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

Abstract

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 ...

Malignancies of suprapubic catheter (SPC) tracts in spinal cord injury patients: a case series and review of literature

“…SCI patients account for 50% of cases currently recorded of malignancy affecting the SPC tract, with 22 cases in total being reported. The majority being attributable to SCC (six cases) [17][18][19][20][21][22], followed by adenocarcinoma (three cases) [22,23], a single case of verrucous carcinoma [24], and our case of sarcoma (Table 1).…”

“…There have been a small number of recorded cases of malignancy affecting and arising from the SPC tract itself [6][7][8][9][10][11][12][13][14][15][16][17], with a significant proportion of those affected being SCI patients [17][18][19][20][21][22][23][24]. We present three patients affected with malignancy of the SPC tract being; mucinous adenocarcinoma, squamous cell carcinoma (SCC) and sarcoma.…”

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

“…There are few case reports describing SCC arising from the suprapubic tract [3–9], most of them in patients with spinal cord injuries, with a long-term catheter in situ (ranging from 5 to 37 years). Bladder involvement amongst these is mixed.…”

“…SCC arising from the site of a suprapubic catheter (SPC) tract, with or without involvement of the bladder urothelium, is very poorly represented in literature with minimal studies to date [3–9]. …”

Regulation of sex hormone receptors in sexual dimorphism of human cancers

“…Urinary bladder cancer is the fifth most common malignancy in industrialized countries [60], arises from the epithelial cells of the urinary bladder, and includes two major histological types: urothelial carcinoma (> 90%) and squamous cell carcinoma (3–5%) [61]. Cigarette smoking, occupational exposures to infected waters, and chronic bladder inflammation are risk factors for urinary bladder cancer [62–64].…”