A 75-year-old female presented with a 7-month history of intermittent macrohematuria and urinary retention. Physical examination revealed a firm, round mass on the anterior vaginal wall. The diagnosis by urethroscopy and radiological evaluation was localized urethral diverticular tumor. Pathological examination of the biopsy specimen revealed adenocarcinoma. The patient received two courses of intra-arterial and systemic chemotherapy using cisplatin, 5-fluorouracil and leucovorin, followed by radiation to the urethra. The tumor shrunk markedly after chemotherapy. The patient underwent total urethrectomy and vesicostomy. Two years after the operation, she had no evidence of recurrence. Adenocarcinoma of the female urethral diverticulum is rare and has been treated by surgery and/or radiation. The present case is the first case of it being treated by multimodality therapy including chemotherapy.
Urachal adenocarcinoma is a rare bladder tumor, occasionally associated with calcification. We report a case of urachal adenocarcinoma with remarkable stromal osseous metaplasia and review the literature on this rare condition. This is the first complete case report in English of this uncommon entity.
Background: Primary invasive adenocarcinoma of the urinary bladder was diagnosed in a 59-yearold man with a 6-month history of macrohematuria. Methods: He was treated with intra-arterial infusion of 5-fluorouracil, leucovorin and cisplatin and underwent radical cystectomy and construction of ileal conduit.
Results:The pathologic examination of the specimen revealed no viable malignant cells. Conclusion: 5-Fluorouracil combined with leucovorin and/or cisplatin has been used in the treatment of gastrointestinal adenocarcinoma and may be useful in primary adenocarcinoma of the bladder.
BackgroundDespite improvement in the response rate and protraction of the progression‐free period of urothelial cancer produced by chemotherapy, severe bone marrow suppression often results in delays in the initiation of treatment cycles and/or decreases in drug dosages. Reduction of leukopenia during chemotherapy has been demonstrated by the combined administration of granulocyte colony‐stimulating factor (G‐CSF) in various malignancies.MethodsA phase I/II study was conducted to assess whether the interval between cycles of CISCA (cyclophosphamide, doxorubicin, cisplatin) chemotherapy could be shortened under support of recombinant human granulocyte colony‐stimulating factor (rhG‐CSF) for urothelial cancer. Three or more patients with transitional cell carcinoma of the urinary tract were allocated to each of four different treatment intervals (step 1: 28 days, step 2: 21 days, step 3: 17 days, and step 4: 14 days) by reducing the interval in a step‐wise manner. Two mg/kg/day of a rhG‐CSF, lenograstim, was injected subcutaneously on days 3 to 16 (until day 14 for the 14‐day interval group).ResultsSixteen patients were enrolled, four patients were treated with the step 1 protocol, five with step 2, four with step 3, and three with step 4. Leukopenia/neutropenia was the most severe toxic reaction, but none of the patients at any step manifested neutropenia of WHO grade 4 for more than four days. There were no significant differences in the hematological and nonhematological toxicities among the 4 steps. Seven of eight patients with measurable diseases were treated with CISCA on shortened schedules (steps 2–4), and one complete remission (CR) and four partial responses (PR) were demonstrated.ConclusionsCISCA chemotherapy supported by rhG‐CSF was safely shortened to a 14‐day interval in the pilot study. The potential role of rhG‐CSF in shortening the interval of CISCA, as well as the benefit of the intensified schedule, remains to be clarified.
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