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Variant Forms of Bladder Cancer: Basic Considerations on Treatment Approaches

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Abstract

Variant forms of bladder cancer are non-urothelial neoplasms or urothelial carcinomas mixed with other histologies. Compared to pure urothelial carcinoma, they all present with a high stage and grade. Prognosis is variable and there is a lack of evidence regarding the ideal treatment approach, because of their relative infrequency and the noninclusion in bladder cancer randomized trials. Despite this, basic recommendations can be extracted from case series. In the present report, existent literature about variant forms of bladder cancer is reviewed with focus on the most frequent: squamous cell, adenocarcinoma, small cell, micropapillary, sarcomatoid, and lymphoepithelioma-like.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Shanks JH, Iczkowski KA. Divergent differentiation in urothelial carcinoma and other bladder cancer subtypes with selected mimics. Histopathology 2009;54(7):885–900. This paper reviews different histological variants of urothelial cancer, focused on their clinicopathologic features.

    Article  PubMed  CAS  Google Scholar 

  2. Amin MB. Histological variants of urothelial carcinoma: diagnostic, therapeutic and prognostic implications. Mod Pathol. 2009;22 Suppl 2:S96–S118.

    Article  PubMed  Google Scholar 

  3. Shokeir AA. Squamous cell carcinoma of the bladder: pathology, diagnosis and treatment. BJU Int. 2004;93(2):216–20.

    Article  PubMed  CAS  Google Scholar 

  4. Gutierrez MI, Siraj AK, Khaled H, Koon N, El-Rifai W, Bhatia K. CpG island methylation in Schistosoma- and non-Schistosoma-associated bladder cancer. Mod Pathol. 2004;17(10):1268–74.

    Article  PubMed  CAS  Google Scholar 

  5. Kassouf W, Spiess PE, Siefker-Radtke A, Swanson D, Grossman HB, Kamat AM, et al. Outcome and patterns of recurrence of nonbilharzial pure squamous cell carcinoma of the bladder: a contemporary review of The University of Texas M D Anderson Cancer Center experience. Cancer. 2007;110(4):764–9.

    Article  PubMed  Google Scholar 

  6. Lagwinski N, Thomas A, Stephenson AJ, Campbell S, Hoschar AP, El-Gabry E, et al. Squamous cell carcinoma of the bladder: a clinicopathologic analysis of 45 cases. Am J Surg Pathol. 2007;31(12):1777–87.

    Article  PubMed  Google Scholar 

  7. Scosyrev E, Yao J, Messing E. Urothelial carcinoma versus squamous cell carcinoma of bladder: is survival different with stage adjustment? Urology. 2009;73(4):822–7.

    Article  PubMed  Google Scholar 

  8. Rogers CG, Palapattu GS, Shariat SF, Karakiewicz PI, Bastian PJ, Lotan Y, et al. Clinical outcomes following radical cystectomy for primary nontransitional cell carcinoma of the bladder compared to transitional cell carcinoma of the bladder. J Urol. 2006;175(6):2048–53.

    Article  PubMed  Google Scholar 

  9. • Black PC, Brown GA, Dinney CP. The impact of variant histology on the outcome of bladder cancer treated with curative intent. Urol Oncol 2009;27(1):3–7. This work reviews treatments with curative intent in different histologic variants of urothelial carcinoma and proposes a treatment algorithm.

    Article  PubMed  Google Scholar 

  10. Johnson DE, Schoenwald MB, Ayala AG, Miller LS. Squamous cell carcinoma of the bladder. J Urol. 1976;115(5):542–4.

    PubMed  CAS  Google Scholar 

  11. Rundle JS, Hart AJ, McGeorge A, Smith JS, Malcolm AJ, Smith PM. Squamous cell carcinoma of bladder. A review of 114 patients. Br J Urol. 1982;54(5):522–6.

    Article  PubMed  CAS  Google Scholar 

  12. Bessette PL, Abell MR, Herwig KR. A clinicopathologic study of squamous cell carcinoma of the bladder. J Urol. 1974;112(1):66–7.

    PubMed  CAS  Google Scholar 

  13. Swanson DA, Liles A, Zagars GK. Preoperative irradiation and radical cystectomy for stages T2 and T3 squamous cell carcinoma of the bladder. J Urol. 1990;143(1):37–40.

    PubMed  CAS  Google Scholar 

  14. von der Maase H, Hansen SW, Roberts JT, Dogliotti L, Oliver T, Moore MJ, et al. Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol. 2000;18(17):3068–77.

    PubMed  Google Scholar 

  15. Saxman SB, Propert KJ, Einhorn LH, Crawford ED, Tannock I, Raghavan D, et al. Long-term follow-up of a phase III intergroup study of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol. 1997;15(7):2564–9.

    PubMed  CAS  Google Scholar 

  16. Lopez-Beltran A, Requena MJ, Alvarez-Kindelan J, Quintero A, Blanca A, Montironi R. Squamous differentiation in primary urothelial carcinoma of the urinary tract as seen by MAC387 immunohistochemistry. J Clin Pathol. 2007;60(3):332–5.

    Article  PubMed  Google Scholar 

  17. Erdemir F, Tunc M, Ozcan F, Parlaktas BS, Uluocak N, Kilicaslan I, et al. The effect of squamous and/or glandular differentiation on recurrence, progression and survival in urothelial carcinoma of bladder. Int Urol Nephrol. 2007;39(3):803–7.

    Article  PubMed  Google Scholar 

  18. Antunes AA, Nesrallah LJ, Dall’Oglio MF, Maluf CE, Camara C, Leite KR, et al. The role of squamous differentiation in patients with transitional cell carcinoma of the bladder treated with radical cystectomy. Int Braz J Urol. 2007;33(3):339–45.

    Article  PubMed  Google Scholar 

  19. •• Scosyrev E, Ely BW, Messing EM, Speights VO, Grossman HB, Wood DP, et al. Do mixed histological features affect survival benefit from neoadjuvant platinum-based combination chemotherapy in patients with locally advanced bladder cancer? A secondary analysis of Southwest Oncology Group-Directed Intergroup Study (S8710). BJU Int 2010 Nov 24. doi:10.1111/j.1464-410X.2010.09900.x. [Epub ahead of print]. This recent retrospective review of the SWOG study (MVAC in locally advanced urothelial cancer) has shown that the presence of squamous or glandular differentiation does not seem to confer resistance to chemotherapy.

  20. Wright JL, Porter MP, Li CI, Lange PH, Lin DW. Differences in survival among patients with urachal and nonurachal adenocarcinomas of the bladder. Cancer. 2006;107(4):721–8.

    Article  PubMed  Google Scholar 

  21. Lughezzani G, Sun M, Jeldres C, Alasker A, Budaus L, Shariat SF, et al. Adenocarcinoma versus urothelial carcinoma of the urinary bladder: comparison between pathologic stage at radical cystectomy and cancer-specific mortality. Urology. 2010;75(2):376–81.

    Article  PubMed  Google Scholar 

  22. Zaghloul MS, Nouh A, Nazmy M, Ramzy S, Zaghloul AS, Sedira MA, et al. Long-term results of primary adenocarcinoma of the urinary bladder: a report on 192 patients. Urol Oncol. 2006;24(1):13–20.

    Article  PubMed  Google Scholar 

  23. Tran B, McKendrick J. Metastatic urachal cancer responding to FOLFOX chemotherapy. Can J Urol. 2010;17(2):5120–3.

    PubMed  Google Scholar 

  24. Tazi E, Lalya I, Tazi MF, Ahallal Y, M’Rabti H, Errihani H. Treatment of metastatic urachal adenocarcinoma in a young woman: a case report. Cases J. 2009;2:9145.

    Article  PubMed  Google Scholar 

  25. Mohile SG, Schleicher L, Petrylak DP. Treatment of metastatic urachal carcinoma in an elderly woman. Nat Clin Pract Oncol. 2008;5(1):55–8.

    Article  PubMed  Google Scholar 

  26. Mukesh M, Cook N, Hollingdale AE, Ainsworth NL, Russell SG. Small cell carcinoma of the urinary bladder: a 15-year retrospective review of treatment and survival in the Anglian Cancer Network. BJU Int. 2009;103(6):747–52.

    Article  PubMed  CAS  Google Scholar 

  27. Choong NW, Quevedo JF, Kaur JS. Small cell carcinoma of the urinary bladder. The Mayo Clinic experience. Cancer. 2005;103(6):1172–8.

    Article  PubMed  Google Scholar 

  28. Cheng L, Pan CX, Yang XJ, Lopez-Beltran A, MacLennan GT, Lin H, et al. Small cell carcinoma of the urinary bladder: a clinicopathologic analysis of 64 patients. Cancer. 2004;101(5):957–62.

    Article  PubMed  Google Scholar 

  29. Mackey JR, Au HJ, Hugh J, Venner P. Genitourinary small cell carcinoma: determination of clinical and therapeutic factors associated with survival. J Urol. 1998;159(5):1624–9.

    Article  PubMed  CAS  Google Scholar 

  30. Quek ML, Nichols PW, Yamzon J, Daneshmand S, Miranda G, Cai J, et al. Radical cystectomy for primary neuroendocrine tumors of the bladder: the university of southern california experience. J Urol. 2005;174(1):93–6.

    Article  PubMed  Google Scholar 

  31. Siefker-Radtke AO, Dinney CP, Abrahams NA, Moran C, Shen Y, Pisters LL, et al. Evidence supporting preoperative chemotherapy for small cell carcinoma of the bladder: a retrospective review of the M. D. Anderson cancer experience. J Urol. 2004;172(2):481–4.

    Article  PubMed  Google Scholar 

  32. Bex A, Nieuwenhuijzen JA, Kerst M, Pos F, van Boven H, Meinhardt W, et al. Small cell carcinoma of bladder: a single-center prospective study of 25 cases treated in analogy to small cell lung cancer. Urology. 2005;65(2):295–9.

    Article  PubMed  Google Scholar 

  33. Lohrisch C, Murray N, Pickles T, Sullivan L. Small cell carcinoma of the bladder: long term outcome with integrated chemoradiation. Cancer. 1999;86(11):2346–52.

    Article  PubMed  CAS  Google Scholar 

  34. Siefker-Radtke AO, Kamat AM, Grossman HB, Williams DL, Qiao W, Thall PF, et al. Phase II clinical trial of neoadjuvant alternating doublet chemotherapy with ifosfamide/doxorubicin and etoposide/cisplatin in small-cell urothelial cancer. J Clin Oncol. 2009;27(16):2592–7.

    Article  PubMed  CAS  Google Scholar 

  35. Comperat E, Roupret M, Yaxley J, Reynolds J, Varinot J, Ouzaid I, et al. Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases. Pathology. 2010;42(7):650–4.

    Article  PubMed  Google Scholar 

  36. Heudel P, El Karak F, Ismaili N, Droz JP, Flechon A. Micropapillary bladder cancer: a review of Leon Berard Cancer Center experience. BMC Urol. 2009;9:5.

    Article  PubMed  Google Scholar 

  37. Kamat AM, Dinney CP, Gee JR, Grossman HB, Siefker-Radtke AO, Tamboli P, et al. Micropapillary bladder cancer: a review of the University of Texas M. D. Anderson Cancer Center experience with 100 consecutive patients. Cancer. 2007;110(1):62–7.

    Article  PubMed  Google Scholar 

  38. Wright JL, Black PC, Brown GA, Porter MP, Kamat AM, Dinney CP, et al. Differences in survival among patients with sarcomatoid carcinoma, carcinosarcoma and urothelial carcinoma of the bladder. J Urol. 2007;178(6):2302–6.

    Article  PubMed  Google Scholar 

  39. Tamas EF, Nielsen ME, Schoenberg MP, Epstein JI. Lymphoepithelioma-like carcinoma of the urinary tract: a clinicopathological study of 30 pure and mixed cases. Mod Pathol. 2007;20(8):828–34.

    Article  PubMed  Google Scholar 

  40. Serrano GB, Funez FA, Lopez RG, Crespo CV, Nicolas VD, Naranjo SD, et al. Bladder lymphoepithelioma-like carcinoma. Bibliographic review and case report. Arch Esp Urol. 2008;61(6):723–9.

    PubMed  Google Scholar 

  41. Amin MB, Ro JY, Lee KM, Ordonez NG, Dinney CP, Gulley ML, et al. Lymphoepithelioma-like carcinoma of the urinary bladder. Am J Surg Pathol. 1994;18(5):466–73.

    Article  PubMed  CAS  Google Scholar 

  42. Lopez-Beltran A, Luque RJ, Vicioso L, Anglada F, Requena MJ, Quintero A, et al. Lymphoepithelioma-like carcinoma of the urinary bladder: a clinicopathologic study of 13 cases. Virchows Arch. 2001;438(6):552–7.

    Article  PubMed  CAS  Google Scholar 

  43. Izquierdo-Garcia FM, Garcia-Diez F, Fernandez I, Perez-Rosado A, Saez A, Suarez-Vilela D, et al. Lymphoepithelioma-like carcinoma of the bladder: three cases with clinicopathological and p53 protein expression study. Virchows Arch. 2004;444(5):420–5.

    Article  PubMed  Google Scholar 

  44. Keck B, Stoehr R, Wach S, Rogler A, Hofstaedter F, Lehmann J, et al. The plasmacytoid carcinoma of the bladder-rare variant of aggressive urothelial carcinoma. Int J Cancer. 2010 Sep 28. [Epub ahead of print].

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Correspondence to Joaquim Bellmunt.

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Pons, F., Orsola, A., Morote, J. et al. Variant Forms of Bladder Cancer: Basic Considerations on Treatment Approaches. Curr Oncol Rep 13, 216–221 (2011). https://doi.org/10.1007/s11912-011-0161-4

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  • DOI: https://doi.org/10.1007/s11912-011-0161-4

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