An ileal conduit or " Bricker conduit " was one of the original types of urinary diversions, and it is still in use today. The conduit is most often placed after cystectomy or cystoprostatectomy for muscle-invasive bladder cancer. Although not a continent diversion, it may be preferred if the patient will have trouble self-catherising and maintaining a continent urinary diversion. The conduit is formed from cm of ileum. The ileal loop continues to peristalse.
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Small cell carcinoma of the urinary bladder is an extremely aggressive and rare tumor. Even though small cell carcinoma most commonly arises from the lungs there are several reports of small cell carcinoma in extrapulmonary sites. Due to its low frequency there is no well-established management for this disease. We report the case of a 61 year-old man with small cell carcinoma of the bladder who underwent radical cystectomy following neoadjuvant chemotherapy.
We also reviewed the literature for the optimal treatment strategy. The diagnosis demands that the pathologist be suspicious and accurate in the analysis of the fragments of a transurethral bladder resection TUR. Multimodal treatment, including radical cystectomy, chemotherapy and radiation therapy should be initiated as soon as possible for a chance of cure and to improve survival.
In the present article we report a case of a male patient with small cell carcinoma of the bladder and the development of the condition, and we aim to show the most current management of this tumor, which has no consensus for treatment in the international literature for being extremely rare. Patient JHC, male, 61 years old, came to the medical service with a complaint of hematuria and hypogastric pain for one year. The urinary tract ultrasound revealed an intravesical tumor, and he was submitted to bladder TUR, with a conclusive report for small cell carcinoma of the bladder.
Faced with the diagnosis, the attending team chose to perform chemotherapy received four sessions of cisplatin, gemcitabine and paclitaxel Figure 1. When referred to our service, he was submitted to thorax and abdomen computerized tomography CT that showed a 6. No lymph nodes were affected and there were no metastatic lesions at other sites. The patent was then submitted to radical cystectomy, with a Bricker ileal derivation procedure, performed uneventfully, lasting 5 hours, with no need for blood transfusion.
It is important to underscore that the time between the last chemotherapy and surgery was 2 months. The pathology report of the surgical specimen proved small cell carcinoma of the bladder with extravesical extension, perineural and vascular infiltration, and one lymph node affected left obturator out of 16 dissected.
Free margins. Final staging T3bN1. During the post-operative period, the patient had pneumonia, was on antibiotics and was discharged 29 days after surgery. There were no surgical events. He was referred to oncology to discuss adjuvant therapy which was not initiated, because the patient died 4 months after surgery due to pulmonary thromboembolism Figure 2. The first report of small cell carcinoma of the bladder was made in by Cramer et al.
Since then, approximately cases were registered in the international literature. The small cell carcinoma of the bladder usually affects individuals of the same age, sex and presents the same symptoms and morphology of urothelial carcinoma. That is why it is a diagnostic challenge, depending only on the skills of the pathologist to differentiate it from urothelial carcinoma, which beside the factors already mentioned, has the same radiological aspect of small cell carcinoma of the bladder.
There is no consensus as to treatment, because it is an uncommon condition. Thus, recommendations are based on retrospective studies, reports of individual cases, and protocols for small cell lung carcinoma. Frequently, it presents with mixed histology. However, management should be different, since it frequently presents metastases and has a poor prognosis.
The pathological diagnosis of this kind of tumor is challenging and requires that the pathologist use immunohistochemical techniques for histological confirmation. As they are histologically identical, the World Health Organization standardization for small cell lung carcinoma is used. On immunohistochemistry, these tumors express quite an amount of neurospecific enolase, chromogranin, synaptophysin and N-CAM CD The presence of one or more markers allows to establish the diagnosis of neuroendocrine tumor.
Pathological staging is based on the consensus for urothelial carcinoma of the bladder Figure 3. Isolated therapies — whether TUR, partial cystectomy or radiation therapy — present benefit only in special cases of initial stage disease. Radical cystectomy is considered the best method to eliminate small cell carcinoma of the bladder completely, but it alone is believed to only change survival in stage I and II tumors.
On the other hand, a Canadian group reported ten patients with pT3-T4, N0 lesions with chemotherapy, attaining complete remission in nine of them. The advantage of this treatment is sparing the organ. Therefore, it is a less invasive treatment when compared to radical surgery, which is related to important rates of morbidity and mortality. Patients with metastatic disease should receive systematic chemotherapy, and the most common treatment regimens are platinum-based cisplatin and etoposide, carboplatin, etoposide and cyclophosphamide Figure 2.
Given the extremely aggressive and rare disease, little is known about pathogenesis and molecular biology. Data on the ideal approach for this kind of tumor are scarce, showing the importance of reporting such cases and, in this way, defining the best diagnostic and treatment methods. Margens livres. Estadiamento final T3bN1. Frequentemente, apresenta-se com histologia mista. National Center for Biotechnology Information , U.
Journal List Einstein Sao Paulo v. Einstein Sao Paulo. Find articles by Bruno Nagel Calado. Find articles by Paulo Eduardo Goulart Maron. Find articles by Tomas Zecchini Barrese. Find articles by Roni de Carvalho Fernandes. Find articles by Marjo Deninson Cardenuto Perez. Author information Article notes Copyright and License information Disclaimer. Received Oct 3; Accepted Aug Copyright notice. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract Small cell carcinoma of the urinary bladder is an extremely aggressive and rare tumor. Open in a separate window. Figure 1. Field with the presence of multiple mitoses, salt-and-pepper nuclei. Figure 2. Figure 3. Zhao X, Flynn EA. Small cell carcinoma of the urinary bladder: a rare, aggressive neuroendocrine malignancy.
Arch Pathol Lab Med. Shahab N. Extrapulmonary small cell carcinoma of the bladder. Semin Oncol. Church DN, Bahl A. Clinical review - small cell carcinoma of the bladder. Cancer Treat Rev. Neurosecretory granules in small cell invasive carcinoma of the urinary bladder. Neuroendocrine tumours of the urinary system and male genital organs: clinical significance.
BJU Int. Small cell carcinoma of the urinary bladder. The Mayo Clinic experience. Small cell carcinoma of the urinary bladder: a clinicopathologic analysis of 64 patients. Genitourinary small cell carcinoma: determination of clinical and therapeutic factors associated with survival. J Urol. Evidence supporting preoperative chemotherapy for small cell carcinoma of the bladder: a retrospective review of the M.
Anderson cancer experience. Small cell carcinoma of the bladder: long term outcome with integrated chemoradiation.
Small cell carcinoma of the bladder