Squamous cell carcinoma of the urinary bladder

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Squamous cell carcinoma of the urinary bladder
Diagnosis in short
LM DDx metastatic squamous cell carcinoma (esp. squamous cell carcinoma of the uterine cervix), urothelial carcinoma with squamous differentiation, condyloma acuminatum, squamous dysplasia, keratinising squamous metaplasia of the urinary bladder
IHC p16 -ve/+ve, CK20 -ve, CK7 -ve, CK14 +ve, GATA3 -ve
Site urinary bladder

Clinical history lived in areas with Schistosoma haematobium
Symptoms hematuria
Prevalence very rare
Prognosis similar to UCC of the bladder
Clin. DDx other bladder tumours
Treatment cystectomy

Squamous cell carcinoma of the urinary bladder, abbreviated SCC of the bladder, is a rare cancer of the urinary bladder.

Squamous differentiation in urothelial carcinoma is common and much more frequent than SCC of the bladder.

General

  • Strong association with Schistosoma haematobium.[1]
    • Common in areas with S. haematobium.
    • Uncommon in areas without S. haematobium.
  • Five year survival of SCC of the bladder is similar to UCC of the bladder.[2]
    • Unadjusted five year survival of UCC, SCC and UCC with squamous differentiation is 34%, 33% and 28% respectively.

Subclassification

Divided into two subtypes: [3]

  • Bilharzial-associated SCC (BSCC) - not associated with bilharziasis (Schistosoma).
  • Non-bilharzial SCC (NBSCC).

Characteristics of NBSCC:[3]

  • Prevalance ~2-5% of bladder tumours (in Western countries).[4]
  • Usually high-grade.
  • Typical patient 7th decade.
    • Fifth decade for BSCC
  • Present with hematuria without irritative bladder symptoms.
  • Risk factors: indwelling catheters, chronic inflammation/irritants.

Microscopic

Features:

DDx:

IHC

Features:

  • p16 -ve/+ve.
    • Not definite for separating from cervix - but suggestive: cervix ~86% +ve, bladder ~37% +ve.[5]
  • CK14 +ve.[6]
  • CK7 -ve.[6]
  • CK20 -ve.[6]

UCC versus SCC

IHC may be of some use as per Gulmann et al.:[7]

Immunostain Pure SCC (12 cases) Pure UCC (15 cases)
CK14 100% (12/12) 27% (4/15)
Desmoglein-3 75% (9/12) 0% (0/15)
GATA3 0% (0/12) 93% (14/15)
Uroplakin III 0% (0/12) 67% (10/15)
S100P 8% (1/12) 93% (14/15)

An another study from Egypt looks at CK7 and CK20 which is widely available:[6]

Immunostain SCC UCC
CK7 0% (0/50) 80% (120/150)
CK20 0% (0/50) 70% (105/120)

Sign out

In areas not endemic for S. haematobium, reports of biopsies should raise the possibility of UCC with squamous differentiation and metastasis.

See also

References

  1. Michaud, DS.. "Chronic inflammation and bladder cancer.". Urol Oncol 25 (3): 260-8. doi:10.1016/j.urolonc.2006.10.002. PMID 17483025.
  2. Izard, JP.; Siemens, DR.; Mackillop, WJ.; Wei, X.; Leveridge, MJ.; Berman, DM.; Peng, Y.; Booth, CM. (Oct 2015). "Outcomes of squamous histology in bladder cancer: a population-based study.". Urol Oncol 33 (10): 425.e7-13. doi:10.1016/j.urolonc.2015.06.011. PMID 26199176.
  3. 3.0 3.1 Martin, JW.; Carballido, EM.; Ahmed, A.; Farhan, B.; Dutta, R.; Smith, C.; Youssef, RF. (Sep 2016). "Squamous cell carcinoma of the urinary bladder: Systematic review of clinical characteristics and therapeutic approaches.". Arab J Urol 14 (3): 183-91. doi:10.1016/j.aju.2016.07.001. PMID 27547458.
  4. URL: https://www.myvmc.com/diseases/bladder-cancer-squamous-cell-carcinoma-of-the-bladder/. Accessed on: 14 February 2018.
  5. Cioffi-Lavina, M.; Chapman-Fredricks, J.; Gomez-Fernandez, C.; Ganjei-Azar, P.; Manoharan, M.; Jorda, M. (Jul 2010). "P16 expression in squamous cell carcinomas of cervix and bladder.". Appl Immunohistochem Mol Morphol 18 (4): 344-7. doi:10.1097/PAI.0b013e3181d2bbd7. PMID 20571342.
  6. 6.0 6.1 6.2 6.3 Hammam, O.; Wishahiz, M.; Khalil, H.; El Ganzouri, H.; Badawy, M.; Elkhquly, A.; Elesaily, K. (Dec 2014). "Expression of cytokeratin 7, 20, 14 in urothelial carcinoma and squamous cell carcinoma of the Egyprian urinary bladder cancer.". J Egypt Soc Parasitol 44 (3): 733-40. PMID 25643514.
  7. Gulmann, C.; Paner, GP.; Parakh, RS.; Hansel, DE.; Shen, SS.; Ro, JY.; Annaiah, C.; Lopez-Beltran, A. et al. (Feb 2013). "Immunohistochemical profile to distinguish urothelial from squamous differentiation in carcinomas of urothelial tract.". Hum Pathol 44 (2): 164-72. doi:10.1016/j.humpath.2012.05.018. PMID 22995333.