Two cases of bladder carcinoma with similar initial features that exhibited completely different clinical courses

Two cases of bladder carcinoma are described. The patients were of similar age, were both smokers and were treated for the same period, but exhibited completely different later clinical courses. Initially, both had a single, papillary, pedunculate tumor, identified as a transitional cell carcinoma, grade 2, pTa. One patient, six years later, had multiple papillary tumors covering almost all the mucosal surface and underwent simple cystectomy. Histologically the tumors were identified as transitional cell carcinomas, grade 2, pT1. The other patient, nine years later, had a single nodular invasive tumor with a concomitant, very tiny papillary tumor and underwent radical cystectomy. Histologically the tumor was transitional cell carcinoma, grade 2 greater than 3, pT4. Many of the questions raised by these cases are unanswered, but comparison of such cases should provide some clues to the natural history of bladder carcinoma.