Long-Term Clinical Outcome of Urothelial Papilloma – Which Patients Need Follow-Up?
Samir Al-Bashir, Cheng Wang, Asli Yilmaz, Tarek Bismar, Kiril Trpkov. Calgary Laboratory Services and University of Calgary, Calgary, AB, Canada
Background: Urothelial papilloma (UP) of the urinary tract is a benign urothelial neoplasm characterized by delicate fibrovascular cores covered by normal urothelium. However, only few larger studies have been published using the contemporary WHO definition and its biologic behavior has not been examined in studies with long-term follow-up.
Design: We retrieved all consecutive cases with a diagnosis of UP from our institutional information system during a 10-year period (01/2000 to 12/2009), diagnosed using the WHO definition. All cases were identified in a regional centralized uropathology setting and the follow-up was obtained through search from pathology and clinical electronic databases. Patients with a previous history of higher grade urothelial neoplasm, diagnostic ambiguity or external consult cases were not included in the study.
Results: The study cohort comprised of 41 de novo ('primary') UP. The average patient age was 57 years (median 56, range, 30-84), with a male:female ratio of 1.9:1. 13 (31%) patients were below the age of 50. The mean patient follow-up was 81 months (median 76; range, 3–127 months). In 37 (90.2%) patients no recurrent neoplasms were documented, including progression to low grade urothelial carcinoma (UC), high grade UC or carcinoma in situ. In 4 patients, subsequent urothelial neoplasms have been diagnosed. Three male patients (7.3%) had a diagnosis of subsequent UP at 1, 31, and 43 months after the initial diagnosis of UP. One of these patients had additional progression to papillary urothelial neoplasm of low malignant potential (PUNLMP) 17 months after the second UP (48 months after the initial UP). The patient with a subsequent UP at 1 month after the initial diagnosis likely represented an incomplete initial resection. The average age of these 3 patients was 62 years (individual age 50, 59 and 77 years). One additional male patient (age, 76 years) had a subsequent diagnosis of PUNLMP 76 months after the initial UP. Both patients diagnosed with PUNLMP presented with hematuria during the follow-up.
Conclusions: Absence of progression on long-term follow-up in patients diagnosed with de novo UP argues strongly against the need of continuous surveillance for patients in which: 1.) the diagnosis is established using strict diagnostic criteria, 2.) the completeness of the resection can be ascertained and 3.) when no previous or synchronous urothelial malignancies are documented. A small percentage of patients, typically male and above the age of 50, who present with subsequent hematuria after the initial UP, require follow-up and repeat cystoscopy.
Category: Genitourinary (including renal tumors)
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 199, Tuesday Afternoon