Surgical management of bladder urothelial carcinoma with squamous differentiation

Urothelial carcinoma (UC) with squamous differentiation (UC w/SD) is the most common variant bladder cancer histology.

Accurate identification at the time of transurethral resection is critical although current barriers exist, which include tumor heterogeneity, sampling limitation during resection, and pathologic interpretation of specimens. Although many cases of UC w/SD present with muscle-invasive bladder cancer, those cancers that are confirmed to be truly non-muscle invasive can be managed with endoscopic resection, adjuvant intravesical therapies (i.e., Bacillus Calmitte Guerin), and close surveillance. Radical cystectomy series suggest that UC w/SD tends to present at a more advanced stage than pure UC does although survival outcomes are similar when controlling for standard clinicopathologic factors.

Future basic science and clinical studies are requisite to better investigate the biology of urothelial carcinoma with squamous differentiation and response to multimodal therapies.