Makoto Washizuka

In Vivo Staining Test with Methylene Blue for Bladder Cancer

An in vivo staining test with 0.2 per cent methylene blue was applied to 129 patients with bladder tumor and 16 patients with chronic cystitis within a 6-year interval. Although normal mucosa did not pick up the stain nonpapillary in situ and microinvasive carcinomas did so frequently. Moderate dysplasia was stained in about half of the patients. The intensity of the stain in papillary tumors was correlated with the histologic anaplasia (grade). Grade 1 tumors were stained poorly or unstained in 86 per cent of the tests, whereas grades 2 and 3 tumors picked up the stain in 74 and 96 per cent of the tests, respectively. Even a tiny tumor, if poorly differentiated, was identified easily by the blue stain. The histologic anaplasia of tumors could be assessed roughly according to the intensity of the stain. However, chronic cystitis occasionally took up the stain, especially in cases of marked inflammatory infiltrate a deep stain was recognized. To differentiate nonpapillary early cancer from chronic cystitis the addition of a cytologic examination may be necessary.

Malignant Mixed Mesodermal Tumor of Bladderoccurring after Radiotherapy for Cervical Cancer: Report of a Case

A rare case of radiation-induced malignant mixed mesodermal tumor of the bladder is reported. A 78-year-old woman complained of hematuria, which originated from a polypoid tumor in the bladder 15 years after radiotherapy for squamous cell carcinoma of the uterine cervix. The bladder tumor recurred 9 months after resection and partial cystectomy then was performed. Histological findings revealed malignant mixed mesodermal tumor composed of carcinomatous and sarcomatous elements. The former element consisted mainly of transitional cell carcinoma with occasional foci of squamous metaplasia and glandular differentiation, while the latter consisted of spindle cell sarcoma showing partly cartilaginous and osseous differentiation. The histogenesis of malignant mixed mesodermal tumor of the bladder also is discussed.

Sequential instillation therapy with mitomycin C and adriamycin for superficial bladder tumors.

SummaryFrom October 1983 to September 1985, 84 patients with superficial bladder tumor (Ta, Tl, Tis) were treated with sequential instillation of mitomycin C (MMC) and adriamycin (ADM). Doses of 20 mg MMC on day 1 and 40 mg ADM on day 2 were instilled into the bladder and retained for at least 2 h; this was repeated once a week for 5 consecutive weeks. Patients who achieved complete response (CR), were randomized and underwent prophylactic treatment taking the form of either intermittent instillation of MMC or daily oral administration of 5-fluorouracil. Of 79 evaluable patients, 72 (91%) had received prior treatment for superficial bladder tumors, 69 (87%) had high-grade tumors, and 18 (23%) had non-papillary Tis. The overall response rate was 68%, made up of CR in 43 patients (54%) and partial response (PR) in 11 (14%). Patients with either five or more tumors or tumors larger than 1 cm showed a significantly lower response rate than those with fewer than five tumors and tumors smaller than 1 cm, respectively. There was no correlation between tumor growth pattern, tumor grade and response rate, though non-papillary Tis appeared to respond better than papillary tumors. A history of prior instillation therapy or of toxicity to this treatment had no significant influence on the response rate. Although no systemic toxicity was observed, 62 patients (74%) experienced cystitis and the treatment had to be discontinued within 4 weeks in 13 of 33 cases with severe symptoms. The preliminary conclusion of prophylactic treatment was that intermittent instillation of MMC was superior to 5-FU medication in reducing the recurrence rate for at least 2 years after the treatment.

Successful treatment of yolk sac tumor of the lower abdominal wall with lymph node metastases.

We report a case of a primary yolk sac tumor of the lower abdominal wall with inguinal lymph node metastases. To our knowledge, this is the first documented case originating in the lower abdominal wall. Radical surgery was performed, followed by combination chemotherapy consisting of bleomycin, vinblastine and cis-platinum. The patient has been free of disease for more than 2 years.