Urothelial Tumors Research Articles

Immunohistochemical expression of androgen receptors in urothelial carcinoma of urinary bladder. Is it significant? Experience from coastal India.

Bladder carcinoma (BC) ranks second among the genitourinary cancers worldwide. Influence of androgens and expression of androgen receptors in neoplasms are recent findings which were implicated in the development of BC. We aimed to study androgen receptor (AR) expression in bladder urothelial neoplasms and correlate its expression with grade and stage of the tumor. Immunohistochemistry (IHC) was done on samples collected in a tertiary care hospital over one year consisting of 71 urothelial BC and 20 non-neoplastic urothelial conditions. Two pathologists graded the IHC and nuclear staining was considered as positive expression. AR was expressed in 23.9% (17/71) of bladder urothelial neoplasms. AR was expressed in 25.7% and 22.3% of high and low-grade tumors and 25% and 22.3% of non muscle-invasive and muscle-invasive BC. AR expression had no significant correlation with gender, age (> 50 years), muscle invasion or grade. AR expression was significantly absent in non-neoplastic conditions (p = 0.018). AR has varied expression in BC and it is relatively lower in this study population.

Pilot study on quantifying the epithelial/mesenchymal hybrid state in the non-muscle invasive and muscle invasive bladder tumors: A promising marker of diagnosis and prognosis

BackgroundManifestation of epithelial-to-mesenchymal transition (EMT) program in tumor cells is associated with the occurrence of multiple intermediate phenotypic states namely epithelial (E), mesenchymal (M) and hybrid E/M across the epithelial-mesenchymal spectrum and these states exhibit different invasive properties. Understanding the cellular and molecular mechanisms defining the E/M hybrid state of the cells during bladder tumor development may significantly aid in the identification of novel diagnostic and prognostic markers. Materials and methodsThe present study is taken up to identify hybrid E/M score based on the immunohistochemical localization and surface expressions of epithelial proteins [E-cadherin and Beta-catenin] and mesenchymal marker proteins [N-cadherin and Vimentin] on formalin fixed paraffin embedded tumor sections of the prospective series of 99 non-muscle invasive bladder cancer (NMIBC) and 87 muscle invasive bladder cancer (MIBC) patients. E/M score was then statistically examined with patients’ demographics to assess its potential in the diagnosis and prognosis of UCB patients. ResultsAmong the E (E-cadherinhigh, β-cateninhigh), hybrid E/M (E-cadherinlow, β-cateninlow, N- cadherinhigh and Vimentinhigh) and M (N-cadherinhigh and Vimentinhigh) phenotypes, E/M phenotype was observed to be more prevalent in MIBC compared to E phenotype in NMIBC subtype. The current study reports the statistical association of tumor stage and tumor grade with the hybrid E/M state of urothelial tumor cells across both the subtypes. Hybrid E/M phenotype in MIBC patients was significantly shown to lower the overall survival time period compared to NMIBC patients. This supports the contribution of hybrid E/M state of tumor cells to the.aggressiveness of the disease. ConclusionsCharacterizing the hybrid E/M state instead of all or none phenotype becomes an imperative to understand the dynamics of EMT and MET in the tumor pathophysiology of NMIBC and MIBC subtypes, and could contribute to better patient stratification and therapeutic strategies.

Urothelial Tumor in Transplant Patient with BK Nephropathy

Urothelial Tumor in Transplant Patient with BK Nephropathy

Mesane Paragangliomu: Olgu sunumu

The majority of bladder lesions are papillary and/or flat-appearing urothelial neoplasms. Neoplasms besides urothelial tumors are very rare. Paragangliomas are rare catecholamine-releasing tumors of sympathetic ganglion or chromaffin cell origin. Approximately 10% of paragangliomas occur in the non-adrenal region, of which 10% are seen in the bladder and constitute 0.05% of all bladder tumors. In a 42-year-old female patient, a 50x43 mm solid mass protruding into the lumen on the left anterolateral aspect of the bladder was observed with necrotic center and increased vascularity on the periphery. The specimens of the TUR material obtained from an external center and our hospital were examined by pathology and diagnosed as paraganglioma. Because of its rarity and confusion with urothelial carcinoma, paraganglioma should always be kept in mind when dealing with bladder tumors.

Papillary Urothelial Neoplasm With Low Malignancy Potential in Adolescence

Bladder urothelial neoplasms are very rare in people in the first two decades of life. We presented our experience in the diagnosis and treatment of a fourteen-year-old adolescent girl with a tumor process on the urinary bladder.

Spectrum of Lesions in the Urinary Bladder: A Histopathological Study in a Tertiary Level Hospital

Background: Urinary Bladder cancer is the 7th most common cancer worldwide, with an estimated 260,000 new cases occurring each year in men and 76,000 in women. 90% of the bladder tumors are of urothelial origin. Cystoscopic examination has a limited role in staging process for which transurethral resection (TURBT) of visible tumor down to the base is required which can accurately assess depth of tumor invasion. Aim & Objectives: The aim is to study the spectrum of urinary bladder lesions according to World Health Organization / International Society of Urological Pathology consensus classification and to determine age and sex distribution of urothelial tumors. Material & Method: Study included 55 TURBT specimens, conducted over a period 12 months, extending from January 2022 to December 2022. Hematoxylin & Eosin (H&E) stained sections were examined for morphologic diagnosis of urothelial lesions. Results: In our study, there was male preponderance with ratio of 3.2:1. Among 55 cases studied, 34.55% cases were diagnosed as invasive urothelial carcinoma, 27.27% cases were of non-invasive urothelial carcinoma, 16.36% cases were of benign urothelial neoplasm and 16.36% cases were of non-neoplastic lesions in urinary bladder. There were also 1.82% cases of adenocarcinoma, metastasis and non-diagnostic each in our study. Amongst invasive carcinoma high grade were encountered most (30.91%) cases. Maximum numbers of urothelial neoplasms (25.45%) were seen in 71-80 years of age group. Conclusion: This study revealed that neoplastic lesions are more common than non-neoplastic lesions. Urothelial tumors are seen commonly in seventh decade with overall male predominance. Also this study, documents a high frequency of invasive than non-invasive type of urothelial neoplasm.

FREQUENCY OF UROLOGICAL CARCINOMA IN PATIENTS PRESENTING WITH GROSS HAEMATURIA

Gross haematuria is one of the most prevalent urological conditions with a high risk of morbidity and death. Numerous studies showed that people with gross haematuria had a greater chance of acquiring urological carcinomas and those with gross haematuria had a high incidence of malignant cells. The current study was carried out to determine the frequency of urological carcinoma amongst patients presenting with gross haematuria. The current study was cross-sectional, done at the Urology Department Khalifa Gul Nawaz Teaching Hospital for six months from January 2023 to June 2023. In the current study, 170 patients were enrolled. Age, gender, place of residence, and socioeconomic level were all noted for patients. All the collected data was analyzed by using 23 version of SPSS. A total of 170 patients were enrolled in the current study. The male participants were 128 (75.29%) and female patients were 42 (24.71%. Most of the patients 82 (48.23%), were 40-50 years old. The frequency of urological carcinomas was observed in 29 (17.06%). According to the findings of our investigation, urological carcinoma is a common problem. The most prevalent causes of gross haematuria were urinary tract infections and trauma. Since urothelial tumors may be efficiently handled with a better long-term result if found early, general practitioners should order an ultrasound scan for individuals presenting with gross haematuria.

Initial experience with the graphical user interface for laser parameters setting of a new thulium fibre laser source device for urinary pathologies treatment.

We aimed to evaluate the concordance between the pre-settings ranges of thulium fibre laser (TFL) (Coloplast TFL Drive, Denmark) with easy-to-use graphical user interface and the laser settings used by a high-volume endo-urologist during surgical procedures. In October 2022, we prospectively collected data of 67 patients who underwent TFL Drive (Coloplast, Denmark) for the management of urinary stones. Urothelial tumour (upper tract urinary cancer (UTUC) and bladder) 200 and 150μm laser fibres were used for procedures. Stones characteristics (size and density) tumours and stenosis localizations, laser-on time (LOT), and laser settings were recorded. We also assessed the ablation speed (mm3/s), laser power (W), and Joules/mm3 values for each lithotripsy. A total 67 patients took part in the study. Median age was 52 (15-81)years. 55 (82%), 8 (12%), and 4 (6%) patients presented urinary stones, urothelial tumour, and stenosis, respectively. Median stone volume was 438 (36-6027)mm3 and median density was 988 (376-2000) HU. Median pulse energy was 0.6 (0.3-1.2), 0.8 (0.5-1) and 1J for urinary stones, urothelial tumour and stenosis respectably. Endoscopically stone-free rate was 89%. Graphical user interface and surgeon accordance with the safety range were observed in 93.2%, 100% and 100% for urinary stones, UTUC and stenosis, respectively. During endoscopic procedures for urinary stones treatment, it is frequently needed to change laser parameters. These new TFL and GUI technology parameters remained in the pre-set security range in 94.1% of procedures.

Amide Proton Transfer-Weighted MRI and Diffusion-Weighted Imaging in Bladder Cancer: A Complementary Tool to the VI-RADS

To investigate the feasibility of amide proton transfer-weighted (APTw) and diffusion-weighted Magnetic Resonance Imaging (MRI) as a means by which to add value to the Vesical Imaging Reporting and Data System (VI-RADS) for discriminating muscle invasive bladder cancer (MIBC) from nonmuscle invasive bladder cancer (NMIBC). This prospective study enrolled participants with pathologically confirmed bladder cancer (BCa) who underwent preoperative multiparametric MRI, including APTw and diffusion-weighted MRI, from July 2020 to January 2023. The exclusion criteria were lesions smaller than 10mm, missing smooth muscle layer in the operation specimen, neoadjuvant therapy before MRI, inadequate image quality, and malignancy other than urothelial neoplasm. Two radiologists independently assigned the VI-RADS score for each participant. Quantitative parameters derived from APTw and diffusion-weighted MRI were obtained by another two radiologists. Receiver operating characteristic (ROC) curve analysis with the area under the ROC curve (AUC) was performed to evaluate the diagnostic performances of quantitative parameters for discriminating BCa detrusor muscle invasion status. A total of 106 participants were enrolled (mean age, 64 ± 12 years [SD]; 90 men): 32 with MIBC and 74 with NMIBC. Lower apparent diffusion coefficient (ADC)values (0.88×10-3 mm2/s±0.12 vs. 1.08×10-3 mm2/s±0.25; P<0.001) and higher APTw values (6.89% [interquartile range {IQR}, 5.05%-12.17%] vs. 3.61% [IQR, 2.23%-6.83%]; P<0.001) were observed in the MIBC group. Compared to VI-RADS alone, both APTw (P=0.003) and ADC (P=0.020) values could improve the diagnostic performance of VI-RADS in differentiating MIBC from NMIBC. The combination of the three yielded the highest diagnostic performance (AUC, 0.93; 95% CI:0.87,0.97) for evaluating muscle invasion status. The addition of the APTw values to the combination of VI-RADS and ADC values notably improved the diagnostic performance for differentiating NMIBC from MIBC (VI-RADS+ADC vs. VI-RADS+APTw+ADC, P=0.046). MRI parameters derived from APTw and diffusion-weighted MRI can be used to accurately assess muscle invasion status in BCa and provide additional value to VI-RADS.

Novel Use of Circulating Tumor DNA to Identify Muscle-invasive and Non–organ-confined Upper Tract Urothelial Carcinoma

BackgroundOptimal patient selection for neoadjuvant chemotherapy prior to surgical extirpation is limited by the inaccuracy of contemporary clinical staging methods in high-risk upper tract urothelial carcinoma (UTUC). ObjectiveTo investigate whether the detection of plasma circulating tumor DNA (ctDNA) can predict muscle-invasive (MI) and non–organ-confined (NOC) UTUC. Design, setting, and participantsPlasma cell-free DNA was prospectively collected from chemotherapy-naïve, high-risk UTUC patients undergoing surgical extirpation and sequenced using a 152-gene panel and low-pass whole-genome sequencing. Outcome measurements and statistical analysisTo test for concordance, whole-exome sequencing was performed on matching tumor samples. The performance of ctDNA for predicting MI/NOC UTUC was summarized using the area under a receiver-operating curve, and a variant count threshold for predicting MI/NOC disease was determined by maximizing Youden’s J statistic. Kaplan-Meier methods estimated survival, and Mantel-Cox log-rank testing assessed the association between preoperative ctDNA positivity and clinical outcomes. Results and limitationsOf 30 patients enrolled prospectively, 14 were found to have MI/NOC UTUC. At least one ctDNA variant was detected from 21/30 (70%) patients, with 52% concordance with matching tumor samples. Detection of at least two panel-based molecular alterations yielded 71% sensitivity at 94% specificity to predict MI/NOC UTUC. Imposing this threshold in combination with a plasma copy number burden score of >6.5 increased sensitivity to 79% at 94% specificity. Furthermore, the presence of ctDNA was strongly prognostic for progression-free survival (PFS; 1-yr PFS 69% vs 100%, p < 0.001) and cancer-specific survival (CSS; 1-yr CSS 56% vs 100%, p = 0.016). ConclusionsThe detection of plasma ctDNA prior to extirpative surgery was highly predictive of MI/NOC UTUC and strongly prognostic of PFS and CSS. Preoperative ctDNA demonstrates promise as a biomarker for selecting patients to undergo neoadjuvant chemotherapy prior to nephroureterectomy. Patient summaryHere, we show that DNA from upper tract urothelial tumors can be detected in the blood prior to surgical removal of the kidney or ureter. This circulating tumor DNA can be used to predict that upper tract urothelial carcinoma is invasive into the muscular lining of the urinary tract and may help identify those patients who could benefit from chemotherapy prior to surgery.

Loss of Upk1a and Upk1b expression is linked to stage progression in urothelial carcinoma of the bladder

BackgroundUroplakin-1a (Upk1a) and uroplakin-1b (Upk1b) have recently been identified as diagnostic markers for the distinction of urothelial carcinomas from other solid tumor entities. Both proteins play an important role in the stabilization and strengthening of epithelial cells that line the bladder.MethodsTo evaluate the prognostic role of uroplakin expression in urothelial carcinomas, more than 2700 urothelial neoplasms were analyzed in a tissue microarray format by immunohistochemistry. To further assess the diagnostic role of uroplakin immunohistochemistry, results were compared with preexisting GATA3 data.ResultThe fraction of Upk1a/Upk1b positive cases decreased slightly from pTaG2 low-grade (88% positive for Upk1a/87% positive for Upk1b) and pTaG2 high-grade (92%/89%) to pTaG3 (83%/88%; p > 0.05) and was lower in muscle-invasive (pT2-4) carcinomas (42%/64%; p < 0.0001/p < 0.0001 for pTa vs. pT2-4). Within pT2-4 carcinomas, high expression of Upk1a and Upk1b was linked to nodal metastasis and lymphatic vessel infiltration (p < 0.05) but unrelated to patient outcome. There were significant associations between Upk1a, Upk1b and GATA3 immunostaining (p < 0.0001 each), but 11% of GATA3 negative cancers were Upk1a/b positive and 8% of Upk1a/b negative cancers were GATA3 positive. Absence of GATA3/Upk1a/b staining was significantly linked to poor patient survival in the subgroup of 126 pT4 carcinomas (p = 0.0004) but not in pT2 and pT3 cancers.ConclusionsIn summary, the results of our study demonstrate that Upk1a and/or Upk1b immunohistochemistry can complement GATA3 for the distinction of urothelial carcinomas. Furthermore, a progressive loss of Upk1a/b expression during stage progression and a prognostic role of the combination GATA3/Upk1a/Upk1b in pT4 carcinomas is evident.

Benign urinary bladder masses: rare entities

BackgroundThis study aimed to present the characteristics and outcomes of benign urinary bladder masses, as well as the characteristics of the patients diagnosed with such lesions.MethodsA single-center, cross-sectional, retrospective study was conducted. The study involved patients who underwent transurethral resection of the primary bladder tumor over a four-year period (May 2017–2021) and were subsequently diagnosed with a benign bladder lesion.ResultsOut of 478 patients who underwent transurethral resection of the primary bladder tumor, 26 (5.4%) were diagnosed with a benign bladder lesion. The most common benign bladder lesion was urothelial papilloma (50%, 13 patients). The majority of patients with urothelial papilloma were men (76.9%) and had a history of smoking (61.5%). The mean age was 62 years. Most were diagnosed accidentally (69.2%), while others presented with hematuria (23.1%) or dysuria (7.7%). Most urothelial papillomas had a macroscopic polypoid appearance (61.5%), and most of them were solitary (84.6%), with a mean size amounting to 1 cm. Only one patient experienced a recurrence and developed papillary urothelial neoplasm of low malignant potential (PUNLMP). Cystitis cystica/glandularis and polypoid cystitis were the second most commonly diagnosed benign bladder lesion, each identified in 3 patients. Singular cases of leiomyoma, inflammatory myofibroblastic tumor, chondroma, paraganglioma, villous adenoma, eosinophilic cystitis (pseudotumor), and ectopic prostatic tissue are described.ConclusionBenign bladder lesions constitute a group of various rare entities that can clinically and radiologically mimic urothelial carcinoma, but mostly show a good prognosis and a low incidence of recurrence.

Efficacy and Safety of Thymoquinone on Suppression of Tumor Growth in N-butyl-N-(4-hydroxybutyl)-Nitrosamine -Induced Bladder Cancer in Rats

Bladder cancer is one of the most common genitourinary malignancies worldwide, the therapeutic approaches for suppression of urothelial tumor and progression toward distant metastasis are not convincing. The present study was conducted to explore the curative effect and safety of THQ in N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) induced bladder cancer in rat.&#x0D; Twenty-two male Wister albino rats were allocated into three group G1; served as control (n=6) received only the vehicle. G2: carcinogen group (n=6); animals had 0.05% BBN in drinking water for nine weeks. G3: Treatment group (n=10); THQ was administered at a dose of 50mg/Kg/day orally one week prior to the last exposure of BBN and continued till week 20. The bladder wall of all the animals was examined macroscopically for assessment of the number and the surface area of the lesions using Image J software program. Histopathological evaluation was also done for abnormal morphological alterations. Serum was analyzed for measurement of total oxidant status (TOS) and nuclear factor kappa- κB (NF-κB), transforming growth factor beta-1 (TGF-β1) as well as vascular endothelial growth factor (VEGF). Safety of THQ in respect of hematological, liver and renal function were also investigated. Bladder lesions in the THQ-treated group was reduced versus the carcinogen group. Histopathological findings in THQ-treated group demonstrated a significant improvement in the abnormal morphological growth in bladder, the TOS, NF-kβ, TGF-β, VEGF were mitigated non-significantly in the treatment group. The safety profile of THQ showed no significant deleterious effect on hematological, liver and renal function parameters with no signs of toxicity. THQ inhibited the development of neoplastic, preneoplastic transformations and it suppressed premalignant and malignant lesion formation in a rat model of bladder cancer. This might be due to antioxidant and anti-inflammatory properties of THQ. These data suggested that THQ may be effective and safe in ameliorating urinary bladder carcinogenesis.

Bladder Neoplasia in Pediatric Patients-A Single-Center Experience Including a Case Series.

Objective: Bladder lesions like urothelial carcinoma are rare in the first two decades of life. A biopsy of the bladder or urinary cytological examination is seldom required. Gross painless hematuria is the most relevant clinical syndrome. Methods: A retrospective analysis of surgical pathology records collected between 1984 and 2014 at our institution was performed in a search for cases of urothelial neoplasms originating within the urinary bladder in pediatric patients. Diagnoses were confirmed based on pathologic examination using the 2004 World Health Organization (WHO) classification system. We selected keywords such as bladder neoplasia, bladder lesion, urothelial neoplasia, rhabdomyosarcoma, and children. In addition, we describe clinical presentation and diagnostic procedures as well as treatment and follow-up of two patients. A review of the literature was performed to analyze recommendations concerning diagnostic staging, treatment, and follow-up examinations as well as surveillance of urothelial tumors in the pediatric population. Results: Screening the pathology database of the Institute of Medical Genetics and Pathology of the University Hospital Basel between 1988 and 2014 yielded 287 samples involving the urinary bladder, 110 autopsies, 135 biopsies, and 42 cytology specimens. Of these, most samples originated from malformations and inflammation. Only five were tumors: two were urothelial tumors and three were rhabdomyosarcomas. The majority of specimens comprised resections of the diverticula or distal ureter. Our case reports include two patients with a urothelial tumor. Among the urothelial tumors, one was a papillary urothelial neoplasm of low malignant potential (PUNLMP). Painless hematuria was the directing clinical symptom. The tumor was investigated by FISH, and a 9p21 deletion was found. The second tumor-like lesion was a fibroepithelial polyp arising from the bladder neck. Conclusions: Bladder tumors in children are rare and mostly consist of urothelial and mesenchymal neoplasms. Rhabdomyosarcoma is the most common malignant bladder tumor in childhood. Similar to adult urothelial neoplasms, the loss of 9p21 is also implicated in urothelial neoplasms in childhood. Despite an increasing number of case reports and small series published within the last 2 decades, general treatment protocols including recommendations for staging, tumor markers, and follow-up examinations are still not yet available for this tumor entity in the pediatric population.

Elucidating the Associated Biological Function and Clinical Significance of RHOJ Expression in Urothelial Carcinoma.

Urothelial cancer, a common urinary system malignancy, often presents treatment challenges due to metastasis and chemotherapy side effects. Angiogenesis, crucial for tumor growth, has become a target for drug development. This study explores the expression, prognostic value, and clinical correlation of RHOJ in the TCGA BLCA, GSE31684, and GSE32894 datasets. We identify common differentially expressed genes across these databases and utilize g:Profiler and Cytoscape ClueGO for functional assessment. Further, we perform a gene set enrichment analysis (GSEA) using Hallmark gene sets and use the imsig package for immune cell infiltration analysis. Our analysis indicates that RHOJ expression levels significantly impact survival rates, tumor progression, and immune response in urothelial tumors. High RHOJ expression correlated with poor prognosis, advanced disease stages, and an increase in monocyte population within the tumor microenvironment. This aligns with current literature indicating a key role of immune infiltration in bladder cancer progression and treatment response. Moreover, the GSEA and imsig results further suggest a potential mechanistic link between RHOJ expression and immune-related pathways. Considering the increasing emphasis on immunotherapeutic strategies in bladder cancer management, our findings on RHOJ's potential as a diagnostic biomarker and its association with immune response open new avenues for therapeutic interventions.

Use of formaldehyde to increase result quality in urinary cytology

Cytology is often used in screening programs for individuals at high risk of certain diseases, such as urothelial (bladder) tumors and prostate cancer. High-risk individuals may include those with a family history of cancer or other risk factors. While cytology is less commonly used for prostate cancer screening compared to other methods like prostate-speci􀂿c antigen (PSA) testing, it can still be employed in certain cases to detect abnormal prostate cells. Specimen collection, often through urine or brushing of specific surfaces, doesn’t typically require special preparation or invasive procedures, reducing the need for prolonged hospitalization. Our study aimed to optimize the long-term preservation of urine samples for cytopathological diagnosis by using 10% formaldehyde, ensuring high-quality smear preparation, and assessing the effectiveness of Papanicolaou staining. These objectives are essential for advancing the field of cytopathology and improving the accuracy of diagnostic procedures.

High grade urothelial carcinoma in kidney transplant patients with a history of BK viremia - Just a coincidence?

Kidney transplant recipients (KTR) have a three-to-four-fold increased risk of developing urothelial carcinoma (UC) compared to the general population. BK polyoma virus (BKV) infection is known to affect approximately 15% of KTR. In vitro models support a potential pathogenic role for BKV in the development of UC. We describe a series of UC in kidney transplant recipients. Electronic patient records were searched to identify KTR with UC who had undergone kidney only or simultaneous kidney and pancreas transplantation in a single UK center between 2009 and 2015. Where available, stored pathological samples were retrieved, re-examined and stained for SV40 as a marker of BKV using standard staining protocols for kidney biopsy samples. Fourteen KTR had developed UC post-transplant. Of these, 10 KTR had a history of BKV infection post-transplant. Six of these 10 KTR developed a rare micropapillary tumor subtype of UC which is typically only found in <1% of UC cases. All six micropapillary tumor samples stained positive for SV40, including samples from metastases. Three tumor samples were available from the four KTR with no history of BKV infection and were not micropapillary subtype and were negative for SV40. Three micropapillary tumors from immunocompetent patients were examined as controls and were negative for SV40. These findings would support a pathogenic role for BK virus in the development of rare micropapillary subtype urothelial tumors in the kidney transplant population.

Tumor-associated thrombosis

The evidence available today from randomized controlled trials shows that for many patients with CAT, direct FXa-inhibitors are a safer and potentially more effective therapy than long-term treatment with Low Molecular Weight Heparin (LMWH), which has been the gold standard. Oral therapy should be used with caution, particularly in the case of gastrointestinal or urothelial tumors, especially if the tumor is still in situ. Even with LMWH there is an increased risk of bleeding. Although no randomized studies are available yet, for selected stable patients, a dose reduction for secondary prophylaxis after 6 months can represent an alternative with a relatively low risk of bleeding - an individual benefit-risk assessment is essential. Incidental VTE are anticoagulated according to the guidelines according to the standard. A less intensive AK may be justifiable in individual cases.

Bladder Lesions in Cystoscopic Bladder Biopsies-A Clinicopathological Study

Introduction: In urinary bladder lesions, the clinical presentation is quite variable, the nonneoplastic lesions can mimic neoplastic and vice-versa bothering both clinicians and patients. The present study aims to study the clinic-pathological and histological features of various lesions of the urinary bladder in the specimens received through cystoscopic biopsy or transurethral resection.&#x0D; Objectives: The objectives of this study were to study the clinicopathological features of various bladder lesions and their frequencies and to correlate the clinical diagnosis with histological diagnosis.&#x0D; Methodology: The study was a descriptive cross-sectional involving patients with urinary bladder lesions requiring cystoscopic biopsy or transurethral resection conducted in the Department of Pathology of BP Koirala Institute of Health Sciences, Dharan over a period of one year (November 2016 to October 2017) .&#x0D; Results: Among 40 patients, mean age was 56.40 years and male and female ratio was 1.5:1. The mean duration of symptoms was 3.49 months. The most common presenting feature for both neoplastic and non-neoplastic was 75%, but hematuria was (86.36%) presenting feature in neoplastic cases and dysuria (88.88%) in non-neoplastic with each group accounting 55% and 45% respectively. Urothelial carcinoma (86.36%) was the commonest neoplastic lesion while cystitis (72.22%) was the commonest non-neoplastic lesion. NMIBC was the predominant lesion (78.95%) in urothelial tumor. Grading showed low grade (63.15%) and high grade (36.85%) respectively. The correlation analysis between clinical diagnosis and histological diagnosis revealed perfect correlation for non-neoplastic lesions and strong correlation for neoplastic lesions having highly significant result (p&lt;0.001)&#x0D; Conclusion: Urinary bladder is a common site of diverse lesions; with neoplastic being more common. Urothelial carcinoma was the most common type of neoplastic lesion and cystitis was the most common type of non-neoplastic lesion. Non-neoplastic lesions can mimic neoplastic lesions clinically. Histological diagnosis differs significantly from the clinical diagnosis indicating the importance of histological diagnosis in planning treatment.

Diagnosis of Low-Grade Urothelial Neoplasm in the Era of the Second Edition of the Paris System for Reporting Urinary Cytology.

The Paris System for Reporting Urinary Cytology (TPS) is considered the gold standard when it comes to diagnostic classifications of urine specimens. Its second edition brought some important changes, including the abolition of the diagnostic category of "low-grade urothelial neoplasm (LGUN)", acknowledging the inability of cytology to reliably discern low-grade urothelial lesions. In this retrospective study, we assessed the validity of this change, studying the cytological diagnoses of histologically diagnosed low-grade urothelial carcinomas during a three-year period. Moreover, we correlated the sum of the urinary cytology diagnoses of this period with the histological diagnoses, whenever available. Although all the cytological diagnoses of LGUN were concordant with the histological diagnoses, most low-grade urothelial carcinomas were misdiagnosed cytologically. Subsequently, the positive predictive value (PPV) of urinary cytology for the diagnosis of LGUN was 100%, while the sensitivity was only 21.7%. Following the cyto-histopathological correlation of the sum of the urinary cytology cases, the sensitivity of urinary cytology for the diagnosis of high-grade urothelial carcinoma (HGUC) was demonstrated to be 90.1%, the specificity 70.8%, the positive predictive value (PPV) 60.3%, the negative predictive value (NPV) 93.6% and the overall accuracy 77.2%, while for LGUN, the values were 21.7%, 97.2%, 87.5%, 58.6% and 61.9%, respectively. Risk of high-grade malignancy was 0% for the non-diagnostic (ND), 4.8% for the non-high-grade urothelial carcinoma (NHGUC), 33.3% for the atypical urothelial cells (AUCs), 65% for the suspicious for high-grade urothelial carcinoma (SHGUC), 100% for the HGUC and 12.5% for the LGUN diagnostic categories. This study validates the incorporation of the LGUN in the NHGUC diagnostic category in the second edition of TPS. Moreover, it proves the ability of urinary cytology to safely diagnose HGUC and stresses the pivotal role of its diagnosis.