Abstract

Introduction: Transitional cell carcinoma is the most common histopathologic type of bladder tumors. But

bladder cancer is a heterogenous disease with an unpredictable clinical course. Non-transitional cell

carcinomas of the bladder are uncommon and aggressive tumors. It is necessary to distinguish histopathologic

type of tumors because squamous or glandular differentiation can be found with transitional cell carcinoma.

In this study, we examined pathologic diagnosis, treatment and prognosis of 34 patients with non-transitional

cell carcinoma.

Materials and Methods: A total of 1150 patients with bladder tumors operated in our clinic between

August 1994 and November 2002 were retrospectively evaluated. 34 (3%) bladder tumors of non-transitional

type were pathologically diagnosed. All patients were treated with transurethral resection of bladder tumor.

After the histological diagnosis of the tumor, radiologic tests (abdominal and chest CT, radionuclide bone

scan) were obtained for accurate staging. Of these tumors, there were 10 (34.5%) squamous cell carcinoma, 9

(31%) adenocarcinoma, 3 (10.3%) sarcomatous carcinoma, 2 (7%) lymphepithelioma, 2 (7%) small cell

carcinoma, 1 (3.4%) clear cell carcinoma, 1 (3.4%) choriocarcinoma and 1 (3.4%) sarcoma. Totally 54

specimens of 34 cases were examined histopathologically (37 TUR-BT, 14 radical cystectomy, 3 consultation

material). In histopathologic examination; development pattern, depth of invasion, angiogenesis, necrosis,

mitosis, immunologic staining, differentiation patterns and superficial epithelium changes, neural and vascular

invasion were evaluated.

Results: Patients were followed-up minimum 6 months to maximum 39 months (mean follow- up 17

months). There were 31 (91.2%) men and 3 (8.8%) women with a mean age of 62.3 (ranging 47 to 76) years.

We could not reach to 5 (14.7%) patients with different histologic types and these patients were excluded from

study. Pathological stages were T2NoMo in 4 (13.8%) patients, T2N+Mo in 4 (13.8%), T2N+M1 in 4 (13.8%),

T3NoMo in 5 (17.2%), T3N+Mo in 5 (17.2%), T3N+M1 in 3 (10.4%), T4N+M1 in 4 (13.8%). Tumor behavior

was very aggressive in all histological types. Of 29 patients, 19 patients (65.5%) had local invasive disease and

10 (34.5%) had metastatic disease at pathologic examination. Fourteen (48.3%) patients were treated with

radical cystectomy and pelvic lymphadenectomy and 12 (41.4%) patients with systemic chemotherapy and/or

radiotherapy. Three patients could not take any therapy because of their clinical status. After a mean followup

of 17 months, 10 (34.5%) patients were alive and 19 (65.5%) died.

Conclusion: Prognosis of urinary bladder tumors were directly related to histologic grade and stage of the

tumor. Non-transitional cell carcinomas are typically deep invasive and advanced tumors indicating that they

are highly aggressive neoplasms and have poor survival rates. Chemotherapy or radiotherapy has limited

response rates. Early radical cystectomy should be done to improve prognosis.