Problems in early diagnosis of bladder cancer in a spinal cord injury patient: Report of a case of simultaneous production of granulocyte colony stimulating factor and parathyroid hormone-related protein by squamous cell carcinomaReportar como inadecuado




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BMC Urology

, 2:8

First Online: 30 August 2002Received: 25 March 2002Accepted: 30 August 2002

Abstract

BackgroundTypical symptoms and signs of a clinical condition may be absent in spinal cord injury SCI patients.

Case presentationA male with paraplegia was passing urine through penile sheath for 35 years, when he developed urinary infections. There was no history of haematuria. Intravenous urography showed bilateral hydronephrosis. The significance of abnormal outline of bladder was not appreciated. As there was large residual urine, he was advised intermittent catheterisation. Serum urea: 3.5 mmol-L; creatinine: 77 umol-L. A year later, serum urea: 36.8 mmol-l; creatinine: 632 umol-l; white cell count: 22.2; neutrophils: 18.88. Ultrasound: bilateral hydronephrosis. Bilateral nephrostomy was performed. Subsequently, blood tests showed: Urea: 14.2 mmol-l; Creatinine: 251 umol-l; Adjusted Calcium: 3.28 mmol-l; Parathyroid hormone: < 0.7 pmol-l 1.1 – 6.9; Parathyroid hormone-related protein PTHrP: 2.3 pmol-l 0.7 – 1.8. Ultrasound scan of urinary bladder showed mixed echogenicity, which was diagnosed as debris. CT of pelvis was interpreted as vesical abscess. Urine cytology: Transitional cells showing mild atypia. Bladder biopsy: Inflamed mucosa lined by normal urothelial cells.

A repeat ultrasound scan demonstrated a tumour arising from right lateral wall; biopsy revealed squamous cell carcinoma. In view of persistently high white cell count and high calcium level, immunohistochemistry for G-CSF and PTHrP was performed. Dense staining of tumour cells for G-CSF and faintly positive staining for C-terminal PTHrP were observed. This patient expired about five months later.

ConclusionThis case demonstrates how delay in diagnosis of bladder cancer could occur in a SCI patient due to absence of characteristic symptoms and signs.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2490-2-8 contains supplementary material, which is available to authorized users.

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Autor: Subramanian Vaidyanathan - Paul Mansour - Munehisa Ueno - Kazuto Yamazaki - Meenu Wadhwa - Bakul M Soni - Gurpreet Singh -

Fuente: https://link.springer.com/







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