An unusual case of a tuberculous granuloma of the liver presenting thirteen years after intravesical BCG - therapy for bladder cancer

The authors present the case of a female patient with a tumor of the 7th liver segment, which was postoperatively identified as a tuberculous granuloma. The patient was admitted for elective surgery for a liver tumor, which had been diagnosed a few months before. Computed tomography and nuclear magnetic resonance had been performed, based on which focal nodular hyperplasia had been suspected. Thirteen years prior to admission the patient had undergone a transurethral resection of a superficial bladder carcinoma, followed by adjuvant intravesical Bacillus Calmette-Guérin (BCG- therapy). Upon surgery, the 7th segment of the liver was resected; postoperative course were uneventful. After identification of the granuloma the patient was referred to a phthysiatric clinic for further diagnostics and treatment. The authors have deemed this case worthy of reporting primarily due to the exceptionally long period between the completion of the BCG therapy and the onset of the hepatic tumor.

A RARE COMPLICATION OF BCG IMMUNOTHERAPY

Intravesical Bacillus Calmette-Guérin immunotherapy is an effective agent for superficial bladder carcinoma. The main adverse effect of this treatment is cystitis. Arthralgia and migratory arthritis occur only in 0.5% of patients. Reiter syndrome is a very rare complication that can occur after intravesical apply of Bacillus Calmette-Guérin Immunotherapy. We report the first Albanian patient who developed Reiter’s syndrome, following intravesical Bacillus Calmette-Guérin. Diagnose of Reiter’s Syndrome was clinically based, excluding every other reason that could have caused it. Treatment was made with non-steroid and steroid anti-inflammatory drugs, followed by a full recovery result. Even though Reiter's Syndrome is a rare, but significant complication of BCG immunotherapy, it’s important to identify it in time, in order we to offer an adequate treatment.

BCG Immunotherapy for Bladder Carcinoma

Purpose: We reviewed the literatures to see history, regimen of BCG and how BCG become a standard therapy for bladder carcinoma.Materials and Methods: We reviewed the previous literature describing the bacillus Calmette-Guerin (BCG) vaccine as an anticancer agent and its success as the most effective immunotherapy used against human bladder cancer and its adverse effects.Results: The association between tuberculosis and carcinoma is well established, It demonstrate that Bacillus Calmette-Guerin have immunological reactivity, inhibiting the tumor growth and progression in experimental animal models, led to clinical trials showing that intravesical Bacillus Calmette-Guerin eradicate and prevent recurrence and progression of superficial bladder carcinoma The exact mechanism of action of intravesical BCG instillation is still under investigation. However, it appears that BCG is mediated by the local immune response, mainly through T-helper cell response. It reduces the recurrence rate by an average of 40% and progression by more than 20% in papillary tumors, Carcinoma-in-situ over the patients without BCG therapy.Conclusions: For the last 45 yrs Bacillus Calmette- Guerin therapy has remained first line intravesical immunotherapy for superficial bladder cancer, an outstanding example of successful immunotherapy.KYAMC Journal Vol. 8, No.-1, Jul 2017, Page 56-60

Bladder perforation after immediate postoperative intravesical instillation of mitomycin C

Intravesical chemotherapy after transurethral resection of a bladdertumour (TURBT) has been observed to significantly decreaserecurrence rates compared to TURBT alone. Though immediatepostoperative intravesical treatment with chemotherapeutic agentsafter transurethral resection for superficial bladder carcinoma isgenerally considered a safe and effective adjunctive therapy indecreasing recurrence rates, its instillation is not always completelyinnocuous. Lately, a more serious complication of bladderperforation associated with immediate instillation of intravesicalmitomycin C (MMC) after TURBT was reported. We reportour own experience of a male patient with bladder perforationafter an early instillation of a single dose of MMC. In this case,systemic toxicity occurred which required intensive care aftersurgical repair.

KARSINOMA KANDUNG KEMIH

We reported a case of bladder carcinoma in a male of 65 years. The main complaints were hematuria, urinary frequency, dysuria, urgency, loss of weight, and pain in the genital area spreading to the lower abdomen. Diagnosis made by clinical, laboratory, and cytological examinations had no result. Final diagnosis was made by ultrasonography and cystoscopy, associated with transurethral biopsy and histopathological examination. The result was papillary transitional cell carcinoma, class II; and according to TNM it was a superficial bladder carcinoma in stadium at least T1. Transurethral resection of the tumor was done, and intravesical medicine was given (mitomycin C 40 mg once a week for 6 weeks). The patient was advised to stop smoking and drinking coffee. The prognosis was good. Key words: hematuria, bladder tumor, USG, cystoscopy, tansurethral resection. Abstrak: Telah dilaporkan kasus karsinoma kandung kemih pada seorang laki-laki berusia 66 tahun. Keluhan utama: hematuri, urgensi, disuri, frekuensi, penurunan berat badan, dan nyeri di kemaluan sampai perut bagian bawah. Diagnosis yang ditegakkan berdasarkan pemeriksaan klinis, laboratorium, sitologi tidak memberi hasil positif. Diagnosis pasti ditegakkan berdasar-kan ultrasonografi dan sistoskopi, disertai biopsi transuretral dan pemeriksaan histopatologi. Hasil yang diperoleh karsinoma sel transisional papiler kelas II, dan berdasarkan TNM sebagai karsinoma kandung kemih superfisial dengan stadium sekurang-kurangnya T1. Penanganan yang dilakukan adalah reseksi tumor transuretral yang diikuti pemberian obat intravesika (mitomicyn C 40 mg sekali seminggu selama 6 minggu), dan penderita dianjurkan untuk berhenti merokok dan berhenti minum kopi. Prognosis penderita ini baik. Kata kunci: hematuria, tumor kandung kemih, USG, sistoskopi, reseksi transuretral.