scholarly journals Spectrum of Urothelial lesions in Cystoscopic biopsies: A Histopathological Perspective

2018 ◽  
Vol 7 (1) ◽  
pp. 6-10
Author(s):  
Nirajan Mainali ◽  
Prabesh Chaudhary ◽  
Niraj Nepal ◽  
Jit Shrestha

 Background: Urinary Bladder lesions are one of the most common presenting lesions in the Outpatient department. On the other hand neoplastic conditions of the urinary bladder are the major cause of morbidity and mortality. Bladder carcinoma is the 7th most common carcinoma worldwide and is the major cause of morbidity and mortality.Material & Methods: All the cystoscopic biopsy received in the Department of Pathology at Nobel medical college and teaching hospital from August 1st 2016 to July 31st 2017 was included in the study. Received cystoscopic biopsies were processed and classified as per 2004 WHO/ISUP classification of urothelial tumors Patients were also categorized according to the age and sex to find out the prevalence of urothelial lesions on them.Results: Out of the 78 patients 54 were males and 24 were females. Very few (n=15, 19.23%) cases of non neoplastic lesions were biopsied. Low grade urothelial carcinoma was the most common diagnosis in the patients which accounts for 49.2 % (n=31) of the total neoplastic conditions.Conclusion: Low grade urothelial carcinoma was the most common lesion encountered with the peak age range of 61-70 years.Journal of Nobel Medical College Volume 7, Number 1, Issue 12, January-June 2018, Page: 6-10

2017 ◽  
Vol 7 (1) ◽  
pp. 1062-1065
Author(s):  
R Thapa ◽  
M Lakhey ◽  
AD Bhatta

Background:  Urinary bladder lesions are the main source of significant clinical symptoms which are more disabling than lethal. Bladder tumors constitute one of the most common urological pathology. Urothelial carcinoma accounts for 90% of all primary tumors of the bladder. This study aimed to determine the frequency of different types of lesions of the urinary bladder and to determine the grade and stage of urothelial tumors.Materials and Methods: This is a 2 years cross sectional study of cystoscopic biopsies carried out in the Department of Pathology, Medicare National Hospital and Research Centre, Kathmandu, Nepal.Results:  Out of 87 cases, 58 (66.67%) cases were neoplastic lesions and 29(33.33%) cases were non- neoplastic lesions. Majority of neoplastic lesions 96.55% were urothelial (transitional cell) tumors comprising predominantly of low grade papillary urothelial carcinoma 50.91%. Muscle invasion was seen only in high grade papillary urothelial carcinomas.Conclusion: Among bladder tumors low grade papillary urothelial carcinoma is the most common. 


2020 ◽  
pp. 1-4
Author(s):  
Nishat Ahmad ◽  
Saurabh Banerjee ◽  
A K. Srivastava

BACKGROUND: Urinary bladder cancer is second most common cancer after prostate cancer in the genitourinary system. Urothelial Carcinoma is the commonest tumour type accounting for 90% of all primary tumours of the bladder Histopathological analysis of cystoscopic bladder biopsy and Transurethral resection of the bladder tumour (TURBT) material are the mainstay for cancer diagnosis. This study was aimed to determine the frequency of different types of neoplastic lesions of the urinary bladder and to determine the grade and stage of urothelial tumours. MATERIAL METHOD: The study was carried out in the Department of Pathology, Rajendra Institute of Medical Sciences (RIMS), Ranchi from January 2018 to June 2020 and included 30 cases of cystoscopic biopsies and TURBT specimens. RESULTS: Out of 30 cases of neoplastic lesions, majority were of high grade papillary urothelial carcinoma (n=14, 46.67%) followed by low grade papillary urothelial carcinoma (n=9, 30%), 3 cases (10%) were of PUNLMP, 2 cases (6.66%) of papilloma and 1 (3.33%) case each of moderately differentiated squamous cell carcinoma and extra nodal NHL. The most common age group was 41-50 years and 51-60 years with 9 (30%) cases each. Muscle invasion was seen only in high grade papillary urothelial carcinomas. CONCLUSION: High-grade urothelial carcinomas with lamina propria and muscle invasion are the most common neoplastic lesion of urinary bladder with significant morbidity and mortality. Muscle invasion and grading, as per TNM staging, are valuable prognostic factors.


2018 ◽  
Vol 9 (6) ◽  
pp. 45-50
Author(s):  
Binita Goyal ◽  
Sheshagiri Rao ◽  
Rajina Sahi ◽  
Subechhya Jaiswal

Background: Urinary bladder cancer is an important cause of morbidity and mortality due to urological conditions. It is tenth most common cancer overall in both sexes. It is seventh most common cancer overall and second most common cancer of genitourinary tract in males. Ninety five percent of bladder tumors are epithelial and the rest are mesenchymal, of which majority are primary urothelial tumors. Urothelial tumors are classified into infiltrating urothelial carcinoma with its variants and non-invasive urothelial neoplasias. Tumor stage is the strongest prognostic parameter.Aims and Objectives: The current study was designed with an aim to elucidate the histologic pattern of bladder tumors and observe whether any association between histologic grade and muscle invasion exists.Materials and Methods: This descriptive study was carried out on 84 cases of urinary bladder tumors received in Department of Pathology, College of Medical Sciences and Teaching Hospital during a time period of 5 years from January 2012 to December 2016.Results: The mean ± SD of age of presentation was 63±13 years with a male female ratio 3.2:1. Ninety-five percent cases were primary epithelial tumors and 93% cases were of urothelial origin. Low grade papillary urothelial carcinoma was the most common urothelial tumor (40.5%) followed by high grade papillary urothelial carcinoma (34.5%). Some rare types like primary adenocarcinoma and small cell carcinoma were also seen in this study (1.2% each). Muscle invasion was significantly higher in high grade (66%) as compared to low grade papillary urothelial carcinoma (3%). Muscle tissue was absent in 8 (9.5%) cases.Conclusion: There is relationship of histologic grade with aggressiveness of tumor. Most of the high grade tumors are muscle invasive at presentation. Submission of muscle tissue is important for optimal patient management.Asian Journal of Medical Sciences Vol.9(6) 2018 45-50


2016 ◽  
Vol 6 (12) ◽  
pp. 1001-1004
Author(s):  
EP Shrestha ◽  
K Karmacharya

Background: Neoplastic and non-neoplastic urinary bladder lesions are the main reasons for morbidity and mortality throughout the world. Amongst these, urothelial carcinoma is a common primary tumor of urinary bladder (90%). The objective of this study is to determine the profile of various urothelial lesions received in Army Hospital within 5 years of period.Materials and methods: Five years retrospective study of cystoscopic biopsies and radical cystectomy specimens were carried out in Department of Pathology, Army hospital.Results: Out of 53 cystoscopic biopsies and radical cystectomy specimens, 42 were neoplastic and 11 were non neoplastic lesions. Thirty six urothelial carcinomas were observed out of which 20 were high grade urothelial carcinoma and 16 were low grade. Out of 20 high grade urothelial carcinoma, 17 had muscle invasion and 3 had invasion upto lamina propria. Of 16 low grade urothelial carcinoma, 12 were noninvasive, 2 had invasion upto lamina propria and 2 had muscle invasion. Papilloma was the commonest benign lesions found (7.1%) followed by papillary urothelial neoplasms of low malignant potential (PUNLMP) (2.4%) and hemangioma (2.4%).Conclusion: This article have highlighted upon the importance of histopathological study in evaluating urinary bladder lesions. Also, it has helped in determining that neoplastic lesions were more common than non-neoplastic lesions as seen in our study. A great majority of neoplastic lesions were of urothelial origin. Cystoscopic studies and biopsies help in early detection of bladder neoplasms and they form the mainstay of the diagnosis and follow up.


2021 ◽  
Vol 6 (1) ◽  
pp. 1310-1314
Author(s):  
Rachana Dhakal ◽  
Hem Nath Joshi ◽  
Ramesh Makaju ◽  
Shailendra Sigdel

Introduction: Non-neoplastic urinary bladder lesions are not life threatening, but are an important source to cause clinical symptoms and signs. However, neoplasms of the bladder are a source of morbidity, mortality, and exhibit more clinical challenges. Cystoscopy provides overall information about an anatomical/pathological condition of the urinary bladder which will be helpful for patients' management. A cystoscopic biopsy is a primary diagnostic tool for diagnosing urinary bladder cancer. Objectives: The objective of the study was to find the frequency and histomorphological characteristics of urinary bladder lesions in Dhulikhel Hospital, to find the clinical presentation of urinary bladder lesions and to grade the urothelial tumors based on the World Health Organization (WHO)/ International Society of Urological Pathology (ISUP) classification 2004. Methodology: This was a retrospective, cross-sectional, observational study carried out in the Department of Pathology, Dhulikhel Hospital-Kathmandu University Hospital. Convenient sampling was done. All cystoscopy biopsies received from January 2014 to December 2018 were studied. All tissue blocks were retrieved, cut, and stained with Hematoxylin and Eosin. The stained slides were examined under a light microscope by the primary investigator. Result: A total of 70 cystoscopic biopsies were analyzed. The majority of patients 20 (28.6%) were in the age group between 60 and 69 years and males were predominant 43 (61.4%). The neoplastic lesions constituted 40 (57.1%) of all bladder lesions, among them urothelial carcinoma accounted for 38 (54.2%). Similarly, chronic cystitis 27(38.6%) was the most common non-neoplastic lesion. Conclusion: The study found that the neoplastic lesions were commonly encountered in urinary bladder lesions. Among them, lowgrade urothelial carcinoma was the most common bladder tumor. However, most of the non-neoplastic lesions were inflammatory in origin. Cystoscopy combined with histomorphological examination helps in the early detection of bladder lesions. 


CytoJournal ◽  
2017 ◽  
Vol 14 ◽  
pp. 17 ◽  
Author(s):  
Theresa Long ◽  
Lester J. Layfield ◽  
Magda Esebua ◽  
Shellaine R. Frazier ◽  
D. Tamar Giorgadze ◽  
...  

Background: The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system uses six categories: unsatisfactory, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells, suspicious for high-grade urothelial carcinoma, high-grade urothelial carcinoma, other malignancies and a seventh subcategory (low-grade urothelial neoplasm). Methods: Three hundred and fifty-seven urine specimens were independently reviewed by four cytopathologists unaware of the previous diagnoses. Each cytopathologist rendered a diagnosis according to the Paris System categories. Agreement was assessed using absolute agreement and weighted chance-corrected agreement (kappa). Disagreements were classified as low impact and high impact based on the potential impact of a misclassification on clinical management. Results: The average absolute agreement was 65% with an average expected agreement of 44%. The average chance-corrected agreement (kappa) was 0.32. Nine hundred and ninety-nine of 1902 comparisons between rater pairs were in agreement, but 12% of comparisons differed by two or more categories for the category NHGUC. Approximately 15% of the disagreements were classified as high clinical impact. Conclusions: Our findings indicated that the scheme recommended by the Paris System shows adequate precision for the category NHGUC, but the other categories demonstrated unacceptable interobserver variability. This low level of diagnostic precision may negatively impact the applicability of the Paris System for widespread clinical application.


2013 ◽  
Vol 137 (10) ◽  
pp. 1337-1341 ◽  
Author(s):  
Melissa L. Stanton ◽  
Li Xiao ◽  
Bogdan A. Czerniak ◽  
Charles C. Guo

Context.—Urothelial tumors are rare in young patients. Because of their rarity, the natural history of the disease in young patients remains poorly understood. Objective.—To understand the pathologic and clinical features of urothelial tumors of the urinary bladder in young patients. Design.—We identified 59 young patients with urothelial tumors of the urinary bladder treated at our institution and analyzed the tumors' pathologic features and the patients' clinical outcomes. Results.—All patients were 30 years or younger, with a mean age of 23.5 years (range, 4–30). Thirty-eight patients (64%) were male, and 21 (36%) were female. Most tumors were noninvasive, papillary urothelial tumors (49 of 59; 83%), including papillary urothelial neoplasms of low malignant potential (7 of 49; 14%), low-grade papillary urothelial carcinomas (38 of 49; 78%), and high-grade papillary urothelial carcinomas (4 of 49; 8%). Only a few (n = 10) of the urothelial tumors were invasive, invading the lamina propria (n = 5; 50%), muscularis propria (n = 4; 40%), or perivesical soft tissue (n = 1; 10%). Clinical follow-up information was available for 41 patients (69%), with a mean follow-up time of 77 months. Of 31 patients with noninvasive papillary urothelial tumors, only 1 patient (3%) later developed an invasive urothelial carcinoma and died of the disease, and 30 of these patients (97%) were alive at the end of follow-up, although 10 (32%) had local tumor recurrences. In the 10 patients with invasive urothelial carcinomas, 3 patients (30%) died of the disease and 5 others (50%) were alive with metastases (the other 2 [20%] were alive with no recurrence). Conclusion.—Urothelial tumors in young patients are mostly noninvasive, papillary carcinomas and have an excellent prognosis; however, a small subset of patients may present with high-grade invasive urothelial carcinomas that result in poor clinical outcomes.


2019 ◽  
Vol 12 (10) ◽  
pp. e231192 ◽  
Author(s):  
Lalit Kumar ◽  
Anubhav Narwal ◽  
Manoj Kumar ◽  
Seema Kaushal

Primary clear-cell urothelial carcinoma (CCUC) is an uncommon type of urothelial cancer with only 16 cases reported in published literature. Due to the rarity of the tumour, its clinical and prognostic values have not been clearly understood. We present one such rare clinical diagnosis in a 60-year- old man who underwent radical cystectomy (RC) with ileal conduit for urinary bladder cancer. Histopathology showed features of high-grade CCUC infiltrating the muscularis propria. Immunohistochemistry revealed diffuse immunopositivity of pan cytokeratin (CK), GATA3, P40, CK7 but was immunonegative for CD10 and vimentin. Our patient expired 4 months after diagnosis. CCUC has recently been included in the WHO 2016 classification of urothelial tumours. Most of the patients present with poor prognosis. Accurate diagnosis and recognition of this unusual variant are essential for better patient management and prognosis. Early RC seems to be the preferred way of management.


2011 ◽  
Vol 14 (6) ◽  
pp. 438-444 ◽  
Author(s):  
Alison R. Huppmann ◽  
Bruce R. Pawel

Although not uncommon in adults, bladder tumors are rare in children. In addition, the histologic types of tumors seen in the pediatric population differ from those seen in adults. Although rhabdomyosarcoma is the most common pediatric bladder tumor, many other benign, malignant, and reactive lesions can be encountered. All may present clinically as a mass or polyp in the bladder. This study was designed to describe the pathology and patient demographics of pediatric bladder masses, because there are few studies describing these entities. Retrospectively reviewing our experience over a 21-year period, we identified 98 specimens from 65 patients with polyps or masses in the urinary bladder. As expected, the most frequent diagnosis was rhabdomyosarcoma. This was followed by fibroepithelial polyp and a variety of additional nonurothelial tumors. Only 7 urothelial tumors were identified, including 1 low-grade papillary urothelial carcinoma. Inflammatory lesions, such as cystitis cystica and nephrogenic adenoma, were invariably associated with an irritating factor when a history was provided. Our findings emphasize that diagnoses made in the pediatric urinary bladder are distinct from those in adults, although a wide variety of lesions may still be seen.


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