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We studied 15 patients with histologically proved multifocal carcinoma in situ of the bladder who were in remission at a mean followup of 21 months after induction intravesical chemotherapy with mitomycin C. These patients have been followed for a further 28 months, for a total mean duration of 49 months. Of the 15 patients 4 suffered new areas of carcinoma in situ, including 3 who subsequently required cystectomy (2 after unsuccessful intravesical bacillus Calmette-Guerin therapy and 1 with a simultaneous invasive tumor). One patient underwent transurethral resection of the prostate for carcinoma in situ of the prostatic urethra, which subsequently was shown to be limited to mucosa and not involving the deeper ducts nor the stroma. Of the remaining 11 patients 1 died of unrelated disease and 2 suffered recurrent papillary transitional cell carcinoma treated successfully with a combination of intravesical bacillus Calmette-Guerin therapy and resection. The other 8 patients have remained free of tumor. None of the 15 patients had metastatic cancer. We believe that these results support the durability of response after induction mitomycin C therapy. We stress the necessity for prolonged close followup to detect recurrent tumor and to avoid metastatic disease.

We report a case of an isolated cardiac metastasis from squamous cell carcinoma of the bladder. The incidence and difficulty in the diagnosis of myocardial deposits from bladder tumors are discussed.

We report a case of xanthogranulomatous pyelonephritis in a renal allograft. The kidney was not removed and there was an initial response to antibiotic therapy, with amelioration of toxicity and improvement in renal function. However, the kidney failed 10 months later in association with histological changes of chronic rejection.

We studied 19 consecutive patients with biopsy proved carcinoma in situ of the bladder who had received 8 weekly doses of 30 mg. intravesical mitomycin C. Followup with cystoendoscopy, biopsy and cytology studies every 3 months ranged from 6 to 48 months, with an average of 21 months. A complete initial response was achieved in 15 patients, 11 of whom have remained free of tumor with no further therapy. The 4 patients who failed to respond to initial therapy subsequently were free of tumor after further intravesical mitomycin C (2), excision (1) or doxorubicin (1). Three patients died of unrelated diseases. Only 1 patient has had metastatic transitional cell carcinoma. No patient had undergone cystectomy or radiotherapy. These data indicate that mitomycin C achieves a high initial response in patients with carcinoma in situ of the bladder and maintains this control in many patients for months or years.