Spectrum of pathological lesions in cystoscopic bladder biopsies: a clinicopathologic study

ABSTRACT

To determine the clinicopathologic characteristics and frequencies of different pathological lesions in cystoscopic bladder biopsies in patients with bladder diseases. Design: A single- institution based retrospective observational study. Place and Duration of Study The study was conducted in the Department of Histopathology, Sindh Institute of Urology and Transplantation [SIUT], Karachi over a period of five years [December, 1996 to December, 2001]. Subjects and All patients, who presented to the urology clinic of SIUT between December 1996 and December 2001 with haematuria, dysuria, urgency and frequency and in whom a cystoscopy and bladder biopsy were performed to elucidate the nature of underlying pathology, were included in this study. A total of 784 patients were studied. Clinical and demographic data and pathological diagnoses were retrieved from the original surgical biopsy reports. Bladder biopsies were received in 10% buffered formalin, gross examination done and processed for paraffin embedding. Histologic sections were stained routinely with Hematoxylin and Eosin, PAS and PAS with diastase. Sections were examined under the light microscope to document the pathologic diagnosis. Of the total 784 patients, 577[73.6%] were males and 207 [26.4%] were females with an overall male to female ratio of 2.81. Age range was wide [4 to 86 years]. The spectrum of pathological lesions included tumours 497 cases [63.7%], followed by acute and chronic non-specific inflammation 86[11%], cystitis cystica and glandularis 40 [5%], Tuberculosis 17[2.16%], squamous metaplasia 13[1.65%] and a number of other rare lesions. Among the tumours, transitional cell tumours [TCC] were most common [95.3%]. Tumours were more common in males than in females [male to female ratio 5.31] and peaked in 4th through 7th decades. Pathologic staging was possible in 89.7% of the cases. A majority of these cases [62%] presented with superficial disease, while in 38% the disease was muscle-invasive when first diagnosed. Grading was possible in all except two cases, which contained only necrotic tissue. A vast preponderance of tumours [74.5%] were well-differentiated, while 25.5% belonged to poorly-differentiated category [Grade 3 and 4]. In a significant number of biopsies 105 cases [13.4%], no significant pathology was noted. TCC is the most common lesion in cystoscopic bladder biopsies