Browsing by Subject "urinary bladder"

Now showing 1 - 5 of 5
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    Distinct Mutational Landscape of Inverted Urothelial Papilloma
    (Wiley, 2019-09) Akgul, Mahmut; MacLennan, Gregory T.; Cheng, Liang; Pathology and Laboratory Medicine, School of Medicine
    A recent study has identified gene mutations involving the MAPK/ERK pathway, particularly the HRAS gene, in all inverted urothelial papillomas (IUPs), in the absence of pathway mutations in TERT promoter, FGFR3, and TP53/RB1genes. Neither recurrence nor progression was observed in IUPs. These data support several longstanding hypotheses: (1) IUPs are benign and do not recur or progress; (2) they harbor mutations that are different from those of urothelial carcinoma; and (3) they arise through different molecular mechanisms than low‐ or high‐grade urothelial carcinoma. As the most critical differential diagnosis in this context is inverted‐type urothelial carcinoma, more comprehensive studies are needed to compare and contrast these entities.
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    Human papillomavirus (HPV)-induced neoplasia in the urinary bladder: a missing link?
    (2016) Alexander, Riley E.; Wang, Lisha; Lopez-Beltran, Antonio; Emerson, Robert E.; Montironi, Rodolfo; Pedrosa, Jose A.; Kaimakliotis, Hristos Z.; Koch, Michael O.; Cheng, Liang; Department of Pathology and Laboratory Medicine, IU School of Medicine
    The discovery that the role human papillomavirus (HPV) plays in the induction of human cancer represents an important achievement in oncologic research. It has taken on even greater importance since the development of vaccines, which promise the hope of preventing these cancers from ever occurring. Because of these important implications, many have attempted to determine a possible role for the virus in cancers of the urinary bladder-an organ in close anatomic proximity to the primary sites of HPV-induced neoplasia and one which already has an established oncogenic infectious agent in Schistosoma haematobium. Here we review the current literature exploring this possible role in the most common subtype of cancer of the urinary bladder, urothelial carcinoma, and two much more rare histologic subtypes that have well established roles for HPV-induced neoplasia in other anatomic sites-squamous cell carcinoma and adenocarcinoma.
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    Long-term outcomes of catheterizable continent urinary channels: what do you use, where you put it and does it matter?
    (Elsevier, 2015-08) Szymanski, Konrad M.; Whittam, Benjamin; Misseri, Rosalia; Flack, Chandra K.; Hubert, Katherine C.; Kaefer, Martin; Rink, Richard C.; Cain, Mark P.; Department of Urology, IU School of Medicine
    Introduction Appendicovesicostomy (APV) and Monti ileovesicostomy (Monti) are commonly used catheterizable channels with similar outcomes on short-term follow-up. Their relative long-term results have not been previously published. Objective Our goal was to assess long-term durability of APV and Monti channels in a large patient cohort. Study design In this retrospective cohort study, we retrospectively reviewed consecutive patients ≤21 years old undergoing APV and Monti surgery at our institution (1990–2013). We collected data on demographics, channel type, location, continence and stomal and subfascial revisions. Kaplan–Meier survival and Cox proportional hazards analysis were used. Results Of 510 patients meeting inclusion criteria, 214 patients had an APV and 296 had a Monti (50.5% spiral Monti). Median age at surgery was 7.4 years for APV (median follow-up: 5.7 years) and 8.7 years for Monti (follow-up: 7.7 years). Stomal stenosis, overall stomal revisions and channel continence were similar for APV and Monti (p ≥ 0.26). Fourteen APVs (6.5%) had subfascial revisions compared to 49 Montis (16.6%, p = 0.001). On survival analysis, subfascial revision risk at 10 years for APV was 8.6%, Monti channels excluding spiral umbilical Monti: 15.5% and spiral umbilical Monti: 32.3% (p < 0.0001, Figure). On multivariate regression, Monti was 2.09 times more likely than APV to undergo revision (p = 0.03). The spiral Monti to the umbilicus, in particular, was 4.23 times more likely than APV to undergo revision (p < 0.001). Concomitant surgery, gender, age and surgery date were not significant predictors of subfascial revision (p ≥ 0.17). Stomal location was significant only for spiral Montis. Discussion Our study has several limitations. Although controlling for surgery date was a limited way of adjusting for changing surgical techniques, residual confounding by surgical technique is unlikely, as channel implantation technique was typically unrelated to channel type. We did not include complications managed conservatively or endoscopically. In addition, while we did not capture patients who were lost to follow-up, we attempted to control for this through survival analysis. Conclusions We demonstrate, durable long-term results with the APV and Monti techniques. The risk of channel complications continues over the channel's lifetime, with no difference in stomal complications between channels. At 10 years after initial surgery, Monti channels were twice as likely to undergo a subfascial revision (1 in 6) than APV (1 in 12). The risk is even higher in for the spiral umbilical Monti (1 in 3).
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    Müllerian Adenosarcoma of the Urinary Bladder: Clinicopathologic and Immunohistochemical Features with Novel Genetic Aberrations
    (Elsevier, 2017-04) Sanfrancesco, Joseph; Williamson, Sean R.; Kum, Jennifer B.; Zhang, Shaobo; Wang, Mingsheng; Lopez-Beltran, Antonio; Montironi, Rodolfo; Gardner, Thomas A.; Cheng, Liang; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Müllerian adenosarcoma is a biphasic neoplasm most commonly of the uterus and less frequently of the ovary. It has been rarely described to occur in other sites such as peritoneum and liver. In this study, we report the clinicopathologic, immunohistochemical and molecular features of a primary müllerian adenosarcoma of the urinary bladder in a 62-year-old woman. To our knowledge, this is the first report of müllerian adenosarcoma primary to the urinary bladder in the literature. Light microscopy showed a biphasic epithelial and stromal tumor with benign-appearing glands surrounded by endometrial-type stroma that is densely cellular with increased mitotic figures. The stroma surrounding the glands is more cellular than the intervening areas, which are more loose and edematous. Immunohistochemistry profile included positive staining for Pax2/8 within the glands, for CD10 and WT-1 within the spindled stroma, and for estrogen and progesterone receptors in both. Staining for desmin, GATA3, p63, and human papilloma virus (HPV) is negative. Molecular analyses identified mutations in AKT1 E17K, FLT3 D835N, KRAS G12D and HRAS G12S. These novel molecular aberrations have yet to be reported in the medical literature. X chromosome inactivation analysis revealed a clonal pattern in the stromal component and a non-clonal pattern in the epithelial component. Currently, the patient is disease/recurrence-free after regular follow-up of approximately 84 months. This case represents the first reported diagnosis of müllerian adenosarcoma arising in the urinary bladder with extensive clinicopathologic, immunohistochemical, and molecular analyses.
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    Not all neurogenic bladders are the same: a proposal for a new neurogenic bladder classification system
    (TAU, 2016-01-25) Powell, Charles R.; Department of Urology, IU School of Medicine
    Neurogenic bladder (NGB) has long been defined as a clinical entity that describes a heterogeneous collection of syndromes. The common theme is a bladder disorder concomitant with a neurologic disorder. This definition does not give the clinician much information about the bladder disorder, nor how to treat it, or even what the natural history of the disorder is likely to be. It may be time for a new classification scheme to better define the bladder defect and prognosis, as well as inform treatment. We propose a classification system based on seven categories, each having a neurologic defect in a distinct anatomic location. This is termed SALE (Stratify by Anatomic Location and Etiology). In addition, the presence or absence of bowel dysfunction and autonomic dysreflexia will be reported. In the future, as more definite prognostic information can be gleaned from biomarkers, we anticipate adding urinary nerve growth factor (NGF) and urinary brain-derived neurotrophic factor (BDNF) levels to the definition. We expect the SALE system to efficiently describe a patient suffering from NGB and simultaneously inform the most appropriate treatment, follow-up regimen, and long-term prognosis.