CLINICO-PATHOLOGICAL STUDIES OF NON-PAPILLARY CARCINOMA IN SITU AND ITS BORDERLINE LESIONS OF THE URINARY BLADDER

Abstract

Non-papillary carcinoma in situ and its borderline lesions of the urinary bladder were histologically defined and the clinical features of twenty five patients including 6 with carcinoma in situ, 3 with severe epithelial atypia and 16 with microinvasive cancer were presented.
The incidence of patients with these early lesions in all bladder tumor patients in this clinic was approxymately six per cent. Clinical symptoms and endoscopic findings mimicked those of acute or chronic cystitis and they were not suggestive of these early lesions. Urinary cytology showed characteristic appearance, sparse exfoliation of malignant cells, and seemed to be most useful clinical tool for the diagnosis. All 19 patients who received this examination showed positive results. In addition, urinary cytology was also useful for the assessment of response in patients who were given conservative treatments such as irradiation or intravesical chemotherapy and for the detection of subsequent recurrence or malignant progression.
For the, accurate histologic diagnosis multiple mucosal biopsies with methylene blue vital staining test was recommended. Four of 5 patients with carcinoma in situ and two of 3 with severe epithelial atypia who received conservative procedures developed microinvasive cancer within 6 to 72 months (mean: 30.5) following the diagnosis. Patients with microinvasive cancer who received surgical treatments, especially conservative methods, showed disastrous results, probably due to the high incidence of submucosal lymphatic permeation. It was, therefore, considered that microinvasive cancer should be histologically differentiated from carcinoma in situ or severe epithelial atypia and should be treated as a deeply invasive cancer, although it is classified into socalled superficial bladder cancer and shows almost similar clinical features as carcinoma in situ or severe epithelial atypia.