Histopathological Spectrum of Neoplastic and Non Neoplastic Lesions of Urinary Bladder- A Retrospective Study

Abstract

Introduction: Urinary bladder encompasses a wide variety of lesions, both neoplastic and non neoplastic responsible for significant morbidity and mortality throughout the world. All bladder lesions require biopsy because of their lack of distinctive features. Urinary bladder cancer is the 9th most common cancer worldwide accounting for 6% and 2% of the cancer incidence in men and women, respectively. Aim: To analyse the histopathological spectrum of bladder specimens with neoplastic and non neoplastic lesions, and categorising them according to recent 2016 World Health Organisation (WHO) classification. Materials and Methods: The present study was conducted from January to June 2020 at Subharti Medical College, Meerut, Uttar Pradesh, India. Retrospective data was retrieved from a period of 10 years from January 2010-December 2019. Histopathological analysis of all the urinary bladder biopsies and radical cystectomy/cystoprostectomy specimens received during this period was done on basis of light microscopic examination of Haematoxylin and Eosin (H&E) stained slides. Lesions were categorised into non neoplastic and neoplastic. The neoplastic lesions were classified based on WHO classification 2016 and staging as per 8th edition of American Joint Committee on Cancer (AJCC). Descriptive data analysis was done. Results: Total 252 cases were evaluated. A total of 200 (79%) cases were neoplastic and 52 (21%) cases were diagnosed as non neoplastic with majority of cases being cystitis. Male to female ratio was 7:1. The most common age group was 4th to 7th decade. In neoplastic category, urothelial tumours constituted 194 (97%) cases with Infiltrating Urothelial Carcinoma (IUC) being 118 (60.8%) cases. In non invasive lesions majority 27 (35.6%) cases were Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP) followed by urothelial carcinoma in situ and papillary urothelial neoplasm of low grade. Entities other than urothelial tumours encountered in the present study were primary adenocarcinoma, small cell carcinoma, melanosis and metastasis from prostate. TNM staging showed lamina propria invasion (pT1) in 59 (37%) cases, followed by pT2 tumours invading muscle in 56 (35%) cases. Conclusion: Proper knowledge of histologic characteristics of various bladder lesions is of utmost importance as few benign conditions mimic neoplastic and few serve as preneoplastic conditions, misdiagnosis may cause further any unnecessary treatment procedure. With a multidisciplinary approach, early diagnosis and immediate intervention can have a better survival and provide a more comfortable life to the patient.