We recommend the biopsy of all RPs found during endoscopic surveillance of patients with intermediate-/high-risk bladder cancer due to the significant incidence of malignant recurrence identified, particularly if no biopsy has been performed within the previous 12 months. This is independent of previous biopsy histology.
Intestinal metaplasia (IM) of the bladder is an extremely rare benign condition. The clinical features are similar to other bladder tumours. Its pathogenesis is unclear and its role as a precursor of adenocarcinoma has long been debated. Transurethral resection is the main form of treatment for IM. We report the case of a 49-year-old gentleman who presented with visible haematuria. He was submitted to multiple cystoscopies which showed no macroscopic irregularities. Radiological (CT urogram and multiparametric MRI) imaging revealed abnormalities within the bladder neck, suspicious of a neoplastic lesion. Following transurethral resection of his trigonal area, pathology demonstrated IM occurring on a background of cystitis glandularis. This case highlights the unusual difficulty in macroscopically diagnosing IM of the bladder compared to other neoplasms of the bladder. Therefore, in patients with persistent visible haematuria there should be a low threshold to perform biopsies.
Multiparametric magnetic resonance imaging is a more accurate diagnostic test than transrectal ultrasound guided biopsy. However, a significant proportion of ISUP (International Society of Urological Pathology) Grade Group 2 prostate cancer remained undetected following multiparametric magnetic resonance imaging. Although multiparametric magnetic resonance imaging could avoid unnecessary biopsy in many patients with ISUP Grade Group 3 or greater prostate cancer, at less stringent definitions of significant cancer a substantial proportion of prostate cancer would remain undetected after multiparametric magnetic resonance imaging.
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