Bladder Mucosal Pathological Changes Accompany High Grade and Squamous Cell Bladder Tumors
Iraqi Postgraduate Medical Journal,
2010, Volume 9, Issue 4, Pages 536-541
Carcinoma of the bladder is the second most common cancer in Iraq. The status of the bladder
urothelium other than the principal lesions can provide distinct diagnostic information with regard to
treatment response and outcome. Positive mucosal biopsy results are a significant indicator of
intravesical recurrence. Currently, in our urological practice, the importance of performing this step in
cystoscopy is relatively underestimated.
The objective of this study is to carry out a histological assessment of 'extra-tumor' bladder mucosa for
dysplasia, and correlate the resulting findings of dysplasia with the grade, the type, and the macroscopic
appearance of the tumor.
MATERIALS AND METHODS:
A total of 350 biopsies were taken by cystoscopy from 68 patients admitted with bladder tumors, either
by cold-cupped biopsy forceps or resectoscope as part of TUR of the tumor. Normal-looking mucosa of
the bladder was included in each patient's biopsy in a four quadrant way. All biopsies were examined
by the same histopathologist. All patients were managed according to their presentation, cystoscopic
and histopathological findings.
Statistical analysis showed that the highest significant difference was obtained in patients with tumor
grade, low against high grade (p<0.005). However, a noticeable difference was found in the other two
comparison groups, namely, the type, transitional against squamous and the macroscopic appearance,
papillary against solid (p<0.05).
The high grade, solid tumors and squamous cell carcinoma are associated with general bladder mucosal
dysplastic changes which may exclude the bladder preserving procedures as an option of surgical
treatment. In Iraq, more extensive studies are necessary to come out with appropriate guidelines for a
better treatment and outcome of bladder carcinoma which is a major health problem.
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