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What Do The Following Biopsy Reports Indicate?
Question: I have a question fro my Mom. Below are her details:
She is a 77 year old woman.
She had a uterine cancer 22 years back.
Was treated with partial hysterectomy and followed by radiation therapy.
Recently she has been having occasional episodes of gross hematuria for past 3 months.
Recently she had a Bladder Biopsy. Below is her Biopsy Results:
***Cystoscopy with bladder biopsy with TURBT (Test done on 11/01/2016)
A. Bladder lesion on bladder dome, transurethral resection:
* Noninvasive papillary urothelial carcinima, high grade.
* Lamina propria present and uninvolved by tumor
* No Muscularis propria identified
B. Bladder lesion adjacent to biopsy#1, transurethral resection:
* Noninvasive papillary urothelial carcinima, high grade.
* Lamina propria present and uninvolved by tumor
* Muscularis propria present and uninvolved by tumor
C. Right lateral bladder wall, transurethral resection:
* Unremarkable urothelium; no dysplasia or carcinoma identified
D. Left lateral bladder wall, transurethral resection:
* Unremarkable urothelium; no dysplasia or carcinoma identified
I have following questions regarding the biopsy results:
1) What is the interpretation and meaning of these biopsy results?
2) Does she need any treatment? If so, What are the possible treatment options for het Diagnosis of high grade urothelial carcinoma?
Thanks you very much for you time and expert advice.
Best Regards
--XXXX
She is a 77 year old woman.
She had a uterine cancer 22 years back.
Was treated with partial hysterectomy and followed by radiation therapy.
Recently she has been having occasional episodes of gross hematuria for past 3 months.
Recently she had a Bladder Biopsy. Below is her Biopsy Results:
***Cystoscopy with bladder biopsy with TURBT (Test done on 11/01/2016)
A. Bladder lesion on bladder dome, transurethral resection:
* Noninvasive papillary urothelial carcinima, high grade.
* Lamina propria present and uninvolved by tumor
* No Muscularis propria identified
B. Bladder lesion adjacent to biopsy#1, transurethral resection:
* Noninvasive papillary urothelial carcinima, high grade.
* Lamina propria present and uninvolved by tumor
* Muscularis propria present and uninvolved by tumor
C. Right lateral bladder wall, transurethral resection:
* Unremarkable urothelium; no dysplasia or carcinoma identified
D. Left lateral bladder wall, transurethral resection:
* Unremarkable urothelium; no dysplasia or carcinoma identified
I have following questions regarding the biopsy results:
1) What is the interpretation and meaning of these biopsy results?
2) Does she need any treatment? If so, What are the possible treatment options for het Diagnosis of high grade urothelial carcinoma?
Thanks you very much for you time and expert advice.
Best Regards
--XXXX
Brief Answer:
Your mother has Papillary carcinoma of bladder (Cancer of Bladder).
Detailed Answer:
Hello
Thanks for your query,based on the facts and report of biopsy of bladder that you have posted it appears that your mother has high grade cancer of the bladder however it has not invaded deep into lamina Propria and muscles of the bladder .
The high grade nature of the cancer of bladder indicates that this type of cancer is the most likely to recur and progress.
As regards further treatment she needs to be treated by
1) Intra Vesical BCG cycles 6 cycles at weekly interval . This helps to reduce chances of recurrence and further progress of high grade minimal invasive cancers .
2) Cystoscopic examination at the interval of 3 months and resect the tumor if there is recurrence.
3) Urine cytology every month to rule out or confirm presence of cancer cells in urine
Consult qualified Medical Oncologist for guide lines as regards chemotherapy.
Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you
Thanks and Regards.
Dr.Patil.
Your mother has Papillary carcinoma of bladder (Cancer of Bladder).
Detailed Answer:
Hello
Thanks for your query,based on the facts and report of biopsy of bladder that you have posted it appears that your mother has high grade cancer of the bladder however it has not invaded deep into lamina Propria and muscles of the bladder .
The high grade nature of the cancer of bladder indicates that this type of cancer is the most likely to recur and progress.
As regards further treatment she needs to be treated by
1) Intra Vesical BCG cycles 6 cycles at weekly interval . This helps to reduce chances of recurrence and further progress of high grade minimal invasive cancers .
2) Cystoscopic examination at the interval of 3 months and resect the tumor if there is recurrence.
3) Urine cytology every month to rule out or confirm presence of cancer cells in urine
Consult qualified Medical Oncologist for guide lines as regards chemotherapy.
Hope I have answered your query ,please feel free to ask if you have more questions ,I shall be happy to help you
Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr. Patil:
Thank you very much for your detailed answer. I greatly appreciate it.
I have following follow-up questions:
1) The biopsy results have a mention of "Lamina propria present" and " Muscularis propria present". What does that mean? Is this something to concern about?
2) She also had CT scan of pelvis and abdomen and a FISH test done sometime back. Below are the results of her both tests:
-------------------------------------------------------------------------------------------
***CT Abdomen/Pelvis- IVP (Test done on 08/03/2016)***
Results:
Asymmetric Irregular bladder wall thickening involving the anterior bladder wall with findings worrisome for transmural extension.
Findings suspicious for primary bladder malignancy - Transitional cell carcinoma. (TCC)
***ProFISH (Test done on 08/23/2016)***
Dx: POSITIVE Profile With 5p15 Amplication.
The ProFISH bladder cancer FISH study detected abnormal copy numbers involving chromosomes 3, 7, 10 and/or 5p15.
A positive result requires a minimum of 5 cells which demonstrate a gain of 2 or more of chromosomes 3, 7 and 10.
Additional copies of 5p15 were observed in this sample. Additional copies of the 5p15 locus may be indicative of a more aggressive, muscle invasive carcinoma with the possible formation of a 5p isochromosome. Twenty-five cells were scored in this sample.
-------------------------------------------------------------------------------------------
Question:
The both tests indicate the MUSCLE INVASIVE CARCINOMA, but recent biopsy indicate Noninvasive carcinoma.
Is there a possibility that she may have a invasive tumor and missed by biopsy?
What can we do to rule-out the invasive carcinoma?
3) The CT scan indicate the wall-thickening of bladder. What could be the possible causes of the wall-thickening?
4) Is there a possibility that other organs like Urethra, Ureter or Kidney may be involved? If yes, what tests need to be done to rule it out?
Thanks again for your help and expert advice!!!
Best Regards
-XXXXX
Thank you very much for your detailed answer. I greatly appreciate it.
I have following follow-up questions:
1) The biopsy results have a mention of "Lamina propria present" and " Muscularis propria present". What does that mean? Is this something to concern about?
2) She also had CT scan of pelvis and abdomen and a FISH test done sometime back. Below are the results of her both tests:
-------------------------------------------------------------------------------------------
***CT Abdomen/Pelvis- IVP (Test done on 08/03/2016)***
Results:
Asymmetric Irregular bladder wall thickening involving the anterior bladder wall with findings worrisome for transmural extension.
Findings suspicious for primary bladder malignancy - Transitional cell carcinoma. (TCC)
***ProFISH (Test done on 08/23/2016)***
Dx: POSITIVE Profile With 5p15 Amplication.
The ProFISH bladder cancer FISH study detected abnormal copy numbers involving chromosomes 3, 7, 10 and/or 5p15.
A positive result requires a minimum of 5 cells which demonstrate a gain of 2 or more of chromosomes 3, 7 and 10.
Additional copies of 5p15 were observed in this sample. Additional copies of the 5p15 locus may be indicative of a more aggressive, muscle invasive carcinoma with the possible formation of a 5p isochromosome. Twenty-five cells were scored in this sample.
-------------------------------------------------------------------------------------------
Question:
The both tests indicate the MUSCLE INVASIVE CARCINOMA, but recent biopsy indicate Noninvasive carcinoma.
Is there a possibility that she may have a invasive tumor and missed by biopsy?
What can we do to rule-out the invasive carcinoma?
3) The CT scan indicate the wall-thickening of bladder. What could be the possible causes of the wall-thickening?
4) Is there a possibility that other organs like Urethra, Ureter or Kidney may be involved? If yes, what tests need to be done to rule it out?
Thanks again for your help and expert advice!!!
Best Regards
-XXXXX
Brief Answer:
She does not have invasive cancer <Not to be worried aboit it
Detailed Answer:
Hello
Thanks for follow up and uploading reports .Answers to your questions are detailed below
1) Biopsy is the direct evidence based investigation and it is more accurate and definitive as far as final diagnosis is concerned as we are examining tissue directly from lesion whereas other tests help us to give a direction and provisional diagnosis .Biopsy can not miss even a minor lesion as the tissue is exmined under microscope .Hence there are no chances of human error .
.
2).Whenever there is tumor in bladder bladder wall gets thickened and it has no significance as far as modality of treatment and outcome is concerned .
4) There is no possibility of other organs like urethra ,ureter getting involved as there is no radiological evidence detected in CT Scan or she has no symptoms pertaining to ureter or urethra.
If you have time please post your review about my suggestions and comments on floor of Health Care Magic .com
Thanks and Regards.
Dr.Patil.
She does not have invasive cancer <Not to be worried aboit it
Detailed Answer:
Hello
Thanks for follow up and uploading reports .Answers to your questions are detailed below
1) Biopsy is the direct evidence based investigation and it is more accurate and definitive as far as final diagnosis is concerned as we are examining tissue directly from lesion whereas other tests help us to give a direction and provisional diagnosis .Biopsy can not miss even a minor lesion as the tissue is exmined under microscope .Hence there are no chances of human error .
.
2).Whenever there is tumor in bladder bladder wall gets thickened and it has no significance as far as modality of treatment and outcome is concerned .
4) There is no possibility of other organs like urethra ,ureter getting involved as there is no radiological evidence detected in CT Scan or she has no symptoms pertaining to ureter or urethra.
If you have time please post your review about my suggestions and comments on floor of Health Care Magic .com
Thanks and Regards.
Dr.Patil.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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