1985 Volume 76 Issue 9 Pages 1357-1367
Photographs of the bladder tumor were taken cystoscopically in 81 cases and the relationship between the cystoscopic appearance and the clinicopathological findings of the tumors was studied. All tumors were transitional cell carcinoma but inverted papilloma was not found in our cases. 4 cases were grade 0, 10 were grade 1, 43 were grade 2 and 24 were grade 3.17 cases were stage pTa, 32 were pT1, 11 were pT2, 10 were pT3, 7 were pT4 and 4 were pTX.
These tumors were classified photocystoscopically in to 6 types according to the pattern of growth (i. e. type I: sea anemone-like, type I-II: transitional or intermediate, type II: grapes-like, type II-III: strawberry-like, type III: knoll or smooth surfaced nodular or type X: unclassified). 8 were classified as type I, 5 type I-II, 44 type II, 9 type II-III, 13 type III and 2 type X. Most sea anemone-like type I tumors were less than 1cm in diameter and low graded and all of them were confined to the mucosa or the submucosa. Of grapes-like type II tumors, approximately 70% were grade 2 and about one-half were pedunculated. All pedunculated type II tumors less than 1-3cm in diameter were still confined to the submucosa. But about one-half of sessile type II tumors from 1 to 3cm in diameter were beyond the submucosa and some of them took bad clinical course. Of knoll-like or smooth surfaced nodular type III tumors, 77% were grade 3 and 83% were sessile tumor. Regardless of the size of the tumor, 85% of type III tumors had infiltrated more than half-way through the muscularis and most of them took the worst clinical course.
It was concluded that there were clinicopathological contrasts in relation to the pattern of infiltration and proliferation between type I, type II and type III, especially between type II and type III, that is, type I and type II grew as papillary tumor and infiltrated downward slowly according to tumor growth or recurrence but type III grew origianlly with downward infiltration. Clinically type I-II tumor must be treated as type II tumor but strawberry-like type II-III tumor must be treated as mixed or intermediate tumor of type II and type III. It is likely that the difference in the growth pattern depends upon the difference of histopathological architecture and the pattern of infiltration is also influenced by the histopathological architecture.
Finally, the new clinical cystoscopic classification of transitional cell carcinoma of the bladder was proposed based on those studies.
