STUDY OF HISTOMORPHOLOGICAL SPECTRUM OF TRANSURETHRAL RESECTED BLADDER TUMOURS: A SINGLE CENTRE EXPERIENCE FROM SOUTH INDIA
Introduction: Urinary bladder lesions can be both neoplastic and non-neoplastic. Incidence of bladder cancer varies in different countries and also in different regions of the same country.
Cystoscopic biopsy remains the mainstay for establishing bladder cancer diagnosis and also to know the morphologic grading and the staging of bladder cancer. Transurethral resection of bladder tumour (TUR-BT) is commonly done as a diagnostic as well as curative procedure in majority of bladder tumours.
Material & Methods: A total of 100 TUR-BT cases were studied from January 2017 to September 2019 at department of Pathology, Institute of Nephrourology. Samples sent in 10% formalin were routinely tissue processed and paraffin embedded,4-micron sections were taken and Hematoxylin and Eosin staining was done. PAS stain and ZN stain were done when indicated. Demographic data and histopathological diagnosis were retrieved from biopsy reports. Partial and radical cystectomy specimens were not included in the study.
Results: Most common age group affected was 6th decade. Male to female ratio of 1.5: 1.
91 cases out of 100 were neoplastic tumours, with remaining 9 cases of inflammatory/granulomatous lesions. Out of these 91 cases of tumours 10 were metastatic deposits from known cases of carcinoma cervix of the rest 81 cases of urothelial cancers, 39 cases(48.14%) were high grade papillary urothelial carcinoma(HGPUC),31 cases(38.27%) were low grade papillary urothelial carcinoma(LGPUC), ,4 cases (4.93%) of papillary urothelial neoplasm of low malignant potential(PUNLMP), 1 case(1.23%) of squamous cell carcinoma and 6 cases(7.40%) of poorly differentiated carcinoma.
Among 81 cases of neoplastic bladder tumours, 40 cases (49.38%) were non-invasive,17 cases (20.98%) were showing invasion into lamina propria (superficially invasive bladder cancer) and 19 cases (23.45%) showing invasion into muscularis propria (muscle invasive bladder cancer) and in the rest 5 cases (6.17%) invasion not identified.
Of the 36 invasive cases, 6 were showing associated divergent differentiation.
Conclusion: In the present study neoplastic lesions of the bladder were more common compared to inflammatory lesions with a male preponderance. High grade tumours were more common than the low-grade tumours. Invasive urothelial carcinomas were common than non-invasive. Bladder cancers are known for divergent differentiation like squamous, glandular, small cell, rhabdoid and microcystic variants and should be mentioned in histopathology report as some of the variants are aggressive and impact prognosis.
Keywords: Bladder tumour, Cystoscopic biopsy, India, TUR-BT, Urothelial carcinoma.