Squamous cell carcinoma of suprapubic cystostomy tract without bladder involvement

Abstract

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...

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

“…Subsequent reports of isolated cases from 1995 to 2011 describe cases of SCC arising from the suprapubic tract in patients with SCIs and suprapubic catheters. [10][11][12][13] The average time from catheter placement to presentation was 31 years, which is in concordance with the typical time of presentation of SCC in the chronic indwelling catheter population. 3,5,6 Only 1 case demonstrated evidence of intravesical disease, 13 while another demonstrated extension, but not penetration of SCC into the detrusor muscle.…”

“…3,5,6 Only 1 case demonstrated evidence of intravesical disease, 13 while another demonstrated extension, but not penetration of SCC into the detrusor muscle. 12 Four cases were treated with wide excision 9,10,12,13 and either partial 9,10 or radical 12,13 cystectomy, with or without neoadjuvant radiotherapy. Palliative radiotherapy was provided to the remaining patient who had positive nodal and metastatic disease on CT.…”

“…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. …”

Intermittent self-catheterization and the risk of squamous cell cancer of the bladder: An emerging clinical entity?

“…More rarely, there are reports of SCC of the bladder following intravesical Bacillus Calmette-Guéri (BCG), 3 systemic cyclophosphamide therapy, 4 and suprapubic catheters. 5 Lapides and colleagues introduced the concept of clean intermittent self-catheterization (ISC) in 1972 as a means of avoiding long-term catheterization or surgery. 6 It was associated with low intravesical pressures, urinary bacterial wall translocation and thus infection, in a variety of neurogenic and non-neurogenic bladder disorders.…”

A case report of squamous cell carcinoma in a suprapubic urinary catheter tract: surgical excision and simultaneous colostomy formation

“…Outcome of treatment was varied. The mortality rate seems to be high in general due to recurrence or complications of treatment, and usually occurred within a year following treatment [4, 5, 9]. …”