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Review
. 2009 Aug 31:9:10.
doi: 10.1186/1471-2490-9-10.

HIV-associated bladder cancer: a case series evaluating difficulties in diagnosis and management

Elizabeth M Gaughan  1 , Bruce J Dezube, Mark Bower, David M Aboulafia, Gerry Bohac, Timothy P Cooley, Liron Pantanowitz
Affiliations
Review

HIV-associated bladder cancer: a case series evaluating difficulties in diagnosis and management

Elizabeth M Gaughan et al. BMC Urol. .

Abstract

Background: Chronic human immunodeficiency virus (HIV) infection is associated with an increased incidence of Non-Acquired Immunodeficiency Syndrome (non-AIDS) defining cancers. To date, only a limited number of cases of bladder cancer have been linked with HIV infection. We sought to describe the clinical characteristics of HIV-associated bladder cancer.

Methods: A retrospective study was performed involving HIV-positive patients with bladder cancer, combining cases from multiple institutions with published case reports. Data regarding patient demographics, HIV status, clinical presentation, pathology, cancer treatment, and outcome were analyzed using descriptive statistics.

Results: Eleven patients were identified with a median age of 55 years (range, 33-67). The median CD4+ count at cancer diagnosis was 280 cells/mm3 (range, 106-572 cells/mm3). Six patients (55%) had a known risk factor for bladder cancer, and nine (82%) presented with hematuria. Ten patients had transitional cell carcinoma, and most had superficial disease at presentation. Treatment included mainly transurethral resection of bladder tumor followed by a combination of local and systemic therapies. One patient received intravesical bacillus Calmette-Guèrin (BCG) without complication. Several patients (55%) were alive following therapy, although many (64%) suffered from local relapse and metastatic disease.

Conclusion: Bladder cancer is part of the growing list of cancers that may be encountered in patients living longer with chronic HIV-infection. Our patients presented at a younger age and with only mild immunosuppression, however, they experienced an expected course for their bladder cancer. Hematuria in an HIV-infected patient warrants a complete evaluation.

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Figures

Figure 1
Figure 1
CT scan of Case 1. large lobulated, enhancing soft tissue mass affecting the left side of the bladder (a).
Figure 2
Figure 2
CT scan of Case 1: bladder cancer mass with associated left hydronephrosis and hydroureter.
Figure 3
Figure 3
invasive high grade transitional cell carcinoma with neuroendocrine features (H&E stain).
Figure 4
Figure 4
invasion of the urinary bladder muscularis propria and local lymphatic vessels (H&E stain).
See this image and copyright information in PMC

References

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