Flat intraepithelial lesions of the urinary bladder

Liang Cheng, John C. Cheville, Roxann M. Neumann, David G. Bostwick

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

BACKGROUND. In the 1998 World Health Organization and International Society of Urologic Pathology (WHO/ISUP) classification system for bladder neoplasms, flat intraepithelial lesions of the urinary bladder were categorized as reactive atypia, atypia of unknown significance, dysplasia, and carcinoma in situ. The clinical outcomes of patients diagnosed with these atypical urothelial proliferations are uncertain. METHODS. The authors studied a series of patients who were diagnosed with reactive atypia of the urinary bladder (25 patients), urothelial atypia of unknown significance (35), or urothelial dysplasia (26) between 1985 and 1993. All histologic slides were reviewed and classified according to the 1998 World Health Organization and International Society of Urologic Pathology classification system. Patients with a concomitant or prior history of carcinoma in situ or urothelial carcinoma were excluded. RESULTS. Patient age at diagnosis ranged from 24 to 88 years (mean, 65 years). The male-to-female ratio was 3:1. The mean follow-up was 3.9 years (range, 0.1-13.4 years; median, 3.5 years). None of the patients with reactive atypia or atypia of unknown significance developed dysplasia, carcinoma in situ, or urothelial carcinoma. Four patients (15%) with urothelial dysplasia developed biopsy-proven cancer, including 3 patients with muscle-invasive cancer. The mean interval from the diagnosis of urothelial dysplasia to the development of cancer was 4.5 years. CONCLUSIONS. Patients with a diagnosis of urothelial atypia of unknown significance or reactive atypia do not have adverse clinical outcomes, whereas patients with urothelial dysplasia of the bladder have an increased risk for the development of carcinoma in situ and urothelial carcinoma.

Original languageEnglish
Pages (from-to)625-631
Number of pages7
JournalCancer
Volume88
Issue number3
DOIs
StatePublished - Feb 1 2000

Fingerprint

Urinary Bladder
Carcinoma in Situ
Carcinoma
Muscle Neoplasms
Pathology
Urinary Bladder Neoplasms
Neoplasms
Biopsy

Keywords

  • Atypia
  • Carcinoma in situ
  • Detection
  • Dysplasia
  • Grading
  • Neoplasms
  • Precursor
  • Progression
  • Screening
  • Urinary bladder

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Flat intraepithelial lesions of the urinary bladder. / Cheng, Liang; Cheville, John C.; Neumann, Roxann M.; Bostwick, David G.

In: Cancer, Vol. 88, No. 3, 01.02.2000, p. 625-631.

Research output: Contribution to journalArticle

Cheng, Liang ; Cheville, John C. ; Neumann, Roxann M. ; Bostwick, David G. / Flat intraepithelial lesions of the urinary bladder. In: Cancer. 2000 ; Vol. 88, No. 3. pp. 625-631.
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AB - BACKGROUND. In the 1998 World Health Organization and International Society of Urologic Pathology (WHO/ISUP) classification system for bladder neoplasms, flat intraepithelial lesions of the urinary bladder were categorized as reactive atypia, atypia of unknown significance, dysplasia, and carcinoma in situ. The clinical outcomes of patients diagnosed with these atypical urothelial proliferations are uncertain. METHODS. The authors studied a series of patients who were diagnosed with reactive atypia of the urinary bladder (25 patients), urothelial atypia of unknown significance (35), or urothelial dysplasia (26) between 1985 and 1993. All histologic slides were reviewed and classified according to the 1998 World Health Organization and International Society of Urologic Pathology classification system. Patients with a concomitant or prior history of carcinoma in situ or urothelial carcinoma were excluded. RESULTS. Patient age at diagnosis ranged from 24 to 88 years (mean, 65 years). The male-to-female ratio was 3:1. The mean follow-up was 3.9 years (range, 0.1-13.4 years; median, 3.5 years). None of the patients with reactive atypia or atypia of unknown significance developed dysplasia, carcinoma in situ, or urothelial carcinoma. Four patients (15%) with urothelial dysplasia developed biopsy-proven cancer, including 3 patients with muscle-invasive cancer. The mean interval from the diagnosis of urothelial dysplasia to the development of cancer was 4.5 years. CONCLUSIONS. Patients with a diagnosis of urothelial atypia of unknown significance or reactive atypia do not have adverse clinical outcomes, whereas patients with urothelial dysplasia of the bladder have an increased risk for the development of carcinoma in situ and urothelial carcinoma.

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