We present an overview of the updated 2023 European Association of Urology (EAU) guidelines for muscle-invasive and metastatic bladder cancer (MMIBC). To provide practical evidence-based recommendations and consensus statements on the clinical management of MMIBC with a focus on diagnosis and treatment. A broad and comprehensive scoping exercise covering all areas of the MMIBC guidelines has been performed annually since 2017. Searches cover the Medline, EMBASE, and Cochrane Libraries databases for yearly guideline updates. A level of evidence and strength of recommendation are assigned. The evidence cutoff date for the 2023 MIBC guidelines was May 4, 2022. Patients should be counselled regarding risk factors for bladder cancer. Pathologists should describe tumour and lymph nodes in detail, including the presence of histological subtypes. The importance of the presence or absence of urothelial carcinoma (UC) in the prostatic urethra is emphasised. Magnetic resonance imaging (MRI) of the bladder is superior to computed tomography (CT) for disease staging, specifically in differentiating T1 from T2 disease, and may lead to a change in treatment approach in patients at high risk of an invasive tumour. Imaging of the upper urinary tract, lymph nodes, and distant metastasis is performed with CT or MRI; the additional value of flurodeoxyglucose positron emission tomography/CT still needs to be determined. Frail and comorbid patients should be evaluated by a multidisciplinary team. Postoperative histology remains the most important prognostic variable, while circulating tumour DNA appears to be an interesting predictive marker. Neoadjuvant systemic therapy remains cisplatin-based. In motivated and selected women and men, sexual organ–preserving cystectomy results in better functional outcomes without compromising oncological outcomes. Robotic and open cystectomy have comparable outcomes and should be combined with (extended) lymph node dissection. The diversion type is an individual choice after taking patient and tumour characteristics into account. Radical cystectomy remains a highly complex procedure with considerable morbidity and risk of mortality, although lower rates are observed for higher hospital volumes (>20 cases/yr). With proper patient selection, trimodal therapy (chemoradiation) has comparable outcomes to radical cystectomy. Adjuvant chemotherapy after surgery improves disease-specific survival and overall survival (OS) in patients with high-risk disease who did not receive neoadjuvant treatment, and is strongly recommended. There is a weak recommendation for adjuvant nivolumab, as OS data are not yet available. Health-related quality of life should be assessed using validated questionnaires at baseline and after treatment. Surveillance is needed to monitor for recurrent cancer and functional outcomes. Recurrences detected on follow-up seem to have better prognosis than symptomatic recurrences. This summary of the 2023 EAU guidelines provides updated information on the diagnosis and treatment of MMIBC for incorporation into clinical practice. The European Association of Urology guidelines panel on muscle-invasive and metastatic bladder cancer has released an updated version of the guideline containing information on diagnosis and treatment of this disease. Recommendations are based on studies published up to May 4, 2022. Surgical removal of the bladder and bladder preservation are discussed, as well as updates on the use of chemotherapy and immunotherapy in localised and metastatic disease. 

European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines.

This publication represents a summary of the updated 2024 European Association of Urology (EAU) guidelines for non-muscle-invasive bladder cancer (NMIBC), TaT1, and carcinoma in situ. The information presented herein is limited to urothelial carcinoma, unless specified otherwise. The aim is to provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation. 

European Association of Urology Guidelines on Non–muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ)—A Summary of the 2024 Guidelines Update

Introduction Orbital rhabdomyosarcoma is the most common orbital malignancy of childhood, with approximately 4 or 5 new cases per year per million children younger under 20 years of age. The most common symptom is rapidly evolving unilateral proptosis. Case presentation We report a 9-year old female who presented with a 1-month history of a rapidly growing mass in the left eyelid. She was diagnosed of stage I orbital embryonal rhabdomyosarcoma with T1N0M0, and clinical group IIA. She was treated with chemoradiotherapy according to standard protocol. Post-treatment evaluation showed a good response. No evidence of recurrence or metastasis was found upon long-term follow-up. Conclusion Orbit embryonal rhabdomyosarcoma is well responded to chemoradiotherapy. Early diagnosis and appropriate treatment are the most important elements resulting in a favorable prognosis.

Pediatric primary orbital rhabdomyosarcoma

Purpose: The aim of this study was to investigate the distribution of different types of malignant tumors in the orbital cavity, surgical treatments, and subsequent prosthetic rehabilitation. Materials and Methods: A retrospective sample of 269 charts of patients attending a public reference cancer hospital in Goiania, Goias, Brazil, between 1998 and 2009 was selected. Study variables included demographic data, clinical and histopathological features, and patient rehabilitation. Frequency analysis, chi-square test and multiple logistic regression were used for data analysis. Results: Patients' age ranged from 1 to 92 years and 50.2% were female. The most prevalent tumors were basal cell carci- noma (58%), retinoblastoma (17.1%), squamous cell carcinoma of the conjunctiva (7.1%), malignant melanoma (6.7%), and rhabdomyosarcoma (4.5%). Surgical treatment was performed in 250 patients (92.3%), but only 29 patients (10.8%) received ocular prosthetic rehabilitation. Lower age (p<0.001) and enucleation surgery (p<0.001) were significantly asso- ciated with prosthetic rehabilitation. Conclusions: Results revealed high occurrence of mutilating interventions and low provision of prosthetic care, limited to younger patients who had undergone enucleation surgery. The high unmet demand for rehabilitation emphasizes the need to incorporate appropriate care for ocular and orbital deformities into the Brazilian public health system.

/pdf/a-12-year-retrospective-survey-of-management-of-patients-a8h61x0yhl.pdf

A 12-Year Retrospective Survey of Management of Patients with Malignant Neoplasms in the Orbital Cavity in a Brazilian Cancer Hospital

Abstract Sarcomatoid Urothelial Bladder Cancer (SARC) is a rare and aggressive histological subtype of bladder cancer for which therapeutic options are limited and experimental models are lacking. Here, we report the establishment of a long-term 3D organoid-like model derived from a SARC patient ( SarBC-01 ). SarBC-01 emulates aggressive morphological, phenotypical, and transcriptional features of SARC and harbors somatic mutations in genes frequently altered in sarcomatoid tumors such as TP53 (p53) and RB1 (pRB). High-throughput drug screening, using a library comprising 1567 compounds in SarBC-01 and conventional urothelial carcinoma (UroCa) organoids, identified drug candidates active against SARC cells exclusively, or UroCa cells exclusively, or both. Among those, standard-of-care chemotherapeutic drugs inhibited both SARC and UroCa cells, while a subset of targeted drugs was specifically effective in SARC cells, including agents targeting the Glucocorticoid Receptor (GR) pathway. In two independent patient cohorts and in organoid models, GR and its encoding gene NR3C1 were found to be significantly more expressed in SARC as compared to UroCa, suggesting that high GR expression is a hallmark of SARC tumors. Further, glucocorticoid treatment impaired the mesenchymal morphology, abrogated the invasive ability of SARC cells, and led to transcriptomic changes associated with reversion of epithelial-to-mesenchymal transition, at single-cell level. Altogether, our study highlights the power of organoids for precision oncology and for providing key insights into factors driving rare tumor entities. 

pdf/patient-derived-organoids-identify-tailored-therapeutic-56kj54o6bx.pdf

Patient-derived organoids identify tailored therapeutic options and determinants of plasticity in sarcomatoid urothelial bladder cancer

Orbital rhabdomyosarcoma is the most common orbital malignancy of childhood with the common presentation of rapidly evolving unilateral proptosis. We studied six patients who were diagnosed and treated for rhabdomyosarcoma between January 1999 and June 2004. The age of the patients ranged from 4 to 29 years. Four patients presented with acute onset proptosis associated with signs of inflammation, mimicking orbital cellulitis. One patient presented with lid mass. Another patient presented with a soft, blind eye that was pushed superotemporally by a large inflammed, vascularised mass. Embryonal rhabdomyosarcoma was the commonest histopathological type in our series found in five patients. One patient was completely cured with chemotherapy alone whereas two patients were treated with a combination of chemotherapy and radiotherapy. Three patients in our series required exenteration.

/pdf/orbital-rhabdomyosarcoma-a-case-series-53770176oo.pdf

Orbital rhabdomyosarcoma: a case series.

The fifth edition of the WHO Blue Book on urological tumours, specifically in the bladder chapter, represents a refinement and update in the classification of bladder tumours building on the aggregate major changes made in previous editions. Progress in the molecular underpinnings of urothelial tumours, particularly with promising stratifiers for more precision‐based treatment approaches, have been made. Special attention has been paid to burning questions in bladder pathology, such as grading, heterogeneous lesions, inverted tumours and substaging. The concept of neuroendocrine tumours will be explained precisely.

What's new in WHO fifth edition – urinary tract

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Orbital rhabdomyosarcoma: a case series.

What's new in WHO fifth edition – urinary tract