Anemia, Hemolytic, Autoimmune ; Carcinoma, Transitional Cell/complications* ; Humans ; Urinary Bladder Neoplasms/complications*

Transitional cell carcinoma has rarely been reported to be associated with disseminated intravascular coagulation (DIC). We report a 55-year-old Chinese man who was diagnosed with transitional cell carcinoma with vertebral metastasis. He presented with severe anaemia and thrombocytopenia, and subsequent evaluation revealed features of DIC. Interestingly, he did not have fever, any localising symptoms or signs of infection. He was treated aggressively with transfusion of packed cells, platelets, intravenous vitamin K and fresh frozen plasma. Despite aggressive treatment, the coagulation abnormalities were resistant to correction. The patient continued to deteriorate and eventually died of cardiac arrest. This case illustrates that transitional cell carcinoma can also be associated with DIC, possibly due to the expression of certain unidentified procoagulant factors similar to the tissue factor responsible for DIC.
Anemia ; etiology ; Carcinoma, Transitional Cell ; blood ; complications ; Disseminated Intravascular Coagulation ; etiology ; Humans ; Male ; Middle Aged ; Ureteral Neoplasms ; blood ; complications

AIMTo determine the incidence of adenocarcinoma of the prostate for patients undergoing radical cystoprostatectomy for bladder cancer in Taiwan.

METHODSA total of 248 patients in Taiwan who were histologically confirmed for transitional cell carcinoma of the bladder underwent cystoprostatectomy. Histopathologic evaluation of the prostate specimens sectioned at 5 mm intervals was performed.

RESULTSOf the 248 patients, 10 (4.03%) were found to have prostate cancer. Of the 10 cases of unsuspected prostate cancer, eight proved to be at stage T1 or T2, and two at T3 and T4, respectively. This rate of incidentally found prostate cancer amongst our bladder cancer patients appeared to be lower than that found in bladder cancer patients in similar studies in USA.

CONCLUSIONAlthough the incidence of incidental prostate cancer in patients in Taiwan with bladder cancer is not high compared with that in Western countries, we suggest that digital rectal examination and prostate-specific antigen (PSA) are important screening tools for men with bladder cancer, especially for those aged 60 years and older in Taiwan.

Carcinoma, Transitional Cell ; pathology ; surgery ; Humans ; Male ; Neoplasm Staging ; Prostatectomy ; Prostatic Neoplasms ; complications ; surgery ; Urinary Bladder Neoplasms ; complications ; pathology ; surgery

Nephroureterectomy with excision of a cuff of the bladder is the standard surgical approach for upper urinary tract carcinoma. In 1952, a modified technique was described based on a prior endoscopic disconnection of the intramural ureter as an initial step for subsequent nephroureterectomy via a single lumbar incision. Two patients underwent surgery with some modification of this technique. We performed nephroureterectomies through a single lumbar incision combined with ureteral intussusception and transurethral resection of bladder cuff. There was no intraoperative complications and with an average follow up of 12 months, tumor has not recurred at either the resected trigonal area or the retroperitoneum. We believe that this method will be a useful alternative in surgical management of upper urinary tract carcinoma.
Carcinoma, Transitional Cell* ; Follow-Up Studies ; Humans ; Intraoperative Complications ; Intussusception ; Kidney Pelvis* ; Ureter ; Urinary Bladder* ; Urinary Tract

Since January 2003, two male patients, 60 and 47 years old, with muscle-invasive, organ-confined, transitional cell carcinomas of the urinary bladder underwent laparoscopic radical cystoprostatectomy with extracorporeal ileal conduit urinary diversion (LRCEIC). The surgical time was 8.5 hours in the first patient and 10 hours in the second. The respective blood losses were 350 and 380ml. In the first patient, ambulation resumed on day 2, bowel sounds on day 3 and oral intake on day 4, with a hospital stay of 8 days. In the second patient, due to inadvertent rectal injury, which was discovered on day 3, ambulation, bowel sounds and oral intake could not be determined. A pathological examination revealed a pT1N0M0 transitional cell carcinoma of the bladder, with the surgical margins negative for cancer, in the first patient, and a pT3bN1M0, with the surgical margins positive for cancer, in the second. Immediate postoperative complications included rectal injury and ileus in the second patient. With further experience and refinement in the operative technique, it is believe that LRCEIC can be performed safely and efficaciously in selected muscle-invasive bladder cancers.
Carcinoma, Transitional Cell ; Cystectomy* ; Humans ; Ileus ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion* ; Walking

PURPOSE: We aimed to describe the surgical technique of hand-assisted retroperitoneoscopic nephroureterectomy (HARNU) with bladder cuffing after preperitoneal and retroperitoneal perivesical ballooning. MATERIALS AND METHODS: From March 2008 to September 2012, we performed HARNU and open bladder cuffing in 28 consecutive series of patients with upper urinary tract urothelial carcinoma. We performed HARNU according to the following procedure: (1) a camera port incision was made on the posterior axillary line; (2) multiple, repeated, preperitoneal and retroperitoneal ballooning was performed on both the posterior axillary line and in the umbilicus; (3) a 7.0 cm skin incision was made from the suprapubic to the lower inguinal with the balloon present in the extraperitoneal area; (4) hand-assisted laparoscopic retroperitoneal nephroureterectomy; (5) cessation of gas insufflation; and (6) extravesical cuffing as an open surgical procedure. RESULTS: The mean estimated blood loss was 250 mL. The mean operation time was 240 minutes. The mean time to oral intake and ambulation was 1.0 day and two days, respectively. As for postoperative complications due to the hand-assisted device, one patient developed febrile urinary tract infection within three weeks postoperatively and was hospitalized again to receive parenteral antibiotics. CONCLUSIONS: We made a low Gibson incision for a route for the hand-assisted procedure as well as a window for open surgery in dissecting the distal ureter and extracting the surgical specimens. Thus, our results indicate that the HARNU might be a feasible surgical modality.
Anti-Bacterial Agents ; Carcinoma, Transitional Cell ; Endoscopy ; Hand-Assisted Laparoscopy ; Humans ; Insufflation ; Nephrectomy ; Postoperative Complications ; Skin ; Umbilicus ; Ureter ; Ureteral Neoplasms ; Urinary Bladder* ; Urinary Tract ; Urinary Tract Infections ; Walking

*Carcinoma, Renal Cell/pathology/surgery ; *Carcinoma, Transitional Cell/pathology/surgery ; Case Report ; Human ; Hypercalcemia/etiology ; Kidney Calculi/complications/surgery ; *Kidney Neoplasms/pathology/surgery ; Kidney Pelvis ; Male ; Middle Age ; *Neoplasms, Multiple Primary/pathology/surgery ; Nephrectomy

OBJECTIVETo investigate the clinicopathological characteristics and the prognosis of bladder neuroendocrine carcinoma (NEC).

METHODSClinicopathological data from 17 NEC of the bladder cases were collected, and immunohistochemical staining was performed with follow-up analysis and literature review.

RESULTSThe recruited included 13 male and 4 female patients, aged from 48 to 86 years old (average 61 years; 14 patients >60 years). Gross hematuria of the whole urination course or intermittent was the initial symptom. Macroscopically, the outer surface of the tumor presented with polypoid, lobulated, fungating or ulcerous structures. Histologically, according to the criteria of WHO classification of neuroendocrine tumor of the lung, our NEC cases were divided into three histological types: 13 cases of small cell carcinoma, 3 cases of large cell neuroendocrine carcinoma and 1 case of atypical carcinoid. The urothelial carcinoma was concurrent with NEC in 6 cases, and adenocarcinoma was concurrent with NEC in 2 cases. Most tumor tissue infiltrated to the muscular layer, some infiltrated to the outer membrane. Immunohistochemically, the positive expression rates of CD56, Syn and CgA were 16/17, 16/17 and 12/17, respectively. The epithelial markers, including CK7 and CKpan, were also expressed with positive rates of 12/17 and 15/17, respectively. TTF-1 was positively expressed in 11 cases. The follow-up data were available in 14 cases, of which 9 patients died of the tumor 1-34 months after surgery (average, 11 months). Five patients lived uneventfully for 1-12 months after surgery.

CONCLUSIONSNEC is a rare malignant tumor of the bladder. Immunohistochemical markers such as CD56, Syn, CgA and CKpan could be helpful in determining the diagnosis and differential diagnosis of the tumor. NEC is a highly invasive malignant tumor with poor prognosis. Based on its biological behavior, radical cystectomy is the preferred method of treatment for the tumor.

Adenocarcinoma ; pathology ; Aged ; Aged, 80 and over ; Biomarkers, Tumor ; Carcinoma, Large Cell ; pathology ; Carcinoma, Neuroendocrine ; classification ; complications ; pathology ; Carcinoma, Small Cell ; pathology ; Carcinoma, Transitional Cell ; classification ; complications ; pathology ; Cystectomy ; Female ; Hematuria ; etiology ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors ; classification ; pathology ; Prognosis ; Urinary Bladder Neoplasms ; classification ; complications ; pathology

BACKGROUNDThe research of cancer in patients on hemodialysis (HD) in China has not been reported. The aim of this study was to investigate the clinical and histological features and outcomes of cancer in Chinese HD patients.

METHODSThe study subjects were 49 cancer patients (1.4%) out of 3448 end stage renal disease (ESRD) patients maintained on HD at China-Japan Friendship Hospital from October 1997 to July 2011.

RESULTSUrinary tract cancer (74%) was the most common followed by gastrointestinal tract cancer (12%), breast cancer (6%), lung cancer (4%), thyroid cancer (2%), and hematologic cancer (2%). Thirty-three patients (67%) had urinary tract transitional cell carcinoma (TCC) and 29 of them had aristolochic acid nephropathy (AAN) as underlying disease. Death occurred in eight patients out of 49, and the survival rate of HD patients with cancer was similar to those without cancer (P = 0.120).

CONCLUSIONThe urinary tract TCC is the most common cancer in HD patients with AAN in one of the centers of northern China.

Adult ; Aged ; Aged, 80 and over ; Aristolochic Acids ; metabolism ; Carcinoma, Transitional Cell ; complications ; epidemiology ; metabolism ; China ; Female ; Humans ; Kidney Diseases ; epidemiology ; etiology ; metabolism ; Male ; Middle Aged ; Renal Dialysis ; adverse effects ; Retrospective Studies ; Urologic Neoplasms ; complications ; epidemiology ; metabolism

Primary tumor of the renal pelvis and ureter is relatively rare disease, but usually malignant. It's prognosis is dependent upon the early detection, accurate diagnosis, procedure for treatment, and tumor grade and stage. Therefore, urologist should endeavor after accurate diagnosis and definitive treatment. A clinical observation was done on the 11 patients with renal pelvic tumor and the 3 patients with ureteral tumor at the Department of Urology, Kyungpook National University Hospital during the period of 4 years from January, 1978 to December, 1981. The results were as follows: 1. There were 9 men and 5 women, giving a ratio of 1.8 to 1. The average age at presentation of the 14 patients was 51.4 years. 2. On excretory urogram, nonvisualization of the kidney was the most prevalent sign in 10 patients. Retrograde pyelogram was done in 11 patients in whom findings of IVP were not sufficient for diagnosis. Renal angi0graphy was done in 9 patients. 3. Urine cytology was positive in 2 of 14 patients. 4. Of the 13 patients treated, 12 were proved to have transitional cell carcinoma, and 1 was leiomyoma. In 3 of the 11 patients with renal pelvic tumor, Concomitant ureteral tumor was present at diagnosis. And in 2 of the 11 patients with renal pelvic tumor developed subsequent urothelial tumors in the ureter and/or bladder after simple nephrectomy. 5. Nephroureterectomy including resection of a bladder cuff was done in 11 patients, and in 2 of these was also performed lymphadenectomy. Simple nephrectomy was done in 2 patients with renal pelvic tumor under the misdiagnosis of renaltuberculosis. 6. Postoperative complications developed in 3 cases, wound infection, pneumothorax, and death, in each case.
Carcinoma, Transitional Cell ; Diagnosis ; Diagnostic Errors ; Female ; Gyeongsangbuk-do ; Humans ; Kidney ; Kidney Pelvis* ; Leiomyoma ; Lymph Node Excision ; Male ; Nephrectomy ; Pneumothorax ; Postoperative Complications ; Prognosis ; Rare Diseases ; Ureter* ; Urinary Bladder ; Urology ; Wound Infection