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Papilloma of the Bladder
Bladder Tumor Type Papilloma

Papilloma of the bladder is defined as a benign lesion of the urinary tract that presents in older adults, with a strong predilection toward male gender. In rare cases, however, transformation into a malignant variant has been observed. Principal symptoms include hematuria, dysuria, and other voiding-related complaints. To make the diagnosis, it is necessary to conduct a detailed clinical assessment followed by invasive imaging studies of the urinary bladder (cystoscopy) and subsequent histopathological examination.

Presentation

Patients of all ages can develop a papilloma of the bladder, but the majority of patients are older adults in their 50s and 60s [1] [2] [3] [4]. There is a marked predominance of male patients, with a male-to-female ratio reportedly of 7:1 in certain studies [2] [3] [5]. The most common symptom identified in patients with a papilloma of the bladder is macroscopic hematuria [4] [6], whereas dysuria and obstructive/irritative symptoms are also frequently encountered [3] [4]. Suprapubic pain, urinary retention, and pyuria were identified in rare cases and isolated studies observed that patients infrequently report more than one symptom [6]. An asymptomatic course occurs in a minority of patients and the diagnosis can be made incidentally [3]. The etiology and pathogenesis of papilloma of the bladder remain undisclosed, but cigarette smoking has been postulated as a possible risk factor [3] [4].

Gastrointestinal

  • Suprapubic Pain

    Suprapubic pain, urinary retention, and pyuria were identified in rare cases and isolated studies observed that patients infrequently report more than one symptom. [symptoma.com]

    Less common symptoms are suprapubic pain and pyuria. [emedicine.medscape.com]

Urogenital

  • Macroscopic Hematuria

    The most common symptom identified in patients with a papilloma of the bladder is macroscopic hematuria, whereas dysuria and obstructive/irritative symptoms are also frequently encountered. [symptoma.com]

    Clinical case: male patient aged 20 presenting at urology consultation with macroscopic hematuria of three days' evolution. Interrogation revealed that the latter was terminal, monosymptomatic and was not accompanied by clots. [new.medigraphic.com]

    Initial symptoms included macroscopic hematuria in 9 cases of which 3 presented with clot retention, 2 with microscopic hematuria, 4 with dysuria, 2 with dysuria and microscopic hematuria, and 2 with bladder outlet obstruction; and 2 cases were asymptomatic [indianjcancer.com]

    Visible blood in the urine is referred to as gross, or macroscopic, hematuria. Bladder cancer often causes no symptoms until it reaches an advanced stage that is difficult to cure. [emedicinehealth.com]

    Clinically, patients with IPB present with symptoms similar to those of transitional cell carcinoma of the bladder, exhibiting intermittent and painless macroscopic hematuria accompanied by symptoms of urothelial irritation in some cases. [cjcr.amegroups.com]

Workup

The diagnosis of papilloma of the bladder may be difficult to make solely on clinical findings, but initial suspicion toward a lower urinary tract pathology can be raised only through a patient history and a physical examination. Physicians should determine the characteristics of symptoms, their progression, and severity, and if sufficient evidence is raised, imaging studies should be employed. Because papillomas grow in an endophytic fashion (the most superficial layer of the transitional urinary bladder epithelium is intact), urine cytology analysis is of little benefit [4], which is why cystoscopy is the procedure of choice. A typical finding is a pedunculated solitary mass that ranges from a few millimeters to several

A detailed medical history will reveal dysuric symptoms as well as hematuria and pain in the suprapubic region. Because papillomas grow in an endophytic fashion (the most superficial layer of the transitional urinary bladder epithelium is intact), urine cytology analysis is of little benefit [4], which is why cystoscopy is the procedure of choice. A typical finding is a pedunculated solitary mass that ranges from a few millimeters to several centimeters in diameter, mainly located in the trigone, the neck, or the lateral walls of the bladder [2] [4] [6]. In very rare cases, multiple papillomas can be identified [2]. To confirm a papilloma of the bladder and exclude malignant disease, a biopsy with a subsequent histopathological examination is crucial. A normal urothelium without dysplastic changes and mitotic figures, formation of epithelial nests of different sizes containing adenoid structures from the epithelium to the lamina propria, and the "umbrella"-shaped appearance of the urothelial cells are some of the key findings that distinguish papilloma of the bladder from other potentially malignant lesions [1] [2] [5] [6].

Treatment

Bladder cancer gene therapy 71 1 711 Treatment of nonTCC adenocarcinomasarcoma 723 Treatment of squamous cell carcinoma 729 Pediatric bladder tumours 735 Ancillary 749 Support groups 755 Index 763 Urheberrecht [books.google.de]

Do not blindly believe folk treatments. Folk remedies can only be part of the comprehensive treatment for medicaments prescribed by the doctor. [medicalj-center.info]

Treatment Treatment includes removal of the bladder tumors through cystoscopic or transurethral resection and fulguration or electrical destruction. [medigest.uk]

Transurethral resection is a safe, effective treatment option. [new.medigraphic.com]

Your Urologist may discuss several types of treatment with you. [newcastleurology.org.uk]

Prognosis

Prognosis  Non–muscle invasive bladder cancer has a good prognosis, with 5-year survival rates of 82-100%. [slideshare.net]

Patients with metastatic disease, in contrast, have a poor prognosis (5-year survival of 6%) 4. [radiopaedia.org]

Prognosis and Predictive Factors The prognosis for inverted papilloma is quite good, with a recurrence rate of less than 5%, and the likelihood of synchronous or subsequent development of urothelial carcinoma 6% and 3%, respectively. [emedicine.medscape.com]

The aim of this systematic review and analysis of the literature since 1990 to date is to contribute to unresolved issues regarding the biological behavior and prognosis of these neoplasms to establish some key points in the clinical and surgical management [ncbi.nlm.nih.gov]

Patients with superficial tumours have an excellent prognosis with five-year survival rates between 80-90%. [patient.info]

Etiology

Human papillomavirus is not an etiologic agent of urothelial inverted papillomas. Am J Surg Pathol. 2013 Aug. 37(8):1223-8. [Medline]. van Oers JM, Lurkin I, van Exsel AJ, et al. [emedicine.medscape.com]

The etiology and pathogenesis of papilloma of the bladder remain undisclosed, but cigarette smoking has been postulated as a possible risk factor. [symptoma.com]

[…] exophytic neoplasm composed of a delicate fibrovascular core covered by normal-appearing urothelium (1,2). a low incidence – representing 1-4% of bladder tumours. cigarette smoking and occupational exposure to aromatic amines are the most important etiology [wsoonli15.wordpress.com]

Cancer of bladder 1) Incidence and prevalence. 2) Etiology/ Risk factors. 3) Pathology. 4) Clinical features. 5) Investigation and diagnosis. 6) Staging and Management. 7) Prognosis 18. [slideshare.net]

Epidemiology

Pathological and epidemiological characteristics of this distinct bladder lesion are outlined, comparison with transitional cell papilloma is investigated, and recommended therapy and follow-up are offered. [ncbi.nlm.nih.gov]

Epidemiology The risk factors for squamous papilloma are similar to those for other urothelial neoplasms; cigarette smoking and occupational exposure to aromatic amines are among the most important. [emedicine.medscape.com]

Definition / general Discrete papillary growth with a central fibrovascular core lined by urothelium of normal thickness and cytology Epidemiology Uncommon if use restrictive diagnostic criteria (less than 1% of bladder tumors) Tends to occur in younger [pathologyoutlines.com]

Journal Journal ID (nlm-ta): Pan Afr Med J Journal ID (iso-abbrev): Pan Afr Med J Journal ID (publisher-id): PAMJ Title: The Pan African Medical Journal Publisher: The African Field Epidemiology Network ISSN (Electronic): 1937-8688 Publication date (Electronic [scienceopen.com]

Pathophysiology

However, the occurrence of upper urinary tract localization is not surprising when considering how the urothelial-lined tissue behaves as a single pathophysiological unit. [spandidos-publications.com]

Prevention

If was discovered papilloma shown mandatory treatment to prevent transition to malignancy. Treatment methods are determined by the degree of proliferation of papillomas in the urinary bladder and can be assigned only by a physician. [medicalj-center.info]

Preventive Services Task Force recommends against routine screening for bladder cancer in adults. A 24 Patients with symptoms of bladder cancer should be evaluated with cystoscopy and bladder wash cytology. [aafp.org]

Is It Possible to Prevent Bladder Cancer? No sure way exists to prevent bladder cancer. You can reduce your risk factors, however. If you smoke, quit. However, the risk of bladder cancer does not diminish. [emedicinehealth.com]

Prevention The United States Preventive Services Task Force (USPSTF) does not recommend routine screening for bladder cancer, as there is little evidence that screening improves long-term health outcomes. [medicalnewstoday.com]

So far, prevention strategies are limited to the elimination of risk factors while treatment of bladder cancer is invasive and intensive in terms of costs and time [ 3 ]. [infectagentscancer.biomedcentral.com]

References

  1. McKenney JK, Amin MB, Young RH. Urothelial (transitional cell) papilloma of the urinary bladder: a clinicopathologic study of 26 cases. Mod Pathol. 2003;16(7):623-629.
  2. Picozzi S, Casellato S, Bozzini G, et al. Inverted papilloma of the bladder: a review and an analysis of the recent literature of 365 patients. Urol Oncol. 2013;31(8):1584-1590.
  3. Brown AL, Cohen RJ. Inverted papilloma of the urinary tract. BJU Int. 2011;107 Suppl 3:24-26.
  4. Sung M, Maclennan GT, Lopez-Beltran A, Montironi R, Cheng L. Natural history of urothelial inverted papilloma Cancer. 2006;107(11):2622-2627.
  5. Magi-Galluzzi C, Epstein JI. Urothelial papilloma of the bladder: a review of 34 de novo cases. Am J Surg Pathol. 2004;28(12):1615-1620.
  6. Guo A, Liu A, Teng X. The pathology of urinary bladder lesions with an inverted growth pattern. Chin J Cancer Res. 2016;28(1):107-121.
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