Papillary Urothelial Hyperplasia of the Bladder: Relationship to Urothelial Carcinoma
N Readal, JI Epstein. The Johns Hopkins Hospital, Baltimore
Background: Limited studies have been performed on the prognosis of papillary urothelial hyperplasia.
Design: 53 patients with papillary urothelial hyperplasia, which is the largest study to date on this issue, were identified from the files of the senior author.
Results: There were 40M & 13F with ages from 46-101 years (median, 74 years). The two most common reasons for performance of cystoscopy with biopsy was follow-up for a papillary urothelial neoplasm (24 cases) and hematuria (19 cases). The most common cystoscopic findings were papillary tumor (24 cases), papillary irregularity (10 cases), and irregular mucosa (9 cases). Prior to the diagnosis of papillary urothelial hyperplasia, 30 patients had a history of 43 prior neoplasms, 79% of which were low grade papillary urothelial neoplasms. After allowing for a minimum of 6 months of follow-up, 15 patients had 20 subsequent neoplasms, 67% which were low grade. 11/30 (37%) patients with prior urothelial neoplasia subsequently developed bladder tumors compared to 4/23 (17%) without a prior history of bladder neoplasia. The 5 year actuarial risk of subsequently developing urothelial neoplasia was 27.4% and 47.8% for patients without and with a prior history of papillary urothelial hyperplasia, respectively (p=0.18) with a combined risk of 38.6%. All together 35/53 (66%) had a history of prior, concurrent, or subsequent urothelial neoplasia.
Conclusions: Papillary urothelial hyperplasia appears to be a precursor lesion to papillary urothelial neoplasms, especially lower grade lesions. If papillary hyperplasia is diagnosed de novo, it does not mean it will inevitably progress to urothelial neoplasia. However, if papillary hyperplasia is diagnosed in someone with a history of urothelial neoplasia, it most likely indicates the recurrence of papillary neoplasia and warrants continued close follow-up.
Category: Genitourinary (including renal tumors)
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 95, Tuesday Afternoon