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Vol. 39. Issue 6.
Pages 387-391 (July - August 2015)
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Vol. 39. Issue 6.
Pages 387-391 (July - August 2015)
Casuistry
The nested variant of bladder transitional cell carcinoma: Review of 12 cases and review of the literature
Carcinoma urotelial vesical variedad en nidos: presentación de 12 casos y revisión de la literatura
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C.J. Carrion-Ballardoa,
Corresponding author
, L. Gala-Solanaa, J.A. Portillo-Martina, A. Azueta-Etxebarriab, D. Truan-Cachoa, F. Campos-Juanateya
a Servicio de Urología, Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Table 1. Demographic characteristics.
Table 2. Tumor characteristics.
Table 3. Treatment and evolution of the 12 patients.
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Abstract
Objectives

The nested variant of bladder transitional cell carcinoma is extremely rare and has a different biological behavior to other bladder tumors.

The aim of this study is to analyse if their behavior is as aggressive as has been described in the literature.

Material and method

Review of 12 diagnosed cases with nested variant of bladder transitional cell carcinoma and analysis of demographic characteristics, clinical presentation, tumor characteristics, treatment options, analysis of recurrence and cancer-specific survival between January 1997 and December 2010 in our hospital.

Results

50% of the cases had a pathologic stage ≥T2, with grade of differentiation G2 (50%) or G3 (50%). After the pathological result of the TUR (transurethral resection) Bladder, 5 cases underwent radical cystoprostatectomy, 3 a second TUR bladder and 4 cases with treatment chemotherapy and/or radiotherapy (RT). Five out of 12 cases (41.7%) died due to bladder cancer and 3 died (25%) of other causes (urinary sepsis, respiratory failure, renal failure). With a median follow up of 40 months, the overall survival was 50% and cancer-specific survival of 65.6%.

Conclusions

The nested variant of bladder transitional cell carcinoma is a disease with an advanced-stage presentation, with high recurrence and mortality rates despite the use of different treatments. So far there is not a clinical practice guideline for this variety of urothelial tumor.

Keywords:
Bladder carcinoma
Urothelial nested variant
Bladder cancer survival
Resumen
Objetivos

El carcinoma urotelial vesical variedad en nidos es extremadamente infrecuente, y tiene un comportamiento más agresivo que el resto de tumores de vejiga. El objetivo principal de este estudio es analizar si su comportamiento en nuestro medio es tan agresivo como lo descrito en la literatura.

Material y método

Revisión de 12 casos diagnosticados de carcinoma urotelial vesical variedad en nidos y análisis de las características tumorales, opciones de tratamiento, análisis de recurrencia y supervivencia de la enfermedad entre enero de 1997 y diciembre del 2010 en nuestra institución.

Resultados

El 50% de los casos tuvo un estadio tumoral ≥T2, siendo el grado de diferenciación G2 (50%) o G3 (50%). Tras el resultado anatomopatológico de la primera resección transuretral (RTU) vesical en 5 pacientes se practicó cistoprostatectomía radical, 3 una segunda RTU y 4 pacientes solo con tratamiento quimioterápico (QT) posterior y/o radioterapia (RT). De los 12 casos 5 (41,7%) fallecieron por causa tumoral y 3 (25%) por otras causas (sepsis urinaria, insuficiencia respiratoria, insuficiencia renal). Con una mediana de seguimiento de 40 meses la supervivencia global fue del 50% y la supervivencia cáncer específica del 65,6%.

Conclusiones

El carcinoma urotelial vesical variedad en nidos es un tumor que se presenta en estadios avanzados, con altas tasas de recurrencias y mortalidad a pesar del uso de diferentes herramientas de tratamiento. No existe hasta la fecha una guía de práctica clínica para esta variedad de tumor urotelial.

Palabras clave:
Carcinoma vesical
Variedad urotelial en nidos
Supervivencia de cáncer vesical

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