Malignant bladder tumors

Question 1

This is a premalignant bladder lesion (pre-squamous cell carcinoma), composed of keratinizing squamous metaplasia

Answer 1

Leukoplakia

*not to be confused with pseudomembranous trigonitis/squamous metaplasia, seen in young females (b/c estrogen)

Question 2

This is a finding of severe dysplasia, occurring in 10% of all bladder cancer patients (associated with high-grade tumors with high risk of muscle invasion progression), and is commonly symptomatic with urgency, frequency, and dysuria.

Answer 2

Carcinoma in situ (CIS)

Question 3

Treatment of CIS?

Answer 3

intravesical BCG

*Early cystectomy for BCG non-responders

Valrubicin (chemotherapy)

Question 4

Most common type of bladder cancer in USA?

Answer 4

transitional cell carcinoma (TCC)

Question 5

TCC stage if limited to the mucosa?

Answer 5

Ta

Question 6

TCC stage if in the muscularis mucosa

Answer 6

T1

Question 7

TCC stage if in the lamina propria

Answer 7

T1

Question 8

TCC stage if in the perivesicle fat?

Answer 8

T3

Question 9

TCC stage if in the muscularis propria?

Answer 9

T2

Question 10

TCC stage if in the prostatic stroma?

Answer 10

T4

Question 11

If primary urethral TCC is in the prostatic stroma, what is the stage?

Answer 11

T2

Question 12

TCC stage if through the adventitia?

Answer 12

T4

Question 13

Non muscle invasive bladder cancer includes which stages?

Answer 13

Ta, T1, CIS

Question 14

Which variant of NMIBC gives an ominous prognosis and the treatment is immediate cystectomy, as it is highly resistant to intravesical BCG and neoadjuvant chemotherapy?

Answer 14

Micropapillary variant and also sarcomatoid variant

Question 15

If a NMIBC is clinical stage T1 with lymphovascular invasion, what is the tx?

Answer 15

Early cystectomy +/- neoadjuvant chemotherapy

Question 16

Altogether, which variants of NMIBC do you skip BCG and go straight to cystectomy and chemotherapy?

Answer 16

1. T1 with lymphovascular invasion
2. Micropapillary variant
3. Sarcomatoid variant
4. Nested variant (very rare, aggressive form)

Question 17

Causes of squamous cell carcinoma of bladder?

Answer 17

1. Bilharzial SqCC (schistosoma haematobium)

2. Chronic irritation (chronic catheter, UTI, bladder calculi)

Question 18

SqCC of bladder, common mutations?

Answer 18

9p and 16p

Question 19

SqCC of bladder most common site of metastasis?

Answer 19

bone

Question 20

SqCC of bladder, this specific compound is found in urine

Answer 20

Psoriasin

Question 21

Is SqCC of bladder treated any differently than TCC?

Answer 21

No

Question 22

Types of adenocarcinoma of bladder?

Answer 22

Primary vesical

Urachal

Question 23

Pathogenesis of primary vesical adenocarcinoma?

Answer 23

usually at bladder dome, response to chronic inflammation. Mucin-producing and poorly differentiated. Signet ring adenocarcinomas may produce linitis plastica of the bladder.

most commonly associated with extrophy

Question 24

Pathogenesis of urachal adenocarcinoma

Answer 24

Located at bladder dome, due to a persistent/patent urachus

One of the few indications for a partial cystectomy

Question 25

What is the dissection template for a partial cystectomy of a persistent urachus? (Anterior, lateral, superior, and inferior)

Answer 25

Anterior: include posterior rectus sheath Lateral: area between medial umbilical ligaments Superior: include the umbilicus Inferior: bladder cuff of benign urothelium surround urachal attachment

Question 26

Before treating adenocarcioma (just like TCC), what must you r/o?

Answer 26

Metastatic etiology, since adenocarcinoma is <2% of all bladder cancers

Question 27

This is a rare, poorly differentiated neuroendocrine bladder epithelial tumor that is very aggressive, with a five year survival rate of all stages near 20%

Answer 27

Small cell carcinoma

Question 28

What are some immunohistochemical stains for neuroendocrine small cell carcinoma of the bladder?

Answer 28

``` neuron-specific Enolase **Synaptophysin Serotonin **S-100 **Chromogranin ```

Question 29

Tx of small cell carcinoma of bladder?

Answer 29

**1st line is chemotherapy (VP-16 = cisplatin, etoposide), then radical cystectomy if responds

Question 30

What is the treatment for symptomatic bone metastasis?

Answer 30

Radiotherapy