Non-urothelial bladder tumors as a diagnostic and therapeutic challenge

Abstract

Background: Bladder cancer is generally classified as urothelial and non-urothelial. Non-urothelial bladder cancer accounts for less than 5% of all bladder tumors, and of those, 90% are of epithelial origin, including: squamous cell carcinoma, small cell carcinoma, and adenocarcinoma. The remaining 10% are non-epithelial in origin (lymphoma, paraganglioma, sarcoma, etc.)

Aim: To present the experience at our hospital center with non-urothelial bladder cancer and describe the patient characteristics

Materials and methods: A retrospective, descriptive study was conducted utilizing the medical records of patients with non-urothelial bladder cancer that were diagnosed and treated at our service within the time frame of 2004 to 2016, obtaining 7 cases.

Results: Our study included 7 patients (5 men and 2 women) with a mean age of 46.8 years (range: 35-76 years). The main symptoms were hematuria (n = 4), lower urinary tract symptoms (n = 2), and mucosuria (n = 1). The histopathology reports stated:  3 cases of adenocarcinoma, 2 cases of squamous cell carcinoma, one case of paraganglioma, and one case of lymphoma. The most frequent location was the bladder dome. The following treatments were carried out:    Adenocarcinoma (n = 3): partial cystectomy in 2 patients and only transurethral resection of the bladder (TURB) in one patient; Squamous cell carcinoma (n = 2): left nephroureterectomy + radical cystoprostatectomy in one patient, radical cystectomy  + pelvic exenteration in one patient, both patients underwent adjuvant radiotherapy; Paraganglioma (n = 1): Robotic-assisted laparoscopic partial cystectomy in one patient;  Lymphoma (n = 1):   TURB + chemotherapy + radiotherapy in one patient. Two patients died from squamous cell carcinoma.

Discussion: Due to the rareness of such cases, it is difficult to standardize treatment and histopathology. However, in general, surgery is the best therapeutic option to prevent recurrence and improve survival. Organ-sparing treatments with individualized adjuvant therapies according to histopathology are recommended in some cases.

Conclusions: The management of non-urothelial bladder tumors is complex and requires a multidisciplinary team. Squamous cell tumors are the most aggressive, with a high probability of locoregional extension. Experience with those tumors is limited in Mexico.