Histopathological Changes in Adjacent Non-Tumour Mucosa in Trans Urethral Resection of Bladder Tumour Specimens of Bladder Carcinoma

BACKGROUND Urinary bladder cancer is associated with high morbidity and mortality rates if not treated optimally. One of the causes of tumour recurrence is undiscovered residual tumour, and the existence of macroscopically invisible premalignant and malignant lesions of urothelium during the primary resection which can be detected by taking biopsy from apparently normal mucosa in the vicinity of the tumour during trans urethral resection of bladder tumour (TURBT). The primary objective was to estimate the proportion of bladder tumour showing changes in adjacent non tumour mucosa in TURBT specimens, within a period of six months. The secondary objectives were to study the association between changes in non-tumour bladder mucosa with the recurrence, seen after six months, and to study the expression of P53 in adjacent non tumour mucosa of bladder cancer. METHODS All cases of bladder carcinoma from trans urethral resection of bladder tumour which were sent along with adjacent non tumour mucosa and received at Department of Pathology, MCH, Trivandrum, for a period of six months were included in the study. Adjacent mucosa sent along with TURBT specimen received at our department was collected. After processing, tissue is embedded in paraffin blocks and thin sections of 4 - 5 m thickness was taken and stained with haematoxylin and eosin (H & E). Using light microscopy, changes in adjacent mucosa were assessed for any abnormal changes and findings were correlated with collected data. P53 expression was studied in the adjacent mucosa. All details were entered in the proforma. Details collected were entered in Excel and analysed using SPSS software. RESULTS Out of 37 TURBT cases that were sent along with adjacent mucosa, 12 cases showed changes in adjacent mucosa accounting for 32.4 %. P53 positivity accounting for 18.9 %, was seen in abnormal mucosa change with carcinoma in situ and dysplasia. On follow up, 8 % of cases with positive biopsy finding showed recurrence. CONCLUSIONS Multiple biopsies from adjacent non tumour mucosa is not necessary for all patients with superficial bladder tumour. Positive findings in adjacent mucosa does not have significant correlation with tumour stage / grade, and tumour size, number of lesions or histopathological findings. Adjacent mucosa may be useful in detecting concomitant carcinoma in situ (CIS), which can be helpful in therapeutic approach. KEY WORDS Normal Looking Mucosa, TURBT, Bladder Cancer

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Significance of prophylactic urethrectomy at the time of radical cystectomy for bladder cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa168 ◽

2020 ◽

Author(s):

Kyohei Hakozaki ◽

Eiji Kikuchi ◽

Koichiro Ogihara ◽

Keisuke Shigeta ◽

Takayuki Abe ◽

...

Keyword(s):

Overall Survival ◽

Bladder Cancer ◽

Survival Rate ◽

Neoadjuvant Chemotherapy ◽

Radical Cystectomy ◽

Carcinoma In Situ ◽

Bladder Tumour ◽

Overall Survival Rate ◽

Definitive Evidence

Abstract Background Prophylactic urethrectomy at the time of radical cystectomy is frequently recommended for patients with bladder cancer at a high risk of urethral recurrence without definitive evidence. The present study attempted to clarify the survival benefits of performing prophylactic urethrectomy. Methods We identified 214 male patients who were treated by radical cystectomy with an incontinent urinary diversion in our seven institutions between 2004 and 2017. We used propensity score matching and ultimately identified 114 patients, 57 of whom underwent prophylactic urethrectomy (prophylactic urethrectomy group) and 57 who did not (non-prophylactic urethrectomy group). Results No significant differences were observed in the 5-year overall survival rate between the prophylactic urethrectomy and non-prophylactic urethrectomy groups in the overall. However, the local recurrence rate was significantly lower in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.015). In the subgroup of 58 patients with multiple tumours and/or concomitant carcinoma in situ at the time of transurethral resection of bladder tumour, the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.021). A multivariate analysis revealed that performing prophylactic urethrectomy was the only independent predictor of the overall survival rate (P = 0.016). In those patients who were treated without neoadjuvant chemotherapy (n = 38), the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.007). Conclusions Prophylactic urethrectomy at the time of radical cystectomy may have a survival benefit in patients with multiple tumours and/or concomitant carcinoma in situ, particularly those who do not receive neoadjuvant chemotherapy.

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Pathological Characteristics of Primary Bladder Carcinoma Treated at a Tertiary Care Hospital and Changing Demographics of Bladder Cancer in Sri Lanka

Advances in Urology ◽

10.1155/2016/5751647 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6

Author(s):

S. Sasikumar ◽

K. S. N. Wijayarathna ◽

K. A. M. S. Karunaratne ◽

U. Gobi ◽

A. Pathmeswaran ◽

...

Keyword(s):

Bladder Cancer ◽

Sri Lanka ◽

Bladder Carcinoma ◽

Carcinoma In Situ ◽

De Novo ◽

Tertiary Care ◽

Care Hospital ◽

High Grade ◽

Female Ratio

Objectives. The aim was to compare demographics and pathological features of bladder carcinoma treated in a urology unit with findings of previous studies done in Sri Lanka.Materials and Methods. Data of newly diagnosed patients with bladder cancer in a tertiary referral centre from 2011 to 2014 were analysed. Data on bladder cancers diagnosed from 1993 to 2014 were obtained from previous publications and Sri Lanka Cancer Registry.Results. There were 148 patients and mean age was 65 years. Male to female ratio was 4.1 : 1. Urothelial carcinoma (UC) was found in 89.2% of patients. Muscle invasion was noted in 35% of patients compared to 48.4% two decades ago. In patients with UC, 16.5% were found to have pT1high grade tumour. It was 5.3% from 1993 to 2000. Pure squamous cell carcinoma was found in 8.1% of patients while primary or de novo carcinoma in situ (not associated with high grade pT1tumours) was seen in one patient only.Conclusions. The percentage of squamous carcinoma is higher among Sri Lankan patients while primary carcinoma in situ is a rarity. The percentage of muscle invasive disease has decreased while the percentage of pT1high grade tumours has increased during the last two decades in Sri Lanka.

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Enhanced formation of nitric oxide in bladder carcinoma in situ and in BCG treated bladder cancer

Nitric Oxide ◽

10.1016/j.niox.2006.01.007 ◽

2006 ◽

Vol 15 (4) ◽

pp. 337-343 ◽

Cited By ~ 16

Author(s):

Abolfazl Hosseini ◽

Lotta Renström Koskela ◽

Ingrid Ehrén ◽

Miguel Aguilar-Santelises ◽

Allan Sirsjö ◽

...

Keyword(s):

Nitric Oxide ◽

Bladder Cancer ◽

Bladder Carcinoma ◽

Carcinoma In Situ

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ROLE OF RESTAGING TRANSURETHRAL RESECTION OF BLADDER TUMOR IN PATHOLOGICAL UPSTAGING OF NON-MUSCLE INVASIVE HIGH-GRADE UROTHELIAL BLADDER TUMORS. OUR INSTITUTE EXPERIENCE

10.36106/6901373 ◽

2021 ◽

pp. 34-35

Author(s):

Jaheer Abbas Shaik ◽

Raghuveer Pedamallu ◽

Ram Reddy. Ch ◽

Rahul Devraj ◽

Vidyasagar. S ◽

...

Keyword(s):

Bladder Cancer ◽

Transurethral Resection ◽

Carcinoma In Situ ◽

Residual Disease ◽

Residual Tumour ◽

High Grade ◽

Bladder Tumors ◽

Muscle Invasive

Background: Transurethral resection of supercial bladder tumours is well known to be gold standard management. It is evident from the literature that initial TURBT is not enough for accurate pathological staging in non-muscle invasive bladder cancer. Aim: Our study is aimed at role of restaging TURBT in detection of residual disease for pathological upstaging in these high-risk patients to plan appropriate treatment. Methods: This is a prospective study of 32 patients with initially diagnosed Ta/T1 high-grade bladder cancer who had restaging TURBT in a study by Department of urology, NIMS, Hyderabad between January 2016 and December 2018 were included. Low-grade tumors, carcinoma in situ and muscle invasive bladder tumors were excluded. Data elements collected on patient demographics, presence of residual disease, disease progression and recurrence in the follow-up period. The data was statistically analyzed using descriptive statistics by SPSS version 17. P value <=0.05 is considered as statistically signicant. Results: The mean age for patients included in the study was 60.5 years. In our study, we found that 15 out of 32 cases (47%) has been detected with residual disease ensuring that single TURBT may not been efcient with complete removal of tumor. Six out of 32 cases (19%) had upstaging and 5 out of 32 cases had concurrent carcinoma in situ leading to change in treatment. Therefore, 11 out of 32 cases (34%) has been under staged by initial TURBT were adequately staged by restaging TURBT and subjected to radical cystoprostatectomy or chemo radiotherapy, This mandates the need for restaging TURBT at 6-8 weeks interval for adequate staging and management. Upstaging on restaging TURBT was seen in 19%. The progression-free survival rate at 16 months was 25 % in patients with residual tumour and 94% in cases without residual disease. Conclusion: We conclude that restaging TURBT effectively detects residual disease, helping pathological upstaging and planning denitive treatment in non-muscle invasive high-grade bladder tumour.

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Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience

African Journal of Urology ◽

10.1186/s12301-020-00099-6 ◽

2020 ◽

Vol 26 (1) ◽

Author(s):

Vivek Sharma ◽

Avinash P. S. Thakur ◽

Vasantharaja Ramasamy ◽

Pushpendra Kumar Shukla ◽

Fanindra Singh Solanki ◽

...

Keyword(s):

Bladder Cancer ◽

Adverse Effects ◽

Bladder Carcinoma ◽

Bladder Tumour ◽

The Body ◽

Bcg Therapy ◽

Intravesical Bcg ◽

Urothelial Bladder ◽

Muscle Invasive ◽

Intravesical Bcg Therapy

Abstract Background Urothelial bladder carcinoma accounts for around 3.9% cases of all the male cancers in India. Non-muscle-invasive bladder carcinoma (NMIBC) is predominant group which constitute approximately three fourth of the urothelial bladder cancer. Intravesical BCG immunotherapy is the corner stone of today’s NMIBC management. However, as with any other therapy it has its own complications and its interruption due to these adverse effects is a major cause of suboptimal efficacy. The aim of this study was to assess the complications of intravesical BCG therapy and their management in NMIBC patients. Methods This was a retrospective descriptive study conducted between October 2016 and November 2019; a backward review of 149 patients with diagnosis of NMIBC that undergone intravesicle BCG therapy was performed. Patient’s demographical, clinical, diagnostic and procedural data regarding bladder tumour, BCG therapy, its complications and management were collected and analysed. Results Total 149 patients were analysed, comprising 116 males and 33 females. The mean age was of 57.2 ± 6.7 years. Total 85.23% were primary and 14.76% were recurrent tumours. Total 96 patients (64.42%) completed the planned course, while 53 (35.57%) interrupted. The reasons for BCG interruption includes adverse effects (15.4%), progression of disease (6.7%), disease refractory to BCG (4.6%) and disease recurrence during BCG (3.3%). Most of the adverse events occurred in first 6 months and most interruptions occurred after the induction period. Cystitis was the most common observed adverse effect seen in 39.6% patients. Frequency, urgency, haematuria were common presentation. Radical cystectomy was the most common (16.10%) further treatment with patients whose treatment was interrupted. Conclusion BCG is an indispensable therapy available for NMIBC, but it is associated with array of adverse effects and complications, which are the main reasons for poor compliance to BCG therapy. Although BCG-related complications can affect any organ in the body, potentially life-threatening systemic BCG-related infections are encountered in only < 5% of patients. There are some difficulties in diagnosis of the BCG complications because acid-fast staining, culture and PCR test are not always positive; tissue biopsies should be indicated sometimes to evaluate histopathology and presence of M. bovis. A persistently monitored multidisciplinary approach with high index of suspicion and prompt anti-TB therapy can help to derive the maximum benefits while keeping the complications at check.

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Intratumoral heterogeneity of surrogate molecular subtypes in urothelial carcinoma in situ of the urinary bladder: implications for prognostic stratification of high-risk non-muscle-invasive bladder cancer

Virchows Archiv ◽

10.1007/s00428-021-03054-0 ◽

2021 ◽

Author(s):

Stefan Garczyk ◽

Felix Bischoff ◽

Ursula Schneider ◽

Reinhard Golz ◽

Friedrich-Carl von Rundstedt ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Carcinoma In Situ ◽

Molecular Subtypes ◽

Smoking Status ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Prognostic Stratification ◽

Muscle Invasive

AbstractReliable factors predicting the disease course of non-muscle-invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) are unavailable. Molecular subtypes have potential for prognostic stratification of muscle-invasive bladder cancer, while their value for CIS patients is unknown. Here, the prognostic impact of both clinico-pathological parameters, including CIS focality, and immunohistochemistry-based surrogate subtypes was analyzed in a cohort of high-risk NMIBC patients with CIS. In 128 high-risk NMIBC patients with CIS, luminal (KRT20, GATA3, ERBB2) and basal (KRT5/6, KRT14) surrogate markers as well as p53 were analyzed in 213–231 biopsies. To study inter-lesional heterogeneity of CIS, marker expression in independent CIS biopsies from different bladder localizations was analyzed. Clinico-pathological parameters and surrogate subtypes were correlated with recurrence-free (RFS), progression-free (PFS), cancer-specific (CSS), and overall survival (OS). Forty-six and 30% of CIS patients exhibited a luminal-like (KRT20-positive, KRT5/6-negative) and a null phenotype (KRT20-negative, KRT5/6-negative), respectively. A basal-like subtype (KRT20-negative, KRT5/6-positive) was not observed. A significant degree of inter-lesional CIS heterogeneity was noted, reflected by 23% of patients showing a mixed subtype. Neither CIS surrogate subtype nor CIS focality was associated with patient outcome. Patient age and smoking status were the only potentially independent prognostic factors predicting RFS, PFS, OS, and PFS, respectively. In conclusion, further clarification of heterogeneity of surrogate subtypes in HR NMIBC and their prognostic value is of importance with regard to potential implementation of molecular subtyping into clinical routine. The potential prognostic usefulness of patient age and smoking status for high-risk NMIBC patients with CIS needs further validation.

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