Bladder paraganglioma: CT and MR imaging characteristics in 16 patients

Background Bladder paraganglioma (BPG) is a rare extra-adrenal pheochromocytoma with variable symptoms and easy to be misdiagnosed and mishandled. The aim of the study was to document the imaging features of BPG using computed tomography (CT) and magnetic resonance imaging (MRI). Patients and methods We retrospectively enrolled consecutive patients with pathology-proven BPG, who underwent CT or MRI examinations before surgery between October 2009 and October 2017. The clinical characteristics, CT, and MRI features of the patients were described and analysed. Results A total of 16 patients with 16 bladder tumours (median age 51 years, 9 females) were included. Among them, 13 patients underwent CT examinations and eight patients underwent MRI examinations preoperatively. Tumour diameters ranged from 1.6−5.4 cm. Most of the tumours grew into the bladder cavity (n = 11) with oval shapes (n = 10) and well-defined margins (n = 14). Intratumour cystic degeneration or necrosis (n = 2) was observed. Two lesions showed peripheral tissue invasion, suggesting malignant BPGs. All 13 lesions imaged with CT exhibited slight hypoattenuation and moderate to marked enhancement. Compared to the gluteus maximus, all lesions showed slight h yperintensity in T2-weighted images, hyperintensity on diffusion-weighted images (DWI), hypointensity on apparent diffusion coefficient maps, hyperintensity on T1-weighted images and a “fast in and slow out” enhanced pattern on contrast-enhanced MRI images. Conclusions BPGs are mostly oval-shaped, broadly-based and hypervascular bladder tumours with hypoattenuation on non-contrast CT, T2 hyperintensity, slight T1 hyperintensity compared to the muscle, marked restricted diffusion on DWI. Peripheral tissue invasion can suggest malignancy of the BPGs. All of these features contribute to preoperative decision-making.

Giant leiomyoma of the urinary bladder: A case report

Urinary bladder leiomyoma is a rare tumour accounting for less than 0.5% of all urinary bladder tumours. Till now, less than 250 cases were documented with variable sizes, most of them were less than 10 cm in maximum diameter. Here we present a 68- year-old female patient with urinary bladder giant leiomyoma measuring about 13 cm. She presented with right loin pain. Postcontrast computed tomography of the abdomen and pelvis revealed a large posterolateral right-sided urinary bladder mass with moderate right hydroureteronephrosis. It was managed by partial cystectomy. The patient had an uneventful postoperative course. Postoperative pathological examination of the specimen confirmed giant leiomyoma of the urinary bladder.

696 Are Group and Save Samples Necessary for Common Urological Procedures?

Aim Blood tests are routinely performed as a part of pre-operative assessment (pre-op). We looked at the number of group and save (G+S) samples taken at pre-op and compared that to the number of patients needing blood transfusion having undergone common Urological procedures at our hospital. Our objective was to assess the utility of this invasive procedure in this clinical setting. Method Data was retrospectively collected from electronic patient records on 413 patients undergoing elective urological procedures 1st June 2020 to 30th September 2020 at Colchester General Hospital. Major procedures like radical prostatectomies, nephrectomies were excluded. Patients who had G+S samples done prior to surgery were checked. This was compared to the patients who required transfusions. Results Amongst 413 patients who underwent an elective urological procedure, 169(41%) were day-case endoscopic, 151(37%) were inpatient, and 93(22%) were penoscrotal procedures. 104(25%) patients had G+S taken, with only 5 patients (1.2%) requiring transfusion. 24(14.2%) patients undergoing day case procedures,79(52.3%) patients undergoing inpatient procedures and 1(1.1%) patient undergoing penoscrotal procedures had G+S tests done. Only 7(1.7%) patients had a baseline haemoglobin of less than 100. Conclusions Our data showed that many G+S samples were unnecessary. TURBTs (transurethral resection of bladder tumours) were most likely to need transfusion. Education was fed-back to those running pre-operative assessment clinics that G+S should be considered for TURBTs and those with Hb < 100. We recommend running this audit again to further quantify the G+S tests which could be avoided.

Glycoproteomics identifies HOMER3 as a potentially targetable biomarker triggered by hypoxia and glucose deprivation in bladder cancer

Background Muscle invasive bladder cancer (MIBC) remains amongst the deadliest genitourinary malignancies due to treatment failure and extensive molecular heterogeneity, delaying effective targeted therapeutics. Hypoxia and nutrient deprivation, oversialylation and O-glycans shortening are salient features of aggressive tumours, creating cell surface glycoproteome fingerprints with theranostics potential. Methods A glycomics guided glycoproteomics workflow was employed to identify potentially targetable biomarkers using invasive bladder cancer cell models. The 5637 and T24 cells O-glycome was characterized by mass spectrometry (MS), and the obtained information was used to guide glycoproteomics experiments, combining sialidase, lectin affinity and bottom-up protein identification by nanoLC-ESI-MS/MS. Data was curated by a bioinformatics approach developed in-house, sorting clinically relevant molecular signatures based on Human Protein Atlas insights. Top-ranked targets and glycoforms were validated in cell models, bladder tumours and metastases by MS and immunoassays. Cells grown under hypoxia and glucose deprivation disclosed the contribution of tumour microenvironment to the expression of relevant biomarkers. Cancer-specificity was validated in healthy tissues by immunohistochemistry and MS in 20 types of tissues/cells of different individuals. Results Sialylated T (ST) antigens were found to be the most abundant glycans in cell lines and over 900 glycoproteins were identified potentially carrying these glycans. HOMER3, typically a cytosolic protein, emerged as a top-ranked targetable glycoprotein at the cell surface carrying short-chain O-glycans. Plasma membrane HOMER3 was observed in more aggressive primary tumours and distant metastases, being an independent predictor of worst prognosis. This phenotype was triggered by nutrient deprivation and concomitant to increased cellular invasion. T24 HOMER3 knockdown significantly decreased proliferation and, to some extent, invasion in normoxia and hypoxia; whereas HOMER3 knock-in increased its membrane expression, which was more pronounced under glucose deprivation. HOMER3 overexpression was associated with increased cell proliferation in normoxia and potentiated invasion under hypoxia. Finally, the mapping of HOMER3-glycosites by EThcD-MS/MS in bladder tumours revealed potentially targetable domains not detected in healthy tissues. Conclusion HOMER3-glycoforms allow the identification of patients’ subsets facing worst prognosis, holding potential to address more aggressive hypoxic cells with limited off-target effects. The molecular rationale for identifying novel bladder cancer molecular targets has been established. Graphical abstract

Evaluation of clinical implications in the use of dose to water versus dose to medium by using NTCP and TCP models for urinary bladder tumours

Purpose: To analyze the dosimetric and radiobiological differences between dose to water versus dose to medium for patients with carcinoma of the urinary bladder. Materials and Methods: 15 patients with cancer of urinary bladder were selected for the study. VMAT plans were generated for each patient. The dose distributions were calculated in the modes dose to water and to medium with the Monaco treatment planning system. A dosimetric comparative analysis has been made between the two modes of planning in this study. Subsequently, NTCP and TCP were determined for OARs and targets respectively. Results: The mean dose to 2 cc of the rectum, small bowel, left and right femoral heads respectively was higher by 0.8, 1.2, 2.7, and 2.2% for the dose to water calculation. Similarly, the mean dose to D2, D50, and D98 for PTV was higher by 0.4, 0.3, and 0.3% for dose to water calculation. Such small dose differences had little effect on the values of TCP and NTCP. Conclusion: For patients with the urinary bladder there were very small differences between results between calculations carried out in dose to medium and dose to water modes.

Histomorphological Study of Urinary Bladder Biopsies- A Retrospective Study in a Tertiary Care Centre, Kerala, India

Introduction: Urinary bladder diseases are quite frequent in clinical practices. Both non neoplastic and neoplastic lesions are quite common. Bladder malignancies are on an increasing incidence and are considered as an important cause of cancer related morbidity and mortality. To provide accurate diagnosis and treatment histopathology remains as the gold standard investigation. Aim: To study the histomorphology of lesions of bladder obtained through Trans Urethral Resection of Bladder Tumour (TURBT) and cystoscopic biopsies. Materials and Methods: The present study was a five years descriptive retrospective study conducted over a period of six months starting from July 2020 to December 2020 and data were collected from records for the period of January 2015 to December 2019 carried out in the Department of Pathology, Government Medical College, Trivandrum, Kerala, India. Record of all patients who visited to Urology Outpatient Department (OPD) with lower urinary tract symptoms and obstructive bladder symptoms and subjected to cystoscopy were included in study. The detailed clinico-histomorphological features of all biopsies were studied using World Health Organization (WHO)/ International Society of Urologic Pathologists (ISUP) 2016 histological grading and Tumour (T), Nodes (N), and Metastasis (M) (TNM) staging were used in classifying the bladder tumours. Results: The data for the present study was collected over a period of five years; during which a total of 742 lesions were histopathologically evaluated. A total of 688 cases (92.72%) were neoplastic, 46 cases (6.19%) were diagnosed as non neoplastic and 8 cases were (1.07%) were metastatic malignancy. A total of 646 cases (87.06%) were males. Most common affected age group was 61-80 years. Haematuria was the most common clinical presentation. A 332 cases (48.25%) were of non invasive papillary urothelial neoplasm low grade. Conclusion: Lesions of urinary bladder are heterogenous in nature. Detailed awareness regarding the various histological features of these lesions, their neoplastic potential, risk of recurrence and possible pitfalls can help pathologists for accurate diagnosis. The study also emphasised on inclusion of smooth muscle in the biopsy for accurate grading and staging in bladder tumours.

The performance of the Xpert Bladder Cancer Monitor Test and voided urinary cytology in the follow-up of urinary bladder tumors

BackgroundCystoscopy in complement with urinary cytology represents the gold standard for the follow-up of patients with urinary bladder tumours. Xpert Bladder Cancer Monitor Test (XBC) is a novel mRNA-based urine test for bladder cancer surveillance. The aim of the study was to evaluate the performance of the XBC and voided urinary cytology (VUC) in the follow-up of bladder tumours.Patients and methodsThe XBC was performed on stabilized voided urine and VUC was performed on urine samples. The results were compared to cystoscopic findings and histopathological results after transurethral resection of the bladder lesion.ResultsFor the prediction of malignant histopathological result sensitivity, the specificity and negative predictive value were 76.9%, 9 7.5% and 93.0% for the XBC and 38.4%, 9 7.5% and 83.3%, respectively for VUC. For the prediction of suspicious or positive cystoscopic finding sensitivity, the specificity and negative predictive value were 75.0%, 95.2%, and 93.0% respectively for the XBC and 41.7%, 97.6%, and 85.4% for VUC. The sensitivities for papilary urothelial neoplasms of low malignant potential (PUNLMP), low- and high-grade tumours were 0.0%, 66.7% an d 100.0% for the XBC and 0.0%, 66 .7% and 42.9%, respectively for VUC.ConclusionsThe XBC showed significantly higher overall sensitivity and negative predictive value than VUC and could be used to increase the recommended follow-up cystoscopy time intervals. Complementing the XBC and voided urinary cytology does not improve performance in comparison to the XBC alone.