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Age
2%
4/188
Alchohol consuption
3/188
Immunosuppressant use
8%
15/188
Occupation
66%
125/188
Recurrent cystitis
18%
33/188
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This patient’s occupation of working in a textile factory likely exposed him to aniline dyes, which is one of the well documented environmental carcinogens associated with transitional cell carcinoma (seen in Figure A). Transitional cell carcinoma is the most common tumor of the urinary tract system and can occur at the bladder, renal calyces, renal pelvis, and ureters. Patients often present with painless hematuria but can also have obstructive symptoms depending on the location of the tumor. Malignancy of the transitional cell arises from environmental carcinogens. The most important cause is cigarette smoking. Chemical exposures, such as aniline dyes from paint/pigment, polycyclic aromatic hydrocarbons, or diesel exhausts, are very well documented risk factors for the disease. Cystoscopy with biopsy is the gold standard for the initial diagnosis of bladder cancer. Management includes surgical resection and/or chemotherapy depending on the staging of disease. It is worth noting that transitional cell carcinoma has a high rate of recurrence. Figure/Illustration A is a pathological study of transitional or urothelial cells demonstrating disordered architecture and cytologic pleomorphism (arrows) characteristic of malignancy. Incorrect Answers: Answer 1: Age is a risk factor associated with transitional cell carcinoma as the disease is more commonly seen in patients between 60-70 years old. However, compared to this patient's occupational exposure, age is a less significant risk factor. Answer 2: Alcohol consumption is not a known risk factor for transitional cell cancer. However, it is a known risk factor associated with renal cell carcinoma. Answer 3: Immunosuppressant use, specifically cyclophosphamide, is a known risk factor for transitional cell cancer. However, this patient is on methotrexate, which is not a medication that is associated with this disease. Answer 5: Recurrent cystitis is associated with transitional cell carcinoma as ongoing bladder inflammation is a known risk factor. However, when compared to exposure to aniline dyes, recurrent cystitis plays a less significant role in the pathogenesis of the disease. Bullet Summary: Transitional cell carcinoma is associated with cigarette smoking, aniline dyes, cyclophosphamide, polycyclic aromatic hydrocarbons, or diesel exhaust exposures.
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