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.
Patients of all ages can develop a papilloma of the bladder, but the majority of patients are older adults in their 50s and 60s    . There is a marked predominance of male patients, with a male-to-female ratio reportedly of 7:1 in certain studies   . 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  . Suprapubic pain, urinary retention, and pyuria were identified in rare cases and isolated studies observed that patients infrequently report more than one symptom . An asymptomatic course occurs in a minority of patients and the diagnosis can be made incidentally . The etiology and pathogenesis of papilloma of the bladder remain undisclosed, but cigarette smoking has been postulated as a possible risk factor  .
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]
The most common presenting symptoms were macroscopic hematuria and dysuria. All were solitary tumors except one, most commonly found at the bladder neck and trigone. The average follow-up period was 2.5 years without any evidence of recurrence. [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]
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 , 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 , 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   . In very rare cases, multiple papillomas can be identified . 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    .
- 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.
- 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.
- Brown AL, Cohen RJ. Inverted papilloma of the urinary tract. BJU Int. 2011;107 Suppl 3:24-26.
- Sung M, Maclennan GT, Lopez-Beltran A, Montironi R, Cheng L. Natural history of urothelial inverted papilloma Cancer. 2006;107(11):2622-2627.
- 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.
- 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.