Clinical Significance of Squamous Differentiation in Bladder Transitional Cell Carcinoma

Cho, Kang Su; Yang, Won Jae; Cho, Nam Hoon; Shim, Hyo Sup; Hong, Sung Joon; Choi, Young Deuk

Abstract

PURPOSE: We evaluated the clinicopathological characteristics and clinical significance of squamous differentiation in bladder transitional cell carcinoma (TCCa).
MATERIALS AND METHODS
Between 1993 and 2002, the medical records of 38 patients, who revealed squamous differentiation in bladder TCCa, were retrospectively analyzed with regard to their clinicopathological characteristics. The mean age and follow-up were 64.8 years (52-83) and 31.2 months (6-86), respectively.
RESULTS
On cystoscopic examination, 68.4% (26 patients) were larger than 3cm in size, 63.2% (24 patients) non-papillary or mixed pattern and 68.4% (26 patients) multiple tumors comprised of more than 3. Histologically, the bladder TCCa, with squamous differentiation, were grade III in 89.5% (34 patients), and showed muscle proper invasion in 60.5% (23 patients). In a superficial bladder TCCa with squamous differentiation, the cancer tended to be multiple, more than 3 (80.0%), despite a size smaller than 3cm (66.7%). Of 15 patients with superficial cancer, recurrences were observed in 10 during follow-up, and in 7 (70.0%) revealing muscle proper invasion. The five-year recurrence and progression free survival were 23.9 and 36.9%, respectively. In invasive bladder TCCa with squamous differentiation, the cancer tended to have tumors larger than 3cm (91.3%). The five-year survival rate was 28.5% for invasive bladder cancer.
CONCLUSIONS
Squamous differentiation in bladder TCCa was associated with high grade and invasive bladder cancer. Superficial bladder TCCa with squamous differentiation tended to be multiple, and showed high recurrence and progression rates. Invasive bladder TCCa with squamous differentiation tended to be large and show a poor prognosis.