Colonic adenocarcinoma in an Indiana pouch successfully treated by endoscopic mucosal resection

Saito, Ryoichi; Hiroyuki, Mishima; Nishikawa, Nobuyuki; Ueda, Toshihisa; Jang, Kim Chul

doi:10.1111/j.1442-2042.2007.01684.x

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…Ten published articles with a pathologic diagnosis of adenoma or carcinoma of the Indiana pouch were identified in our search interval from December 1996 to April 2012. [6][7][8][9][10][11][12][13][14][15] Data were gathered and tabulated regarding the following 12 variables: age, sex, primary malignancy, latency period, stone formation, tumor size, tumor site, signs and symptoms, tumor pathology, presence or absence of metastatic disease, therapy, and outcomes.…”

Section: Methodsmentioning

confidence: 99%

“…At present, 10 cases of malignancies originating in an Indiana pouch have been reported (Table 1). [6][7][8][9][10][11][12][13][14][15] We report an 80-year-old patient who presented with metastatic adenocarcinoma of the Indiana pouch, and was treated with palliative systemic chemotherapy. To our knowledge, this is the first reported case that presented with widespread metastatic disease, and was managed with palliative chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Cancer of the Indiana Pouch: A Case Report and Review of the Literature

Saba

Janbain

et al. 2013

Clinical Genitourinary Cancer

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cancer of the Indiana Pouch: A Case Report and Review of the Literature

Saba

Janbain

et al. 2013

Clinical Genitourinary Cancer

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“…The literature prior to 2004 has been summarized by Austen and Kälbe (25). Our literature search yielded four case reports of intestinal adenocarcinoma arising in a urinary conduit created from an isolated segment of intestine since 2004 (46)(47)(48)(49). It seems likely that the overall incidence of such second cancers is increasing.…”

Section: Discussionmentioning

confidence: 99%

Intestinal adenocarcinoma arising in urinary conduits

Moyer

Grubb²,

Johnson

2011

Oncol Rep

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Abstract. It is estimated that >10,000 patients who undergo cystectomy for bladder cancer in the US each year receive a conventional ileal conduit and that >2,000 receive a continent urinary diversion. Case reports of primary intestinal adenocarcinomas in urinary conduits have been published recently, mainly in the urology literature. An epidemic of such cancers in this small, high-risk population seems to be emerging, particularly in conduits that utilize the colon. A case report and literature review was carried out. We describe a patient with a new primary adenocarcinoma arising in a colonic neobladder. We summarize prior literature describing intestinal adenocarcinomas that developed in an intestinal segment used for urinary diversion. Patients with urinary conduits of all types (particularly those utilizing colon rather than ileum) are at high risk of developing a second primary intestinal adenocarcinoma in the conduit. This population is likely to benefit from surveillance measures aimed at detecting such cancers. The primary form of therapy remains adequate surgical resection. General surgeons should be aware of such patients as they may be involved in the diagnosis of, and surgery for, the cancer in the conduit. IntroductionIn 2008, the World Health Organization projected that cancer would become the leading cause of death in the world (1). Carcinoma of the urinary bladder is the ninth most commonly diagnosed type of cancer in the world (2). Over 70,000 people in the US develop this cancer every year (3) and the incidence is projected to increase (4). Comparable data are reported from other wealthy nations (5). In the US and most other countries, tobacco abuse is the main known environmental risk factor for the development of bladder cancer (6-8). The incidence in smokers is estimated to be two to three times as great as the incidence in non-smokers. In countries where S. haematobium is endemic, bladder infestation is the leading cause (2). In river basins draining the Himalayas (e.g., India, Pakistan, Myanmar, Vietnam), the groundwater contains high concentrations of arsenic, which is a major cause of bladder carcinoma (9). Additional known etiologic agents include exposure to certain aromatic amines such as those found in dyes and rubber, the chemotherapeutic agent cyclophosphamide, ionizing radiation, and various textiles and metals (7,10,11).Colorectal carcinoma is the third most commonly diagnosed type of cancer in the world (1). Over 150,000 people in the US develop cancer of the colon or rectum every year (12). Adenomas arising in subjects without known polyposis syndromes are the most common precursor lesion. Hamartomas are also welldescribed precursor lesions, as in Peutz-Jehgers syndrome. Other known causes of colorectal cancer include hereditary polyposis syndromes, Li-Fraumeni syndrome, inflammatory bowel disease, and ionizing radiation (13,14). Charred food and diets high in red meat and low in fiber, fruits and vegetables have been implicated as causative environmental agents (15-17). There...

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“…Seven cases have been described in the literature (Table 1, Table 2). [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The most common initial symptom is gross hematuria. Other signs and symptoms include particulate discharge from the pouch, stones in the pouch, difficulty with catheterization, pouch distention and overflow incontinence.…”

Section: Discussionmentioning

confidence: 99%

“…Third, de novo adenocarcinoma may develop in any bowel segment, including the portion used in urinary diversions. 3 Thus, the origin of these tumours is likely to be multifactorial. The following uncommon presentations of adenocarcinoma following urinary diversion surgery emphasize the diverse circumstances in which these malignancies can develop.…”

Section: Introductionmentioning

confidence: 99%

Adenocarcinoma following urinary diversion

Jian

Godoy

Coburn

et al. 2012

cuaj

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The use of bowel segments in urinary diversions has been associated with an increased risk of neoplasia. This report describes three cases of intestinal adenocarcinoma following urinary diversion. In the first case, a 73-year-old woman developed moderately-differentiated colonic adenocarcinoma in her Indiana pouch 10.5 years after cystectomy. The second case involved a 77-year-old man with well-differentiated adenocarcinoma in his Indiana pouch 9 years after radical cystoprostatectomy and en bloc urethrectomy. The third case involved a 38-year-old man with moderately-differentiated adenocarcinoma arising in his ileal conduit 33 years after the creation of the conduit. These cases highlight the diagnostic signs of adenocarcinoma arising in urinary diversions and emphasize the importance of lifelong surveillance in these patients. IntroductionExposure of intestinal mucosa to urine has been associated with an increased risk of tumorigenesis.1 Although the pathogenesis of these tumours has not been well-established, many possible explanations exist. First, in patients with ureterosigmoidostomy, the blending of fecal and urinary materials is thought to increase the production of nitrosamines at the site of the uretero-colonic anastamosis.2 Second, in the absence of fecal and urinary blending, chronic inflammation, irritation, presence of stones and elevation of a variety of substances have been implicated in carcinogenesis within the intestinal segment.1 The carcinogenic substances currently being investigated include nitrosamine, reactive oxygen species, epidermal growth factor, transforming growth factor, cyclo-oxygenase, mucin and ornithine transcarbamylase.1 Many of these substances have also been suggested as potential causes of adenocarcinoma in not only Indiana pouches and ileal conduits, but also in neobladders. In the absence of mixing of the urinary and fecal streams, there does not appear to be any increased risk per se in a urinary diversion beyond that inherent in the bowel segment in a non-diverted patient. Third, de novo adenocarcinoma may develop in any bowel segment, including the portion used in urinary diversions.3 Thus, the origin of these tumours is likely to be multifactorial. The following uncommon presentations of adenocarcinoma following urinary diversion surgery emphasize the diverse circumstances in which these malignancies can develop. Case 1A 73-year-old female with a history of recurrent non-muscle invasive urothelial carcinoma of the bladder came to urology clinic. Her chief complaint was hematuria 10.5 years after radical cystectomy, extended lymph node dissection and continent urinary diversion with an Indiana pouch. Final pathology of the cystectomy showed a pTaG2 urothelial carcinoma of the bladder and carcinoma in situ. She had been in continuous follow-up postoperatively without evidence of recurrence. Magnetic resonance imaging (MRI) of the abdomen demonstrated a solid 2.5-cm mass localized in the posterior-inferior wall inside the Indiana pouch (Fig. 1, panel A). Endosco...

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Colonic adenocarcinoma in an Indiana pouch successfully treated by endoscopic mucosal resection

Cited by 10 publications

References 9 publications

Cancer of the Indiana Pouch: A Case Report and Review of the Literature

Cancer of the Indiana Pouch: A Case Report and Review of the Literature

Intestinal adenocarcinoma arising in urinary conduits

Adenocarcinoma following urinary diversion

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