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

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INTRODUCTION
Both neoplastic and non-neoplastic lesions of the urinary bladder are quite common. The non-neoplastic lesions comprise a number of symptoms and signs which are more disabling than fatal. 1 The prevalence of bladder tumors in developed countries is approximately six times higher when compared with that in developing countries. 2 Neoplasm of the bladder accounts for 6% and 2% of cancer in men and women respectively 3 Urothelial carcinoma is the common type accounting for 90% of all primary tumours of the bladder. 1 Urinary bladder cancer is the sixth most common cancer in the world and the most common neoplasm of the genitourinary tract. 3 Cystoscopy is the primary diagnostic tool for direct examination of the bladder neoplasm which also helps in taking biopsies from respective diseased area 4 . 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 and depth of tumor invasion both parameters that are useful in the elaboration of diagnosis and prognosis assessment 5 In this study, we aim to find out the histopathological features of various lesions in bladder biopsies.

METHODS AND MATERIALS
This was a retrospective and prospective study conducted in the department of pathology with approval from the institutional review board, MMIHS. The study was done for a period of two years (January 2016 to December 2018). The material for the study comprised of biopsies from transurethral resection of bladder tumour (TURBT) and cystoscopic samples. Clinical history and cystoscopic findings were taken from the patient record. All the bladder biopsies were received during the study period. in the department of pathology, MMTH was included. Inadequate bladder biopsies were defined as biopsies that could not be interpreted by the pathologist due to inadequate content or poor preservation. All the biopsies were immediately fixed in 10% formalin and processed routinely. The slides were stained with H and E and light microscopy technique was used for diagnosis.

DISCUSSION
Urinary bladder malignancy is the major cause of morbidity and mortality. It is the fourth most common malignancy in men. 6 Primary diagnostic tool is cystoscopy and the most frequently used diagnostic procedure is TURBT. 7 In the present study 86% were neoplastic lesions and 14% were nonneoplastic lesions which were comparable with the study of Shruthi et al 7 and Shrestha et al. 8 The commonest age group of tumor presentation was 60-80 years with a male to female ratio of 4.6:1 which were comparable with other studies Shrestha et al 8 and Kousthuba et al. 9 The most common presenting complaints were hematuria followed by urgency, frequency, and pain abdomen which were comparable with a study conducted by Shruthi et al. 7 The most common non-neoplastic lesion in our study is cystitis cystic (8%) followed by urothelial hyperplasia(4%). This was in contrast with a study conducted by Shrestha et al 8 , where papilloma (7.1%) was the commonest followed by Papillary urothelial neoplasm of low malignant potential (2.4%) and Suba et al 10 where chronic non-specific cystitis was commonest followed by follicular cystitis.
As already known, a vast majority of tumors of the urinary bladder are of epithelial origin, which arises from urothelium, a transitional type epithelium that lines the bladder. 9

CONCLUSIONS
TURBT is done in neoplastic lesions more commonly than in non-neoplastic lesions. Most of the non-neoplastic lesions are cystitis cystica and urothelial hyperplasia. A great majority of neoplastic lesions are of urothelial origin. The majority of which are invasive urothelial neoplasm Cystoscopic studies and biopsies help in the early detection of bladder neoplasms and they form the mainstay of the diagnosis and follow up.