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C202: A rare case of squamous cell carcinoma in urinary bladder diverticulum successfully treated by bladder - sparing surgery
C202: A rare case of squamous cell carcinoma in urinary bladder diverticulum successfully treated by bladder - sparing surgery Knezevic M.1, Grubisic I.2, Soipi S.2, Tomas D.3, Kruslin B.3, Stimac G.2 1
General Hospital “dr. Josip Bencevic”, Dept. of Urology, Slavonski Brod, Croatia, 2"Sestre Milosrdnice" University Hospital Center, Dept. of Urology, Zagreb, Croatia, 3"Sestre Milosrdnice" University Hospital Center, Dept. of Pathology, Zagreb, Croatia INTRODUCTION & OBJECTIVES: Tumors arising within urinary bladder diverticula are rare. Pathophysiological explanation of carcinogenic transformation is based on urinary stasis within poorly contractile diverticula and chronic inflammation. Additionally, bladder diverticula neoplasms have a poorer prognosis than tumors arising within the urinary bladder lumen. Early transmural infiltration through a thinned diverticular wall is considered as a main causal factor. Most of the intradiverticular neoplasms are urothelial, with rare incidence of adenocarcinomas, squamous cell carcinomas and sarcomas. A carcinoma within a urinary bladder diverticulum represent a therapeutic challenge regarding poor prognosis and lack of clear and sufficiently supported therapeutic guidelines. This paper presents recent and concise literature overview on treatment options, and illustrates the rare case of a successfully treated patient with primary intradiverticular squamous cell carcinoma despite the non-radical treatment. MATERIAL & METHODS: RESULTS: Clinical Presentation and Intervention: A 56-year-old man presented with intermittent hematuria. Ultrasound examination indicated primary carcinoma in the urinary bladder diverticulum. Diagnosis was confirmed with cystoscopy and computer tomography. Transvesical diverticulectomy with regional lymphadenectomy was undertaken. Histopathology verified squamous cell carcinoma of the bladder diverticulum with extradiverticular penetration but clear margins. Two years after initial treatment patient is well without evidence of tumor relapse. CONCLUSIONS: This report presented the case of a patient with rare squamous cell diverticular carcinoma who underwent bladder-sparing surgical treatment based on diagnostic evaluation. Histopathology revealed extradiverticular spread of the tumor with clear surgical margins. Despite the non-radical approach, the patient was successfully treated and remained free of recurrence two years after initial treatment. This report implicates that although aggressive surgical approach is recommended in the majority of bladder diverticulum tumors, simple diverticulectomy may be indicated in selected, confined cases. Eur Urol Suppl 2014; 13(6) e1371
General Hospital “dr. Josip Bencevic”, Dept. of Urology, Slavonski Brod, Croatia, 2"Sestre Milosrdnice" University Hospital Center, Dept. of Urology, Zagreb, Croatia, 3"Sestre Milosrdnice" University Hospital Center, Dept. of Pathology, Zagreb, Croatia INTRODUCTION & OBJECTIVES: Tumors arising within urinary bladder diverticula are rare. Pathophysiological explanation of carcinogenic transformation is based on urinary stasis within poorly contractile diverticula and chronic inflammation. Additionally, bladder diverticula neoplasms have a poorer prognosis than tumors arising within the urinary bladder lumen. Early transmural infiltration through a thinned diverticular wall is considered as a main causal factor. Most of the intradiverticular neoplasms are urothelial, with rare incidence of adenocarcinomas, squamous cell carcinomas and sarcomas. A carcinoma within a urinary bladder diverticulum represent a therapeutic challenge regarding poor prognosis and lack of clear and sufficiently supported therapeutic guidelines. This paper presents recent and concise literature overview on treatment options, and illustrates the rare case of a successfully treated patient with primary intradiverticular squamous cell carcinoma despite the non-radical treatment. MATERIAL & METHODS: RESULTS: Clinical Presentation and Intervention: A 56-year-old man presented with intermittent hematuria. Ultrasound examination indicated primary carcinoma in the urinary bladder diverticulum. Diagnosis was confirmed with cystoscopy and computer tomography. Transvesical diverticulectomy with regional lymphadenectomy was undertaken. Histopathology verified squamous cell carcinoma of the bladder diverticulum with extradiverticular penetration but clear margins. Two years after initial treatment patient is well without evidence of tumor relapse. CONCLUSIONS: This report presented the case of a patient with rare squamous cell diverticular carcinoma who underwent bladder-sparing surgical treatment based on diagnostic evaluation. Histopathology revealed extradiverticular spread of the tumor with clear surgical margins. Despite the non-radical approach, the patient was successfully treated and remained free of recurrence two years after initial treatment. This report implicates that although aggressive surgical approach is recommended in the majority of bladder diverticulum tumors, simple diverticulectomy may be indicated in selected, confined cases. Eur Urol Suppl 2014; 13(6) e1371