Isolated Secondary Urothelial Dysplasia of the Bladder, a Clinicopathologic Characterization
Jing-Jing Yang, Edward Diaz, Donna Hansel. Cleveland Clinic, Cleveland, OH
Background: Isolated secondary urothelial dysplasia is a poorly characterized entity, with no consensus on its progression rate and clincial management. Very little data is published on secondary urothelial dysplasia, with most not differentiating between concurrent secondary dysplasia (dysplasia with concomitant recurrent urothelial carcinoma) versus isolated secondary dysplasia (dysplasia as a sole finding on surveillance biopsy/TUR, in patients with established urothelial carcinoma diagnosis. Concurrent secondary dysplasia, by definition, is 100% progression, and thus should not be included in a secondary progression rate study. This explains the current wide variation in progression rate in published data, from 30 – 100%.
Design: The pathologic and clinical database of our institution was queried for specimens with a diagnosis of isolated secondary dysplasia of the bladder from 1995 to 2007. Isolated secondary urothelial dysplasia was defined as sole diagnosis of dysplasia on surveillance biopsy/TUR, in patients with prior urothelial neoplasia (carcinoma in-situ, low grade urothelial carcinoma and/or high grade urothelial carcinoma). Specimens were reviewed to determine histopathologic features associated with relapse/progression to CIS, low or high grade carcinoma. Patient follow-up was obtained by a retrospective review of clinical records.
Results: 47 patients with isolated secondary urothelial dysplasia of the urinary bladder were identified, with specimens consisting of surveillance biopsy or TUR. Treatment of the initial CIS, low or high grade carcinoma included TUR (37%), TUR+BCG (45.7%), TUR+mitomycin (8.7%), TUR+BCG+mitomycin (4.3%), TUR+chemotherapy (4.3%). Average time between primary diagnosis to finding isolated secondary dysplasia is 2.8 years. As of 2011, the rate of recurrence/progression is 52%, the rate of non-recurrence is 41%, not available 7%. Urine cytology after treatment of primary neoplasia and prior to secondary dysplasia is negative (35%), atypical (24%), positive (6%), or unavailable (35%). The most common features that contributed to a diagnosis of secondary urothelial dysplasia included architectural disorder and increased nuclear size 3-4 times normal.
Conclusions: Isolated secondary urothelial dysplasia is poorly characterized, and its true progression rate is essentially unknown. With our cohort of 46 patients, we find the rate of relapse/progression to be 50%, far less than the 100% of published series that mixed in concurrent secondary dysplasia. This progression rate is notably higher than the 6% progression rate of primary urothelial dysplasia in our earlier study.
Category: Genitourinary (including renal tumors)
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 153, Wednesday Afternoon