bladder tumors

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I- Epidemiology :

Second urological tumor after prostate cancer. More common in men than in women. L & rsquo; median age of onset : 69 years with the & rsquo; man 71 years in women.

Risk factors :

the tobacco : relative risk multiplied by 4.

  • l & rsquo; occupational exposure: 1 bladder cancer 4. products involved : derivatives of hydrocarbons and the & rsquo; aniline, [Trades dyeing, rubber)
  • bilharzia urinaire, represents the squamous cell bladder cancer. This Kc is found in 70 % cases of bladder tumors in Egypt, prevalence of schistosomiasis is 45%.

II- Circumstances of discovery :

  • hematuria [85 % cases): conventionally terminal, painless and intermittent.
  • About 20% patients show signs of & rsquo; bladder irritation (compelling urination, pollakiurie) readily reflecting the presence of CIS,
  • Sometimes, discovery is fortuitous (scan).
  • Events metastases or & rsquo; loco-regional invasion

III- Diagnostic :

  • Diagnosis is based on la cystoscopie : She can see the bladder tumor, d & rsquo; determine its location, d & rsquo; specify morphological characters

L & rsquo; ultrasound : is indicated:
– Faced with a worrying clinic, for the monitoring of patients treated for superficial bladder tumor,
– or for those who refuse cystoscopy. "The objective characteristic picture of vegetation endo-luminal, based & rsquo; pedicle implantation or sessile.

L & rsquo; intravenous urography: UIV :

– in the event of bladder tumor sufficiently large, it shows a gap image with partial parietal rigidity.

Urine cytology (WITH) :
– C & rsquo; is & rsquo; examination of exfoliated cells are eliminated naturally in the & rsquo; patient's urine or collected from a bladder irrigation during a cystoscopy.
– Their study can detect anomalies, which is very useful for diagnosis, monitoring and in particular the detection of recurrence after treatment.
– The CU is useful to the tumores haunted grade and in cases of carcinomas in situ .

IV- WHO classification of bladder tumors :

A- Coming from TUMORS EPITHELIUM VESICAL :

1- Urothelial tumors : 90%

  • They form a whole lesional, may sit at any point of the excréto tract (chalice, pyelon, ureter, bladder, urethra).
  • These tumors have the distinction of being multiple, reoffend in the same place or elsewhere and become in filter.
  • 2 categories :

– non-invasive tumors 2/3 (IV, pTl, ptisi) 70% of recurrence 2 years, 15% progression (pT2) at 2 years , requiring treatment Conservative : iterative resections, instillations endovésicales

– invasive tumors immediately, requiring radical treatment : cystectomie

Macroscopie : 75 % Urothelial tumors are macroscopically papillary tumors on the surface of the bladder mucosa, performing an appearance Cauliflower.

and histological grading of urothelial tumors

1- Carcinomas in situ : c & rsquo; is a flat lesion cancerization intraepithelial : it may be isolated or associated with a more or less papillomatous tumor infiltrating. It is difficult identification cystoscopy but can be detected by urine cytology hence its major interest in this case.

The CEO relies on architectural disorganization, the nuclear atypia cyto( are those high grade) and the existence of visible mitosis throughout the height of the urothelium ( plan, thickened or thinned)

2- The Benin papilloma- papilloma Mostofi : very rare tumor : 1%, about young,, short (< or = 2cm),. Solitaire, Fringed finesjes papillae are lined by urothelium normaL.Absence atypia cyto-nuclear

3- inverted papilloma :

Represented 1 at 2% of bladder tumors, Benin constantly and not recurrent. endoscopy : single polypoid tumor, without vegetation papillary.

Microscopy : urothélium plan, by intussusception mechanism gives rise to cords of tumor cells that develop in the lamina propria, absence of cellular atypia and mitotic.

4- Low potential for malignancy urothelial tumor :

  • Represented 20 at 30% the pTA. Vegetations are more or less thick. Architectural disorganization and abnormal maturation are discrete. The nuclei are slightly enlarged but overall irregular size. Mitosis are exceptional and basal.
  • Evolution: 40 at 60 % of recurrence 5 years and low growth rates ( about 5%).

5- urothelial carcinoma of low grade :

  • This is the most important grade PTA ( 50 %), vegetations are more or less thick, architectural cyto abnormalities are moderate with loss of nuclear polarity, Nuclei are irregular with some little mitosis in the basal layers and medium.
  • Evolution : recurrence rate 5 years ( 50 at 70 %) and growth rate of 5 at 10 %;

6- urothelial carcinoma of high grade :

represents about 20 at 30 % the pTA. C & rsquo; is the very majority Ptl grade tumors and especially pt2 tumors.. les.Végétations more or less thick. The architectural cyto are marked atypia: Loss of cell polarity and nuclear, nuclear overlap, anisocytose, Many anisokaryosis and mitosis.

  • Evolution : recurrence rate 5 years ( 50 at 70 %], high risk of progression to invasive carcinoma ptl ( 15 %].

2- epidermoid carcinoma :

3%, association with schistosomiasis.

Macroscopie : generally invasive tumor.

Microscopy : The tumor is composed of lobules differentiated more or less mature or poorly differentiated.

3- adenocarcinomas :

2%

Macroscopie : invasive tumor.

Microscopy : Adenocarcinoma more or less well-differentiated, various types (Leiberkuhnien, mucosal colloid, independent cells to goblet

B – OTHER TUMORS :

Tumors and malignant connective hénignes, exp : le rhabdomyosarcome, fibroma…etc.

malignant lymphoma, tumeurs neuroendocrines, melanocytic tumors of Müllerian-type etc.… Extension or metastasis & rsquo; a neighborhood tumor

C- Tumors of the urinary upper tract :

You can meet the same type of tumors throughout the urinary tract. The grade and stage of malignancy must also be specified in the report pathologic.

Tumors of upper urinary tract

T Primary tumor

  • Tx Primary tumor can not be assessed
  • Primary tumor T0 Not Found
  • Ta Papillary noninvasive
  • 'Tis carcinoma in situ
  • T1 Tumor invades the lamina propria
  • T2 Tumor invades muscularis
  • T3 Bassinet and chalices : tumor invading beyond the muscular fat peri-renal pelvis or renal parenchyma
  • Ureter : tumor invading beyond the muscular and fat pe ri -urétérale
  • X4 Tumor invades adjacent organs or perirenal fat through the kidney

N Regional lymph nodes

  • Nx not evaluable nodes
  • N0 No regional lymph node metastasis
  • N1 single lymph node metastasis < 2 cm
  • N2 lymph node metastasis single > 2 cm " 5 cm or multiple lymph node metastasis < 5 cm

D- Role of & rsquo; pathologist in bladder tumors :

  • Diagnoses
  • Setting the stage according to the level of & rsquo; extension in the bladder wall. L & rsquo; d & rsquo study; cystectomy piece allows an accurate assessment of the stage.
  • Establish the degree depending on the degree of histological differentiation (architecture, cytology, mitoses,.,,).

Classification OMS 2016 bladder tumors

Classification OMS 2016 bladder tumors

TNM classification of bladder tumors 2010

TNM classification of bladder tumors 2010 (Bladder cancer staging “TNM”)

T Primary tumor

  • Tx Primary tumor can not be assessed
  • Primary tumor T0 Not Found
  • Ta Papillary noninvasive
  • 'Tis carcinoma in situ "plan»
  • T1 Tumor invades the lamina propria
  • T2 Tumor invades muscularis
  • T2a Tumor invades superficial muscle (inner moiety)
  • T2b Tumor invades deep muscle (outer half)
  • T3 Tumor tissue peri-bladder
  • T3a microinvasion
  • T3b bladder Invasion extra macroscopic
  • T4 Tumor peri-vesical structure
  • T4a Prostate, vagina or uterus
  • T4b pelvic or abdominal wall

N Regional lymph nodes

  • Nx not evaluable nodes
  • N0 No regional lymph node metastasis
  • N1 single lymph node metastasis < 2 cm
  • N2 lymph node metastasis single > 2 cm < 5 cm
  • or multiple lymph node metastasis < 5 cm
  • N3 Metastasis(s) ganglionic(s) > 5 cm

Dr K's course. Benabaddou – Faculty of Constantine