Histopathological Changes in Adjacent Non-Tumour Mucosa in Trans Urethral Resection of Bladder Tumour Specimens of Bladder Carcinoma

Abstract

BACKGROUND Urinary bladder cancer is associated with high morbidity and mortality rates if not treated optimally. One of the causes of tumour recurrence is undiscovered residual tumour, and the existence of macroscopically invisible premalignant and malignant lesions of urothelium during the primary resection which can be detected by taking biopsy from apparently normal mucosa in the vicinity of the tumour during trans urethral resection of bladder tumour (TURBT). The primary objective was to estimate the proportion of bladder tumour showing changes in adjacent non tumour mucosa in TURBT specimens, within a period of six months. The secondary objectives were to study the association between changes in non-tumour bladder mucosa with the recurrence, seen after six months, and to study the expression of P53 in adjacent non tumour mucosa of bladder cancer. METHODS All cases of bladder carcinoma from trans urethral resection of bladder tumour which were sent along with adjacent non tumour mucosa and received at Department of Pathology, MCH, Trivandrum, for a period of six months were included in the study. Adjacent mucosa sent along with TURBT specimen received at our department was collected. After processing, tissue is embedded in paraffin blocks and thin sections of 4 - 5 m thickness was taken and stained with haematoxylin and eosin (H & E). Using light microscopy, changes in adjacent mucosa were assessed for any abnormal changes and findings were correlated with collected data. P53 expression was studied in the adjacent mucosa. All details were entered in the proforma. Details collected were entered in Excel and analysed using SPSS software. RESULTS Out of 37 TURBT cases that were sent along with adjacent mucosa, 12 cases showed changes in adjacent mucosa accounting for 32.4 %. P53 positivity accounting for 18.9 %, was seen in abnormal mucosa change with carcinoma in situ and dysplasia. On follow up, 8 % of cases with positive biopsy finding showed recurrence. CONCLUSIONS Multiple biopsies from adjacent non tumour mucosa is not necessary for all patients with superficial bladder tumour. Positive findings in adjacent mucosa does not have significant correlation with tumour stage / grade, and tumour size, number of lesions or histopathological findings. Adjacent mucosa may be useful in detecting concomitant carcinoma in situ (CIS), which can be helpful in therapeutic approach. KEY WORDS Normal Looking Mucosa, TURBT, Bladder Cancer