from oligonucleotide microarrays, and immunoblotting. Cul3, an overexpressed protein in T24T, involved in the ubiquitination and subsequent proteasomal degradation of target proteins, was selected for further investigation. Functional analyses revealed that Cul3 silencing diminished proliferative, migration and invasive rates of T24T cells, and restored the expression of cytoskeleton proteins identified to be underexpressed in T24T cells by SILAC, such as ezrin, moesin, filamin or caveolin. Cul3 immunohistochemical protein patterns performed on bladder tumours spotted onto tissue microarrays (n = 284), were associated with tumor staging, lymph node metastasis and disease-specific survival. Thus, the SILAC approach identified that Cul3 modulated the aggressive phenotype of T24T cells by modifying the expression of cytoskeleton proteins involved in bladder cancer aggressiveness; and played a biomarker role for bladder cancer progression, nodal metastasis and clinical outcome assessment.
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