bladder papillary transitional cell neoplasm

Bladder Papillary Transitional Cell Neoplasm: A Rare but Important Type of Bladder Cancer

The bladder papillary transitional cell neoplasm, also known as urothelial carcinoma or transitional cell carcinoma, is a type of cancer that affects the lining of the bladder. This rare form of bladder cancer accounts for about 90% of all cases of bladder cancer and 7% of all cases of kidney cancer (1).

Characteristics

Bladder papillary transitional cell neoplasm typically develops within the urothelium, the tissue that lines parts of the urinary system, including the bladder, ureters, and lower kidneys. The cells affected by this type of cancer are called transitional cells because they change shape depending on their location (6).

Types

There are several types of bladder papillary transitional cell neoplasm, ranging from non-invasive to invasive forms. Noninvasive papillary carcinoma may appear as long, thin, finger-like growths under a microscope and can be low grade or high grade, depending on how abnormal the cells look (9). In contrast, more advanced stages of cancer have spread deeper into the muscle of the bladder wall (T2) or even through the bladder wall and into surrounding organs (T3) (4).

Symptoms

The symptoms of bladder papillary transitional cell neoplasm are similar to those of other types of bladder cancer. They may include blood in the urine, pain while urinating, or a frequent need to urinate.

References:

• [1] Urothelial carcinoma accounts for about 90% of all cases of bladder cancer and 7% of all cases of kidney cancer.
• [4] Cancer has spread deeper into the muscle of the bladder wall (T2) or even through the bladder wall and into surrounding organs (T3).
• [6] Urothelial cells are also called transitional cells because they change shape depending on their location.
• [9] Noninvasive papillary carcinoma may appear as long, thin, finger-like growths under a microscope.

Diagnostic Tests for Bladder Papillary Transitional Cell Neoplasm

Bladder papillary transitional cell neoplasm, also known as urothelial carcinoma, is a type of cancer that affects the lining of the bladder. Diagnosing this condition requires a combination of physical examination, medical history, and various diagnostic tests.

Physical Exam and Medical History A thorough physical exam and medical history are essential to identify any symptoms or risk factors associated with bladder papillary transitional cell neoplasm. This includes a review of the patient's urinary habits, such as frequency, urgency, or pain while urinating [1].

Diagnostic Tests

• Cystoscopy: A cystoscope is inserted through the urethra to visually inspect the inside of the bladder and identify any abnormalities, including tumors [9].
• Urine Cytology: This test examines urine samples for abnormal cells that may indicate cancer [7]. However, it has a low sensitivity and may not detect all cases of bladder cancer [8].
• Imaging Tests: Imaging tests such as ultrasound, CT scans, or MRI may be used to evaluate the extent of the tumor and rule out any metastasis [5].
• Biopsy: A biopsy involves removing a sample of tissue from the bladder for further examination under a microscope. This is often performed during cystoscopy [15].

Staging and Grading The staging and grading of bladder papillary transitional cell neoplasm are crucial in determining the prognosis and treatment plan. The tumor, node, metastasis (TNM) system is used to stage the cancer, while the World Health Organization (WHO) classification system is used to grade it [12].

• Ta: Noninvasive papillary urothelial carcinoma has not spread.
• T1: Cancer has spread into the connective tissue layer underneath the lining of the bladder but not the muscle of the bladder.
• T2: Cancer has spread deeper into the muscle of the bladder wall.
• T3: Cancer has spread through the bladder wall and into the fatty tissue and surrounding organs.

References

[1] Mitra AP, Birkhahn M, Penson DF, Cote RJ. Urine biomarkers for the detection of urothelial (transitional cell) carcinoma of the bladder. UpToDate. 2023.

[2] Bladder cancer is the sixth most prevalent malignancy in the United States. The most common type of bladder cancer is urothelial (transitional cell) carcinoma.

[3] Ta: Noninvasive papillary urothelial carcinoma has not spread.

[4] T1: Cancer has spread into the connective tissue layer underneath the lining of the bladder but not the muscle of the bladder.

[5] Imaging tests such as ultrasound, CT scans, or MRI may be used to evaluate the extent of the tumor and rule out any metastasis.

[6] Biopsy involves removing a sample of tissue from the bladder for further examination under a microscope.

[7] Urine cytology examines urine samples for abnormal cells that may indicate cancer.

[8] However, it has a low sensitivity and may not detect all cases of bladder cancer.

[9] Cystoscopy is inserted through the urethra to visually inspect the inside of the bladder and identify any abnormalities, including tumors.

[10] TURBT can also be used to treat bladder cancer.

[11] What is urothelial carcinoma? Urothelial carcinoma accounts for about 90% of all cases of bladder cancer and 7% of all cases of kidney cancer.

Treatment Options for Bladder Papillary Transitional Cell Neoplasm

Bladder papillary transitional cell neoplasm, also known as noninvasive carcinoma (Ta), is a type of cancer that affects the lining of the bladder. The treatment options for this condition are focused on eliminating the cancer cells while preserving the bladder function.

Chemotherapy and Immunotherapy

• Chemotherapy may be used to treat bladder papillary transitional cell neoplasm, especially in cases where the cancer has recurred or metastasized [6].
• Intravesical chemotherapy, which involves placing chemotherapy drugs directly into the bladder, is a common treatment approach for this condition [7].

Targeted Therapy

• Targeted therapy with FGFR inhibitors, such as Erdafitinib (Balversa), can be effective in treating some people with bladder cancer, including those with papillary transitional cell neoplasm [4].

Surgery and Other Treatments

• Surgery, including transurethral resection and radical cystectomy, may be necessary for more advanced cases of bladder cancer [14].
• Radiation therapy and other treatments may also be considered on a case-by-case basis.

Standard Treatment Regimens

• The combination of methotrexate, vinblastine, doxorubicin (Adriamycin), and cisplatin (MVAC) is the standard treatment for metastatic bladder cancer [7].
• Gemcitabine plus cisplatin (gc) or methotrexate, vinblastine, doxorubicin, and cisplatin (mvac) are also commonly used treatment regimens [8].

It's essential to consult with a healthcare professional to determine the best course of treatment for an individual case of bladder papillary transitional cell neoplasm.

References:

[4] - Context result 4 [6] - Context result 5 [7] - Context result 6 [8] - Context result 8

The differential diagnosis for bladder papillary transitional cell neoplasm (PTCN) includes several conditions that can mimic its appearance on gross inspection and microscopic examination.

Key Differential Diagnoses:

• Papillary urothelial carcinoma: This is a type of cancer that arises from the urothelium, similar to PTCN. However, it has a higher malignant potential and can invade through the basement membrane [12].
• Polypoid cystitis: This condition involves the formation of polyps or papillary growths in the bladder wall, which can be mistaken for PTCN on gross inspection [13].
• Papillary transitional cell carcinoma: As mentioned earlier, this is a type of cancer that arises from the urothelium and can have a similar appearance to PTCN.

Other Differential Diagnoses:

• Reactive inflammatory outgrowths: These are non-neoplastic growths that can occur in response to inflammation or irritation in the bladder [15].
• Papillary urothelial neoplasm of low malignant potential (PUNLMP): This is a type of neoplastic proliferation of the urothelium that has a low malignant potential and does not invade through the basement membrane [12].

Clinical Significance:

It's essential to accurately diagnose PTCN, as it can have significant implications for patient management and prognosis. A correct diagnosis can help guide treatment decisions and provide patients with the most appropriate care.

References:

[12] Papillary urothelial neoplasm of low malignant potential (PUNLMP) is a neoplastic proliferation of the urothelium in a papillary configuration, with no invasion through the basement membrane [12].

[13] The most important differential diagnosis of papillary and polypoid cystitis is with papillary transitional cell carcinoma. On gross inspection and microscopic examination, the fronds of polypoid cystitis can be mistaken for PTCN [13].

[15] The macroscopic differential diagnosis of a papillary lesion includes: 9 Reactive inflammatory outgrowths including the site... TRANSITIONAL CELL CARCINOMA OF THE BLADDER 1 11 Fig. 2--Base of papillary TCC, grade 1, stage pTa. The fibres of the muscularis mucosae are drawn [15].