Clinical results of patients with primary bladder cancer inside the diverticula

Abstract

Objective: In this study, we examined the clinical courses of bladder tumors primary detected in a vesicular diverticulum. 

Materials and Methods: We retrospectively examined our clinical data between 2006- 2015 and 8 patients has diagnosed primary bladder cancer within a vesicular diverticulum. All diagnosis were made with cystoscopic examination. After the diagnosis CT or MRI was done for the staging. Initially transurethral resection of bladder tumour with subsequent intravesical chemoterapy mitomycin\epirubicine was applied. According to the pathological results, if needed intravesical chemoterapy / immunotherapy was given in the follow up. 

Results: In our study diverticular bladder cancer patients generally presented to the urology service with hematuria and they were incidentally detected with USG while they were evaluating for bladder outlet obstruction. The majority of tumors detected in diverticula were <3cm and half was fixed in one focus. Obstructive prostate lobes were seen in all patients and in the follow-up period ‘s additional prostate surgery has been applied in 40% of the patients. Primary tumor pathology was reported as pTa low garde in 87.5% of the patients. In 62.5% of patients recurrence was found in the same diverticulum or in other locations of the bladder). In follow-up period intravesical chemotherapy was applied in 37.5% of the patients, 25% received treatment with immunotherapy. After the first surgery no recurrence was seen in 37.5% of patients. None of the patients showed stage progression. In one patient grade progression was seen who had disease recurrence . 

Conclusion: According to our current data, bladder tumors in the diverticulum tend to be small and low grade. 

Keywords

• Bladder tumor
• diverticulum

Divertikül içi primer mesane tümörlü hastalarımızın klinik takip sonuçları

Abstract

Giriş: Bu çalışmada kliniğimizde primer olarak divertikül içerisinde tespit edilen mesane tümörlerinin klinik seyirleri incelenmiştir. 

Gereç ve Yöntem: 2006-2015 yılları arasında divertikül içi mesane tümörü tespit edilen toplam 8 hastanın verileri retrospektif olarak değerlendirildi. Sistoskopi ile tanısı kesinleştirilen ve bilgisayarlı tomografi veya manyetik rezonans görüntüleme kullanılarak mesane dışına yayılım olmadığı gösterilen hastalara standart olarak TUR-mesane ameliyatı ve postoperatif 6 saat içerisinde intravezikal mitomisin/epirubisin kemoterapisi uygulandı. Patoloji sonuçlarına göre takip programına alınan hastalara lüzum halinde intravezikal kemoterapi/immünoterapi tedavileri de verildi. 

Bulgular: En sık şikayet mesane çıkım obstrüksiyonuna bağlı işeme yakınmaları ve hematüri olarak değerlendirildi. Divertikül içerisinde tespit edilen tümörlerin büyük çoğunluğu <3cm ve yarısı tek odak halinde tespit edildi. Tüm hastalarda prostat lobları obstrüktif olarak görüldü ve takip süresi içerisinde % 40 ‘ına ilave prostat cerrahisi de uygulandı. Primer tümör patolojileri %87.5 pTa düşük grade olarak raporlandı. % 62.5 hastada aynı divertikül veya mesanenin başka yerinde nüks tespit edildi. Hastaların %37.5’ i takip süresi içerisinde intravezikal kemoterapi, %25’ i immünoterapi tedavisi aldı. %37.5 hastada ilk ameliyat sonrası hiç nüks gelişmedi. Hiçbir hastada evre ilerlemesi görülmedi. 1 hastada ise nükslerinde yüksek grade ilerleme tespit edildi. 

Sonuç: Elde edilen verilere göre primer divertikül içi mesane tümörleri 

Keywords

• divertikül
• Mesane
• Tümörü

References

1. 1. Zhong H, George S, Kauffman E, et al. Clinicopathologic characterization of intradiverticular carcinoma of urinary bladder - a study of 22 cases from a single cancer center. Diagn Pathol 2014;9:222.
2. 2. Walker NF, Gan C, Olsburgh J, et al. Diagnosis and manage- ment of intradiverticular bladder tumours. Nature Reviews Urology 2014;11:383-90.
3. 3. Prakash, Rajini T, Kumar Bhardwaj A, V J, et al. Urinary bladder diverticulum and its association with malignancy: an anatomical study on cadavers. Rom J Morphol Embryol 2010;51:543-5.
4. 4. Micic S, Ilic V. Incidence of neoplasm in vesical diverticula. The Journal of urology 1983;129:734-5.
5. 5. Das S, Amar AD. Vesical diverticulum associated with blad- der carcinoma: therapeutic implications. The Journal of urology 1986;136:1013-4.
6. 6. Baniel J, Vishna T. Primary transitional cell carcinoma in vesical diverticula. Urology 1997;50:697-9.
7. 7. Kong MX, Zhao X, Kheterpal E, et al. Histopathologic and clinical features of vesical diverticula. Urology 2013;82:142-7.
8. 8. Tamas EF, Stephenson AJ, Campbell SC, et al. Histopatho- logic features and clinical outcomes in 71 cases of bladder diverticula. Arch Pathol Lab Med 2009;133:791-6.

9. 9. Idrees MT, Alexander RE, Kum JB, et al. The spectrum of histopathologic findings in vesical diverticulum: impli- cations for pathogenesis and staging. Human pathology 2013;44:1223-32.
10. 10. Bourgi A, Ayoub E, Merhej S. Diverticulectomy in the Management of Intradiverticular Bladder Tumors: A Twelve-Year Experience at a Single Institution. Adv Urol 2016;2016:2345306.
11. 11. Babjuk M, Oosterlinck W, Sylvester R et al.Guidelines on nonmuscle-invasive bladder cancer (TaT1 and CIS). Euro- pean Association of Urology 2016.
12. 12. Faysal MH, Freiha FS. Primary neoplasm in vesical diverti- cula. A report of 12 cases. Br J Urol 1981;53:141-3.
13. 13. Di Paolo PL, Vargas HA, Karlo CA, et al. Intradiverticular bladder cancer: CT imaging features and their association with clinical outcomes.Clin Imaging 2015;39:94-8.