Profiles of histopathological lesions of urinary bladder : A five years study

Correspondence: Dr. Eva Shrestha (Piya), MBBS, MD Department of Pathology, Army Hospital chhauni, Kathmandu, Nepal Email: evapiya@yahoo.com Background: Neoplastic and non-neoplastic urinary bladder lesions are the main reasons for morbidity and mortality throughout the world. Amongst these, urothelial carcinoma is a common primary tumor of urinary bladder (90%). The objective of this study is to determine the profile of various urothelial lesions received in Army Hospital within 5 years of period.

mortality throughout the world. 1 Tumors of bladder however continue to be the most common cause of morbidity and mortality. 2Amongst bladder tumors, urothelial carcinoma, also known as transitional cell carcinoma is a common malignant tumor of urinary bladder and comprises of 90% of primary tumor of bladder. 3It is the ninth most common cancer in the world, with 430,000 new cases diagnosed in 2014. 4The remaining 10% comprises of all other types of 1004 carcinomas, a small number of sarcomas and miscellaneous tumors. 5Approximately 98% of malignant tumors arising in the urinary bladder are of epithelial origin and of these, 90% are usual urothelial carcinoma. 6The highest incidence is sixth and seventh decades of life.It is more common in men than women in the ratio of 3-4:1.Cystoscopy is the primary diagnostic tool for patients who are suspected to have bladder tumors. 7The objective of this study is to determine the profile of various urothelial lesions received in Army Hospital within 5 years of period.

MATERIALS AND METHODS
This is a retrospective analysis of biopsies taken from urinary bladder were performed in Army hospital.Prior to study permission was obtained from institutional review committee.A total 53 biopsies were reviewed within 5 years of period.All cystoscopic biopsies and radical cystectomy specimens were included in the study.All cases of urothelial carcinomas were graded histologically according to WHO (2004)/ISUP classification.Statistical analysis was performed using Excel wherever applicable.
Most of the patients who had bladder tumor were in the age group on 61-70 years.Out of 53 cases studied, 45 cases were male and 8 were female.Amongst 42 neoplastic lesions 36 urothelial bladder tumors were seen in male and 6 were seen in females, the male to female ratio being 6:1.(fig. 1)

DISCUSSION
Cystoscopic biopsy and radical cystectomy specimens of 53 patients were included in this study.In the present study, of 11 non-neoplastic lesions, whose age ranged from 40 to 90 years, 3 cases had ulcerative polypoid cystitis which showed polypoid lesions with ulceration with oedematous lamina propria with variable amount of chronic inflammatory infiltrate. 8Three cases were diagnosed as chronic nonspecific cystitis which showed the urothelium within normal limits with lamina propria showing oedema and inflitration by chronic inflammatory cells.
In present study, 2 cases were of cystitis glandularis, which showed slitlike and cystic spaces, lined by cuboidal and columnar epithelium and a rim of urothelium, which were present in lamina propria which co-relates well with the study shown by Semins et al. 9 All 3 cases of granulomatous cystits showed ulcerations with characteristic granuloma of epitheoid cells, histiocytes, giant cells and lymphocytes.As already known, a vast majority of tumors of urinary bladder are of epithelial origin, which arise from the urothelium, transitional type of epithelium that lines the bladder. 1 Approximately 90% of malignant bladder tumors are transitional cell carcinomas.The remaining 10% comprises of all other types of carcinomas. 11In our study too, urothelial carcinoma was the most common urinary bladder neoplasm comprising 36 cases (85.7%), which correlates well with the study conducted by Kalpana Beniwal et al (93.6%),[14] The commonest age group of tumor presentation was 60-80 years with male to female ratio 6:1 which matches with other studies conducted in other part of Asia.In our study, bladder cancer was the most commonly seen in males as compared to females which is comparable to other studies. 14,15 our study, High grade TCC was seen in 20 cases (56%), and 16 cases (44%) were low grade TCC.This correlated well with the study conducted by

CONCLUSION
Most of the non-neoplastic lesions were of inflammatory origin comprising of ulcerative polypoid cystitis, chronic inflammatory lesions, cystitis glandularis and granulomatous cystitis.A great majority of neoplastic lesions were of urothelial origin while only 1 case was from non-urothelial origin.Amongst urothelial origin neoplastic lesion, transitional cell carcinoma formed the bulk of the cases (87.5%), majority of which showed muscle invasion (45.2%), high grade lesions being the commonest with detrusor muscle invasion.Muscle invasion are the most important determinants of prognosis and treatment for bladder cancer.All urothelial neoplasms were more common in males.Cystoscopic studies and biopsies help in early detection of bladder neoplasms and they form the mainstay of the diagnosis and follow up.

Table 3 : Spectrum of different urinary bladder tumors
This correlated with the findings of Young et al.10 15,14a et al, who documented high grade TCC in 35 cases (43.21%) and low grade TCC in 32 cases (39.57%) and study conducted by Mahesh et al, in which high grade TCC comprised of 53.57% compared to low grade TCC which comprised of 42.85%.13,14IncontrastLashirametal,found53.9% of cases were of Low grade TCC and only 34.6% were of high grade.15Detrusormuscleinvasionwasseen in 16% of cases of low grade TCC and 76.92% cases of high grade TCC in the study done by Vaidya et al which correlated well with our study.1418.2% of low grade tumors and 75% of high grade tumors were invasive to the detrusor muscle layer in the study conducted by Lashiram et al., which again correlated well with our study.15