Urothelial Carcinoma of the Urinary Bladder Associated with Intestinal Augmentation Cystoplasty
MT Sung, Z Zhang, M Wang, MO Koch, MP Cain, RC Rink, L Cheng. Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Indiana University School of Medicine, Indianapolis, IN
Background: Patients who have undergone intestinal augmentation cystoplasty are at risk for developing latent vesical malignancy.The present study was conducted to evaluate the histological and immunohistochemical characteristics and molecular genetic alterations in these neoplasms.
Design: Four patients developing urothelial neoplams after augmentation cystoplasty were included in the current study. Tumor specimens were assessed for morphological features and immunohistochemical expression of uroplakin III, CDX2, -catenin, and cytokeratin 7 and 20. Gene mutations in fibroblast growth factor receptor 3 (FGFR3) gene and p53 gene were analyzed and the UroVysion fluorescence in situ hybridization (FISH) tests were performed.
Results: The mean age of the patients, including two men and two women, was 37. The latency from bladder augmentation to developing malignancy ranged from 17 to 21 years (mean 19 years). All patients died of widespread metastasis months after cancer diagnosis (mean, 5 months). All tumors were high-grade (grade 3) invasive urothelial carcinoma comprising various architectural patterns with brisk mitoses and tumor necrosis. Three harbored glandular differentiation (75%) and the remaining one showed squamous differentiation (25%). All cases revealed abnormal decreasing -catenin expression with moderate to strong membranous staining in 3060% of tumor cells. Two tumors (50%) showed nuclear expression of CDX2, with variable staining intensity and percentages. Moderate uroplakin III staining was focally identified in one case. All but one tumors (75%) were intensely stained by cytokeratin 7. One case (25%) displayed focal cytokeratin 20 expression. In FISH analysis, all tumors displayed characteristic chromosomal abnormalities (100%). Point mutations of both FGFR3 and p53 genes were identified in one case.
Conclusions: Neoplasms developed after augmentation cystoplasty were extremely aggressive urothelial carcinoma and exhibited distinct morphologic, immunohistochemical and genetic characteristics. These neoplasms represent a rare and specific variant of urothelial carcinoma which is uniformly lethal. The UroVysion FISH analysis may offer a surveillance strategy in patients who underwent augmentation cystoplasty.
Category: Genitourinary (including renal tumors)
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 97, Tuesday Morning