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Bilharziasis of urinary bladder and ureter: comparative histopathologic study.

The relative incidence and intensity of oviposition in schistosomiasis in different layers of both the urinary bladder and the ureter are presented. Histopathological changes in both organs are elucidated. Oviposition was heaviest in the submucosa of the urinary bladder, while the muscle layer was affected in 15% of specimens. Oviposition was mainly periureteral and in outer muscle layer of the ureter, and was present in only 22% in the ureteral submucosa. Epithelial changes, namely, Brunn nests, cystitis glandularis, cystitis cystica, and squamous metaplasia, were more marked in the bladder specimens than in the ureteral specimens. Squamous cell papilloma and squamous metaplasia associated with acanthosis of the bladder specimens were identified. Results indicate unanimously that the heavy deposition of ova in the submucosa of the bladder leads through its mechanical and toxic irritation to marked epithelial and premalignant changes which pave the way for the disturbing frequency of carcinoma of the bladder in the bilharzial patients which is not the case in the ureter.

Humans↗

Neuroblastoma of the urinary bladder, preclinically detected by mass screening.

BACKGROUND: Since the introduction of mass screening of infants for neuroblastoma, the incidence of neuroblastoma has increased in Japan. The reason for this increased incidence is the possible inclusion of many neuroblastomas that would have regressed spontaneously and would never have been detected clinically. An extremely rare tumor at the dome of the urinary bladder in a 7-month-old infant was detected by the mass screening. METHODS: A case of neuroblastoma of the urinary bladder is reported with a review of the literature. The data in the Japan Children's Cancer Registry are also reviewed to analyze the incidence and the site of origin of neuroblastoma for evaluation of mass screening. RESULTS: A 7-month-old female infant was referred because of a positive urine vanillylmandelic acid screening test. Ultrasonography showed a solid mass attached to the urinary bladder. At laparotomy a 35 x 30 x 25-mm egg-shaped tumor was found at the dome of the bladder, and a partial cystectomy was performed. During the operation no changes in blood pressure occurred when the tumor was manipulated. Histologic diagnosis was rosette-fibrillary neuroblastoma originating in the bladder wall, with a favorable Shimada histopathologic classification. N-myc was not amplified, which predicted a favorable prognosis, and no postoperative chemotherapy was given. The patient was free of symptoms and tumor after a follow-up period of 16 months. Literature review revealed that this was the second case of neuroblastoma of the urinary bladder ever reported in the world, although several cases of pheochromocytoma originating in the bladder wall had been reported. Both neuroblastoma and pheochromocytoma derive from the neural crest. The sympathogonia from the neural crest, a common stem cell, differentiates into a ganglion cell or into a secretory cell known as a chromaffin cell, able to manufacture catecholamines. The first case in the world that was reported as neuroblastoma of the urinary bladder was in a 4-month-old infant who was noted to have a 4-cm lower abdominal mass on routine physical examination. A ganglioneuroblastoma of the dome of the bladder was excised and the patient was doing well. On reviewing the Japan Children's Cancer Registry, the incidence of neuroblastomas in infants has increased as well as the number of stage 1, 2, and 4s (stage 4 special) neuroblastomas since the introduction of mass screening. However, there has been no significant change in the number of stage 3 or 4 diseases diagnosed in older children. According to the Japan Children's Cancer Registry, pelvic origin neuroblastoma, which has been noted to have spontaneous regression, was more frequent in the primary tumors detected by mass screening when compared with those presenting clinically. During preparation of this manuscript another case of bladder dome neuroblastoma was detected by urinary vanillylmandelic acid screening of 6-month-old infants for neuroblastoma in Japan. CONCLUSION: These extremely rare cases of neuroblastoma of the urinary bladder involved children younger than 1 year of age and were incidentally detected by routine physical examination or mass screening. This raises the question of whether these tumors might have regressed spontaneously had they gone undetected and untreated.

Female↗

Promoting effects of various agents in rat urinary bladder carcinogenesis initiated by N-butyl-N-(4-hydroxybutyl)nitrosamine.

The effects of various chemicals on the development of neoplastic lesions in the urinary bladder were investigated in male F344 rats given 0.05% N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) as an initiator in their drinking water for 4 weeks. The compounds tested, indomethacin, acemetacin, epsilon-aminocaproic acid (EACA), diphenyl, allopurinol and acetaminophen (AAP), were added to the diet or drinking water for 32 weeks, and all animals were killed at the end of week 36. Of the chemicals tested, only diphenyl significantly increased the incidences and average numbers (per 10 cm basement membrane) of papillary or nodular hyperplasias (PN hyperplasia), papillomas and carcinomas of the urinary bladder over those in animals treated with BBN alone. These findings show that diphenyl is a promoter of urinary bladder carcinogenesis in male F344 rats.

Acetaminophen↗

Evidence for a unique elastic sheath surrounding the vesicular arteries of the rabbit urinary bladder--studies of the microvasculature with microscopy and vascular corrosion casting.

Because the urinary bladder stores and releases urine, its normal function includes filling and emptying, accompanied by distension and relaxation. It is known that chronic distension compromises blood flow. Recent studies of the rabbit bladder vasculature have described specializations of that vasculature that appear to enhance blood flow in the bladder wall during distension. The present report describes the location, orientation, and structure of an elastic sheath surrounding the vesicular arteries, which may represent one of these specializations. The location, vasculature, and structure of an accessory elastic sheath surrounding the vesicular arteries of the rabbit bladder is described using light and electron microscopy, India ink injection, and vascular corrosion casting. The common iliac arteries of rabbits were cannulated to permit perfusion of the distal vasculature including the urinary bladder. After the bladder vasculature was visually cleared of blood by perfusion with buffered saline, one of the following procedures was used: 1) for light or electron microscopy, the bladder was perfuse-fixed with buffered 2% glutaraldehyde; 2) the bladder vasculature was filled with India ink for vessel tracing; or 3) corrosion casts of the bladder vasculature were prepared by infusion of a Mercox resin mixture. Casts, cleaned of tissue with KOH, and water and formic acid rinses, are dried, and mounted for routine scanning electron microscopy. The presence of an accessory sheath surrounding the main vesicular arteries and some of their branches in the basal two thirds of the urinary bladder was observed on India ink injected specimens and confirmed by micrographs and vascular corrosion casts. The sheath consists of elastic and collagenous fibers and is separated from the tunica media of the arteries by a loose connective tissue layer of variable width. The sheath is circumscribed by a layer of fine blood vessels. The vesicular arteries undulate within the sheath to an extent which is dependent upon the degree of distension of the bladder. This sheath likely represents a specialization which permits the bladder vasculature to accommodate expansion and contraction of the wall during normal filling and emptying. Undulations or coiling of the vesicular arteries within the loose connective tissue core of the sheath increase with bladder contraction, and apparently the sheath simply holds the artery in position during such coiling. The sheath, may represent a modification of the external elastic lamina found in some muscular arteries.

Animal Structures↗

p53 mutations in early neoplastic lesions of the urinary bladder in rats treated with N-butyl-N-(4-hydroxybutyl)nitrosamine.

Rat experimental models using N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) as an initiating agent have been widely used to study carcinogenic processes in the urinary bladder. In this study, early neoplastic lesions from 10 male F344 rats treated with 0.05% BBN for 16 weeks were analyzed for changes in the H-ras or p53 genes by polymerase chain reaction (PCR)-single strand conformation polymorphism (SSCP) analysis and subsequent DNA sequencing. Lesions were pooled for each of the 10 rats and six showed point mutations in the p53 gene and one in the H-ras gene. These results would indicate that BBN-induced rat urinary bladder carcinomas are similar to human urinary bladder carcinomas with respect to alterations in the p53 and H-ras genes and that p53 gene alterations are relatively early events in rat urinary bladder carcinogenesis induced by BBN treatment.

Animals↗

Endocervical type glands in urinary bladder: a clinicopathologic study of six cases.

The authors report six cases of glandular lesions made up of endocervical type glands in the urinary bladders of women aged 34 to 65 years (mean, 39 years). Two patients presented with dysuria, one with painless hematuria, one with complaints of pelvic discomfort and hematuria, and one with vaginal discharge. The sixth patient was asymptomatic, but on a routine gynecologic examination, a pelvic mass was found. On physical examination, three women had masses between the bladder and uterus. Four lesions were located in the posterior wall of the urinary bladder, one in the dome, and one in the trigone. Four patients underwent biopsy of the bladder lesion. One of these patients had undergone a hysterectomy 10 years earlier. One woman with a pelvic mass between the bladder and uterus underwent a hysterectomy, bilateral salpingo-oophorectomy, and partial cystectomy. The sixth patient had a transurethral resection of the bladder tumor and left oophorectomy. Histologically, all cases showed intermediate to large-sized irregularly shaped endocervical type glands in the muscularis propria of the urinary bladder. Some glands exhibited cystic dilatation and contained mucinous secretions. The glands elicited no desmoplastic tissue reaction. The intraluminal mucin frequently contained polymorphonuclear leukocytes. In all cases, the glands were lined by mucinous, tall, columnar cells and less commonly by flattened to cuboidal cells. Rare admixed ciliated cells were also observed. The lining epithelium was bland in five cases, but moderate nuclear atypia was seen in one case. Mitoses were not observed in any case. Associated lesions included endometrial type glands surrounded by elastotic stroma in one case, exuberant cystitis glandularis in one case, and a pseudodiverticulum of the bladder in one case. Review of the slides from the patient who had had a hysterectomy 10 years previously revealed endocervical adenocarcinoma in situ. Follow-up (mean = 30 months; range = 6 to 60 months) shows that all patients are alive and well, suggesting that the lesion is benign.

Adult↗

[Occupational cancer of the urinary bladder: the diagnostic value of urinary cytology in dyestuff workers exposed to aromatic amines].

A total of 90 dyestuff workers who were engaged in the production of aromatic amines during the post-war period after the 2nd world war have been examined since 1967 by exfoliative cytologic examination. Those identified as class-3 or over by this first screening test were then submitted to a second screening which consisted of periodic cystoscopic examination and 1 or 2 intravenous pyelographies per year. This system of mass screening has been used for the past 20 years, and we have discovered 23 cases of bladder tumor, a case of asynchronous bilateral ureteral tumor and a case of ureteral tumor. Out of the 13 cases, bladder tumors were discovered in 6 cases within 3 months after a positive exfoliative cytology result and in 5 cases within 1 year. The presence of a tumor was confirmed in 85% of those patients within 1 year and in all of them in about 3 years. Periodic examinations have revealed all the tumors when they were about 5 mm in size and in stage 0 through A, demonstrating the usefulness of systematic examination. Treatment included intravesical instillation of anticancer agents, mostly mitomycin C, for 7 cases transurethral resection (TUR) for 8 cases and partial cystectomy was performed in one case. One patient with an asynchronous bilateral ureteral tumor was treated first by right total nephro-ureterectomy with cuff resection of bladder, and later by ureter excision and nephrostomy. This patient died of ileus in the 7th year of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Benzidines↗

Activin and activin receptors in the normal urinary bladder: immunohistochemistry, in situ hybridization, and RT-PCR.

To determine whether rat urinary bladder produces activin-A, a multifunctional growth factor in the transforming growth factor beta superfamily (TGF beta), we have conducted immunohistochemistry using specific antibodies for activin beta A-subunit which were raised against a synthetic cyclic fragment of the beta A-subunit of activin. The mature activin-A molecule was identified at transitional epithelial cells, smooth muscle, and endothelial cells. To determine if messenger RNAs for the beta A-subunits of activin-A and activin receptors are expressed in these cells, both in situ hybridization with specific probes and the reverse transcription-polymerase chain reaction (RT-PCR) technique with primers specific for the beta A-subunit of activin and activin receptors, respectively, were used. Messenger RNA expression of the beta A-subunit of activin-A and activin receptors were detected by RT-PCR and localized in the transitional epithelial, smooth muscle, and endothelial cells as determined by in situ hybridization. In addition, the identity of the cDNA product of RT-PCR was verified with DNA sequencing. The localization of mature activin-A protein and its corresponding message as well as that of activin receptors to urinary bladder cells suggest that activin-A may have an autocrine function in the urinary bladder, perhaps in the transitional epithelial, smooth muscle, and endothelial cells themselves.

Activin Receptors↗

Changes of rat urinary bladder during acute phase of spinal cord injury.

Spinal cord injury (SCI) at Th13 was induced in female Wistar rats, and changes in the urinary bladder were examined during the acute phase of SCI. Wet weights of the spinal bladders increased twofold over controls by 7 days after SCI. Intravesical volumes increased sixfold over control values by day 3, and then decreased 7 days after the injury. Maximal pressure within the bladder decreased in all spinal rats compared with controls. Smooth muscle cells were isolated from the urinary bladder, and their total protein and DNA content were measured by multiparametric cytofluorometry. DNA content of isolated smooth muscle cells decreased by day 3 and remained 7 days after the spinal injury. Total protein content of isolated smooth muscle cells was decreased 1 day after and increased 7 days after the spinal injury, just when spinal reflex of the bladder recovered. These findings suggest that hypertrophy of smooth muscle cells in urinary bladder is related to the activity of peripheral autonomic nerve and that smooth muscle cells already begin to hypertrophy during the spinal shock period to adjust themselves to the new state, that is, the spinal bladder.

Acute Disease↗

Central cholinergic mechanisms in L-DOPA induced hyperactive urinary bladder of the rat.

The involvement of central and peripheral cholinergic structures in the mediation of a centrally induced hyperactive urinary bladder response to L-2,3-dihydroxyphenylalanine (L-DOPA), after peripheral decarboxylase inhibition, registered by a cystometric procedure, has been analysed pharmacologically in anaesthetised rats. The urinary bladder response to L-DOPA was unchanged after blockade of cholinergic receptors with methylscopolamine, diminished after atropine and totally inhibited after hexamethonium. In addition, activation of muscarinic receptors in the pontine-mesencephalic brain region with oxotremorine after methylscopolamine pretreatment generates a hyperactive urinary bladder response, mediation of which seems to be independent of endogenous catecholamine stores. It is suggested that cholinergic receptors in the pontine-mesencephalic brain region are of importance for regulation of urinary bladder function in the rat. Furthermore, the bladder hyperactivity induced by L-DOPA might be propagated via muscarinic receptors in this brain area, and mediated peripherally via cholinergic receptors in the autonomic ganglia, but in the bladder detrusor via non-cholinergic receptors.

Animals↗

Rhabdomyosarcoma of the urinary bladder and vagina: a clinicopathologic study with emphasis on recurrent disease: a report from the Kiel Pediatric Tumor Registry and the German CWS Study.

Rhabdomyosarcomas (RMS) of the urinary bladder and vagina vary in their biologic and clinical behavior and require different types of treatment. Anatomically the two organs are close, and the reason for these differences in behavior is unknown. We investigated tumor specimens of 51 urinary bladder RMS and 14 vaginal RMS with regard to histologic subtype, growth pattern, differentiation, and proliferation morphologically and immunohistochemically. Recurrences and/or "second look" specimens from 15 patients after chemotherapy were compared with the primary tumors. Within the 65 specimens we found 31 "classical" embryonal RMS, 26 embryonal RMS of botryoid subtype (BRMS), 3 embryonal RMS of spindle cell subtype, and 5 alveolar RMS. BRMS is more common in the vagina (11 BRMS of 14 cases) than in the urinary bladder RMS (15 BRMS of 54 cases). Classical embryonal RMS with a polypoid (exophytic) growth pattern is associated with a more favorable prognosis (92% 10-year survival) than the same type with a diffuse intramural (endophytic) growth pattern (68% 10-year survival, p = 0.02). The proliferation rate was associated with the degree of differentiation, but neither showed a correlation with prognosis. A marked maturation after chemotherapy was seen in the majority of recurrences and SL specimens, associated with lowered proliferation activity. Two of 12 patients with recurrences showing chemotherapy-induced maturation died of the disease. In conclusion, we determined that polypoid embryonal RMS of both the urinary bladder and the vagina have a comparably good prognosis. This includes all botryoid RMS. The poorer prognosis of the group of urinary bladder RMS as a whole was caused by a high incidence of diffusely growing RMS, which have a less favorable prognosis than polypoid RMS. Maturation after chemotherapy occurs frequently in RMS. In contrast to the excellent prognosis reported in other studies, we had two patients with fatal outcome despite chemotherapy-induced maturation in the recurrences.

Adolescent↗

Contractile mechanisms coupled to TRPA1 receptor activation in rat urinary bladder.

TRPA1 is a member of the transient receptor potential (TRP) channel family present in sensory neurons. Here we show that vanilloid receptor (TRPV1) stimulation with capsaicin and activation of TRPA1 with allyl isothiocyanate or cinnamaldehyde cause a graded contraction of the rat urinary bladder in vitro. Repeated applications of maximal concentrations of the agonists produce desensitization to their contractile effects. Moreover, contraction caused by TRPA1 agonists generates cross-desensitization with capsaicin. The TRP receptor antagonist ruthenium red (10-100 microM) inhibits capsaicin (0.03 microM), allyl isothiocyanate (100 microM) and cinnamaldehyde (300 microM)-induced contractions in the rat urinary bladder. The selective TRPV1 receptor antagonist SB 366791 (10 microM) blocks capsaicin-induced contraction, but partially reduces allyl isothiocyanate- or cinnamaldehyde-mediated contraction. However, allyl isothiocyanate and cinnamaldehyde (10-1000 microM) completely fail to interfere with the specific binding sites for the TRPV1 agonist [(3)H]-resiniferatoxin. Allyl isothiocyanate or cinnamaldehyde-mediated contractions of rat urinary bladder, which rely on external Ca(2+) influx, are significantly inhibited by tachykinin receptor antagonists as well as by tetrodotoxin (1 microM) or indomethacin (1 microM). Allyl isothiocyanate-induced contraction is not changed by atropine (1 microM) or suramin (300 microM). The exposure of urinary bladders to allyl isothiocyanate (100 microM) causes an increase in the prostaglandin E(2) and substance P levels. Taken together, these results indicate that TRPA1 agonists contract rat urinary bladder through sensory fibre stimulation, depending on extracellular Ca(2+) influx and release of tachykinins and cyclooxygenase metabolites, probably prostaglandin E(2). Thus, TRPA1 appears to exert an important role in urinary bladder function.

Acrolein↗

Primary extra-nodal lymphoma of the urinary bladder.

Primary non-Hodgkin's lymphoma of the urinary bladder is rare. Only a few cases have been reported. We report the case of a woman with non-Hodgkin's lymphoma of urinary bladder and review the literature.

Antigens, CD20↗

Lack of induction of epithelial cell proliferation by sodium saccharin and sodium L-ascorbate in the urinary bladder of NCI-black-Reiter (NBR) male rats.

The susceptibility to induction of epithelial cell proliferation by three urinary bladder cancer promoters was investigated in NCI-Black-Reiter (NBR) rats, which lack alpha 2u-globulin-synthesizing ability. Six-week-old male NBR and F344 rats were given 5% sodium saccharin (Na-Sac), 5% sodium L-ascorbate (Na-AsA), or 3% uracil in the basal diet for 8 weeks. Administration of uracil evoked a marked cell proliferation response and papillomatosis associated with calculus formation in NBR as well as F344 rats. This result indicates that NBR rats are also susceptible to direct mechanical stimulation. In contrast, both strains of rats given Na-Sac or Na-AsA demonstrated an alkalization of urinary pH and an increase in urinary Na ion concentration, but increase in cell proliferation in the urinary bladder transitional epithelium was only observed in F344 rats. Since previous studies revealed that elevation of urinary pH and Na ion concentration are essential factors for exertion of promotion activity by Na-Sac and Na-AsA, the results of the present investigation suggest that alpha 2u-globulin might also be a necessary component of the mechanisms of their promotion of male rat urinary bladder carcinogenesis.

Animals↗

A case report of inflammatory pseudotumor of the urinary bladder.

A case of an inflammatory pseudotumor of the urinary bladder in a 46-yr-old man is presented. This rare, benign, and presumed non-neoplastic, reactive lesion must be differentiated from sarcomas of the urinary bladder. In the present case, we could demonstrate an inflammatory and reactive nature for the pseudotumor. Histologically, the presence of many Brunn's nests with infiltration of inflammatory cells and proliferation of capillaries in the myxoid stroma indicated a chronic inflammatory background for this lesion. It is apparent from morphology and immunohistochemistry findings that the proliferating spindle-shaped cell is of mesenchymal origin and not malignant in nature. These findings suggest that chronic inflammation can induce an overreaction of the bladder wall resembling tumor formation.

Granuloma, Plasma Cell↗

Dopamine D1 and D2 receptors in the human ureter and urinary bladder: a radioligand binding and autoradiographic study.

OBJECTIVE: To analyse the pharmacological profile and the anatomical localization of the dopamine D1 and D2 receptors in sections of the pelvic part of the ureter and of the fundus of the urinary bladder. PATIENTS, MATERIALS AND METHODS: Samples of the pelvic part of the ureter and of the fundus of the urinary bladder were taken in men (age range 61 +/- 4 years) who were undergoing lower urinary tract surgery. Biochemical characterization and autoradiographical techniques were used on frozen sections of the ureter or the urinary bladder. [3H]-SCH 23390 was used as a ligand of dopamine D1 receptors and [3H]-spiroperidol as a ligand of dopamine D2 receptors. RESULTS: [3H]-SCH 23390 and [3H]-spiroperidol were bound by specific sections of the ureter and of the urinary bladder. The pharmacological profile of the binding was consistent with the labelling of D1 and D2 receptors respectively. Light microscope analysis of the localization of D1 and D2 receptors revealed the accumulation of the two radioligands in the tunica muscularis of the ureter or of the urinary bladder. CONCLUSION: A possible role of the dopaminergic system in the control of urine flow and of some dysfunctions of the lower urinary tract is suggested.

Aged↗

Primary, pure, large-cell neuroendocrine carcinoma of the urinary bladder.

We report what to our knowledge is the first case in the English-language literature of a primary, pure, undifferentiated large-cell neuroendocrine carcinoma of the urinary bladder. To date, only one case of a large-cell neuroendocrine carcinoma was reported, and it was associated with an adenocarcinoma most likely of urachal origin. On the other hand, slightly more than 100 cases of undifferentiated small-cell carcinoma of the urinary bladder were reported, approximately one-half of which were associated with poorly differentiated transitional-cell carcinoma of the conventional type. The patient in our case was a 73-year-old man with a history of prostatic cancer treated with radiation therapy. He presented with hematuria, leading to the discovery of a solitary tumor on the dorsal wall of the urinary bladder. A diagnosis of large-cell neuroendocrine carcinoma was made, supported by immunohistochemical reactivity for chromogranin, neuron-specific enolase, and synaptophysin; a variety of other hormonal markers of neuroendocrine tumors were negative. The radical cystoprostatectomy and bilateral pelvic lymphadenectomy specimen showed a transmurally invasive tumor, without regional lymph node metastases. The patient died 2 months after surgery, and the autopsy revealed disseminated metastases histologically identical to the urinary bladder neoplasm. Awareness of the occurrence of large-cell neuroendocrine carcinoma of the urinary bladder seems to be important because of the possible aggressive outcome associated with this tumor and because of differential diagnostic considerations, which include malignant lymphoma and metastasis from another primary, especially in tumors occurring in a pure form.

Aged↗