Unusual histomorphological spectrum of urinary bladder cancers and their treatment modalities revisited: Our experience with series of five cases

Abstract

Background: Urinary bladder cancer is the eighth-most frequent carcinoma in men, commonly occurs in elderly male. Major risk factors are smoking, chronic cystitis, urinary stones. The most common histologic variant of bladder cancer is urothelial carcinoma (UC), but certain variants are unusual yet aggressive for which there is no consensus guideline of therapy. Those entities include neuroendocrine tumors both primary and metastatic, squamous cell carcinoma, and sarcomatoid carcinoma. Neuroendocrine tumors comprise carcinoid, small-cell carcinoma, and large-cell carcinoma. Aim: The present study is undertaken to highlight certain biological features of these unusual aggressive histological forms of bladder carcinoma and their recent treatment modality to prevent recurrence, metastasis, upgrading of tumor stage, and enable surprisingly complete remission. Methods: This piece of hospital-based perspective study was done from June 2018 to May 2020. Both transurethral resection of bladder tumor and cystectomy surgical samples of the symptomatic patients were collected from the urology department of our institute along with demographic data. Then processed, stained in both routine H and E stain and immunohistochemical stains (Immunohistochemistry [IHC]) like PanCK, NSE, synaptophysin, chromogranin, etc. Results: Total number of bladder cancer encountered was 42 cases; of these five rare variants were observed, i.e., one case each of primary and secondary small cell neuroendocrine carcinoma, one large cell carcinoma, one squamous cell carcinoma (SCC), and one case of sarcomatoid carcinoma. Histomorphology with IHC conferred the diagnosis then multimodality therapy (neoadjuvant/radiotherapy/surgery) was installed and followed up. Conclusion: The unconventional forms of UC can be easily diagnosed by histomorphology and can have better survival with the help of the recent multimodal treatment approach.

Primary pure large cell neuroendocrine carcinoma of the urinary bladder: a case report and literature review

“…LCNEC was first identified in the lung and typically found in the respiratory and digestive tracts. Primary LCNEC of the urinary bladder is an exceedingly uncommon malignant tumor, with only 54 cases documented in the literature in detail ( Table 1 ), of which 80% are males ( 4 , 6 , 7 , 9 , 11 – 47 ). Abenosa et al.…”

Primary large cell neuroendocrine carcinoma of the bladder: A case report

“…The common clinical treatments include surgery, chemotherapy, and radiotherapy. Compared to surgery alone, multimodal treatment is more conducive to prolonging survival[ 4 , 10 , 12 ]. There was no significant difference in overall survival between patients who underwent radical cystectomy and those who underwent bladder-sparing surgery[ 2 ].…”