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Urology/histopathology report consultation for the mass removed from my father's urinary bladder

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Question
histopathology report
histopathology report  
Patient name: sunil kumar raheja
Age: 54 yrs
Location: Allahabad, Uttar Pradesh, India

Patient got the ultrasound amd CT scan done of the lower abdomen which stated:

Liver: mildly enlarged in size (167.3mm) in mid clavicular line.Moderate diffuse fatty infiltration seen. Intrahepatic biliary radicles are not dilated.No focal lesion present.

Urinary bladder: is normal in outline and distensibility. The walls appear normal. An echogenic polypoidal mass of 16.2*15.8 mm seen in posterior urinary bladder wall. Post void urine vol. = 63cc

Prostate: Mildly enlarged in size 35*39*41 mm= 30.3 gram. Capsule intact.



After getting this report the doctors here advised to undergo surgery amd get the mass removed. We got it removed on 9th April 2014.


I am attatching the histopathology report. Kindly let me know the interpretation of this report. Doctor here has asked to do the vaccination course of BCC for 2 yrs monthly and for cystoscopy check up every 3 months for a yr.

I wanted an assurance from you doctor that nothing is wrong now and my father's reports ae normal.please let me know as soon as possible

Answer
Shruti, all of the test reports were essentially normal except for the lesion in the bladder.  Even fatty infiltration of the liver is usually not a serious condition (although this is really beyond my expertise).  The most important factors in determining the seriousness of a bladder tumor are the grade and stage.  The grade is an interpretation by the pathologist of how angry the tumor cells look.  Grade 1 is almost benign appearing and grade 4 the most malignant.  A grade 2 tumor such as this one is mild to moderately malignant.  The stage of the tumor represents the depth of penetration into the bladder wall.  The lamina propria is a thin strip of tissue that separates the lining epithelium of the bladder (transitional cells) from the muscle.  A tumor that DOES NOT penetrate into the lamina or muscle is much less serious - as is this tumor.  The tumor you describe has a high rate of being cured by the transurethral section alone.  Some urologists prefer to give a course of BCG to further reduce the incidence of recurrence.  Periodic cystoscopy is indicated as these tumors do have a tendency to recur and the earlier they are detected the better.  To follow is some information I have written on bladder tumors to further inform you about this condition.


In the USA, bladder cancer is the 4th most common cancer in men and the 8th highest in females.  The incidence of this neoplasm increases with age and is 2-3 times more common in men than in women.  This cancer originates in the lining of the urinary bladder and accounts for 90% of cancers that occur in the lining the entire urinary tract.  The patient will typically present with the gross passage of blood in the urine or with irritative urinary symptoms.  The diagnosis is generally made by cystoscopic examination of the bladder which shows the typical cauliflower like tumor(s) on a pedicle of varying thickness.  Some tumors may be more solid and broad based.  These tend to be more aggressive and have a worse prognosis.  Although the gross appearance is characteristic, biopsy is needed to confirm the diagnosis and to evaluate the grade and stage of the tumor.  The grade is based on microscopic examination of the cancer cells and varies from one for the least to 4 for the most malignant.  The stage measures the depth of penetration into the balder wall and is classified similarly.  After the diagnosis is established, and depending on the grade and stage, other test may be needed to evaluate the extent of the tumor such as CT or MRI scans of the abdomen and pelvis.  Low grade noninvasive tumor are usually cured by TUR (transurethral resection) of the tumor.  High grade or stage tumors may require more intensive therapy such as radiation, chemotherapy or radical surgical removal of the bladder.  Even low grade tumor have a tendency to recur so life long periodic evaluation is necessary to try and detect recurrences early.  Sometimes, especially in a patient with multiple tumors on presentation or many recurrences, instillation of medication into the bladder is used to try and prevent such episodes.  Some of the agents used for this include BCG, Mitomycin C, Thiotepa, Doxorubicin, Epirubicin, Valrubicin, and interferon alpha 2b.  The latter agent has the added advantage of causing minimal bladder irritation.  Good luck.

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Arthur Goldstein, M.D.

Expertise

Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.

Experience

I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

Organizations
American Medical Association, American Urological Association, American College of Surgeons

Education/Credentials
College degree - BS Medical degree - MD Master of Science - MS

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