|LETTER TO THE EDITOR
|Year : 2019 | Volume
| Issue : 1 | Page : 40-41
Untreated urinary bladder stone and subsequent squamous cell carcinoma
Jen-Shu Tseng1, Marcelo Chen2, Wen-Chou Lin3
1 Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
2 Department of Medicine, Mackay Medical College, Taipei, Taiwan
3 Department of Cosmetic Applications and Management, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
|Date of Web Publication||2-Jan-2019|
Department of Urology, Mackay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Zhongshan District, Taipei 104
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tseng JS, Chen M, Lin WC. Untreated urinary bladder stone and subsequent squamous cell carcinoma. Urol Sci 2019;30:40-1
A 67-year-old male visited our outpatient department with the chief complaint of gross hematuria for a long time. He was diagnosed with a large bladder stone for more than 20 years, but he refused surgery. The stone size increased gradually year-by-year and reached 8.7 cm during the latest visit. The patient finally agreed to surgery due to intractable hematuria. During cystolithotomy [Figure 1], diffusely thickened bladder wall and a wide-based tumor were seen. Biopsy was performed and showed low-grade squamous cell carcinoma (SCC), which at least invaded the subepithelial connective tissue. Computed tomography showed an irregular tumor involving the anterior bladder wall, peritoneal metastatic tumors, and a lymph node in the left pelvic sidewall [Figure 2] and [Figure 3]. Chemotherapy with gemcitabine and cisplatin was started immediately after the diagnosis. However, obstructive uropathy and bowel obstruction developed rapidly despite chemotherapy. He died of intra-abdominal infection-related sepsis 6 months later.
|Figure 1: The stone fragments. The stone was partially disintegrated during the operation in hope to minimize the abdominal incision|
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|Figure 2: Computed tomography of the abdomen. Computed tomography revealed a 3.8 cm × 10.0 cm irregular tumor involving anterior bladder wall (a) and a 3.7 cm × 1.6 cm lymph node in the left pelvic sidewall (arrow)|
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|Figure 3: Computed tomography of the abdomen. Computed tomography revealed a 3.8 cm × 10.0 cm irregular tumor involving anterior bladder wall (a) and a 3.2 cm × 9.2 cm peritoneal metastatic tumor (b)|
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As a variant malignancy of the urinary tract other than urothelial carcinoma, SCC is rarely seen, but it frequently presents in an advanced stage at diagnosis. The development of SCC of the bladder can be separated into bilharzia SCC and nonbilharzia (NB-SCC) on etiology. SCC accounts for <5% of bladder malignancies but can account for up to 60% in the schistosomiasis-endemic regions. The predisposing factors of bladder NB-SCC include tobacco smoking, chronic infection, long-term indwelling catheterization, bladder outlet obstruction, and as in our case, urolithiasis. Chronic inflammation caused by these predisposing factors may facilitate proliferation, metaplasia, and malignant change of the bladder epithelium. The prominent symptom of bladder SCC is hematuria, while irritative symptoms occur in some cases. A subanalysis using the Surveillance, Epidemiology, and End Result registries database found that more than 85% of SCCs presented as muscle-invasive tumors in contrast to 22% of urothelial carcinomas (UC). The study found comparable 2-year overall survival and cancer-specific survival between localized SCC and UC after radical cystectomy. In higher-staged tumors with radical cystectomy and in all-stage tumors without radical cystectomy, the 2-year overall survival and cancer-specific survival were better in the UC group. A later study using the same database in patients receiving radical cystectomy did not find differences in 5-year cancer-specific mortality between the different pathological subtypes. These results support the role of radical cystectomy as the standard treatment. Other treatment choices include radiation and chemotherapy. The optimal treatment modalities and the efficacy of these treatments remain controversial due to the small case numbers, and treatments other than radical cystectomy seem to be less effective. Lin et al. inspected the relationship between urolithiasis and intervention with subsequent cancer development using a population-based database. After reviewing 42,732 participants with a history of urolithiasis using the National Health Insurance Research Database in Taiwan, they found a 1.82-fold increased risk of developing urinary tract cancer. Furthermore, patients who received early intervention (within 3 months) had a decreased risk of subsequent urinary tract cancers (adjusted hazard ratio: 0.53, 95% confidence interval: 0.40–0.71, P < 0.001).
In conclusion, untreated bladder stones may lead to the development of bladder SCC. Early intervention for bladder stones is therefore recommended.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]