Tumor heterogeneity evaluated by computed tomography detects muscle-invasive upper tract urothelial carcinoma that is associated with inflammatory tumor microenvironment

To detect muscle-invasive upper tract urothelial carcinoma, we evaluated the internal texture of the tumor using texture analysis of computed tomography images in 86 cases of upper tract urothelial carcinoma. The internal texture of the tumor was evaluated as the value of computed tomography attenuation number of the unenhanced image, and the median, standard deviation, skewness and kurtosis were calculated. Each parameter was compared with clinicopathological factors, and their associations with postoperative prognosis were investigated. Immunohistochemistry was performed to investigate the histological and molecular mechanisms of the inflammatory tumor microenvironment. The histogram of computed tomography attenuation number in non-muscle invasive tumor was single-peaked, whereas muscle invasive tumor showed a multi-peaked shape. In the parameters obtained by texture analysis, standard deviation was significantly associated with pathological stage (p < 0.0001), tumor grade (p = 0.0053), lymphovascular invasion (p = 0.0078) and concomitant carcinoma in situ (p = 0.0177) along with recurrence-free (p = 0.0191) and overall survival (p = 0.0184). The standard deviation value correlated with the amount of stromal components (p < 0.0001) and number of tumor-infiltrating macrophages (p < 0.0001). In addition, higher expression of high mobility group box 1 was found in heterogeneous tumor. Tumor heterogeneity evaluated by texture analysis was associated with muscle-invasive upper tract urothelial carcinoma and represented an inflammatory tumor microenvironment and useful as the clinical assessment to differentiate muscle invasive tumor.

New Insights into the Diagnosis, Molecular Taxonomy, and Treatment of Bladder Cancer

<p>This review aims to emphasize new insights into the diagnosis, classification, and therapy of bladder cancer (BC). Bladder cancer is a heterogeneous, complex disease on a morphological, molecular, diagnostic, and prognostic level. Cancer stage is still the most important attribute for prognosis and treatment, while early detection with optimal and rapid individual therapeutic and surveillance approach is crucial. The vast majority of patients have a superficial, non-muscle-invasive tumor associated with a good prognosis after resection and adjuvant intravesical maintenance immuno or chemotherapy if needed. On the other hand, muscle-invasive bladder cancer is a highly aggressive disease with high morbidity and mortality. However, it has become a model for oncology success over the last five years with many available targeted therapeutic modalities. Metastatic BC is now amenable to multimodal treatment combining cystectomy and neoadjuvant chemotherapy and immunotherapy and is a target for precision medicine.</p><p><strong>Conclusion</strong>. A new molecular taxonomy for bladder cancer has been proposed and provided insight into BC’s carcinogenesis, with some possible effects on therapy decisions. However, this classification is still not applicable in routine clinical practice. It opens new questions regarding the interplay between tumor genetic signature, intratumoral heterogeneity, therapy implications, and tumor progression.</p>

Giant Muscle Invasive Dermatofibroma Clinically Mimicking a Malignant Tumor

Dermatofibromas are common benign fibrohistiocytic lesions, usually appearing as slow growing firm dermal nodules with a predilection for the extremities (mostly the lower legs). They are found mostly in middle-aged women and are usually smaller than 2 cm in diameter. Giant dermatofibromas exceeding 5 cm in diameter are rare. In recent years, reports have suggested a relationship between the primary size of dermatofibromas and rates of local recurrence and metastases after surgery. This relationship is however debated. The present report describes the case of a giant muscle invasive tumor in a 51-year-old female patient who presented with a large ulcerated mass in the right upper arm. The tumor appeared clinically malignant, measuring approximately 12 cm × 6 cm in size, with ulceration and invasion of surrounding muscle. Wide resection of the tumor was performed with myocutaneous flap-plasty. Histopathological examination showed evidence of a dermatofibroma. No recurrence, metastases, or other complications were noted at 5 years after surgery. The present case demonstrates that although dermatofibromas are essentially benign, they may present with atypical features including large size, ulceration, and muscle invasion, clinically mimicking malignant tumors.

Analytical study of bladder tumor

Background: Treatment of bladder tumor still provides the romance in Urology. The purpose of this study is to study the prevalence of various types of bladder tumors, to compare various treatment modalities for bladder tumors, to study different presentations of patients with bladder tumor.Methods: The present study was a prospective analytical study of 30 patients of bladder tumor conducted at Dhiraj General Hospital attached to S.B.K.S Medical College from October 2011 to July 2013. All the details of patients in term of demography, risk factors, symptoms and sign, radiological, endoscopic, histopathological features, various treatment modalities offered, and follow-up of patients were studied and analysed using descriptive statistics.Results: Maximum number of patients was presented in sixth decade of life. Youngest patient was 30 years old and oldest patient was 77 years old. 80% patients were male, and 20% patients were female. History of smoking was present in 22 patients, history of exposure to occupational hazards was present in 4 patients and only 2 patients had positive family history. Majority 93.3% patients were presented with haematuria and 16 patients had anaemia. 15 patients had high grade muscle invasive TCC, followed by 10 patients with low grade non-muscle invasive TCC. 3 patients were having low grade non-muscle invasive SCC, 1 patient was having high grade muscle invasive SCC and 1 patient was having high grade non-muscle invasive TCC.Conclusions: The findings of the study conclude that TURBT followed by intravesical instillation of BCG gave good results in patients with low grade and high grade non-muscle invasive tumor. For muscle invasive tumor radical cystectomy with urinary diversion is the ideal treatment but TURBT followed by radiotherapy has also given good results with fewer side effects.

Inflammatory Myofibroblastic Tumor in the Bladder: A Case Report

A 36-year-old male was referred to our department for further examination of asymptomatic gross hematuria emanating from a bladder tumor. Cystoscopy revealed a broad-based tumor 40 mm in diameter. Urinary cytology was negative. Preoperative magnetic resonance imaging suggested a muscle invasive tumor. Transurethral resection was performed, and the pathological findings revealed an inflammatory myofibroblastic tumor. We herein report a rare case of bladder inflammatory myofibroblastic tumor.