OBJECTIVE To assess the impact of preoperative C‐reactive protein (CRP) levels on the prognosis in patients with upper urinary tract (UUT) urothelial carcinoma (UC) primarily treated surgically, as it is increasingly recognized that a systemic inflammatory response is associated with the prognosis for patients with various malignancies. PATIENTS AND METHODS The clinical records of 130 patients treated surgically for UUT‐UC were reviewed retrospectively. An elevated CRP was defined as >0.5 mg/dL. Actuarial survival curves were calculated by Kaplan–Meier method, with the difference between curves evaluated using the log‐rank test. A multivariate analysis was used to identify prognostic factors, with Cox’s proportional hazard model. RESULTS The median (range) follow‐up was 47 (3–190) months. The preoperative serum CRP level was elevated in 24 patients (23%). There were significant associations between CRP level and haemoglobin concentrations, pathological T stage, tumour grade, lymph node involvement and lymphovascular invasion. The 5‐year disease‐specific and recurrence‐free survival rates of 24 patients with elevated CRP were significantly worse than those of the 106 with no CRP elevation (both P < 0.001). On multivariate analysis, preoperative CRP level, pathological T stage and lymph node involvement were significant prognostic factors for disease‐specific and recurrence‐free survival. CONCLUSION This study indicated that an elevated preoperative CRP level predicts a poor survival in patients with UUT‐UC.

A novel reaction involving allene and water took place using palladium(0)–triphenylphosphine as a catalyst in the presence of carbon dioxide to yield 3-methyl-2-methylene-3-buten-1-ol, selectively. A related reaction of allene with methanol or ethanol was found to occur without carbon dioxide.

OBJECTIVE To investigate the association between the expression of uroplakin III (UPIII) and the prognosis of patients with urothelial carcinoma of the upper urinary tract, as uroplakins are urothelium‐specific markers of terminal urothelial differentiation. PATIENTS AND METHODS Clinicopathological and follow‐up data from 71 patients who had undergone radical nephroureterectomy and lymph node dissection or sampling for urothelial carcinoma of the upper urinary tract were reviewed. The expression of UPIII was evaluated immunohistochemically in surgical specimens. Cancer‐specific survival was calculated using Kaplan–Meier plots. Prognostic values of clinicopathological variables including UPIII expression status, tumour stage and grade were evaluated by univariate analyses, followed by multivariate analysis using the Cox proportional‐hazard model. RESULTS In all specimens there was intense UPIII immunoreactivity of umbrella cells of normal urothelium. In tumour samples, UPIII expression was positive in 75% of ≤ pT1 tumours and 40% of ≥ pT2 (P = 0.02), and in 65% of grade 1–2 tumours and 33% of grade 3 (P = 0.009). Of the 71 patients, 21 died from the disease during the median follow‐up of 61 months. The cancer‐specific survival of patients with negative UPIII expression was significantly worse than that of those with positive UPIII expression (5‐year cancer‐specific survival, 100% vs 46%, P < 0.001). Neither patient age at diagnosis, histological grade, sex, or multiplicity of the tumour had significant prognostic value. Multivariate analysis revealed that UPIII expression was the most powerful prognostic indicator (P < 0.001) followed by tumour stage (P = 0.04) and lymph node metastasis (P = 0.05). CONCLUSION The present data suggest that UPIII expression is a powerful prognostic factor in patients with upper urinary tract urothelial carcinoma.

A case of invasive bladder cancer accompanied with enlarged pelvic lymph nodes, which were interpreted as metastasis, is reported. The lymphadenopathy eventually regressed spontaneously while the bladder cancer increased in size. Total cystectomy and pelvic lymph node dissection were performed. Histopathological examination of the lymph nodes revealed dilation of the sinuses and marked increase in the number of histiocytes, which suggested sinus histiocytosis. Sinus histiocytosis is often associated with malignant tumor. It is considered as a sign of the host's immune activation with favorable prognostic significance. Nevertheless, such lymphadenopathy mimics a metastatic lymph node, making proper staging difficult.

We report a case of spontaneous bladder rupture due to bladder carcinoma. A 52-year-old female presented in septic shock, and computed tomography revealed free air in the subphrenic space and a mass in the middle of the pelvis. The exploratory laparotomy helped to confirm a definitive diagnosis: bladder rupture due to bladder carcinoma. She underwent a radical cystectomy and survived. Surgical intervention is recommended to manage carcinomatous bladder rupture. Timely and accurate diagnosis is essential to optimize the patient's outcomes. The possibility of spontaneous bladder rupture should not be overlooked as a differential diagnosis in cases of the acute abdomen.

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