Spectrum and Presentation of Urinary Bladder Growth: a Single-Center Retrospective Study

Introduction: Urinary bladder cancers are heterogeneous diseases consisting of a divergent group of tumors. Diseases of the urinary bladder, both neoplastic and nonneoplastic contribute to notable mortality and morbidity. Histopathology remains the gold standard of diagnosis. Bladder transurethral resection of the tumor is a therapeutic procedure that ensures the material necessary for histopathological diagnosis because it allows assessment of the degree of differentiation, depth of tumor invasion, parameters useful in the elaboration of diagnosis and prognosis assessment Material and Methods: All the urinary bladder biopsies submitted in the pathology laboratory during 1 year time period were included in the study. Results: Among the 51 total cases in the study, the male to female ratio was 4.67:1 with the age group of 22-96 years. Among the study population, 30 (52.7%) presented with hematuria, 10 (19.2%) with burning micturition, frequent urination, and lower abdominal pain. In the study, 44 (86%) showed neoplastic lesions while 7(14%) remaining were non-neoplastic lesions. Infiltrative urothelial carcinoma with low and high grades was diagnosed in 23% (12/51) Conclusions: This study has revealed that neoplastic lesions are more common than non-neoplastic lesions. A great majority of neoplastic lesions are of urothelial origin. Majority of which are invasive urothelial neoplasm. All urothelial neoplasms are more common in males. Cystoscopic studies and biopsies help in the early detection of bladder neoplasms and they form the mainstay of the diagnosis and follow-up.

An Unusual Location for a Nonurachal Bladder Adenocarcinoma

Malignant bladder neoplasms represent a significant disease burden not only for urologists but also the broader medical community. While the majority of bladder tumors are urothelial in origin, up to two percent are found to be adenocarcinomas. Among bladder adenocarcinomas, roughly one-tenth are urachal and are frequently located at the dome of the bladder where urachal remnants can often be found. We describe a case of bladder adenocarcinoma that presented at the dome of the bladder but ultimately exhibited a nonurachal histology. A 65-year-old male with a history of myocardial infarction and cerebrovascular accident with residual right-sided hemiparesis and aphasia was referred to our clinic for evaluation of a bladder mass discovered in the setting of painless gross hematuria. Diagnostic cystoscopy demonstrated a large mass at the dome of the bladder, and subsequent transurethral resection revealed stage T1 mucinous adenocarcinoma arising in a villous adenomatous lesion without the presence of muscle in the specimen. The patient underwent a robotic-assisted laparoscopic partial cystectomy with extended bilateral pelvic lymph node dissection. Postoperatively, the patient experienced short-lived paralytic ileus and was discharged on postoperative day 5. Follow-up surveillance imaging at 6 months with CT chest, abdomen, and pelvis, repeat office cystoscopy, and negative tumor markers postoperatively indicated no evidence of disease recurrence. Characterization of bladder adenocarcinomas into urachal and nonurachal subtypes is critical in differentiating the operative management and oncologic outcomes of the respective neoplasms. However, given the paucity of literature describing treatment approaches to bladder adenocarcinoma in general, existing methods have largely mirrored genetically similar neoplasms, including ovarian and colon adenocarcinomas. Although there is still much to be understood regarding the potential mechanisms of carcinogenesis of nonurachal adenocarcinomas, further investigation may pave the way for a more standardized treatment paradigm and provide insight into the potential utility of modern immunotherapies.

KI 67 EXPRESSION IN DIFFERENT HISTOLOGIC VARIANTS OF BLADDER NEOPLASMS: AN INTRIGUING OBSERVATION

Bladder neoplasms have diverse categories, both benign and malignant. Ki-67 has increasing expression with increasing grade and stage of cancer. This may serve as an important diagnostic and prognostic marker in Urothelial neoplasms, that may aid in clinical outcome and predict recurrence and progression.

Urinary Bladder Metastasis from Gastric Cancer: A Case Report and Review of the Literature

Bladder metastasis from gastric cancer is a unique clinical entity, which can be revealed infrequently in patients with metastatic gastric cancer. Secondary neoplasms to the bladder are also a less frequent clinical entity representing only 15% of all bladder neoplasms. Gastric cancers consist of an exceptionally small percentage of all secondary bladder neoplasms. Until now only 27 cases were recorded in the international medical literature. The current work analyzes a 65-year old male patient who presented initially with a locally advanced gastric adenocarcinoma. He was treated with a combination of total gastrectomy and perioperative chemotherapy. Eight months later presented a relapse with bladder metastasis, liver metastasis and peritoneal involvement. Furthermore, in this manuscript, we conducted a review of the recorded cases with bladder metastasis from gastric cancer. In the most of cases the diagnosis of bladder metastasis was metachronous with an average time of presentation in four years after the primary diagnosis of gastric cancer and most of the patients of our review presented with urinary symptoms at the time of diagnosis of bladder metastasis. Concerning the management of the metastatic disease surgical management with total or partial cystectomy was performed in 11% of patients and TUR was performed in 22% of patients. Palliative chemotherapy for the management of metastatic disease was initiated in 46% of patients.

The Role p53 Protein Expression in Urothelial Neoplasm

The urinary bladder had a line with transitional epithelium. Urothelial neoplasms are the majority among the bladder neoplasms. Urothelial neoplasms were more common in males than in females. Urothelial neoplasms usually occur in the elderly age group. The majority of the tumor size was more significant than 3 cm, and papillary type is majorly found among the tumors. The present study aimed to identify the grade and staging of the p53 in urothelial neoplasms. The bladder carcinoma (54) cases from Department of Pathology, Sree Balaji Medical College and hospital (during September 2015 to September 2017) were analysed. The median age for bladder carcinoma in the present study was 66 years. The clinical parameter studied was the size of the lesion based on the cytoscopic or radiological findings (31- 33). Based on tumor size, lesions were classified into two groups, less than equal to 3cm and greater than 3cm, which was found to be 42% and 58%, respectively This study concludes that p53 is useful in differentiating benign and malignant neoplasms in morphologically difficult cases. Immunohistochemistry for p53 is useful adjunct to histomorphology.

Gall bladder carcinoma: the facts and the mimics

Background Gall bladder carcinoma (GBC) is the most common biliary epithelial neoplasm. Its slow progression and late presentation lend it a poor prognosis. The risk factors can be divided into cholelithiasis, inflammatory causes, infection, exposure, and gall bladder pathologies. It usually spreads by hematogenous or lymphatic route or directly invades the liver. There are many controversies related to guidelines for management of gall bladder polyps and treatment options. Main text This review article attempts to give definitive guidelines for the same and helps the reader distinguish it from other benign mimickers. The emerging role of newer modalities like contrast ultrasound, elastography, and magnetic resonance cholangiopancreatography has also been briefly mentioned. This paper reviews the literature to provide concise background, etiopathogenesis, radiological findings, and management options of GBC. Conclusions Out of all the available modalities MDCT, FDG-PET CT, and image-guided biopsies play the most important role in diagnosis and follow-up. Imaging remains elementary in pre-operative planning and management of gall bladder neoplasms.

CARCINOMA UROTELIAL DA BEXIGA: RELATO DE CASO

Among male patients, bladder cancer is the fourth most common and is rarely identified in young individuals. The most common symptom is macroscopic hematuria and the initial treatment is transurethral resection of the bladder, in which the stage and classification are identified. Smoking is known to be the main risk factor for bladder cancers. Radical cystectomy and bilateral pelvic lymphadenectomy are the “gold standard” treatment for muscle-invasive bladder cancer. Around 25% of bladder neoplasms are muscle-invasive at diagnosis, but the patients have a good prognosis with this kind of treatment. The Bricker technique is the most used for the reconstruction of the neobladder. In this paper we report the case of a male patient, 55 years old, with invasive high-grade bladder cancer, treated with a radical cystectomy, lymphadenectomy and neobladder using the Bricker technique. After the surgical procedure, the patient remained in the Intensive Care Unit for two days, presenting acute kidney injury and the need for three hemodialysis sessions. The recovery was adequate, with a good postoperative evolution. We emphasize the importance of reporting to the patient about the indispensable clinical follow-up, which must be done until medical discharge, to avoid disease recurrence and the need for more aggressive treatments, as we will see in this case.