상부요로와 방광 이행상피세포암 간 세포분화도의 일치도

우광재,곽경원,최한용,이현무 대한비뇨의학회 2008 Investigative and Clinical Urology Vol.49 No.1

Purpose: Transitional cell carcinoma(TCC) is thought to involve the entire urothelium as a multifocal field change. The tumor grade is a major prognostic factor in TCC and predicting the grade of TCC may be of clinical significance. The objective of this study is to clarify the grade concordance between upper tract TCC and bladder TCC. Materials and Methods: From 1994 to 2006, a total of 241 patients underwent nephroureterectomy for upper tract TCC. Seventy-four of the 241 patients who had a history of previous bladder cancer and/or synchronous or metachronous bladder TCC were included in this study. The grade was recorded for each tumor. Fisher's exact test of concordance was used for statistical analysis. Results: For the 74 patients who were analyzed, 42 patients(56.8%) developed bladder TCC during their follow up after nephroureterectomy, 14 patients(18.9%) had a history of bladder TCC prior to nephroureterectomy and 18 patients(24.3%) had a synchronous bladder tumor. In the case of developing bladder TCC during their follow up after nephroureterectomy, the grade concordance is highest between upper tract TCC and bladder TCC in 81.0% of the cases(p=0.005). Overall, the concordance rate between the upper tract TCC grade and the bladder TCC grade was 77.0%(p<0.001). Conclusions: Concordance of the TCC in the upper urinary tract and bladder was present in 77.0% of the cases. The patients who developed bladder tumor during their follow up after nephroureterectomy had the highest grade concordance between upper tract TCC and bladder TCC in 81.0% of the cases. This knowledge can have a significant impact on the therapeutic and follow up plans for transitional cell carcinoma. (Korean J Urol 2008;49:7-11) Purpose: Transitional cell carcinoma(TCC) is thought to involve the entire urothelium as a multifocal field change. The tumor grade is a major prognostic factor in TCC and predicting the grade of TCC may be of clinical significance. The objective of this study is to clarify the grade concordance between upper tract TCC and bladder TCC. Materials and Methods: From 1994 to 2006, a total of 241 patients underwent nephroureterectomy for upper tract TCC. Seventy-four of the 241 patients who had a history of previous bladder cancer and/or synchronous or metachronous bladder TCC were included in this study. The grade was recorded for each tumor. Fisher's exact test of concordance was used for statistical analysis. Results: For the 74 patients who were analyzed, 42 patients(56.8%) developed bladder TCC during their follow up after nephroureterectomy, 14 patients(18.9%) had a history of bladder TCC prior to nephroureterectomy and 18 patients(24.3%) had a synchronous bladder tumor. In the case of developing bladder TCC during their follow up after nephroureterectomy, the grade concordance is highest between upper tract TCC and bladder TCC in 81.0% of the cases(p=0.005). Overall, the concordance rate between the upper tract TCC grade and the bladder TCC grade was 77.0%(p<0.001). Conclusions: Concordance of the TCC in the upper urinary tract and bladder was present in 77.0% of the cases. The patients who developed bladder tumor during their follow up after nephroureterectomy had the highest grade concordance between upper tract TCC and bladder TCC in 81.0% of the cases. This knowledge can have a significant impact on the therapeutic and follow up plans for transitional cell carcinoma. (Korean J Urol 2008;49:7-11)

조직학적 부화도가 낮은 표재성방광암에 대한 임상적 고찰

염규영,최진선 凡石學術奬學財團 1999 凡石學術論文集 Vol.3 No.-

비근침윤성 방광암 진단에 따른 보험금 지급에 대한 고찰 Ⅱ - 비근침윤성 방광암 고위험군에 대한 상피내암 보험금 한정 지급 관련 문제를 중심으로 -

박민영 ( Minyoung Park ) 한국손해사정학회 2021 손해사정연구 Vol.22 No.-

대다수의 암보험 약관에서는 방광의 상피내암 진단시, 일반암 보험금을 지급하지 않고, 소액의 상피내암 보험금만을 한정 지급하도록 규정하고 있다. 방광의 상피내암 경우, 종양의 형태 및 침윤성암으로의 진행률에 따라, Ta와 Tis 두가지로 달리 분류하고 있는, 방광암 고유의 T 병기 체계를 가지고 있다. 이러한 방광암 고유의 T 병기 체계로 인해, 조직병리적 정의 및 그에 따른 분류에 의해 작성된 약관에 따라, 일반암 보험금이 아닌 상피내암 보험금만을 지급하는 보험사가 규정하는 약관상 방광상피내암과, 실제 임상에서 진단 및 치료를 시행하는 비뇨의학과 전문의가 규정하는 임상적 의미의 방광상피내암은, 적용 및 치료의 범주에 있어, 명확한 차이점이 존재한다. 보험사에서는 국내의 요로상피암 진료지침서는 물론, 세계적으로 공인된 AUA guideline(미국 비뇨기과 학회의 진료지침) 및 EAU guideline(유럽 비뇨기과 학회의 진료지침)에서도, 그 적용 및 치료에 있어, 침윤성 방광암 기준으로 다루어야 함을 명시하고 있는, 고위험군 비근침윤성 방광암조차 광의적 범주를 예외없이 적용시켜, 일반암 보험금과 비교하여 훨씬 소액에 해당하는 상피내암 보험금만을 한정 지급함으로써 많은 문제점들이 나타나고 있다. 이러한 문제점들의 핵심은, 방광암의 침윤성암으로의 진행에 가장 중요한 위험 인자는, 병기가 아니라 암종의 세포등급임에도 불구하고, 보험약관에서 암보험금의 지급을, 일괄적으로 병기를 기준으로 질병을 분류하고 있는 한국표준질병 사인분류(KCD)에 기초하고 있는데 있다. 이에 먼저 고위험 비근침윤성 방광암 진단시 일반암 보험금 지급을 인정하지 않고, 상피내암 보험금 한정 지급을 다룬 판례 및 KCD 질병코딩 사례집의 오류를 검토해 봄으로써, 의학적으로 매우 중대한 문제점을 야기시키고 있는 법적 판단의 한계를 지적하고자 한다. 다음으로 이런 문제점들을 효과적으로 해결하기 위해, 향후 금융감독원, 보험사, 대한비뇨기과학회 및 대한병리과학회가 논의하여 보험금 지급에 관한 새로운 기준 정립의 필요성 및 기준 정립시까지 합리적 분쟁해결 대안을 제시해 보는 것으로 논의를 진행하고자 한다. According to most of cancer insurance terms, a certain patient is paid not the full insurance for general cancer but the restricted insurance when diagnosed as intraepithelial carcinoma of bladder. In case of intraepithelial carcinoma of bladder, there is a inherent T-staging system classified under two heads. Due to this unique T-staging system, there are definite differences between insurance company (insurer) and clinical urologists. As to diagnosis and payment of insurance, the insurance companys (insurers) adopt a ralatively wide range of intraepithelial carcinoma of bladder diagnosis. On the other hand, clinical urologists clearly distinguish between non-invasive papillary Ta and invasive flat Tis. Despite high risk non-muscle invasive bladder cancer must be treated with invasive cancer guidance of medical treatment in KUA(Korean urology association) guideline, AUA(American urology association) guideline and EAU(European association of Urology) guideline, the insurance companys (insurers) only pay the restricted insurance to the insured who is diagnosed as intraepithelial carcinoma of bladder. This kernel problem is that the diagnosis of bladder cancer is concluded in accordance with KCD(Korean Standard Classification of Diseases) classified on mainly T-staging basis. The most important risk factor for bladder cancer progression is grade, not stage. Therefore, new payment standards of insurance payment must be prepared with agreement of the persons concerned. Hence, I will indicate the limit of legal decision for medical problem and present the rational alternative for conflict solution.

Lymphovascular Invasion in Transurethral Resection Specimens as Predictor of Progression and Metastasis in Patients With Newly Diagnosed T1 Bladder Urothelial Cancer

Cho, K.S.,Seo, H.K.,Joung, J.Y.,Park, W.S.,Ro, J.Y.,Han, K.S.,Chung, J.,Lee, K.H. Williams and Wilkins Co 2009 The Journal of urology Vol.182 No.6

Purpose: We evaluated the clinical significance of lymphovascular invasion in transurethral resection of bladder tumor specimens in patients with newly diagnosed T1 urothelial carcinoma of the bladder. Materials and Methods: Enrolled in the study were 118 patients with newly diagnosed T1 urothelial carcinoma of the bladder who underwent transurethral resection of bladder tumor between 2001 and 2007. Patient records were retrieved from a prospectively maintained bladder cancer database. We evaluated the correlation between lymphovascular invasion and other clinicopathological features, and the impact of lymphovascular invasion on disease recurrence, disease progression and metastasis. Results: Lymphovascular invasion was histologically confirmed in 33 patients (28.0%). While lymphovascular invasion correlated with tumor grade (p = 0.002), it was not associated with gender, age, bladder tumor history, tumor size, multiplicity or concomitant carcinoma in situ. Recurrence, progression and metastasis developed in 45 (38.1%), 19 (16.1%) and 10 patients (8.5%), respectively. Univariate analysis showed that lymphovascular invasion was marginally associated with recurrence and significantly associated with progression (p = 0.011) and metastasis (p = 0.019). Multivariate Cox proportional hazards analysis revealed that recurrence was significantly associated with lymphovascular invasion (p = 0.029), and with bladder tumor history (p <0.001), tumor size (p = 0.031) and multiplicity (p = 0.043). Lymphovascular invasion was the only independent prognostic factor associated with progression (p = 0.016). Conclusions: In patients with newly diagnosed T1 urothelial carcinoma of the bladder lymphovascular invasion in transurethral resection of bladder tumor specimens predicts disease progression and metastasis.

Expression of survivin in squamous cell carcinoma and transitional cell carcinoma of the urinary bladder: A comparative immunohistochemical study

Rania Makboul,Abeer EL-Refaiy M. Refaiy,Fatma Ahmed Mahmoud Badary,Islam F. Abdelkawi,Axel S. Merseburger,Rabab Ahmed Ahmed Mohammed 대한비뇨의학회 2015 Investigative and Clinical Urology Vol.56 No.1

Purpose: To compare the expression of survivin and its association with clinicopathological criteria in major types of urinary bladdercarcinoma, specifically, transitional cell carcinoma with and without squamous differentiation and squamous cell carcinoma. Materials and Methods: Immunohistochemical staining for survivin and Ki67 was performed on paraffin-embedded sections of104 carcinomas: 52 transitional cell carcinoma, 20 transitional cell carcinoma with squamous differentiation, and 32 squamous cellcarcinoma. Expression of survivin in >10% of tumor cells was described as altered survivin status. Ki67 staining in >20% of tumorcells was described as a high proliferation index. Results: Altered survivin expression was detected in 60/104 specimens (58%) and was significantly more frequent in transitionalcell carcinoma (78%) than in squamous cell carcinoma (38%) or transitional cell carcinoma with squamous differentiation (40%)(p<0.0001). In transitional cell carcinoma but not in squamous cell carcinoma, altered survivin status was associated with highertumor grade, higher proliferation index, and recurrence. In the whole specimens, altered survivin expression was significantly associatedwith advanced stage (p<0.001), recurrence (p=0.005), distant metastasis (p<0.001), and death (p=0.001). In the multivariateanalysis, altered survivin was an independent poor prognostic factor for recurrence. Conclusions: Unlike in transitional cell carcinoma, alteration of survivin expression in squamous cell carcinoma occurs less frequentlyand is not associated with features of tumor aggression or patient outcome. These findings raise a question: are urinarybladder carcinoma patients with squamous cell carcinoma type suitable candidates for survivin vaccine? This is an important questionto be answered before approving the vaccine in management.

Comparison of Synchronous and Metachronous Primary Carcinomas of the Bladder and Prostate

Ho Seok Chung,Young Ho Seo,Seung Il Jung,Eu Chang Hwang,Taek Won Kang,Dong Deuk Kwon 대한비뇨기종양학회 2017 대한비뇨기종양학회지 Vol.15 No.1

Purpose: The incidence of multiple primary malignant neoplasms increases with age. An unforeseen finding is the high number of prostate and bladder cancers pairs. Of prostate and bladder cancers pair as first primary and second primary cancers and vice versa, we investigated the differences in clinicopathological features between synchronous and metachronous primary carcinomas of the bladder and prostate. Materials and Methods: Fifty-three patients diagnosed with dual prostate and bladder cancer in a 12-year period (2004–2015) excluding cases with incidental prostate cancer after radical cystectomy were reviewed. Enrolled patients were divided into 3 groups according to cancer development (group I, synchronous cancer; group II, prostate cancer with metachronous bladder cancer; group III, bladder cancer with metachronous prostate cancer). Each group was compared according to clinicopathological features. Results: Median age was 72 years (range, 54–83 years). Groups I, II, and III comprised 29 (54.7%), 8 (15.1%), and 16 patients (30.2%), respectively. Age, prostate-specific antigen, tumor stage, grade, multifocality of bladder tumor, and treatment modality did not show statistical differences between groups. However, group III showed a lower prostate cancer stage (National Comprehensive Cancer Network anatomic stage; p=0.009) and had low-risk of prostate cancers (p=0.025). Conclusions: Bladder tumor showed no differences in the clinicopathological features between synchronous and metachronous primary carcinomas. However, metachronous prostate cancer showed better clinicopathological features of prostate cancer. It is important for clinicians to counselling and decision making in clinical situations.

방광 상피내암의 뇨 세포학적 소견

정두현,박인애,함의근,Chung, Doo-Hyun,Park, In-Ae,Ham, Eui-Keun 대한세포병리학회 1991 대한세포병리학회지 Vol.2 No.1

The diagnosis of carcinoma in situ of urinary bladder is difficult in that the symptoms and cystoscopic findings are nonspecific. The cytology of urine could be helpful for diagnosis of carcinoma in situ of urinary bladder. We present a case of bladder washing cytology of carcinoma in situ. A 54-year-old man presented with dysuria for 1 year. Cystoscopic findings revealed multifocal reddish trabeculated lesions. The bladder washing cytology revealed rather uniform tumor cells which were singly scattered of forming syncytium in the clean back-ground. The nuclei were round to oval with inconspicious nucleoli. The cystoscopic biopsy revealed typical histologic features of carcinoma in situ of urinary bladder.

Comparison of Synchronous and Metachronous Primary Carcinomas of the Bladder and Prostate

정호석,서영호,정승일,황의창,강택원,권동득 대한비뇨기종양학회 2017 대한비뇨기종양학회지 Vol.15 No.1

Purpose: The incidence of multiple primary malignant neoplasms increases with age. An unforeseen finding is the high number of prostate and bladder cancers pairs. Of prostate and bladder cancers pair as first primary and second primary cancers and vice versa, we investigated the differences in clinicopathological features between synchronous and metachronous primary carcinomas of the bladder and prostate. Materials and Methods: Fifty-three patients diagnosed with dual prostate and bladder cancer in a 12-year period (2004–2015) excluding cases with incidental prostate cancer after radical cystectomy were reviewed. Enrolled patients were divided into 3 groups according to cancer development (group I, synchronous cancer; group II, prostate cancer with metachronous bladder cancer; group III, bladder cancer with metachronous prostate cancer). Each group was compared according to clinicopathological features. Results: Median age was 72 years (range, 54–83 years). Groups I, II, and III comprised 29 (54.7%), 8 (15.1%), and 16 patients (30.2%), respectively. Age, prostate-specific antigen, tumor stage, grade, multifocality of bladder tumor, and treatment modality did not show statistical differences between groups. However, group III showed a lower prostate cancer stage (National Comprehensive Cancer Network anatomic stage; p=0.009) and had low-risk of prostate cancers (p=0.025). Conclusions: Bladder tumor showed no differences in the clinicopathological features between synchronous and metachronous primary carcinomas. However, metachronous prostate cancer showed better clinicopathological features of prostate cancer. It is important for clinicians to counselling and decision making in clinical situations.

방광에 발생한 원발성 소세포암종의 세포학적 소견 -1 예 보고-

권미선,안긍환,정진행,이승숙,고재수,Kwon, Mi-Seon,Ahn, Geung-Hwan,Chung, Jin-Haeng,Lee, Seung-Sook,Koh, Jae-Soo 대한세포병리학회 2001 대한세포병리학회지 Vol.12 No.2

Primary small cell carcinoma of the urinary bladder is a rare malignant tumor. A more rapidly fatal course may be seen in advanced stages of small cell carcinoma as compared to similar stages of urothelial carcinoma. It is very important to recognize this distinct form of bladder cancer by urinary cytology The differential diagnosis of small cell carcinoma of the urinary bladder includes metastatic small cell carcinoma, urothelial carcinoma, and primary or secondary malignant lymphoma. This article highlights the urinary cytologic diagnosis of a case of primary small cell carcinoma. A 59-year-old male presented with gross hematuria for five months. Urinary cytology showed high cellularity consisting of tiny monotonous tumor cells in the necrotic background. The tumor cells occurred predominantly singly, but a few in clusters. The cytoplasm was so scanty that only a very narrow rim of it was seen. The nuclei were oval or round and had finely stippled chromatin. Rarely, the nuclei contain visible nucleoli. Frequently cell molding was noted in clusters. Many single cells demonstrated nuclear pyknosis or karyorrhexis. The histologic findings of transurethral resection and partial cystectomy specimen were those of small cell carcinoma. Cytologic distinction may be very difficult but careful attention to clinical features and cellualr details can classify these neoplasms correctly.

상부요로이행상피암의 근치적 수술 후 방광암 재발의 예측인자

하성헌,박진성,홍준혁,김청수,안한종 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.7

Purpose: We investigated the predictors for developing intravesical recurrence following curative surgery for primary upper tract transitional cell carcinoma (UTTCC). Materials and Methods: The data of 207 patients without a prior history of bladder tumor or distant metastasis were analyzed. We evaluated the influence of multiple clinicopathologic parameters, such as age, sex, T stage, N stage, grade, carcinoma-in-situ, anatomical location, multifocality, lymphovascular invasion (LVI), preoperative urine cytology, and operative methods, on intravesical recurrence. Considering the possibility of bias from the effect of adjuvant treatment, the same analyses were performed in 184 patients excluding those who underwent adjuvant therapy. Mean follow-up was 59.7 months. Results: Of 207 patients, 91 (44%) experienced intravesical recurrence at a mean interval of 13.2 months. Among them, 66% (60/91) experienced intravesical recurrence within 12 months postoperatively. Eighty-nine percent of the recurred bladder tumors were superficial tumors and 64% were grade 1 or 2. Among the multiple parameters analyzed, LVI was the only significant predictor for intravesical recurrence in univariate and multivariate analysis (p=0.008; HR=1.911), whereas preoperative urine cytology was marginally significant. Similar results were obtained in the analysis for 184 patients without adjuvant therapy. Ten patients (11%) underwent muscle-invasive bladder tumor recurrence. Muscle-invasive bladder tumor recurrence was significantly associated with the presence of LVI compared with superficial bladder tumor recurrence (70% vs. 30%; p=0.005). Conclusions: LVI in primary UTTCC was a significant predictor of intravesical recurrence after curative surgery, whereas preoperative urine cytology was a possible predictor. Therefore, we recommend more rigorous cystoscopic follow-up in patients with these risk factors. Purpose: We investigated the predictors for developing intravesical recurrence following curative surgery for primary upper tract transitional cell carcinoma (UTTCC). Materials and Methods: The data of 207 patients without a prior history of bladder tumor or distant metastasis were analyzed. We evaluated the influence of multiple clinicopathologic parameters, such as age, sex, T stage, N stage, grade, carcinoma-in-situ, anatomical location, multifocality, lymphovascular invasion (LVI), preoperative urine cytology, and operative methods, on intravesical recurrence. Considering the possibility of bias from the effect of adjuvant treatment, the same analyses were performed in 184 patients excluding those who underwent adjuvant therapy. Mean follow-up was 59.7 months. Results: Of 207 patients, 91 (44%) experienced intravesical recurrence at a mean interval of 13.2 months. Among them, 66% (60/91) experienced intravesical recurrence within 12 months postoperatively. Eighty-nine percent of the recurred bladder tumors were superficial tumors and 64% were grade 1 or 2. Among the multiple parameters analyzed, LVI was the only significant predictor for intravesical recurrence in univariate and multivariate analysis (p=0.008; HR=1.911), whereas preoperative urine cytology was marginally significant. Similar results were obtained in the analysis for 184 patients without adjuvant therapy. Ten patients (11%) underwent muscle-invasive bladder tumor recurrence. Muscle-invasive bladder tumor recurrence was significantly associated with the presence of LVI compared with superficial bladder tumor recurrence (70% vs. 30%; p=0.005). Conclusions: LVI in primary UTTCC was a significant predictor of intravesical recurrence after curative surgery, whereas preoperative urine cytology was a possible predictor. Therefore, we recommend more rigorous cystoscopic follow-up in patients with these risk factors.