Kundlia Aakriti, Dharwadkar Arpana, Gore Charusheela, Viswanathan Vidya, Ingale Yaminy
Pathology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pune, Pune, IND.
Cureus. 2024 Jul 15;16(7):e64557. doi: 10.7759/cureus.64557. eCollection 2024 Jul.
Introduction Urinary bladder lesions encompass a wide spectrum, from benign inflammatory conditions to malignant neoplasms, presenting diagnostic and therapeutic challenges. Urothelial carcinoma predominates among bladder malignancies, exhibiting diverse clinical presentations and prognoses. Objective This study aimed to delineate the histopathological spectrum of urinary bladder lesions and correlate demographic profiles, clinical features, and cystoscopic findings with various bladder lesions. Methods This prospective descriptive observational study spanned 24 months at a tertiary care center, involving 65 cases of urinary bladder biopsies, including transurethral resection of bladder tumors, cystoscopic biopsies, and cystectomy specimens. The histopathological examination followed the WHO 2022 classification of urinary bladder tumors and the American Joint Committee on Cancer eighth edition staging. Clinical data, including age, gender, cystoscopic findings, and presenting symptoms, were correlated with histopathological diagnoses to explore the spectrum of bladder lesions. Results Neoplastic lesions predominated, constituting 92.3% of cases, with urothelial carcinoma comprising 83.33% of these cases. Among neoplastic lesions, invasive high-grade urothelial carcinoma (36.7%) and non-invasive low-grade papillary urothelial neoplasm (20.0%) were the most frequently observed subtypes. Non-neoplastic lesions accounted for 7.7%, including various forms of cystitis. Hematuria was the predominant presenting symptom (81.5%), while cystoscopic examinations revealed that most lesions were situated in the lateral bladder wall. High-grade urothelial carcinomas were mostly associated with muscularis propria invasion. Conclusion This study underscores the critical role of histopathological examination in diagnosing and managing urinary bladder diseases and distinguishing between non-neoplastic and neoplastic lesions. Urothelial carcinoma, prevalent among older age groups, often demonstrated muscle invasion indicative of high-grade tumors. Including the muscle layer in cystoscopic biopsies is crucial for an accurate diagnosis. Conversely, though less common, non-neoplastic conditions encompass various forms of cystitis. These findings highlight the importance of precise diagnostic tools such as cystoscopy and histopathological examination for the early detection and management of bladder neoplasms. Histopathological assessment offers essential prognostic guidance, aids in precise staging and grading, and directs tailored treatment strategies.
引言 膀胱病变范围广泛，从良性炎症性疾病到恶性肿瘤，带来了诊断和治疗方面的挑战。尿路上皮癌在膀胱恶性肿瘤中占主导地位，临床表现和预后多样。目的 本研究旨在描绘膀胱病变的组织病理学谱，并将人口统计学特征、临床特征和膀胱镜检查结果与各种膀胱病变相关联。方法 这项前瞻性描述性观察性研究在一家三级医疗中心开展，为期24个月，纳入65例膀胱活检病例，包括经尿道膀胱肿瘤切除术、膀胱镜活检和膀胱切除标本。组织病理学检查遵循世界卫生组织2022年膀胱肿瘤分类和美国癌症联合委员会第八版分期标准。将年龄、性别、膀胱镜检查结果和主要症状等临床数据与组织病理学诊断相关联，以探索膀胱病变谱。结果 肿瘤性病变占主导，占病例的92.3%，其中尿路上皮癌占这些病例的83.33%。在肿瘤性病变中，浸润性高级别尿路上皮癌（36.7%）和非浸润性低级别乳头状尿路上皮肿瘤（20.0%）是最常见的亚型。非肿瘤性病变占7.7%，包括各种形式的膀胱炎。血尿是主要的首发症状（81.5%），而膀胱镜检查显示大多数病变位于膀胱侧壁。高级别尿路上皮癌大多与肌层浸润相关。结论 本研究强调了组织病理学检查在膀胱疾病诊断和管理以及区分非肿瘤性和肿瘤性病变方面的关键作用。尿路上皮癌在老年人群中普遍存在，常表现出肌层浸润，提示为高级别肿瘤。在膀胱镜活检中包括肌层对于准确诊断至关重要。相反，虽然不太常见，但非肿瘤性疾病包括各种形式的膀胱炎。这些发现凸显了膀胱镜检查和组织病理学检查等精确诊断工具对于膀胱肿瘤早期检测和管理的重要性。组织病理学评估提供重要的预后指导，有助于精确分期和分级，并指导制定个性化的治疗策略。
