What Do The Following Test Reports Indicate?
Question: I would like to get Oncologist's opinion on the condition:
I have a question about my Mom's health condition.
She is a 77 year old woman.
She had a uterine cancer 22 years back.
Was treated with partial hysterectomy and followed by radiation therapy.
Recently she has been having occasional symptoms of gross hematuria for past 3 months.
Below is the list of gross hematuria episodes and diagnostic tests done to find the cause of the bleeding.
***Gross Hematuria History***
-----------------------------
July 1st week - Noticed blood in the urine 2-3 times.
8/24/16 to 8/27/2016 - Noticed blood in the urine 3 times
***9/15/2016 - Profuse bleeding in night time. 10-12 bathroom visits. Most time no urine but only bleeding***
9/21-9/22 - Blood in the Urine.
***Diagnostic Test Results***
-----------------------------
1) CT Abdomen/Pelvis- IVP (Test done on 08/03/2016)
Results:
Asymmetric Irregular bladder wall thickening involving the anterior bladder wall with findings worrisome for transmural extension.
Findings suspicious for primary bladder malignancy - Transitional cell carcinoma. (TCC)
2) Cysto w/ bladder Bx and Fulguration of radiation Cystitis Test done on 08/15/2016)
Results:
Anterior bladder wall biopsy:
Mild urothelial atypia consistent with radiation cystitis.
3) ProFISH (Test done on 08/23/2016)
Dx: POSITIVE Profile With 5p15 Amplication.
The ProFISH bladder cancer FISH study detected abnormal copy numbers involving chromosomes 3, 7, 10 and/or 5p15.
A positive result requires a minimum of 5 cells which demonstrate a gain of 2 or more of chromosomes 3, 7 and 10.
Additional copies of 5p15 were observed in this sample. Additional copies of the 5p15 locus may be indicative of a more aggressive, muscle invasive carcinoma with the possible formation of a 5p isochromosome. Twenty-five cells were scored in this sample.
4) Urine Cytology (Test done on 08/23/2016)
Dx: NEGATIVE For Malignancy
Results:
Reactive urothelial cells, squamous cells, acute inflammatory cells and red blood cells.
5) Urine Cytology (Test done on 09/28/2016)
Dx:
POSITIVE for malignant cells Urothelial carcinoma, high grade
Background of benign squamous cells, acute inflammation and erythrocytes
We have following questions and concerns:
-----------------------------------------
1) She had negative biopsy result and negative first urine cyto.
But she had positive CT scan, positive FISH test and positive second urine cyto.
These results are very confusing. What should we do next to get the definitive diagnosis?
2) What are the chances she may have cancer?
3) Do radiation cystitis (RC) cause positive FISH and Urine Cytology results?
4) Is there a possibility that the bladder biopsy could have missed the cancer? If so, what do we need to do next to confirm Dx?
5) Are there any chances that the cause of bleeding is not bladder but somewhere else?
6) What further tests you will recommend in this situation?
Thanks you very much for your help!
Appreciate your time.
Best Regards
I have a question about my Mom's health condition.
She is a 77 year old woman.
She had a uterine cancer 22 years back.
Was treated with partial hysterectomy and followed by radiation therapy.
Recently she has been having occasional symptoms of gross hematuria for past 3 months.
Below is the list of gross hematuria episodes and diagnostic tests done to find the cause of the bleeding.
***Gross Hematuria History***
-----------------------------
July 1st week - Noticed blood in the urine 2-3 times.
8/24/16 to 8/27/2016 - Noticed blood in the urine 3 times
***9/15/2016 - Profuse bleeding in night time. 10-12 bathroom visits. Most time no urine but only bleeding***
9/21-9/22 - Blood in the Urine.
***Diagnostic Test Results***
-----------------------------
1) CT Abdomen/Pelvis- IVP (Test done on 08/03/2016)
Results:
Asymmetric Irregular bladder wall thickening involving the anterior bladder wall with findings worrisome for transmural extension.
Findings suspicious for primary bladder malignancy - Transitional cell carcinoma. (TCC)
2) Cysto w/ bladder Bx and Fulguration of radiation Cystitis Test done on 08/15/2016)
Results:
Anterior bladder wall biopsy:
Mild urothelial atypia consistent with radiation cystitis.
3) ProFISH (Test done on 08/23/2016)
Dx: POSITIVE Profile With 5p15 Amplication.
The ProFISH bladder cancer FISH study detected abnormal copy numbers involving chromosomes 3, 7, 10 and/or 5p15.
A positive result requires a minimum of 5 cells which demonstrate a gain of 2 or more of chromosomes 3, 7 and 10.
Additional copies of 5p15 were observed in this sample. Additional copies of the 5p15 locus may be indicative of a more aggressive, muscle invasive carcinoma with the possible formation of a 5p isochromosome. Twenty-five cells were scored in this sample.
4) Urine Cytology (Test done on 08/23/2016)
Dx: NEGATIVE For Malignancy
Results:
Reactive urothelial cells, squamous cells, acute inflammatory cells and red blood cells.
5) Urine Cytology (Test done on 09/28/2016)
Dx:
POSITIVE for malignant cells Urothelial carcinoma, high grade
Background of benign squamous cells, acute inflammation and erythrocytes
We have following questions and concerns:
-----------------------------------------
1) She had negative biopsy result and negative first urine cyto.
But she had positive CT scan, positive FISH test and positive second urine cyto.
These results are very confusing. What should we do next to get the definitive diagnosis?
2) What are the chances she may have cancer?
3) Do radiation cystitis (RC) cause positive FISH and Urine Cytology results?
4) Is there a possibility that the bladder biopsy could have missed the cancer? If so, what do we need to do next to confirm Dx?
5) Are there any chances that the cause of bleeding is not bladder but somewhere else?
6) What further tests you will recommend in this situation?
Thanks you very much for your help!
Appreciate your time.
Best Regards
Brief Answer:
hello dear. she requires further evaluation.
Detailed Answer:
Hello dear. I have gone through the details. I undrrstand your concern. It is quite possible that the biopsy missed the tumor and only some atypia was picked up as the tumor sometimes is very heterogeneous. Moreover, as the 2nd urine cytology is positive there is high suspicion for malignancy. Radiation cystits can cause bleeding but can also lead to cancer.
Gross blood in urine is verymuch suggestive of bladder tumor and it is the first diagnosis.
A second trans urethral resection of tumor and biopsy is warranted to check for tumor and muscle invasion and then the treatment can be planned.
Thanks and regards.
hello dear. she requires further evaluation.
Detailed Answer:
Hello dear. I have gone through the details. I undrrstand your concern. It is quite possible that the biopsy missed the tumor and only some atypia was picked up as the tumor sometimes is very heterogeneous. Moreover, as the 2nd urine cytology is positive there is high suspicion for malignancy. Radiation cystits can cause bleeding but can also lead to cancer.
Gross blood in urine is verymuch suggestive of bladder tumor and it is the first diagnosis.
A second trans urethral resection of tumor and biopsy is warranted to check for tumor and muscle invasion and then the treatment can be planned.
Thanks and regards.
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Above answer was peer-reviewed by :
Dr. Nagamani Ng