Posted by CLDing on February 17, 1998 at 09:52:59:
In Reply to: ca bladder posted by Guan Chou on February 17, 1998 at 06:38:44:
Welcome aboard Guan Chou.
There are a few things which do not tie up in this patient.
My first impression would have been a diffuse CIS which has been neglected, even though I
do no like the history of 'many years'. Is it really 'many' years?
I suggest you get another pathologist to review the slides (unless you already have a good
uropathologist). If this is TCC, the HPE does not match the clinical picture and the cysto
findings. If this is Ca, it is going to be very anaplastic. Have you had a look at the
slides yourself? On which specimen did the the pathologist report the G1 TCC?
I have had a man and a woman with almost the same situation except for the severely raised
creatinine. The man had a open prostatectomy done for his symptoms and never improved. He
got on to my clinic 18 months after his prostate surgery. The lady was treated for UTI for
'many' years before seeing me. Both of them did not live very long after I made the
diagnosis of diffuse CIS. They were so symptomatic and CXR were both clear. I took off
their bladders and within 18 months both developed metastatic disease and died shortly
after that.
You certainly make it look like there is no reason to suspect a neurogenic bladder. Does KUB and APG show any evidence of tuberculosis?
Do not hesitate to rescope and biopsy if necessary.