Invasive carcinoma in bladder exstrophy with transitional, squamous and mucus-producing...
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British Journal of Urology (1998), 81, 173–174 CASE REPORT Invasive carcinoma in bladder exstrophy with transitional, squamous and mucus-producing diVerentiation V. VIK, E.W. GERHARZ andC.R.J. WOODHOUSE The Institute of Urology and Nephrology, University College London Medical School, London, UK larly soft. Histology showed invasive carcinoma with Case report transitional, squamous and mucus-producing diCeren- tiation. Three weeks after the diagnosis, pelvic lymphad- A 48-year-old man who had undergone ureterosigmoid- ostomy and cystectomy for bladder exstrophy at age 2 enectomy was performed and the remnant of the exstrophy bladder was removed together with the pros- years presented with intermittent bleeding from a ‘seminal fistula’ (Figs 1 and 2) at the annual routine tate. A small undescended testicle was discovered on the left side and exstirpated. A large defect in the abdominal follow-up. Physical examination revealed a firm, non- tender mass underneath the lesion. Under general anaes- wall was filled using a 20×30 cm Marlex mesh. The patient recovered uneventfully. The final histopathology thesia, a biopsy was taken from the irregular wart-like area. On bimanual palpation, the prostate was irregu- report confirmed the result of the biopsy, describing carcinoma with transitional, squamous and glandular diCerentiation invading the prostate. A prostatic origin of the tumour was excluded immunohistochemically. The surgical margins and lymph nodes were free of tumour. Comment Advances in paediatric medicine and urology have led to a dramatic decrease in mortality of patients with bladder exstrophy. In 1926, 67% of patients suCering from this condition died before the age of 20 years. Within the last four decades only a few deaths related to malignancy in exstrophy bladders have been reported [1]. In these cases, the tumours showed the histological Fig. 1. Seminal fistula in a previous bladder exstrophy 46 years Fig. 2. Staging CT of the abdomen, showing an irregular defect in front of the prostate and ureterosigmoidostomy. after cystectomy. 173 © 1998 British Journal of Urology
Transcript of Invasive carcinoma in bladder exstrophy with transitional, squamous and mucus-producing...
British Journal of Urology (1998), 81, 173–174
CASE RE PORT
Invasive carcinoma in bladder exstrophy with transitional,squamous and mucus-producing diVerentiationV. VIK, E .W. GERHARZ and C.R.J. WOODHOUSEThe Institute of Urology and Nephrology, University College London Medical School, London, UK
larly soft. Histology showed invasive carcinoma withCase report
transitional, squamous and mucus-producing diCeren-tiation. Three weeks after the diagnosis, pelvic lymphad-A 48-year-old man who had undergone ureterosigmoid-
ostomy and cystectomy for bladder exstrophy at age 2 enectomy was performed and the remnant of theexstrophy bladder was removed together with the pros-years presented with intermittent bleeding from a
‘seminal fistula’ (Figs 1 and 2) at the annual routine tate. A small undescended testicle was discovered on theleft side and exstirpated. A large defect in the abdominalfollow-up. Physical examination revealed a firm, non-
tender mass underneath the lesion. Under general anaes- wall was filled using a 20×30 cm Marlex mesh. Thepatient recovered uneventfully. The final histopathologythesia, a biopsy was taken from the irregular wart-like
area. On bimanual palpation, the prostate was irregu- report confirmed the result of the biopsy, describingcarcinoma with transitional, squamous and glandulardiCerentiation invading the prostate. A prostatic originof the tumour was excluded immunohistochemically.The surgical margins and lymph nodes were free oftumour.
Comment
Advances in paediatric medicine and urology have ledto a dramatic decrease in mortality of patients withbladder exstrophy. In 1926, 67% of patients suCeringfrom this condition died before the age of 20 years.Within the last four decades only a few deaths relatedto malignancy in exstrophy bladders have been reported[1]. In these cases, the tumours showed the histological
Fig. 1. Seminal fistula in a previous bladder exstrophy 46 years Fig. 2. Staging CT of the abdomen, showing an irregular defect infront of the prostate and ureterosigmoidostomy.after cystectomy.
173© 1998 British Journal of Urology
174 CASE REPORTS
2 Justrabo E, Poulard G, Arnould R. Invasive adenocarcinomafeatures of an adenocarcinoma. A case of invasive aden-with epidermoid carcinoma on the site of bladder exstrophy.ocarcinoma and in situ squamous cell carcinoma wasArch Anat Cytol Pathol 1991; 39: 223–7recently published [2]. To our knowledge, this is the first
3 Williams DI. Epispadias and exstrophy. In Eckstein HB,report of a tumour disclosing all three elements ofHohenfellner R, Williams DI eds, Surgical Paediatric Urology.exstrophy mucosa, as described by Williams in 1977Stuttgart: Georg Thieme 298–312
[3]. As the patient’s bladder had not been exposed tourine for the last 46 years, urinary carcinogens areunlikely to have contributed to the aetiology of the
Authorstumour.V. Vik, MD, Senior House OBcer.E.W. Gerharz, MD, Research Fellow.
References C.R.J. Woodhouse, FRCS, Senior Lecturer, Consultant Urologist.Correspondence: Mr C.R.J. Woodhouse, The Institute of Urology1 Strachan JR, Woodhouse CRJ. Malignancy following uretero-
sigmoideostomy in patients with exstrophy. Br J Surg 1991; and Nephrology, University College London Medical School,48 Riding House Street, London W1P 7PN, UK.78: 1216–8
