Alteration of colonic mucin after ureterosigmoidostomy

PURPOSE: Patients undergoing urinary diversion by ureterosigmoidostomy afte r complete cystectomy for malignant bladder tumors show a high incidence of neoplasia at and near the site of anastomosis. We examined a risk factor f or tumor occurrence in the area of anastomosis, alterations of mucus glycop roteins in the surrounding colonic mucosa. METHODS: Colonoscopy was perform ed in 37 patients who had undergone ureterosigmoidostomy. Biopsy specimens were obtained near the ureteral anastomosis and were stained with hematoxyl in and eosin, high iron-diamine alcian blue (pH 2.5), and a fluorescent lec tin conjugate (peanut agglutinin). RESULTS: At the anastomotic site colonos copy showed protruding lesions in 26 of 37 patients (71 percent), all histo logically representing inflammatory granulomas. The mucosa around the anast omosis was normal in endoscopic appearance; however, histologically, slight inflammatory cell infiltration, edema, and increased numbers of Paneth cel ls were observed. Alcian blue staining revealed an increase in mucosal sial omucin postoperatively compared with preoperatively. The proportion of pean ut agglutinin-binding mucin, not observed in normal mucosa but seen in mali gnant or premalignant tissue, was increased. CONCLUSION: As postoperative i nterval increases, changes in properties of the "background" mucosa become greater, which suggests an association with colonic carcinogenesis.