Small cell carcinoma of the urinary bladder. A clinicopathologic, morphometric, immunohistochemical, and ultrastructural study of 18 cases

• Published in: Cancer Vol. 64; no. 6; pp. 1347 - 1357
• Main Authors: Blomjos, C. Edward, Vos, Winand, de Voogt, Herman J., Valk, Paul Van Der, Meijer, Chris J. L. M.
• Format: Journal Article
• Language: English
• Published: New York Wiley Subscription Services, Inc., A Wiley Company 15.09.1989; Wiley-Liss
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Small Cell - analysis; Carcinoma, Small Cell - mortality; Carcinoma, Small Cell - pathology; Carcinoma, Small Cell - secondary; Cell Membrane - ultrastructure; Cytoplasm - ultrastructure; Cytoplasmic Granules - ultrastructure; Female; Humans; Immunohistochemistry; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Nephrology. Urinary tract diseases; Organelles - ultrastructure; Tumors of the urinary system; Urinary Bladder Neoplasms - analysis; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary tract. Prostate gland; Human; Immunohistochemistry; Pathology; Urinary system disease; Urinary bladder; Respiratory disease; Tumor; Malignant tumor; Urinary tract disease; Oat cell carcinoma; Bronchopulmonary
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/1097-0142(19890915)64:6<1347::AID-CNCR2820640629>3.0.CO;2-Q

A multiinstitutional review of 3778 patients with a primary malignancy of the urinary bladder revealed 18 cases (0.48%) of small cell carcinoma which were histologically and morphometrically identical to pulmonary small cell undifferentiated carcinoma. Age, sex, and symptoms at first presentation were comparable to that known in transitional cell carcinoma. Sixteen patients (89%) developed metastatic disease, with most frequent involvement of regional lymph nodes, liver, skeleton, and abdominal cavity. The unfavorable clinical outcome was worse as compared with that reported in advanced stage poorly differentiated transitional cell carcinoma, and was similar to the rapidly fatal outcome of pulmonary small cell undifferentiated carcinoma. Fourteen patients (78%) died by tumor at a mean follow‐up period of 9.4 months, and only one patient was free of recurrent disease more than 5 years after cystectomy. This apparent aggressive tumor behavior was independent of the presence of neuroendocrine differentiation characteristics at immunohistochemical (13 cases, 72%) or electron microscopic study (eight cases, 44%). The prolonged survival periods (15‐‐38 months) of the five patients who received combination chemotherapy suggested that, just as in small cell lung carcinoma, chemotherapy may be profitable. A unified concept of histogenesis of bladder cancer with a common origin from a multipotent mucosal stem cell is proposed.