A case of squamous cell carcinoma arising from a suprapubic cystostomy tract in a patient with spinal bifida: Immunohistochemical analysis and literature review

Abstract

Introduction: Squamous cell carcinoma arising from a suprapubic cystostomy tract is a rare complication of an indwelling catheter and is caused by long-term inflammation and mechanical irritation. Prognosis is relatively poor. Biomarkers in the cancer pathway have not been investigated.

Case presentation: A 61-year-old woman with a 34-year history of suprapubic catheter placement presented with a rapidly growing elevated lesion around the cystostomy site. Tumor biopsy confirmed squamous cell carcinoma. Local excision with partial cystectomy was performed. Multiple metastases were identified 5 months later. The patient died 14 months after the initial treatment. Immunohistochemical analysis of the resected specimen revealed alterations in vascular endothelial growth factor, epidermal growth factor receptor, cyclooxygenase-2, and Ki-67.

Conclusion: We encountered a case of squamous cell carcinoma arising from a suprapubic cystostomy tract. Immunohistochemical analysis revealed activation of multiple carcinogenic pathways in cancer cells, including those for angiogenesis, signal transduction by epidermal growth factor receptor, inflammation, and cell proliferation.

Keywords: biomarker; immunohistochemical analysis; spina bifida; squamous cell carcinoma; suprapubic cystostomy tract.

Fig. 1

SCC arising from a SCT. (a) Clinical photograph showing an elevated lesion around the suprapubic cystostomy. (b) Tumor biopsy demonstrated a well‐differentiated SCC. (c, d). Magnetic resonance images showing that the tumor involved the bladder wall along the site of the catheter.

Fig. 2

(a) Clinical photograph of the en bloc‐resected specimen, including the skin lesion, muscle, suprapubic catheter, and urinary bladder. (b) Micrograph demonstrating well‐differentiated SCC composed of well‐defined intercellular bridges with keratinization in individual cells and keratin pearls.

Fig. 3

Results of IHC. The expression level of each biomarker was evaluated according to the staining intensity and proportion of positive cells in the total cell population. The antibodies used for the analyses were as follows: rabbit anti‐VEGF polyclonal antibody (dilution 1:50, Zymed, South San Francisco, CA, USA), mouse anti‐EGFR monoclonal antibody (ready to use, 2‐18C9; Dako Corp, Carpinteria, CA, USA), mouse anti‐COX‐2 monoclonal antibody (dilution 1:100, CX‐294, 1:100; Dako Corp), rabbit anti‐Ki‐67 monoclonal antibody (ready to use, SP6; Nichirei, Tokyo, Japan), mouse anti‐p53 monoclonal antibody (dilution 1:50, DO‐7; Dako Corp), mouse anti‐p21 monoclonal antibody (dilution 1:50, SX118; Dako Corp), mouse anti‐cyclin E monoclonal antibody (ready to use, ME12; Diagnostic BioSystems, Pleasanton, CA, USA), and mouse anti‐Bcl‐2 monoclonal antibody (dilution 1:100, clone 124; Dako Corp).