Squamous cell carcinoma arising from suprapubic cystotomy site without bladder involvement

Stroumbakis, Nicholas; Choudhury, Muhammed; Hernandez-Graulau, Jose M.

doi:10.1016/0090-4295(93)90107-l

Cited by 18 publications

(25 citation statements)

References 7 publications

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“…Box 4446, 6401 CX Heerlen, The Netherlands carcinoma of the bladder in patients with indwelling catheters for more than 10 years. 4 Based on a study of spinal cord injury patients with indwelling catheters for more than 10 years, demonstrating a prevalence of 20% of squamous cell carcinoma of the bladder, Kaufman et al 2 advocate periodic cystoscopy combined with random bladder biopsies for this category of patients. Squamous cell carcinoma of the suprapubic tract or arising from the skin and subcutaneous tissues tends to be localised at the time of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore wide excision of the abdominal wall involved, together with partial removal of the bladder dome as in our patient, seems justi®ed. 4 However, other authors stress that aggressive surgical excision of the complete bladder and the abdominal wall involved is the only e ective current treatment. 3 Since this type of cancer is so extremely rare, it must be concluded that treatment recommendations are necessarily anecdotal.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 The ®rst case reported in 1993 concerned a squamous cell carcinoma arising adjacent to the suprapubic cystostomy site and extending anteriorly to the abdominal wall in a 80-yearold man, 5 years after suprapubic urinary diversion for urethral stricture. 4 A second case published in 1995 described a 50-year-old paraplegic man (T11 ± T12 spinal cord injury) in whom a suprapubic cystostomy tract squamous cell carcinoma developed after 25 years of urinary diversion. The tumour involved the cystostomy tract primarily with extension into the bladder but did not penetrate the bladder wall muscle.…”

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Squamous cell carcinoma of suprapubic cystostomy tract without bladder involvement

1999

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This report describes a third case of squamous cell carcinoma of the suprapubic cystostomy tract. 3,4 The ®rst case reported in 1993 concerned a squamous cell carcinoma arising adjacent to the suprapubic cystostomy site and extending anteriorly to the abdominal wall in a 80-yearold man, 5 years after suprapubic urinary diversion for urethral stricture. 4 A second case published in 1995 described a 50-year-old paraplegic man (T11 ± T12 spinal cord injury) in whom a suprapubic cystostomy tract squamous cell carcinoma developed after 25 years of urinary diversion. The tumour involved the cystostomy tract primarily with extension into the bladder but did not penetrate the bladder wall muscle. 3 Our patient is in fact the second one to have a suprapubic cystostomy tract squamous carcinoma not involving the bladder.Keywords: spinal cord injury; suprapubic catheter; squamous cell carcinoma of cystostomy tract Case ReportA 63-year-old Caucasian paraplegic male patient who had a suprapubic Foley catheter for 37 years after spinal cord injury, developed a huge suprapubic mass. He had su ered from advanced kyphoscoliosis in infancy (thoracic kyphosis, lumbar lordosis), which needed surgical correction at the age of 18 years. An operation on the spinal column (laminectomy T5 ± T9) resulted in a spinal cord injury, incomplete T4 and complete T7 (T4 ± T7 sensory/motor de®cit). Six years later a urethral diverticulum with abscess formation perforated spontaneously. A urethral ®stula persisted, and a suprapubic cystostomy tube was eventually required 2 years later. The further medical history revealed recurrent urinary tract infections and the growth of a bladder stone. Physical examination showed an exophytic mass (1065 cm in size) in the abdominal wall enveloping the suprapubic catheter. Urine cytology was negative. Cystoscopy revealed in¯ammatory changes of the mucosa without evidence of tumour growth. Earlier urodynamic examination showed a neurogenic bladder (upper motor neuron lesion with hyperre¯exia of the bladder). Ultrasound examination of the kidneys did not show any dilatation. Both on the CT-scan and the MRI of the abdomen a tumour mass surrounding the suprapubic cystostomy tract was clearly visible ( Figure 1). Multiple at random biopsies of the bladder failed to show any malignant changes. However, histological examination of biopsies from the suprapubic tract and the suprapubic mass revealed squamous cell carcinoma.The patient underwent a wide excision of the tumour mass also invading the rectus muscle, with partial removal of the dome of the bladder (Figure 2). Microscopic analysis revealed a moderately differentiated squamous cell carcinoma of the suprapubic tract but there was no bladder involvement. All the surgical margins were free of tumour. Five months after surgery the patient died of pneumonia but autopsy showed no evidence of any local recurrence or metastasis. DiscussionSquamous cell carcinoma is a rare form of carcinoma of the bladder, accounting for 5% of the total. 1 The prognosis is generally un...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Squamous cell carcinoma of suprapubic cystostomy tract without bladder involvement

1999

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“…7 This was first described by Stoumbakis and colleagues in 1993. 9 They presented a patient who required suprapubic catheterization for urethral strictures. Five years after the insertion, SCC was found at the cystotomy site with extension into the squamous cell carcinoma of the suprapubic tract abdominal wall, but no bladder involvement.…”

Section: Discussionmentioning

confidence: 99%

“…This has been described in only a handful of cases. [9][10][11][12][13] We present 2 additional patients who developed SCC arising from their suprapubic catheter sites and discuss their surgical management and outcomes. …”

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Squamous cell carcinoma of the suprapubic tract: A rare presentation in patients with chronic indwelling urinary catheters

Massaro

Moore

Rahmeh

et al. 2014

CUAJ

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Squamous cell carcinoma (SCC) of the bladder is uncommon, but can arise in the setting of long-term bladder catheterization and chronic inflammation. SCC can arise primarily from the suprapubic catheter tract, but fewer than 10 such cases have been reported. We document 2 cases of SCC arising from the suprapubic tract associated with chronic indwelling urinary catheters. SCC must be differentiated from granulomatous conditions, which are quite common in patients with suprapubic catheters. IntroductionSquamous cell carcinoma (SCC) of the bladder is a rare condition in the general population, making up about 5% of all bladder tumours.1 Risk factors for SCC of the bladder include states of chronic inflammation and infection, such as long-term indwelling catheters or infection with Schistosoma haematobium primarily in endemic regions. 2A higher incidence of SCC in the spinal cord injury (SCI) population has been documented on the order of 2% to 10% beyond 10 years of catheterization.3-6 Among patients with SCI, about 50% of cases of primary bladder cancer are SCC. The risk is thought to stem from irritation and inflammation related to the chronic use of both urethral and suprapubic catheters, 3,7 chronic infections, 8 bladder stones 8 or, possibly, the inherent pathology of the neurogenic bladder itself. 5Although patients requiring long-term indwelling catheters are at increased risk of developing SCC, those with suprapubic catheters may more rarely develop SCC arising primarily from the suprapubic tract itself. This has been described in only a handful of cases. [9][10][11][12][13] We present 2 additional patients who developed SCC arising from their suprapubic catheter sites and discuss their surgical management and outcomes. Case 1A 55-year-old male, with a history of paraplegia secondary to spinal tuberculosis acquired at 16 years of age, presented with a 15-month history of an expanding, large, fungating lesion encircling his suprapubic catheter site. The catheter had been inserted within the first year of the onset of paraplegia. The patient's history was otherwise unremarkable and he was a lifelong non-smoker. There was no history of travel to areas endemic with Schistosoma haematobium. Examination of the lesion revealed an area of 15-cm in maximum diameter around the catheter site (Fig. 1). A biopsy of the lesion was diagnostic for SCC.Cystoscopy revealed a contracted bladder, but no evidence of stones, fistulae, or tumours of the mucosa or suprapubic tract. Biopsies of the bladder and suprapubic tract were negative for malignancy. Computed tomography (CT) showed infiltration of the mass into the anterior bladder wall, extending into the deep subcutaneous tissue and abdominal wall musculature (Fig. 2). Lymph nodes were negative. Subsequent bone scan was negative for bony metastases.Excision of the tumour was carried out by both the urology and plastic surgery services. Intra-operatively, the tumour invaded the anterior rectus fascia, rectus abdominus, periosteum of the pubic symphysis and spermatic ...

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A case of squamous cell carcinoma arising from a suprapubic cystostomy tract in a patient with spinal bifida: Immunohistochemical analysis and literature review

et al. 2022

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Introduction Squamous cell carcinoma arising from a suprapubic cystostomy tract is a rare complication of an indwelling catheter and is caused by long‐term inflammation and mechanical irritation. Prognosis is relatively poor. Biomarkers in the cancer pathway have not been investigated. Case presentation A 61‐year‐old woman with a 34‐year history of suprapubic catheter placement presented with a rapidly growing elevated lesion around the cystostomy site. Tumor biopsy confirmed squamous cell carcinoma. Local excision with partial cystectomy was performed. Multiple metastases were identified 5 months later. The patient died 14 months after the initial treatment. Immunohistochemical analysis of the resected specimen revealed alterations in vascular endothelial growth factor, epidermal growth factor receptor, cyclooxygenase‐2, and Ki‐67. Conclusion We encountered a case of squamous cell carcinoma arising from a suprapubic cystostomy tract. Immunohistochemical analysis revealed activation of multiple carcinogenic pathways in cancer cells, including those for angiogenesis, signal transduction by epidermal growth factor receptor, inflammation, and cell proliferation.

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Squamous cell carcinoma arising from suprapubic cystotomy site without bladder involvement

Cited by 18 publications

References 7 publications

Squamous cell carcinoma of suprapubic cystostomy tract without bladder involvement

Squamous cell carcinoma of suprapubic cystostomy tract without bladder involvement

Squamous cell carcinoma of the suprapubic tract: A rare presentation in patients with chronic indwelling urinary catheters

A case of squamous cell carcinoma arising from a suprapubic cystostomy tract in a patient with spinal bifida: Immunohistochemical analysis and literature review

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