Urothelial tumors

Logothetis CJ, Dexeus FH, Finn L, et al. A prospective randomized trial comparing MV AC and CISC A chemotherapy for patients with metastatic urothelial tumors. J Clin Oncol 1990 8 1050-1055. 

One patient who had a urothehal malignancy 6 years after the onset of Chinese herb nephropathy later developed a breast carcinoma that metastasised to the liver (31). The urothelial mahgnancy contained aristolochic acid-DNA adducts and mutations in the p53 gene, and the same mis-sense mutation in codon 245 of exon 7 of p53 was found in DNA from the breast and liver tumors. However, DNA extracted from the urothelial tumor also showed a mutation in codon 139 of exon 5, which was not present in the breast and liver. 

Between 1/3 and 1/2 of patients with Balkan nephropathy develop urothelial tumors [21]. An exceptionally high frequency of these tumors was also observed in the general population of endemic regions [22]. When initially studied, the attributive risk of developing upper urothehal fumors in inhabitants of endemic foci amounted to several dozen or even to as much as 100-200. 

Genetic factors may play a role in different individual risk of developing Balkan nephropathy, upper urothelial tumors, both diseases or none of them [68]. However, epidemiological data indicate that one or more external, environmental factors are crucial for the occurrence of both Balkan nephropathy and excessive frequency of these tumors in endemic areas. 

Balkan nephropathy is a chronic tuhulointerstitial disease with occult, insidious onset, usually progressing slowly with no apparent signs of symptoms. After a long asymptomatic period, the disease is manifested as chronic renal failure. Less commonly hlunt lumbar pain or renal colic may develop or, occasionally, dysuric symptoms induced by urinary tract infechon. If hematuria exists, urothelial tumor should be suspected. In an advanced case polyuria and nocturia are present due to impaired concentrating ability of the kidneys. The disease is tolerated well and the patients preserve their working ability until advanced stages of renal failure [18, 76, 88, 89]. 

An important feature of Balkan nephropathy is its association with a high incidence of tumors of the renal pelvis and ureters, but not urinary bladder tumors [22, 94,95]. However, the difference between the incidence of upper urothelial tumors in endemic and non-endemic regions diminished in the last decades. In the sixties and seventies the incidence of these tumors was reported to be several dozen times higher in endemic than in non-endemic regions, while in the last decades this difference almost disappeared [21, 22, 94, 96, 97]. 

Upper urothelial tumors of patients originating from the region with Balkan nephropathy differ from tumors identified in patients from other regions in their similar incidence in both sexes, bilateral occurrence, and more common association with chronic renal failure [95]. 

However, recent studies indicated that patients with Balkan nephropathy are at increased risk for the development of upper urothelial tumors in both native and transplanted kidneys [117]. 

Brenner tumors of the ovary have an immunoprofile similar to urothelial tumors. 

Prostatic involvement by urothelial carcinoma can result from direct invasion of an infiltrating bladder cancer into prostate stroma, as well as through extension of urothelial tumor through intraductal route with or without subsequent stromal invasion of the prostate. 37... 

Helpap B, Kollermann J. Assessment of basal cell status and proliferative patterns in flat and papillary urothelial lesions a contribution to the new WHO classification of the urothelial tumors of the urinary bladder. Hum Pathol. 2000 31 745. 

Lascombe I, Clairotte A, Fauconnet S, et al. N-cadherin as a novel prognostic marker of progression in superficial urothelial tumors. Clin Cancer Res. 2006 12 2780. 

Clairotte A, Lascombe I, Fauconnet S, et al. Expression of E-cadherin and alpha-, beta-, gamma-catenins in patients with bladder cancer identification of gamma-catenin as a new prognostic marker of neoplastic progression in T1 superficial urothelial tumors. Am J Clin Pathol. 2006 125 119. 

R. Waidelich, A. Hofstetter, H. Stepp, R. Baumgartner, E. Weninger, M. Kriegmair (1998). Early clinical experience with 5-aminolevulinic acid for the photodynamic therapy of upper tract urothelial tumors. J. Urol., 159, 401-404. 

Selman SH, Keck RW, Klauning JE, Kriemer-Bimbaum M, Goldblatt PJ, Britton SL. Acute blood flow changes in transplantable FANFT-induced urothelial tumors treated with hematoporphyrin derivative and light. Surg Forum 1983 34 676-678. 

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