Urinary bladder. Mimics of neoplasia and new pathologic entities

Squamous and glandular metaplasia related to a renal pelvis stone leading to secondary pyeloureteral junction syndrome

Keratinizing squamous metaplasia of the renal pelvis is a rare lesion of the upper urinary tract that can occur in the context of chronic aggression to the urothelium, potentially leading to a secondary pyeloureteral junction syndrome. We report the case of a 43-year-old patient discovered intraoperatively in relation to a renal pelvis stone causing a pyeloureteral junction syndrome. The extemporaneous histological examination ruled out a malignant process, and we performed a pyeloplasty according to KUSS-ANDERSON technique. This pathology should be recognized by the urologist for appropriate management. Treatment is conservative, with extended follow-up to detect recurrences or carcinomatous degenerations.

Profile of lesions in cystoscopic bladder biopsies: a histopathological study

Aim and Introduction: Urinary bladder lesions, non-neoplastic and neoplastic, are collectively responsible for significant morbidity and mortality throughout the world. The present study aimed to study the histopathology of various lesions of the bladder through cystoscopic biopsies.

MATERIAL AND METHODS

The present prospective study aimed to study the histopathology of various lesions of the urinary bladder through cystoscopic biopsies. All patients who visited Urology Outpatients Department for haematuria and dysuria were subjected to cystoscopy.

RESULTS

Histopathological examinations revealed an equal share of non neoplastic lesions and neoplastic lesions. Amongst the non neoplastic lesions, 84% were inflammatory lesions. Urothelial tumours (96%) formed the bulk amongst neoplastic lesions.

CONCLUSION

This article has stressed upon the importance of histopathological examinations in evaluating bladder pathologies.

Low-grade mucinous cystic tumor mimicking urinary bladder tumor: imaging-pathologic correlation

Mucin-producing cystitis glandularis is a rare proliferative and metaplastic change of the bladder mucosa that produces large amounts of mucus, thus taking a pseudotumoral pattern and resulting in urinary tract obstruction. We report a case of florid mucin-producing cystitis glandularis mimicking bladder carcinoma in a 77-year-old man that was documented by computed tomography and magnetic resonance imaging. Computed tomography showed diffuse, circumferential, irregular, and lobulated thickening of the bladder wall suggestive of urinary bladder carcinoma. Magnetic resonance imaging showed findings consistent with mucinous content and suggested the correct diagnosis preoperatively.

Outcomes of pT0N0 at radical cystectomy: The Canadian Bladder Cancer Network experience

INTRODUCTION

: Radical cystectomy is the standard treatment for muscle invasive bladder cancer. We assessed clinical outcomes in patients found to have no evidence of disease (i.e., pT0N0) following radical cystectomy.

METHODS

: We collected and pooled a database of 2287 patients who underwent radical cystectomy between 1993 and 2008 in eight centres across Canada. Of this number, 135 patients were found to have pT0N0 bladder cancer at the time of cystectomy. Survival data and prognostic variables were analyzed using Kaplan-Meier method and Cox proportional hazard regression analysis.

RESULTS

: Median patient age was 66 years with a mean follow-up of 42 months. Clinical stage distribution was Tis 8.9%, Ta 1.5%, T1 20.7%, T2 45.2%, T3 5.2%, and T4 5.2%. The five-year recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) were 83%, 96%, and 88%, respectively. The 10-year RFS, DSS and OS were 66%, 92%, and 70%, respectively. On Cox proportional regression analysis, no variables were associated with disease recurrence and only patient age was associated with overall survival.

INTERPRETATION

: Patients with pT0N0 pathology after cystectomy have excellent outcomes with high five- and 10-year RFS, DSS and OS. However, there is still a risk of tumour recurrence in this patient population and thus postoperative surveillance is still required.

The current classification of urothelial neoplasms

The classification of urothelial neoplasms has been a subject of significant controversy and debate over the last decade. Only recently has a general level of agreement developed on the utility of the classification first proposed by the World Health Organization and the International Society of Urologic Pathology in 1998. Recent adoption of this scheme in therapeutic guidelines indicates the clinical utility of the system. In this review a brief historical perspective is presented, followed by a review of the classification system, the histological criteria for the specific categories and the clinical significance of these diagnoses.

Effect of a pT0 cystectomy specimen without neoadjuvant therapy on survival

BACKGROUND

In some cases of radical cystectomy for bladder cancer, no residual tumor is found in the cystectomy specimen (the pT0 classification). The aim of this study was to evaluate the outcome of such patients in a large cystectomy series.

METHODS

All 900 patients with radical cystectomy and pelvic lymphadenectomy for TCC of the bladder in the period January 1986 to September 2003 who received no neoadjuvant therapy were included. Cystectomy specimens from 181 (20.1%) patients were graded as pT0. Complete follow-up was obtained in all cases. Tumor-specific survival (pT0 vs. pT+) was calculated with the Kaplan-Meier method and compared with the log-rank test.

RESULTS

The rate of lymph node metastases in the pT0 group was 6.6%. pT0 status was found with Ta/is/1 in 36.8%, T2a in 41.8%, and T2b in 10.9%. The 169 patients with pT0pN0 tumors had 10-year tumor-specific survival rates of 91.0. There was no statistically significant survival benefit for pT0pN0 tumors compared with pT+pN0 tumors for maximal tumor classifications of pTa/pTis/pT1 and pT2b, but patients with a pT0T2apN0 tumor had a statistically significantly better tumor-specific survival than those with a pT2apN0 tumor (P = 0.002). No patient with a pT0pN0 tumor had a local recurrence. The rate of incidental second primary malignancies in a specimen was 15.5%.

CONCLUSIONS

A pT0pN0 cystectomy specimen indicates a curative therapy, but there is a substantial risk of tumor recurrence. In the group of tumors with a maximal classification of pT2a, the pT0 tumors constitute a subgroup with a significantly higher likelihood of survival.

Lésions bénignes diverses de la vessie et de la voie excréto urinaire

Miscellaneous benign lesions of the bladder are composed of morphologic aspects of the urothelial mucosa. They are epithelial lesions (von Brunn nests, glandularis cystitis, nephrogenic adenoma, polypoid cystitis and epidermoid metaplasia), myofibroblastic proliferations and heterotopias (endometriosis, endocervicosis, endosalpingiosis and ectopic prostatic tissue). Etiology, morphologic aspects and differential diagnosis are discussed.