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Papilloma of the Bladder

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].

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]
  • 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]

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]
  • Transurethral resection is a safe, effective treatment option.[new.medigraphic.com]
  • These observations stimulated my interest in this method of treatment and, as a consequence, smaller pedunculated tumors of the bladder have been excised intravesically in this fashion in twenty-six instances during the last three years.[mdedge.com]
  • We analyze their clinical presentations, histological findings and the outcome of treatments. RESULTS: Four patients presented with hematuria, and four with obstructive symptoms.[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • Prognosis and Predictive Factors Urothelial papilloma is a benign tumor that may recur but does not progress. Rare cases of progression have been described in association with immunosuppressive therapy. [ 5 ][emedicine.medscape.com]
  • Conclusions: We conclude that when diagnosed by strictly defined criteria, IP as benign urothelial neoplasm was with extremely low incidence of recurrence and good prognosis.[indianjcancer.com]
  • Differential diagnosis and prognosis of nonmuscle invasive tumor entities of urinary bladder epithelium are often challenging.[pubfacts.com]
  • Prognosis  Non–muscle invasive bladder cancer has a good prognosis, with 5-year survival rates of 82-100%.[slideshare.net]

Etiology

  • The etiology and pathogenesis of papilloma of the bladder remain undisclosed, but cigarette smoking has been postulated as a possible risk factor.[symptoma.com]
  • Urothelial papilloma tends to occur in younger patients and may be seen in children. [1] Etiology The risk factors for urothelial papilloma are similar to those of other urothelial neoplasms.[emedicine.medscape.com]
  • Read More Etiological role of human papillomavirus infection for inverted papilloma of the bladder.[pubfacts.com]
  • The aim of this study was to determine if low and high risk HPV play a role in the etiology of superficial low grade and invasive high grade urothelial carcinoma of the bladder.[infectagentscancer.biomedcentral.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]
  • Definition Urothelial papilloma is a benign exophytic neoplasm composed of a delicate fibrovascular core covered by normal-appearing urothelium. [1, 2 ] Epidemiology Urothelial papilloma has a low incidence; it represents 1-4% of bladder tumors.[emedicine.medscape.com]
  • Classification of weakly carcinogenic human papillomavirus types: addressing the limits of epidemiology at the borderline , Infect Agent Cancer , 2009 , vol. 1 (pg. 4 - 8 ) 19.[academic.oup.com]
  • 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]
Sex distribution
Age distribution

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]
  • Article navigation 1 National Office for Cancer Prevention and Control, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China Search for other works by this author on: Ni Li 1 National Office for Cancer Prevention and Control[academic.oup.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]
  • 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]

References

Article

  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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Last updated: 2018-06-21 22:15