Background: Nephrogenic adenoma is an uncommon, benign, tumour-like lesion within the urothelial ... more Background: Nephrogenic adenoma is an uncommon, benign, tumour-like lesion within the urothelial mucosa of the urinary tract caused by reimplantation and proliferation of the renal tubular cells that have been shed by chronic irritation of the mucosa of the urinary tract. Case Study: We report a case of the rare fibromyxoid variant of nephrogenic adenoma in the prostate urethra. To the best of our knowledge, only a few cases have been described in the literature. Conclusion: This tumour can have variable morphological patterns with occasional worrisome features that can mimic carcinoma of the lower urinary tract.
Clear or involved resection margins have significant bearings on the outcome of colorectal cancer... more Clear or involved resection margins have significant bearings on the outcome of colorectal cancer cases. There are two aspects of resection margins: longitudinal and circumferential. Pathological staging for rectal and colonic tumour specimens is a useful tool for providing continuous feedback to surgeons and may serve to improve the quality of surgery and pathology reporting. It is expected that a good pathology report will evaluate and audit the quality of other services such as radiology, surgery, and oncology. The aim of this paper is to outline how this parameter can be audited by surgeons and pathologists to improve both communication and standards.
The word polyp simply means mucosal protrusion and it carries clinical significance only if the p... more The word polyp simply means mucosal protrusion and it carries clinical significance only if the pathologist attaches a histopathological label. The polyp could be inflammatory, hamartomatous, serrated (hyperplastic), or neoplastic (dysplastic). Polyps assume one of two classical appearances: pedunculated polyps, which protrude for >2-fold the thickness of the adjacent mucosa and have a base smaller than one-third of the diameter of the head of the lesion; or sessile polyps, which have a base and top of the lesion that are approximately the same width. The term subpedunculated polyps is used by some specialists; these polyps are intermediate broad-based lesions that are dealt with in the same way as sessile lesions.1,2 Malignant colorectal polyps (MCRP) are common enough to warrant special attention and, with the introduction of bowel cancer screening programmes worldwide, large numbers of these polyps are being detected. Results have indicated that up to 50% of screen-detected ca...
Despite that, other studies reported that around one-fifth of the cases will have no response to ... more Despite that, other studies reported that around one-fifth of the cases will have no response to RT. Other workers reported that the contribution of neoadjuvant RT to pathological complete response in terms of survival was of limited or minimal benefit [8]. In view of the above changes, the real challenge in rectal cancer treatment is to identify patients who would fully benefit from the new treatment protocols which involve RT. The aim of this article is to present the different histological systems used to classify the response rate of the patients and to discuss the different types of biomarkers used to predict of the response of patients to RT/ chemoradiotherapy (CRT). RT Mechanism of Action Oxidative stress damage is extensive in cells exposed to ionising radiation. This damage mainly targets nuclear DNA through inhib-The management of rectal cancer is a major undertaking. There are currently multiple treatment modalities with variable degrees of complications. Radiotherapy (RT) is one of the more frequently used modalities either on its own or more frequently with chemotherapy mostly before the definitive surgery. The outcome of RT is unpredictable. RT has its serious side effects and there are no guarantees of its usefulness in all patients. This article outlines the effect of RT on the tumor, reviews the various staging systems of responses to RT and present recent evidence of which case is less responsive to such treatments to avoid unnecessary complications.
The significance of nodal metastasis as a prognostic factor in colorectal cancer is universally r... more The significance of nodal metastasis as a prognostic factor in colorectal cancer is universally recognised and accepted. This article discusses the various factors that govern lymph node harvest and how to improve that. We will discuss the outcome of lymph node harvest as a possible form of auditing the surgical technique and the pathologist dedication.
Phyllodes tumour occurring in the vulva is rare with only a few cases reported in the literature.... more Phyllodes tumour occurring in the vulva is rare with only a few cases reported in the literature. We report a case of a 33-year-old lady who presented with a small vulval swelling in which subsequent excision of the lesion showed a benign phyllodes tumour. She was followed-up by re-excision which did not reveal any residual lesion and she is well without recurrence 6 months after surgery.
Russell bodies are not uncommon in reactive plasma cells with distinctive intra-cytoplasmic eosin... more Russell bodies are not uncommon in reactive plasma cells with distinctive intra-cytoplasmic eosinophilic inclusions. However, Russell body cervicitis is uncommon with only one previously reported case in the English literature. We report a case of Russell body cervicitis in a 29-year-old female who presented with post-coital bleeding and the subsequent examination showed a benign cervical polyp that was excised. One-year follow-up was uneventful.
We read with interest the article on SPECC and SPECULATION by Moran and Dattani [1] and would lik... more We read with interest the article on SPECC and SPECULATION by Moran and Dattani [1] and would like to congratulate them and the Pelican faculty on their foresight in organising such an important training programme. There are a few points that need focussing on to solidify their effort and we hope they will meet with their philosophy. The first is the point of definitions for the sake of unification. We would like to expand this area beyond anatomy to involve histopathological reporting. This article is protected by copyright. All rights reserved.
Reconstructive Surgery of the Rectum, Anus and Perineum, 2012
This chapter discusses the risks of cancer transformation in inflammatory bowel disease and provi... more This chapter discusses the risks of cancer transformation in inflammatory bowel disease and provides guidelines concerning controversial issues surrounding screening and the management of dysplasia and dysplasia-associated lesions or masses. These screened and colitis-associated lesions are contrasted with sporadic cancers along with their differing molecular biology.
Inflammatory Bowel Disease and Familial Adenomatous Polyposis
Definition of dysplasia is standard. Classifications are clear. Genetic studies are variable and ... more Definition of dysplasia is standard. Classifications are clear. Genetic studies are variable and may be useful in differentiating between lesions and helpful in choosing treatment modalities. Treatment varies according to condition of lesion. Not all CRC in IBD follow the logic of the lowgrade dysplasia, high-grade dysplasia then carcinoma sequence. Modified chromoendoscopy is more sensitive than routine endoscopy in identifying dysplastic epithelium.
The use of flexible sigmoidoscopy has also been investigated as a screening tool (Atkin et al., 1... more The use of flexible sigmoidoscopy has also been investigated as a screening tool (Atkin et al., 1993; UK-Flexible-Sigmoidoscopy-Screening-Trial-Investigators, 2002) which showed that a once-only flexible sigmoidoscopy between the ages of 55 and 64 could reduce CRC incidence by 33% and mortality from CRC by 43% (Atkin et al., 2010). The test was also found to be safe and acceptable (Atkin et al., 1993). Several randomised trials and Cochrane reviews have provided high-quality evidence that this test, if offered every 2 years, has the potential to reduce mortality rates associated with CRC by 16% (Towler et al., 1998) and reduces incidence and mortality rates of distal CRC by 60-80% (Newcomb et al., 2003; Selby et al., 1992). In general, the NHS Bowel Cancer Screening Programme (NHS BCSP) commenced in April 2006 and invites men and women aged 60-69 to participate via submission of faecal occult blood test every 2 years; those with a positive result will be offered colonoscopy (West et al., 2008). As a marker of the success of the programme, at colonoscopy, the proportion of Duke's stage A and B lesions is markedly higher than that diagnosed amongst the symptomatic population (Goodyear et al., 2008; Halloran, 2009).
Background: The early molecular changes preceding the onset of mucosal inflammation in colitis an... more Background: The early molecular changes preceding the onset of mucosal inflammation in colitis and their temporal relationship with gut permeability remain poorly defined. This study investigated functional and transcriptomic changes in mdr1a(Ϫ/Ϫ) mice lacking the intestinal transporter P-glycoprotein, which develop colitis spontaneously when exposed to normal enteric flora. Methods: Mdr1a(Ϫ/Ϫ) mice were housed in specific pathogenfree conditions to slow colitis development and compared to congenic controls. Mucosal permeability and cytokine secretion were analyzed in ex vivo colon. Gene expression in colonic mucosal and epithelial preparations was analyzed by microarray and qPCR. Colonocyte responsiveness to bacterial antigens was measured in short-term culture. Results: Colon from 4-5-week-old, disease-free mdr1a(Ϫ/Ϫ) mice was histologically normal with no evidence of increased permeability compared to controls. However, these tissues display a distinctive pattern of gene expression involving significant changes in a small number of genes. The majority of upregulated genes were associated with bacterial recognition and the ubiquitin-proteasome system and were gamma-interferon (IFN-␥) responsive. Expression of the antiinflammatory factor pancreatitis-associated protein (PAP) and the related gene RegIII␥ were markedly reduced. Colonocytes from 4-5-week mdr1a(Ϫ/Ϫ) exhibit similar transcriptomic changes, accompanied by higher basal chemokine secretion and increased responsiveness to LPS. Significant increases in colonic permeability were associated with older (12-16-week) mdr1a(Ϫ/Ϫ) mice displaying molecular and functional evidence of active inflammation. Conclusions: These studies show that early epithelial changes associated with altered responsiveness to bacteria precede increased permeability and mucosal inflammation in this model of colitis, highlighting the importance of P-glycoprotein in regulating interactions with the commensal microflora.
The risk of lymph node metastasis (LNM) in colorectal cancer (CRC) has been extensively reported ... more The risk of lymph node metastasis (LNM) in colorectal cancer (CRC) has been extensively reported in advanced and early disease. It has been shown to be directly related to the depth of submucosal invasion [1–7], although one study failed to identify this to be a risk factor [8]. The logical and scientific explanation of this association is summarized in a passage taken from the paper by Duff et al. [9] as follows: ‘In normal colonic tissue, lymphatic vessels were prominent in deeper layers of the bowel wall in particular in the submucosa and throughout the muscularis propria clustering between muscle layers. Lymphatic vessels were found rarely in colonic mucosa’. The specific question, the association of the measured depth of submucosal invasion with the risk of nodal metastasis and therefore management planning, is frequently encountered in our current routine work [10–12]. This is mostly due to the increasing endoscopic removal of polyps that are subsequently found to be malignant. It is also a result of the National Bowel Screening Programme, which is identifying more patients with early CRC compared with symptomatic patients. The standard accepted assessment of the depth of invasion in flat or depressed T1 CRC is made using Kudo’s and Kikuchi’s classifications [3,4]. The latter divides the submucosa (Sm) into three equal thirds, Sm1, Sm2 and Sm3. There is general agreement that the greater the depth of invasion of the submucosa the more the risk of LNM (Table 1). This assessment works very well when the specimen removed contains some muscularis propria, but if there is none it is simply not possible to use the system since without any muscularis propria in the specimen there is no means of defining the outer limit of the submucosa. Kimura et al. [13] have recently suggested that submucosal invasion up to 1000 lm represents Sm1 whilst invasion of more than 1000 lm represents Sm2. Other authors have suggested that the term ‘massive submucosal invaded cancer’, which is frequently used, is similar to tumour invasion equal to Sm2 or Sm3, i.e. with a depth of invasion of more than 1000 lm [2,14]. In this issue, the systematic review by Beaton et al. [15] that included 23 cohort studies is timely and throws light on some important difficulties encountered by the pathologist who is charged with giving an accurate and meaningful assessment of invasion. The study included 4510 patients of whom 567 had LNM. Twenty of the 23 studies included all early CRC, two included only pedunculated tumours and one only included sessile tumours. The authors correctly pointed out the difficulties of applying the various staging systems measuring the depth of invasion and their relation to LNM. In the review, submucosal invasion was measured using both the Kikuchi system and the absolute depth in millimetres. One of the findings was that invasion of more than 1 mm (1000 lm) into the submucosa was associated with increased risk of LNM. This is an important piece of information that we need to keep in mind. The second finding was that measuring the absolute depth of submucosal invasion was more appropriate in endoscopically resected tumours rather than classifying them as Sm1 Sm3. This is an opportune time to pause and analyse critically the implications of these observations. It is important to realize that measuring the depth of invasion is influenced by various factors including the quality of the specimen and its technical preparation for histopathological examination. To maximize the efficiency of assessing specimens correctly, it is important to pay special attention to the way in which the initial specimen is prepared and how it is transmitted to the pathology Table 1 Percentages of Kikuchi stages in three different series and the associated risk of lymph node metastasis.
A 58-year-old woman with a previous clam ileocystoplasty was referred to the urology department f... more A 58-year-old woman with a previous clam ileocystoplasty was referred to the urology department for the investigation of haematuria. CT urogram showed a large left-sided soft tissue mass arising from the bladder. Histological analysis of the shavings from transurethral resection revealed a G3pT2 transitional cell carcinoma and T4N1Mx adenocarcinoma. The patient was referred to oncology for the discussion of palliative chemotherapy; however, in the interim she deteriorated and was admitted to hospital with a post-renal acute kidney injury. A right-sided nephrostomy was inserted relieving her obstruction and she subsequently made a good recovery. This case report illustrates the difficulties in the long-term follow-up of patients having undergone what is now a rarely performed procedure. In the absence of regular cystoscopic follow-up post ileocystoplasty, malignancy may present late and with complications from advanced disease.
Background: Nephrogenic adenoma is an uncommon, benign, tumour-like lesion within the urothelial ... more Background: Nephrogenic adenoma is an uncommon, benign, tumour-like lesion within the urothelial mucosa of the urinary tract caused by reimplantation and proliferation of the renal tubular cells that have been shed by chronic irritation of the mucosa of the urinary tract. Case Study: We report a case of the rare fibromyxoid variant of nephrogenic adenoma in the prostate urethra. To the best of our knowledge, only a few cases have been described in the literature. Conclusion: This tumour can have variable morphological patterns with occasional worrisome features that can mimic carcinoma of the lower urinary tract.
Clear or involved resection margins have significant bearings on the outcome of colorectal cancer... more Clear or involved resection margins have significant bearings on the outcome of colorectal cancer cases. There are two aspects of resection margins: longitudinal and circumferential. Pathological staging for rectal and colonic tumour specimens is a useful tool for providing continuous feedback to surgeons and may serve to improve the quality of surgery and pathology reporting. It is expected that a good pathology report will evaluate and audit the quality of other services such as radiology, surgery, and oncology. The aim of this paper is to outline how this parameter can be audited by surgeons and pathologists to improve both communication and standards.
The word polyp simply means mucosal protrusion and it carries clinical significance only if the p... more The word polyp simply means mucosal protrusion and it carries clinical significance only if the pathologist attaches a histopathological label. The polyp could be inflammatory, hamartomatous, serrated (hyperplastic), or neoplastic (dysplastic). Polyps assume one of two classical appearances: pedunculated polyps, which protrude for >2-fold the thickness of the adjacent mucosa and have a base smaller than one-third of the diameter of the head of the lesion; or sessile polyps, which have a base and top of the lesion that are approximately the same width. The term subpedunculated polyps is used by some specialists; these polyps are intermediate broad-based lesions that are dealt with in the same way as sessile lesions.1,2 Malignant colorectal polyps (MCRP) are common enough to warrant special attention and, with the introduction of bowel cancer screening programmes worldwide, large numbers of these polyps are being detected. Results have indicated that up to 50% of screen-detected ca...
Despite that, other studies reported that around one-fifth of the cases will have no response to ... more Despite that, other studies reported that around one-fifth of the cases will have no response to RT. Other workers reported that the contribution of neoadjuvant RT to pathological complete response in terms of survival was of limited or minimal benefit [8]. In view of the above changes, the real challenge in rectal cancer treatment is to identify patients who would fully benefit from the new treatment protocols which involve RT. The aim of this article is to present the different histological systems used to classify the response rate of the patients and to discuss the different types of biomarkers used to predict of the response of patients to RT/ chemoradiotherapy (CRT). RT Mechanism of Action Oxidative stress damage is extensive in cells exposed to ionising radiation. This damage mainly targets nuclear DNA through inhib-The management of rectal cancer is a major undertaking. There are currently multiple treatment modalities with variable degrees of complications. Radiotherapy (RT) is one of the more frequently used modalities either on its own or more frequently with chemotherapy mostly before the definitive surgery. The outcome of RT is unpredictable. RT has its serious side effects and there are no guarantees of its usefulness in all patients. This article outlines the effect of RT on the tumor, reviews the various staging systems of responses to RT and present recent evidence of which case is less responsive to such treatments to avoid unnecessary complications.
The significance of nodal metastasis as a prognostic factor in colorectal cancer is universally r... more The significance of nodal metastasis as a prognostic factor in colorectal cancer is universally recognised and accepted. This article discusses the various factors that govern lymph node harvest and how to improve that. We will discuss the outcome of lymph node harvest as a possible form of auditing the surgical technique and the pathologist dedication.
Phyllodes tumour occurring in the vulva is rare with only a few cases reported in the literature.... more Phyllodes tumour occurring in the vulva is rare with only a few cases reported in the literature. We report a case of a 33-year-old lady who presented with a small vulval swelling in which subsequent excision of the lesion showed a benign phyllodes tumour. She was followed-up by re-excision which did not reveal any residual lesion and she is well without recurrence 6 months after surgery.
Russell bodies are not uncommon in reactive plasma cells with distinctive intra-cytoplasmic eosin... more Russell bodies are not uncommon in reactive plasma cells with distinctive intra-cytoplasmic eosinophilic inclusions. However, Russell body cervicitis is uncommon with only one previously reported case in the English literature. We report a case of Russell body cervicitis in a 29-year-old female who presented with post-coital bleeding and the subsequent examination showed a benign cervical polyp that was excised. One-year follow-up was uneventful.
We read with interest the article on SPECC and SPECULATION by Moran and Dattani [1] and would lik... more We read with interest the article on SPECC and SPECULATION by Moran and Dattani [1] and would like to congratulate them and the Pelican faculty on their foresight in organising such an important training programme. There are a few points that need focussing on to solidify their effort and we hope they will meet with their philosophy. The first is the point of definitions for the sake of unification. We would like to expand this area beyond anatomy to involve histopathological reporting. This article is protected by copyright. All rights reserved.
Reconstructive Surgery of the Rectum, Anus and Perineum, 2012
This chapter discusses the risks of cancer transformation in inflammatory bowel disease and provi... more This chapter discusses the risks of cancer transformation in inflammatory bowel disease and provides guidelines concerning controversial issues surrounding screening and the management of dysplasia and dysplasia-associated lesions or masses. These screened and colitis-associated lesions are contrasted with sporadic cancers along with their differing molecular biology.
Inflammatory Bowel Disease and Familial Adenomatous Polyposis
Definition of dysplasia is standard. Classifications are clear. Genetic studies are variable and ... more Definition of dysplasia is standard. Classifications are clear. Genetic studies are variable and may be useful in differentiating between lesions and helpful in choosing treatment modalities. Treatment varies according to condition of lesion. Not all CRC in IBD follow the logic of the lowgrade dysplasia, high-grade dysplasia then carcinoma sequence. Modified chromoendoscopy is more sensitive than routine endoscopy in identifying dysplastic epithelium.
The use of flexible sigmoidoscopy has also been investigated as a screening tool (Atkin et al., 1... more The use of flexible sigmoidoscopy has also been investigated as a screening tool (Atkin et al., 1993; UK-Flexible-Sigmoidoscopy-Screening-Trial-Investigators, 2002) which showed that a once-only flexible sigmoidoscopy between the ages of 55 and 64 could reduce CRC incidence by 33% and mortality from CRC by 43% (Atkin et al., 2010). The test was also found to be safe and acceptable (Atkin et al., 1993). Several randomised trials and Cochrane reviews have provided high-quality evidence that this test, if offered every 2 years, has the potential to reduce mortality rates associated with CRC by 16% (Towler et al., 1998) and reduces incidence and mortality rates of distal CRC by 60-80% (Newcomb et al., 2003; Selby et al., 1992). In general, the NHS Bowel Cancer Screening Programme (NHS BCSP) commenced in April 2006 and invites men and women aged 60-69 to participate via submission of faecal occult blood test every 2 years; those with a positive result will be offered colonoscopy (West et al., 2008). As a marker of the success of the programme, at colonoscopy, the proportion of Duke's stage A and B lesions is markedly higher than that diagnosed amongst the symptomatic population (Goodyear et al., 2008; Halloran, 2009).
Background: The early molecular changes preceding the onset of mucosal inflammation in colitis an... more Background: The early molecular changes preceding the onset of mucosal inflammation in colitis and their temporal relationship with gut permeability remain poorly defined. This study investigated functional and transcriptomic changes in mdr1a(Ϫ/Ϫ) mice lacking the intestinal transporter P-glycoprotein, which develop colitis spontaneously when exposed to normal enteric flora. Methods: Mdr1a(Ϫ/Ϫ) mice were housed in specific pathogenfree conditions to slow colitis development and compared to congenic controls. Mucosal permeability and cytokine secretion were analyzed in ex vivo colon. Gene expression in colonic mucosal and epithelial preparations was analyzed by microarray and qPCR. Colonocyte responsiveness to bacterial antigens was measured in short-term culture. Results: Colon from 4-5-week-old, disease-free mdr1a(Ϫ/Ϫ) mice was histologically normal with no evidence of increased permeability compared to controls. However, these tissues display a distinctive pattern of gene expression involving significant changes in a small number of genes. The majority of upregulated genes were associated with bacterial recognition and the ubiquitin-proteasome system and were gamma-interferon (IFN-␥) responsive. Expression of the antiinflammatory factor pancreatitis-associated protein (PAP) and the related gene RegIII␥ were markedly reduced. Colonocytes from 4-5-week mdr1a(Ϫ/Ϫ) exhibit similar transcriptomic changes, accompanied by higher basal chemokine secretion and increased responsiveness to LPS. Significant increases in colonic permeability were associated with older (12-16-week) mdr1a(Ϫ/Ϫ) mice displaying molecular and functional evidence of active inflammation. Conclusions: These studies show that early epithelial changes associated with altered responsiveness to bacteria precede increased permeability and mucosal inflammation in this model of colitis, highlighting the importance of P-glycoprotein in regulating interactions with the commensal microflora.
The risk of lymph node metastasis (LNM) in colorectal cancer (CRC) has been extensively reported ... more The risk of lymph node metastasis (LNM) in colorectal cancer (CRC) has been extensively reported in advanced and early disease. It has been shown to be directly related to the depth of submucosal invasion [1–7], although one study failed to identify this to be a risk factor [8]. The logical and scientific explanation of this association is summarized in a passage taken from the paper by Duff et al. [9] as follows: ‘In normal colonic tissue, lymphatic vessels were prominent in deeper layers of the bowel wall in particular in the submucosa and throughout the muscularis propria clustering between muscle layers. Lymphatic vessels were found rarely in colonic mucosa’. The specific question, the association of the measured depth of submucosal invasion with the risk of nodal metastasis and therefore management planning, is frequently encountered in our current routine work [10–12]. This is mostly due to the increasing endoscopic removal of polyps that are subsequently found to be malignant. It is also a result of the National Bowel Screening Programme, which is identifying more patients with early CRC compared with symptomatic patients. The standard accepted assessment of the depth of invasion in flat or depressed T1 CRC is made using Kudo’s and Kikuchi’s classifications [3,4]. The latter divides the submucosa (Sm) into three equal thirds, Sm1, Sm2 and Sm3. There is general agreement that the greater the depth of invasion of the submucosa the more the risk of LNM (Table 1). This assessment works very well when the specimen removed contains some muscularis propria, but if there is none it is simply not possible to use the system since without any muscularis propria in the specimen there is no means of defining the outer limit of the submucosa. Kimura et al. [13] have recently suggested that submucosal invasion up to 1000 lm represents Sm1 whilst invasion of more than 1000 lm represents Sm2. Other authors have suggested that the term ‘massive submucosal invaded cancer’, which is frequently used, is similar to tumour invasion equal to Sm2 or Sm3, i.e. with a depth of invasion of more than 1000 lm [2,14]. In this issue, the systematic review by Beaton et al. [15] that included 23 cohort studies is timely and throws light on some important difficulties encountered by the pathologist who is charged with giving an accurate and meaningful assessment of invasion. The study included 4510 patients of whom 567 had LNM. Twenty of the 23 studies included all early CRC, two included only pedunculated tumours and one only included sessile tumours. The authors correctly pointed out the difficulties of applying the various staging systems measuring the depth of invasion and their relation to LNM. In the review, submucosal invasion was measured using both the Kikuchi system and the absolute depth in millimetres. One of the findings was that invasion of more than 1 mm (1000 lm) into the submucosa was associated with increased risk of LNM. This is an important piece of information that we need to keep in mind. The second finding was that measuring the absolute depth of submucosal invasion was more appropriate in endoscopically resected tumours rather than classifying them as Sm1 Sm3. This is an opportune time to pause and analyse critically the implications of these observations. It is important to realize that measuring the depth of invasion is influenced by various factors including the quality of the specimen and its technical preparation for histopathological examination. To maximize the efficiency of assessing specimens correctly, it is important to pay special attention to the way in which the initial specimen is prepared and how it is transmitted to the pathology Table 1 Percentages of Kikuchi stages in three different series and the associated risk of lymph node metastasis.
A 58-year-old woman with a previous clam ileocystoplasty was referred to the urology department f... more A 58-year-old woman with a previous clam ileocystoplasty was referred to the urology department for the investigation of haematuria. CT urogram showed a large left-sided soft tissue mass arising from the bladder. Histological analysis of the shavings from transurethral resection revealed a G3pT2 transitional cell carcinoma and T4N1Mx adenocarcinoma. The patient was referred to oncology for the discussion of palliative chemotherapy; however, in the interim she deteriorated and was admitted to hospital with a post-renal acute kidney injury. A right-sided nephrostomy was inserted relieving her obstruction and she subsequently made a good recovery. This case report illustrates the difficulties in the long-term follow-up of patients having undergone what is now a rarely performed procedure. In the absence of regular cystoscopic follow-up post ileocystoplasty, malignancy may present late and with complications from advanced disease.
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