PRIMARY CARCINOMA IN SITU OF THE URINARY BLADDER WITH PROSTATIC INVOLVEMENT
1980 Volume 71 Issue 3 Pages 257-263
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1980 Volume 71 Issue 3 Pages 257-263
A case report of primary carcinoma in situ of the bladder is presented.
A 63-year-old man with complaints of urinary frequency and dysuria was seen at the Osaka University Hospital in January, 1978. The patient gave hematuria on a microscopic test, but no distinctive abnormality in the urinary tract on X-ray examination except mucosal hyperemia at the left lateral wall of the bladder on a cystoscopic test. TUR biopsy of the bladder was done because a urinary cytological test showed persistently positive results. On histological examination, denuded surface, submucosal edema, teleangiectasis and marked cellular infiltration were observed. These findings were suggestive of chronic cystitis.
Although the patient continued to give the positive cytology test, there was no abnormality on X-ray and cystoscopic tests even after a 4 months follow-up. However, histologic proof of carcinoma in situ of grade IV transitional cell carcinoma was established after analysis of the repeatedly biopsied specimen, and total cystectomy with ileal conduit urinary diversion was performed on the 12th of July, 1978.
Histological examination of the dissected bladder revealed carcinoma in situ in almost all area of the bladder mucosa and in the prostatic urethra. Section of the prostate revealed intra-ductal and intra-acinal involvement by the malignant cells that were similar to those seen in the bladder, and the prostatic stroma was also partially infiltrated. The cancer cells infiltrated through the basement membrane of the prostatic acini, but not directly through the bladder mucosa.
Reviewing the literature on the bladder carcinoma in situ, the present case seems to be different from the type found in visible bladder cancer. Therefore, we propose to name it a “primary” carcinoma in situ of the bladder. The “primary” carcinoma in situ has a tendency to infiltrate into the prostate through the prostatic ducts, prior to its invasion to the basement membrane of the bladder, and is characteristic of developing directly from the stage O to the stage D.
