Vulvar and Vaginal Implantation of Transitional Cell Carcinoma of the Urinary Tract

Transitional cell carcinoma (TCC) of the bladder is the seventh most frequent cancer of women. The possible mechanisms of local tumor recurrence are seeding and multicentricity. Distant metastases are most frequently as a result of vascular or lymphatic spread and to a lesser extent by seeding of the tumor cells with urine or transurethral instrumentation. We report a clitoral metastasis of a TCC of the bladder, which is a very unexpected and extremely rare site for metatstasis and discuss whether the possible mechanism is vascular spreading or direct seeding. To our knowledge this is the third case in the literature.

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“…Another publication strongly advocates the direct implantation of seedded tumor cells during micturation or transurethral instrumentation [6].…”

Section: Discussionmentioning

confidence: 99%

“…Shedding of tumor cells during the micturation or transurethral instrumentation said to be the cause of TCC ocurrence at the vulva and vagina [1,6].…”

Section: Discussionmentioning

confidence: 99%

Transitional cell carcinoma of the clitoris: direct implantation or metastasis

et al. 2006

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“…These include a primary UC originating from the vagina, direct invasion of a bladder UC [20,21], metastasis from a bladder UC, and implantation via urine in a urinary tract UC. Seven cases were considered to be implantation by irrigation fluid of transurethral resection or transfer of urine [8,9,14,[16][17][18][19]. Many of these cases were non-muscle invasive urinary tract UC that had a low likelihood of distant metastasis and had a history of frequent endoscopic procedures or intravesical injection therapies.…”

Section: Discussionmentioning

confidence: 99%

“…They most likely occur because of the close relationship between the urothelium and Mullerian-type epithelium in embryological development [2,3]. UCs of the ovary [2], the fallopian tube [4], the endometrium [5], the cervix [3], and the vagina [6][7][8][9][10][11][12][13][14][15][16][17][18][19] have been reported. Herein we report a case of non-muscle invasive bladder carcinoma with concomitant vaginal UC.…”

Section: Introductionmentioning

confidence: 99%

Non-muscle invasive bladder cancer with concomitant vaginal urothelial carcinoma: a case report and review of the literature

et al. 2010

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A 74-year-old female was referred to our hospital for non-muscle invasive bladder tumors initially treated at another hospital. Preoperatively, computed tomography and magnetic resonance imaging demonstrated non-muscle invasive bladder tumors and a vaginal tumor. A second transurethral resection of the bladder tumors, transvaginal tumor resection, and systemic chemotherapy were performed. The histopathological appearances of both tumors were very similar and the diagnoses were urothelial carcinoma (UC). The pathogenesis of the vaginal UC was considered to be the primary UC or metastasis from the bladder UC. Vaginal UC is extremely rare and this is only the 15th report in the literature.

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“…Thus, while distant metastases are widely accepted as the result of vascular or lymphatic spread this mechanism cannot explain the phenomenon of locally recurrent noninvasive urothelial carcinomas. Urothelial carcinoma recurrences in urothelium are thought to occur by either tumor multicentricity due to a field effect of carcinogenesis or tumor seeding during micturition or instrumentation 12–14. Genetic studies have shown evidence supporting both theories 15.…”

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confidence: 99%

Urothelial carcinoma involving vaginal specimens from patients with neobladder: A potential pitfall in diagnostic cytopathology

Sigel

Park

Fine

et al. 2010

Diagnostic Cytopathology

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Most vaginal neoplasms represent metastasis from the cervix, endometrium, colon and ovary and distinction from a primary lesion does not pose a diagnostic problem. Recently, it has been recognized that women with urothelial carcinoma (UC) who have undergone radical cystectomy with orthotopic neobladder reconstruction are at risk for recurrence in the lower gynecologic tract. Our objective is to describe the cytologic features of cases with confirmed UC in the vagina in this clinical setting. Four vaginal specimens from patients with prior radical cystectomy and orthotopic neobladder reconstruction with histologically confirmed UC were evaluated. The vaginal specimens consisted of Thinprep® and Papanicolaou-stained slides. Cytomorphologic parameters including cellular arrangement, cell size and shape, cytoplasm, and nuclear features were evaluated and compared with a corresponding surgical biopsy. All four cases were highly cellular with abundant neoplastic cells arranged singly and in loose three-dimensional clusters with overlapping nuclei. The neoplastic cells were large and polygonal with well-defined cell borders, high nuclear to cytoplasmic ratio, and granular basophilic cytoplasm. The chromatin was coarse with small nucleoli. Scattered keratinized single cells with atypical hyperchromatic nuclei were observed in each case. In summary, UC involving the vagina can share many morphologic features with primary squamous cell carcinomas at this site, including focal keratinization. Abundant three dimensional clusters of neoplastic cells and a previous history of orthotopic neobladder reconstruction are helpful cytomorphologic and clinical features supporting a diagnosis of UC involving the vagina and may prevent unnecessary work-up for a new primary lesion.

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Vulvar and Vaginal Implantation of Transitional Cell Carcinoma of the Urinary Tract

Cited by 13 publications

References 3 publications

Transitional cell carcinoma of the clitoris: direct implantation or metastasis

Transitional cell carcinoma of the clitoris: direct implantation or metastasis

Non-muscle invasive bladder cancer with concomitant vaginal urothelial carcinoma: a case report and review of the literature

Urothelial carcinoma involving vaginal specimens from patients with neobladder: A potential pitfall in diagnostic cytopathology

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