Clinicopathological importance of primary dysplasia of bladder.

Abstract

LondonSUMMARY A retrospective study of 15 patients with primary dysplasia of bladder urothelium was performed in an attempt to clarify some of the clinical and histopathological features. The lesion occurs predominantly in middle aged men who present with irritative bladder symptoms with or without haematuria and show no evidence of bacteriological urinary tract infection. Appearances at cystoscopy are non-specific. Thirteen patients showed no progression to carcinoma in situ after a long period of follow up, but primary dysplasia cannot be regarded as an entirely innocuous condition as the remaining two patients did develop carcinoma in situ. The grade of dysplasia on presentation bears no relation to the final outcome. Regular cytological analysis of urine seems to be the best means of follow up, and more active treatment does not seem to be justified.Over the past 30 years, following early work by Melicow and Hollowel in 1952' and Melamed, Voutsa, and Grabstald in 1962,2 interest in bladder carcinoma has focused on the early stages of tumour development. These stages included dysplasia (or "atypical hyperplasia")3 and transitional cell carcinoma in situ (CIS). Experimental studies on animals suggest that bladder cancers usually grow slowly through several stages of increasing dysplasia to invasive tumours.4In patients with overt bladder cancer or patients undergoing follow up of previously treated transitional cell carcinoma a complete search of the bladder mucosa often shows that macroscopically normal epithelium is histologically abnormal, with changes varying from minor degrees of dysplasia to CIS" This concomitant or secondary dysplasia or CIS is much more common than that found in the absence of exophytic bladder cancer-that is, primary dysplasia and primary CIS.Little is known about the clinical presentation, natural history, or incidence of primary dysplasia of the bladder. We performed a retrospective study on patients with this condition in an attempt to assess the features of primary vesical urothelial dysplasia.Accepted for publication 23 June 1988 Material and methods Cases ofbladder urothelial dysplasia were found in the files of our pathology and urology departments. Forty cases of dysplasia were identified. From this group 25 cases were excluded because the histological features were not those of dysplasia, or the patient had confirmed bladder carcinoma.Multiple mucosal biopsy specimens had been taken on each of the remaining 15 cases, the histology of which was reviewed by three pathologists without knowledge ofthe clinical history. Histological features were graded according to the criteria used by Nagy, Frable, and Murphy9: (a) Mandatory features degree of change of urothelial polarisation; presence or absence of superficial cells; variation in nuclear size; presence of nuclear crowding; degree of nuclear irregularity; chromatin structure.

Targeted imaging of urothelium carcinoma in human bladders by an ICG pHLIP peptide ex vivo

“…Urothelial dysplasia is an incidental microscopic finding where urothelial cells show mild atypical features short of the diagnosis of carcinoma in situ. It is considered a precancerous process, and studies have shown that up to 19% of urothelial dysplasia cases develop urothelial carcinoma (22)(23)(24). Although precancerous, it is recommended that patients with dysplasia receive proper clinical follow-up for early detection of an imminent carcinoma.…”

Flat intraepithelial lesions of the urinary bladder

“…In this study, we found that patients diagnosed with urothelial atypia of unknown significance or reactive atypia do not have adverse clinical outcomes, whereas patients with urothelial dysplasia of the bladder have increased risk for the development of carcinoma in situ and urothelial carcinoma (Table 3). 2,3,5,6 Based on these findings, we recommend that the diagnostic category "atypia of unknown significance" be eliminated in the next future classification (Table 4). Fewer diagnostic "bins" should decrease interobserver variability without, in this case, compressing significant clinically useful information.…”

“…Recognition of lesions that are precursors of bladder carcinoma, especially in bladder biopsy specimens, is of paramount importance. 2,3,5,6 However, the lack of uniformity in the diagnostic criteria and nomenclature has made it difficult to compare results among different institutions. Several classification systems for flat intraepithelial lesions of the urinary bladder have been proposed (Table 4).…”

Fluorescence diagnosis and flat lesions of urothelium: New challenges for pathologists and urologists (Review)

“…Aberrant CK20 expression in basal urothelial cells plus overexpression of p53 and Ki-67 and loss of CD44 expression might be helpful (21)(22)(23). Several studies have demonstrated increasing incidence if associated with Cis or papillary carcinoma, but we lack recent studies concerning prognosis of isolated lesions (1,24). One reason for the lack of data might be the problem of reproducibility in grading dysplasia (12,13,25,26).…”