Bladder Mucosal Pathological Changes Accompany High Grade and Squamous Cell Bladder Tumors


ABSTRACT:BACKGROUND:Carcinoma of the bladder is the second most common cancer in Iraq. The status of the bladderurothelium other than the principal lesions can provide distinct diagnostic information with regard totreatment response and outcome. Positive mucosal biopsy results are a significant indicator ofintravesical recurrence. Currently, in our urological practice, the importance of performing this step incystoscopy is relatively underestimated.OBJECTIVE:The objective of this study is to carry out a histological assessment of 'extra-tumor' bladder mucosa fordysplasia, and correlate the resulting findings of dysplasia with the grade, the type, and the macroscopicappearance of the tumor.MATERIALS AND METHODS:A total of 350 biopsies were taken by cystoscopy from 68 patients admitted with bladder tumors, eitherby cold-cupped biopsy forceps or resectoscope as part of TUR of the tumor. Normal-looking mucosa ofthe bladder was included in each patient's biopsy in a four quadrant way. All biopsies were examinedby the same histopathologist. All patients were managed according to their presentation, cystoscopicand histopathological findings.RESULTS:Statistical analysis showed that the highest significant difference was obtained in patients with tumorgrade, low against high grade (p<0.005). However, a noticeable difference was found in the other twocomparison groups, namely, the type, transitional against squamous and the macroscopic appearance,papillary against solid (p<0.05).CONCLUSION:The high grade, solid tumors and squamous cell carcinoma are associated with general bladder mucosaldysplastic changes which may exclude the bladder preserving procedures as an option of surgicaltreatment. In Iraq, more extensive studies are necessary to come out with appropriate guidelines for abetter treatment and outcome of bladder carcinoma which is a major health problem.