Histopathological study of cystoscopic bladder biopsies

Background: Urinary bladder diseases constitute an important source of clinical signs and symptoms which are more disabling than lethal. The prevalence of bladder tumor in developed countries is approximately six times higher compared with that in developing countries. The aim of this study was to find out various lesions in urinary bladder biopsies and its frequencies. Materials and Methods: This was a five year retrospective study from January 2008 to December 2013, carried out at B&B Hospital, Lalitpur. All the relevant data of 324 patients who had undergone cystoscopic biopsy of urinary bladder were included in the study. All blocks were retrieved and stained with Hematoxylin and Eosin stain and examined under light microscope. Results: The spectrum of pathological lesions included inflammations and tumors. Non-neoplastic lesions were predominant (61.11%) followed by Transitional cell tumors accounted for 124 cases (38.27%). Non-neoplastic lesions comprises of cystitis and tuberculosis. Papillary urothelial neoplasms was the most common tumors seen in this study with 55 low grade, and 54 high grade Papillary urothelial carcinoma according to recent WHO grading. Single cases each of adenocarcinoma and paraganglioma were diagnosed. Conclusion: Cystoscopic biopsies help in the early diagnosis and treatment of various bladder lesions. Analysis of cystoscopic biopsies was done to ascertain the type of urinary bladder lesions in our country. Journal of Pathology of Nepal (2015) Vol. 5, 717-719

countries is approximately six times higher when compared with that in developing countries. 3is study was carried out with the aim of finding out the histopathological features of various lesions in bladder biopsies and to study them along with the frequency of different pathological lesions, particularly transitional cell carcinoma (TCC) in urinary bladder biopsies.

MATERIALS AND METHODS
This was a retrospective and prospective study done in the department of pathology at B&B Hospital for a period of 3 years and 4 months from October 2012 to January 2015.Patients were explained and written consent was taken.Permission from the hospital institutional review committee was taken.A total of 324 cases were included in this study.Cystoscopic bladder biopsies were performed.The biopsies were preserved in 10% formalin.Gross examination was done and processed routinely.The slides were stained with Hematoxylin and Eosin stain light microscopy technique was used for diagnosis.Data were analyzed and statistically evaluated wherever possible.

RESULTS
Out of 324 patients, 216 (66.66%) were male and 108 (33.33%) were females.The peak age of incidence was between 61-70 years (Table 1.) The spectrum of pathological lesions included inflammations and tumors as shown in Table 2.Non-neoplastic lesions were predominant (61.11%) followed by Transitional cell tumors accounted for 124 cases (38.27%).Non-neoplastic lesions comprises of cystitis and tuberculosis.Papillary urothelial neoplasms was the most common tumors seen in this study with 55 low grade, and 54 high grade Papillary urothelial carcinoma according to recent WHO grading (Table .2).In this study, 1 case of adenocarcinoma and 1 case of paraganglioma were diagnosed.

DISCUSSION
In our study, maximum numbers of cases 58.95% were of chronic nonspecific cystitis.Chronic cystitis usually occurs from repeated attacks of acute cystitis.It varies greatly in severities.There may be only a mild exudate predominantly of lymphocytes and macrophages in the subepithelial tissues, or the inflammation may involve the whole thickness of the bladder wall, with an extensive exudate of lymphocytes, macrophages, and plasma cells.
In the present study, tubercular cystitis was found in 0.93% cases.Tuberculosis remains the most common cause of granulomatous inflammation of the bladder in many parts of the world.It invariably develops from the secondary foci, most often located in kidney. 4Most bladder lesions are found in the trigone, especially around the ureteral orifices.The usual tuberculous granulomata appear in the submucosa which are usually few but may become confluent, with caseous necrosis.In males, there may be secondary involvement of the prostate, whereas in the females the disease may be complicated by vasico-vaginal fistula. 5rcinoma in situ is a neoplastic change of the urethelium considered to be a high-grade neoplasm and is an indicator of progression of urothelial neoplasm that requires specific treatment. 6In this study incidence of carcinoma in situ was 0.62%.Majority of urothelial tract tumors are epithelial.Bladder cancer is the 7th most common cancer worldwide.In general, the prevalence of bladder tumors in developed countries is approximately 6 times higher to developing countries.The most common type of bladder cancer in developed countries is urothelial carcinoma (90%). 3In our study, TCC accounted 38.28% of all tumors while the adenocarcinoma and paraganglioma were 0.31%respectively.In Sri Lanka, TCC accounted for 93.4% of primary bladder cancer, there was a male predominance with sex ratio of 6:1. 2 Tumor staging and the grading are the two major factors for recurrence and progression, and for determination of treatment options for patients with bladder carcinoma. 7Histological distribution according to WHO grading reveals that the maximum number of cases (16.98%) observed TCC-low grade followed by high grade TCC with 16.67%.This correlates well with the study done by Matalka et al which showed 40% cases of high grade TCC and 60% of low grade TCC. 7pillary urothelial Neoplasm of low malignant potential (PUNLMP) was seen in 4.01%.jung-Weon Shiam et al showed 27.3% in his study. 8PUNLMP is a urothelial lesion that biologically carries a low risk of progression of up to Study of cystoscopic bladder biopsies 8% according to some studies.Many of these patients had tumor recurrence (60%) and they often presented with higher grade tumor recurrence. 9,10

CONCLUSION
Cystoscopic biopsies help in the early diagnosis and treatment of various bladder lesions.Analysis of cystoscopic biopsies was done to ascertain the type of urinary bladder lesions in our country.