BACKGROUND At present,there is controversy on the role of microvessel density(MVD)in tumors as a prognostic indicator of bladder transitional cell carcinoma(BTCC).However,the MVD in tumors is simply classified based o...BACKGROUND At present,there is controversy on the role of microvessel density(MVD)in tumors as a prognostic indicator of bladder transitional cell carcinoma(BTCC).However,the MVD in tumors is simply classified based on the expression of several different vascular markers,which has not been related to analytical research on the prognosis of patients with BTCC.AIM To explore the classification of blood vessels in tumors and studied the relationship between MVD and the prognosis of patients with BTCC.METHODS The tissue mass was detected by tissue microarray and immunohistochemical analysis with monoclonal antibodies against CD31,CD34,CD105,and vascular smooth muscle actin to investigate the MVD in BTCC.The measurement data are expressed as the mean±SD.The difference between the groups was analyzed by the t-test,the counting data were analyzed byχ2 test.The Kaplan-Meier survival curve was estimated by the product-limit method.The log-rank time-series test was employed to compare the tumor-free survival curves.RESULTS The MVD was closely related to the pathological grade,invasive depth,and prognosis of BTCC.Significant differences were found between grade I and grade II,grade II and grade III,superficial and invasive type,and the tumor-free survival group and the recurrence or metastasis group(P<0.01).Multivariate analysis showed that undifferentiated MVD was an independent prognostic factor for patient survival time.An inverse correlation between undifferentiated tumor MVD and differentiated tumor MVD in BTCC was also shown.CONCLUSION The classification of blood vessels in BTCC could act as an important prognostic indicator and may also be of great significance in the treatment of cancer.展开更多
To stduy the association between the prognosis of Ta transitional cell carcinoma (TCC) of the bladder and risk-related factors.Methods A total of 88 cases (62 males and 26 females;mean age,61 years;age range,41-81 yea...To stduy the association between the prognosis of Ta transitional cell carcinoma (TCC) of the bladder and risk-related factors.Methods A total of 88 cases (62 males and 26 females;mean age,61 years;age range,41-81 years) of initial T.TCC of the bladder treated with transurethral resection of bladder tumor (TURBt) plus intravesical chemotherapy or immunotherapy were enrolled.Among them,there were 26 cases of G1,61 cases of G2 and 1 case of G3.For tumor site,62 cases (16 cases of G1,45 of G2,1 of G3) had single tumor and 26 cases (10 cases of G1,16 of G2) had multi-site tumors.The mean follow-up was 113 months (range,56-168 months).The tumor grade,original tumor number and their association with the recurrence and progression of this type of TCC were retrospectively analyzed.Results The overall recurrence rate (RR) was 60% (53/88).In single tumor group,RR of G1 cases was 25% (4/16);RR of G2 cases was 62% (28/45) and the total RR was 52% (32/62).In multi-site tumor group,RR of G1 cases was 80% (8/10),RR of G2 cases was 75% (12/16) and the total RR was 77% (20/26).The RR of multi-site tumor group was significantly higher than that of single tumor group (P<0.01).In single tumor group,RR of G2 cases was significantly higher than that of G1 cases (P<0.001).In multi-site tumor group,there was no association of RR with tumor grade.There was no progression in G1 tumor cases.The progression rate was 42.5% (17/40) in G2 tumor cases;among them,30% (12/40) progressed to T1G2 tumors and 12.5% (5/40) progressed to T2G2 tumors.The RR of cases who received thiotepa,mitomycin and BCG were 75% (12/16),68% (30/44) and 40% (11/27),respectively.Tumor specific mortality was 1.14% (1/88,a T2G3 case).Conclusion The multi-site Ta TCC of the bladder has relatively higher RR and greater chance of progression after the treatment of TURBt plus intravesical chemotherapy or immunotherapy,especially in the poor differentiated tumors,thus active treatment and close follow-up are essential in clinical practice.9 refs.展开更多
Bladder cancer(BC)is the 10th most common cancer worldwide,with about 0.5 million reported new cases and about 0.2 million deaths per year.In this scoping review,we summarize the current evidence regarding the clinica...Bladder cancer(BC)is the 10th most common cancer worldwide,with about 0.5 million reported new cases and about 0.2 million deaths per year.In this scoping review,we summarize the current evidence regarding the clinical implications of single-cell sequencing for bladder cancer based on PRISMA guidelines.We searched PubMed,CENTRAL,Embase,and supplemented with manual searches through the Scopus,and Web of Science for published studies until February 2023.We included original studies that used at least one single-cell technology to study bladder cancer.Forty-one publications were included in the review.Twenty-nine studies showed that this technology can identify cell subtypes in the tumor microenvironment that may predict prognosis or response to immune checkpoint inhibition therapy.Two studies were able to diagnose BC by identifying neoplastic cells through single-cell sequencing urine samples.The remaining studies were mainly a preclinical exploration of tumor microenvironment at single cell level.Single-cell sequencing technology can discriminate heterogeneity in bladder tumor cells and determine the key molecular properties that can lead to the discovery of novel perspectives on cancer management.This nascent tool can advance the early diagnosis,prognosis judgment,and targeted therapy of bladder cancer.展开更多
The mRNA and protein expression of phos-phatase of regenerating liver 1(PRL-1)and phosphatase of regenerating liver 3(PRL-3)in transitional cell carcinoma of bladder(BTCC)and normal epithelia of bladder was investigat...The mRNA and protein expression of phos-phatase of regenerating liver 1(PRL-1)and phosphatase of regenerating liver 3(PRL-3)in transitional cell carcinoma of bladder(BTCC)and normal epithelia of bladder was investigated,and the relationship between the BTCC and pathological changes was clarified.The expression of PRL-1 and PRL-3 mRNA was detected by using reverse transcription polymerase chain reaction(RT-PCR)in 30 cases of BTCC and 10 cases of normal bladder,and the expression of PRL-1 and PRL-3 protein was checked by using immunohistochemistry in 30 cases of BTCC and 15 cases of normal bladder.The expression levels of PRL-1 and PRL-3 mRNA and protein were higher in BTCC than those in normal bladder epithelia(P<0.05).The increased expression of PRL-1 and PRL-3 mRNA and protein was detectable in deep invasion and metastasis of BTCC(P<0.05).There was no correlation between the expres-sion of PRL-1 and PRL-3 and gender,age or recurrence of BTCC(all P>0.05).A significantly positive correlation was found between PRL-1 and PRL-3 in BTCC(P<0.05).PRL-1 and PRL-3 are expressed consistently and may contribute to the growth,differentiation,invasion and metastasis of BTCC.展开更多
BACKGROUND It is rare for urothelial and renal cell carcinomas to coexist in the same patient,and even rarer for them to be detected simultaneously.Because of this rarity,a standard treatment has not been established ...BACKGROUND It is rare for urothelial and renal cell carcinomas to coexist in the same patient,and even rarer for them to be detected simultaneously.Because of this rarity,a standard treatment has not been established and studies about overall survival are scarce.Therefore,physicians must modify treatments according to the individual’s situation and the stage of each disease.In recent years,with advances in the instruments and techniques,minimal invasive robotic surgeries have become available for advanced-stage or high-risk patients.CASE SUMMARY An 85-year-old woman with a medical history of hypertension and hyperlipidemia visited our institution.She had visited her local hospital complaining of intermittent,painless,gross hematuria that had started 3 mo earlier.On computed tomography,a right renal mass and left proximal ureteral mass with hydronephrosis were found simultaneously.We decided to perform robot-assisted surgery on both sides during one operation.Considering renal function and kidney loading,right partial nephrectomy was performed first,followed by left nephroureterectomy with bladder cuff excision.At the 6-mo follow-up,no specific symptoms were reported and dialysis was not considered.There were no unusual findings in the imaging study,and regular follow-up and imaging studies are scheduled.CONCLUSION This case report assessed the feasibility of simultaneous minimal invasive robotic surgery as an alternative to conventional open or laparoscopic surgery.展开更多
BACKGROUND The standard treatment of transitional cell carcinoma of the upper urinary tract consists of radical nephroureterectomy with bladder cuff removal,which can be performed either in open or laparoscopy or robo...BACKGROUND The standard treatment of transitional cell carcinoma of the upper urinary tract consists of radical nephroureterectomy with bladder cuff removal,which can be performed either in open or laparoscopy or robot-assisted laparoscopy.Treatment of chronic renal insufficiency patients with upper urothelial tumor is in a dilemma.Urologists weigh and consider the balance between tumor control and effective renal function preservation.European Association of Urology guidelines recommend that select patients may benefit from endoscopic treatment,but laparoscopic treatment is rarely reported.CASE SUMMARY In this case report,we describe a case of 79-year-old female diagnosed with urothelial carcinoma of the renal pelvis and adrenal adenoma with chronic renal insufficiency.The patient was treated with retroperitoneal laparoscopic partial resection of the renal pelvis and adrenal adenoma resection simultaneously.CONCLUSION Retroperitoneal laparoscopic partial resection of the renal pelvis is an effective surgical procedure for the treatment of urothelial carcinoma of the renal pelvis.展开更多
Background:Heterogeneity of tumor cells and the tumor microenvironment(TME)is significantly associated with clinical outcomes and treatment responses in patients with urothelial carcinoma(UC).Comprehensive profiling o...Background:Heterogeneity of tumor cells and the tumor microenvironment(TME)is significantly associated with clinical outcomes and treatment responses in patients with urothelial carcinoma(UC).Comprehensive profiling of the cellular diversity and interactions between malignant cells and TME may clarify the mechanisms underlying UC progression and guide the development of novel therapies.This study aimed to extend our understanding of intra-tumoral heterogeneity and the immunosuppressive TME in UC and provide basic support for the development of novel UC therapies.Methods:Seven patients with UC were included who underwent curative surgery at our hospital between July 2020 and October 2020.We performed single-cell RNA sequencing(scRNA-seq)analysis in seven tumors with six matched adjacent normal tissues and integrated the results with two public scRNA-seq datasets.The functional properties and intercellular interactions between single cells were characterized,and the results were validated using multiplex immunofluorescence staining,flow cytometry,and bulk transcriptomic datasets.All statistical analyses were performed using the R package with two-sided tests.Wilcoxon-rank test,log-rank test,one-way analysis of variance test,and Pearson correlation analysis were used properly.Results:Unsupervised t-distributed stochastic neighbor embedding clustering analysis identified ten main cellular subclusters in urothelial tissues.Of them,seven urothelial subtypes were noted,and malignant urothelial cells were characterized with enhanced cellular proliferation and reduced immunogenicity.CD8^(+)T cell subclusters exhibited enhanced cellular cytotoxicity activities along with increased exhaustion signature in UC tissues,and the recruitment of CD4^(+)T regulatory cells was also increased in tumor tissues.Regarding myeloid cells,coordinated reprogramming of infiltrated neutrophils,M2-type polarized macrophages,and LAMP3^(+)dendritic cells contribute to immunosuppressive TME in UC tissues.Tumor tissues demonstrated enhanced angiogenesis mediated by KDR^(+)endothelial cells and RGS5^(+)/ACTA2^(+)pericytes.Through deconvolution analysis,we identified multiple cellular subtypes may influence the programmed death-ligand 1(PD-L1)immunotherapy response in patients with UC.Conclusion:Our scRNA-seq analysis clarified intra-tumoral heterogeneity and delineated the pro-tumoral and immunosuppressive microenvironment in UC tissues,which may provide novel therapeutic targets.展开更多
Treatment of clinically-organ confined high grade urothelial carcinoma of the upper tract has historically comprised open nephroureterectomy,with the distal ureter and bladder cuff mobilized through a separate open pe...Treatment of clinically-organ confined high grade urothelial carcinoma of the upper tract has historically comprised open nephroureterectomy,with the distal ureter and bladder cuff mobilized through a separate open pelvic incision.To decrease morbidity,urologists have increasingly adopted laparoscopy and robotics in performing nephroureterectomy.In many published series of laparoscopic nephroureterectomy,the distal ureter and bladder cuff are detached from the bladder endoscopically by a variation of the“pluck”technique,with the resulting bladder defect left to heal by prolonged indwelling urethral catheter drainage.While the distal ureter and bladder cuff can be excised laparoscopically,it does require advanced laparoscopic skills.With the wrist articulation and stereoscopic vision in robotic surgery,robotic nephroureterectomy(RNU)and bladder cuff excision can be performed in antegrade fashion to mimic the open technique together with the ability to intracorporeally close the bladder defect in a watertight,mucosa to mucosa fashion after excising the bladder cuff.In this review,we discuss the published minimally invasive techniques in resecting the distal ureter and bladder cuff during laparoscopic and RNU.展开更多
Background:Traumatic spinal cord injury(SCI)is also a combat-related injury that is increasing in modern warfare.The aim of this work is to inform medical experts regarding the different course of bladder cancer in ab...Background:Traumatic spinal cord injury(SCI)is also a combat-related injury that is increasing in modern warfare.The aim of this work is to inform medical experts regarding the different course of bladder cancer in able-bodied patients compared with SCI patients based on the latest medical scientific knowledge,and to present decision-making aids for the assessment of bladder cancer as a late sequela of traumatic SCI.Methods:A study conducted between January 1998 and December 2019 in the BG Trauma Hospital Hamburg formed the basis for the decision-making aids.Urinary bladder cancer was diagnosed in 40 out of 7396 treated outpatient and inpatient SCI patients.General patient information,latency period,age at initial diagnosis,type of bladder management and survival of SCI patients with bladder cancer were collected and analysed.T category,grading and tumor entity in these patients were compared with those in the general population.Relevant bladder cancer risk factors in SCI patients were analysed.Furthermore,relevant published literature was taken into consideration.Results:Initial diagnosis of urinary bladder cancer in SCI patients occurs at a mean age of 56.4 years(SD±10.7 years),i.e.,approximately 20 years earlier as compared with the general population.These bladder cancers are significantly more frequently muscle invasive(i.e.,T category≥T2)and present a higher grade at initial diagnosis.Furthermore,SCI patients show a significantly higher proportion of the more aggressive squamous cell carcinoma than that of the general population in areas not endemic for the tropical disease schistosomiasis.Consequently,the survival time is extremely unfavourable.A very important finding,for practical reasons is that,in the Hamburg study as well as in the literature,urinary bladder cancer is more frequently observed after 10 years or more of SCI.Based on these findings,a matrix was compiled where the various influencing factors,either for or against the recognition of an association between SCI and urinary bladder cancer,were weighted according to their relevance.Conclusions:The results showed that urinary bladder cancer in SCI patients differs considerably from that in ablebodied patients.The presented algorithm is an important aid in everyday clinical practice for assessing the correlation between SCI and bladder cancer.展开更多
Mixed epithelial and stromal tumour(MEST)is an uncommon renal tumour with a tendency to protrude into the collecting system.We present a 50-year-old woman with a renal tumour extending up to the vesicoureteric junctio...Mixed epithelial and stromal tumour(MEST)is an uncommon renal tumour with a tendency to protrude into the collecting system.We present a 50-year-old woman with a renal tumour extending up to the vesicoureteric junction(VUJ)who was suspected to have an upper tract transitional cell carcinoma for which a nephroureterectomy was performed.Histopathologic examination revealed a MEST arising from the kidney and extending up to the VUJ.To the best of our knowledge,this is the first report of a renal MEST with extension to the VUJ.展开更多
Cancer of unknown primary site is a group of uncommon cancers where patients present with metastatic disease and the primary site is not identifi ed,even after a complete workup to establish the diagnosis.Inguinal met...Cancer of unknown primary site is a group of uncommon cancers where patients present with metastatic disease and the primary site is not identifi ed,even after a complete workup to establish the diagnosis.Inguinal metastasis with unknown primary is even more uncommon,and histological type is the most important guiding factor to look for the primary.This report describes the rare situation of inguinal metastasis with an unknown primary site where a combination of squamous and transitional cell carcinoma was found on fi nal histopathology.It highlights the importance of multimodality approach including an aggressive surgical resection combined with adjuvant radiation therapy to achieve an optimal outcome.展开更多
文摘BACKGROUND At present,there is controversy on the role of microvessel density(MVD)in tumors as a prognostic indicator of bladder transitional cell carcinoma(BTCC).However,the MVD in tumors is simply classified based on the expression of several different vascular markers,which has not been related to analytical research on the prognosis of patients with BTCC.AIM To explore the classification of blood vessels in tumors and studied the relationship between MVD and the prognosis of patients with BTCC.METHODS The tissue mass was detected by tissue microarray and immunohistochemical analysis with monoclonal antibodies against CD31,CD34,CD105,and vascular smooth muscle actin to investigate the MVD in BTCC.The measurement data are expressed as the mean±SD.The difference between the groups was analyzed by the t-test,the counting data were analyzed byχ2 test.The Kaplan-Meier survival curve was estimated by the product-limit method.The log-rank time-series test was employed to compare the tumor-free survival curves.RESULTS The MVD was closely related to the pathological grade,invasive depth,and prognosis of BTCC.Significant differences were found between grade I and grade II,grade II and grade III,superficial and invasive type,and the tumor-free survival group and the recurrence or metastasis group(P<0.01).Multivariate analysis showed that undifferentiated MVD was an independent prognostic factor for patient survival time.An inverse correlation between undifferentiated tumor MVD and differentiated tumor MVD in BTCC was also shown.CONCLUSION The classification of blood vessels in BTCC could act as an important prognostic indicator and may also be of great significance in the treatment of cancer.
文摘To stduy the association between the prognosis of Ta transitional cell carcinoma (TCC) of the bladder and risk-related factors.Methods A total of 88 cases (62 males and 26 females;mean age,61 years;age range,41-81 years) of initial T.TCC of the bladder treated with transurethral resection of bladder tumor (TURBt) plus intravesical chemotherapy or immunotherapy were enrolled.Among them,there were 26 cases of G1,61 cases of G2 and 1 case of G3.For tumor site,62 cases (16 cases of G1,45 of G2,1 of G3) had single tumor and 26 cases (10 cases of G1,16 of G2) had multi-site tumors.The mean follow-up was 113 months (range,56-168 months).The tumor grade,original tumor number and their association with the recurrence and progression of this type of TCC were retrospectively analyzed.Results The overall recurrence rate (RR) was 60% (53/88).In single tumor group,RR of G1 cases was 25% (4/16);RR of G2 cases was 62% (28/45) and the total RR was 52% (32/62).In multi-site tumor group,RR of G1 cases was 80% (8/10),RR of G2 cases was 75% (12/16) and the total RR was 77% (20/26).The RR of multi-site tumor group was significantly higher than that of single tumor group (P<0.01).In single tumor group,RR of G2 cases was significantly higher than that of G1 cases (P<0.001).In multi-site tumor group,there was no association of RR with tumor grade.There was no progression in G1 tumor cases.The progression rate was 42.5% (17/40) in G2 tumor cases;among them,30% (12/40) progressed to T1G2 tumors and 12.5% (5/40) progressed to T2G2 tumors.The RR of cases who received thiotepa,mitomycin and BCG were 75% (12/16),68% (30/44) and 40% (11/27),respectively.Tumor specific mortality was 1.14% (1/88,a T2G3 case).Conclusion The multi-site Ta TCC of the bladder has relatively higher RR and greater chance of progression after the treatment of TURBt plus intravesical chemotherapy or immunotherapy,especially in the poor differentiated tumors,thus active treatment and close follow-up are essential in clinical practice.9 refs.
文摘Bladder cancer(BC)is the 10th most common cancer worldwide,with about 0.5 million reported new cases and about 0.2 million deaths per year.In this scoping review,we summarize the current evidence regarding the clinical implications of single-cell sequencing for bladder cancer based on PRISMA guidelines.We searched PubMed,CENTRAL,Embase,and supplemented with manual searches through the Scopus,and Web of Science for published studies until February 2023.We included original studies that used at least one single-cell technology to study bladder cancer.Forty-one publications were included in the review.Twenty-nine studies showed that this technology can identify cell subtypes in the tumor microenvironment that may predict prognosis or response to immune checkpoint inhibition therapy.Two studies were able to diagnose BC by identifying neoplastic cells through single-cell sequencing urine samples.The remaining studies were mainly a preclinical exploration of tumor microenvironment at single cell level.Single-cell sequencing technology can discriminate heterogeneity in bladder tumor cells and determine the key molecular properties that can lead to the discovery of novel perspectives on cancer management.This nascent tool can advance the early diagnosis,prognosis judgment,and targeted therapy of bladder cancer.
文摘The mRNA and protein expression of phos-phatase of regenerating liver 1(PRL-1)and phosphatase of regenerating liver 3(PRL-3)in transitional cell carcinoma of bladder(BTCC)and normal epithelia of bladder was investigated,and the relationship between the BTCC and pathological changes was clarified.The expression of PRL-1 and PRL-3 mRNA was detected by using reverse transcription polymerase chain reaction(RT-PCR)in 30 cases of BTCC and 10 cases of normal bladder,and the expression of PRL-1 and PRL-3 protein was checked by using immunohistochemistry in 30 cases of BTCC and 15 cases of normal bladder.The expression levels of PRL-1 and PRL-3 mRNA and protein were higher in BTCC than those in normal bladder epithelia(P<0.05).The increased expression of PRL-1 and PRL-3 mRNA and protein was detectable in deep invasion and metastasis of BTCC(P<0.05).There was no correlation between the expres-sion of PRL-1 and PRL-3 and gender,age or recurrence of BTCC(all P>0.05).A significantly positive correlation was found between PRL-1 and PRL-3 in BTCC(P<0.05).PRL-1 and PRL-3 are expressed consistently and may contribute to the growth,differentiation,invasion and metastasis of BTCC.
基金Supported by Soonchunhyang University Research Fund,No.1022-0015.
文摘BACKGROUND It is rare for urothelial and renal cell carcinomas to coexist in the same patient,and even rarer for them to be detected simultaneously.Because of this rarity,a standard treatment has not been established and studies about overall survival are scarce.Therefore,physicians must modify treatments according to the individual’s situation and the stage of each disease.In recent years,with advances in the instruments and techniques,minimal invasive robotic surgeries have become available for advanced-stage or high-risk patients.CASE SUMMARY An 85-year-old woman with a medical history of hypertension and hyperlipidemia visited our institution.She had visited her local hospital complaining of intermittent,painless,gross hematuria that had started 3 mo earlier.On computed tomography,a right renal mass and left proximal ureteral mass with hydronephrosis were found simultaneously.We decided to perform robot-assisted surgery on both sides during one operation.Considering renal function and kidney loading,right partial nephrectomy was performed first,followed by left nephroureterectomy with bladder cuff excision.At the 6-mo follow-up,no specific symptoms were reported and dialysis was not considered.There were no unusual findings in the imaging study,and regular follow-up and imaging studies are scheduled.CONCLUSION This case report assessed the feasibility of simultaneous minimal invasive robotic surgery as an alternative to conventional open or laparoscopic surgery.
文摘BACKGROUND The standard treatment of transitional cell carcinoma of the upper urinary tract consists of radical nephroureterectomy with bladder cuff removal,which can be performed either in open or laparoscopy or robot-assisted laparoscopy.Treatment of chronic renal insufficiency patients with upper urothelial tumor is in a dilemma.Urologists weigh and consider the balance between tumor control and effective renal function preservation.European Association of Urology guidelines recommend that select patients may benefit from endoscopic treatment,but laparoscopic treatment is rarely reported.CASE SUMMARY In this case report,we describe a case of 79-year-old female diagnosed with urothelial carcinoma of the renal pelvis and adrenal adenoma with chronic renal insufficiency.The patient was treated with retroperitoneal laparoscopic partial resection of the renal pelvis and adrenal adenoma resection simultaneously.CONCLUSION Retroperitoneal laparoscopic partial resection of the renal pelvis is an effective surgical procedure for the treatment of urothelial carcinoma of the renal pelvis.
基金supported by grants from the National Nature Science Foundation(No.81970658)Natural Science Foundation of Shanghai(No.20ZR1434100)
文摘Background:Heterogeneity of tumor cells and the tumor microenvironment(TME)is significantly associated with clinical outcomes and treatment responses in patients with urothelial carcinoma(UC).Comprehensive profiling of the cellular diversity and interactions between malignant cells and TME may clarify the mechanisms underlying UC progression and guide the development of novel therapies.This study aimed to extend our understanding of intra-tumoral heterogeneity and the immunosuppressive TME in UC and provide basic support for the development of novel UC therapies.Methods:Seven patients with UC were included who underwent curative surgery at our hospital between July 2020 and October 2020.We performed single-cell RNA sequencing(scRNA-seq)analysis in seven tumors with six matched adjacent normal tissues and integrated the results with two public scRNA-seq datasets.The functional properties and intercellular interactions between single cells were characterized,and the results were validated using multiplex immunofluorescence staining,flow cytometry,and bulk transcriptomic datasets.All statistical analyses were performed using the R package with two-sided tests.Wilcoxon-rank test,log-rank test,one-way analysis of variance test,and Pearson correlation analysis were used properly.Results:Unsupervised t-distributed stochastic neighbor embedding clustering analysis identified ten main cellular subclusters in urothelial tissues.Of them,seven urothelial subtypes were noted,and malignant urothelial cells were characterized with enhanced cellular proliferation and reduced immunogenicity.CD8^(+)T cell subclusters exhibited enhanced cellular cytotoxicity activities along with increased exhaustion signature in UC tissues,and the recruitment of CD4^(+)T regulatory cells was also increased in tumor tissues.Regarding myeloid cells,coordinated reprogramming of infiltrated neutrophils,M2-type polarized macrophages,and LAMP3^(+)dendritic cells contribute to immunosuppressive TME in UC tissues.Tumor tissues demonstrated enhanced angiogenesis mediated by KDR^(+)endothelial cells and RGS5^(+)/ACTA2^(+)pericytes.Through deconvolution analysis,we identified multiple cellular subtypes may influence the programmed death-ligand 1(PD-L1)immunotherapy response in patients with UC.Conclusion:Our scRNA-seq analysis clarified intra-tumoral heterogeneity and delineated the pro-tumoral and immunosuppressive microenvironment in UC tissues,which may provide novel therapeutic targets.
文摘Treatment of clinically-organ confined high grade urothelial carcinoma of the upper tract has historically comprised open nephroureterectomy,with the distal ureter and bladder cuff mobilized through a separate open pelvic incision.To decrease morbidity,urologists have increasingly adopted laparoscopy and robotics in performing nephroureterectomy.In many published series of laparoscopic nephroureterectomy,the distal ureter and bladder cuff are detached from the bladder endoscopically by a variation of the“pluck”technique,with the resulting bladder defect left to heal by prolonged indwelling urethral catheter drainage.While the distal ureter and bladder cuff can be excised laparoscopically,it does require advanced laparoscopic skills.With the wrist articulation and stereoscopic vision in robotic surgery,robotic nephroureterectomy(RNU)and bladder cuff excision can be performed in antegrade fashion to mimic the open technique together with the ability to intracorporeally close the bladder defect in a watertight,mucosa to mucosa fashion after excising the bladder cuff.In this review,we discuss the published minimally invasive techniques in resecting the distal ureter and bladder cuff during laparoscopic and RNU.
文摘Background:Traumatic spinal cord injury(SCI)is also a combat-related injury that is increasing in modern warfare.The aim of this work is to inform medical experts regarding the different course of bladder cancer in able-bodied patients compared with SCI patients based on the latest medical scientific knowledge,and to present decision-making aids for the assessment of bladder cancer as a late sequela of traumatic SCI.Methods:A study conducted between January 1998 and December 2019 in the BG Trauma Hospital Hamburg formed the basis for the decision-making aids.Urinary bladder cancer was diagnosed in 40 out of 7396 treated outpatient and inpatient SCI patients.General patient information,latency period,age at initial diagnosis,type of bladder management and survival of SCI patients with bladder cancer were collected and analysed.T category,grading and tumor entity in these patients were compared with those in the general population.Relevant bladder cancer risk factors in SCI patients were analysed.Furthermore,relevant published literature was taken into consideration.Results:Initial diagnosis of urinary bladder cancer in SCI patients occurs at a mean age of 56.4 years(SD±10.7 years),i.e.,approximately 20 years earlier as compared with the general population.These bladder cancers are significantly more frequently muscle invasive(i.e.,T category≥T2)and present a higher grade at initial diagnosis.Furthermore,SCI patients show a significantly higher proportion of the more aggressive squamous cell carcinoma than that of the general population in areas not endemic for the tropical disease schistosomiasis.Consequently,the survival time is extremely unfavourable.A very important finding,for practical reasons is that,in the Hamburg study as well as in the literature,urinary bladder cancer is more frequently observed after 10 years or more of SCI.Based on these findings,a matrix was compiled where the various influencing factors,either for or against the recognition of an association between SCI and urinary bladder cancer,were weighted according to their relevance.Conclusions:The results showed that urinary bladder cancer in SCI patients differs considerably from that in ablebodied patients.The presented algorithm is an important aid in everyday clinical practice for assessing the correlation between SCI and bladder cancer.
文摘Mixed epithelial and stromal tumour(MEST)is an uncommon renal tumour with a tendency to protrude into the collecting system.We present a 50-year-old woman with a renal tumour extending up to the vesicoureteric junction(VUJ)who was suspected to have an upper tract transitional cell carcinoma for which a nephroureterectomy was performed.Histopathologic examination revealed a MEST arising from the kidney and extending up to the VUJ.To the best of our knowledge,this is the first report of a renal MEST with extension to the VUJ.
文摘Cancer of unknown primary site is a group of uncommon cancers where patients present with metastatic disease and the primary site is not identifi ed,even after a complete workup to establish the diagnosis.Inguinal metastasis with unknown primary is even more uncommon,and histological type is the most important guiding factor to look for the primary.This report describes the rare situation of inguinal metastasis with an unknown primary site where a combination of squamous and transitional cell carcinoma was found on fi nal histopathology.It highlights the importance of multimodality approach including an aggressive surgical resection combined with adjuvant radiation therapy to achieve an optimal outcome.
