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HEADLINES
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Introduction Classification Bladder cancer -Epidemiology Bladder cancer -Etiology Bladder cancer -Pathogenesis Bladder cancer -pathology Bladder cancer -Staging and grading Bladder cancer -Diagnosis Bladder cancer -Treatment Nonurothelial & nonepithelial bladder tumors
INTRODUCTION
Urinary bladder (UB)hollow muscular organreservoir for urine Capacity- 350-500 ml Empty UB- pelvic organ Full UB- pelviabdominal Parts: apex-bladder neckfour surfaces (superior-2 inferolateral basal)
INTRODUCTION
Interior of UB: trigone-ureteric orificesinterureteric ridgebladder walls(posterior,late ral, anterior)
INTRODUCTION
BLADDER HISTOLOGY Normal mucosa - urothelium-transitional cells-3-7 layers on basement membrane - Lamina propria- fibro-elastic connective tissue - Muscularis mucosa-scattered smooth muscle fibers Detrusor muscle meshwork of smooth muscle fibers Adventia and perivesical fat
CLASSIFICATION -WHO
Epithelial tumors
-transitional cell papilloma -transitional cell carcinoma -adenocarcinoma -squamous cell papilloma -squamous cell carcinoma -undifferentiated carcinoma
Nonepithelial tumors
-benign- fibroma, lipoma, angioma -malignant- rhabdomyosarcoma - angiomyosarcoma -pheochromocytoma -malignant melanoma -metastatic tumors -leiomyosarcoma, - liposarcoma -lymphomas -Carcinosarcoma
Epithelial abnormalities
-papillary (polypoid )cystitis -cystitis cystica -squamous metaplasia -Brunns nests -glandular metaplasia -nephrogenic adenoma -malakoplakia -endometriosis -Cysts
Tumorlike lesions
-follicular cystitis -amyloidosis -hamartomas
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Atypical hyperplasia-No. of cell layers with nuclear abnormalities Cystitis glandularis: submucosal nests of columnar cells(TC undergone glandular metaplasia) suurrounding liquefied center. adenocarcinoma Dysplasia:nuclear and arrangement changes with no increase in No. of cell layers (low-moderate-high grade) Inverted papilloma: papillary fronds projecting down words into the wall Nephrogenic adenoma: metplastic changes into primitive renal tubules as response to chronic trauma, infection or radiation Vesical Leukoplakia: Keratinized squamous metplasia due to chronic infection, stone disease , BilharziasisSCC Pseudosarcoma:benign lesion of spindle cells in response to surgical trauma or infection
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According to the hystologic type Transitional cell carcinoma-TCC Squamous cell carcinoma- SCC Adenocarcinoma Mixed carcinoma Undifferentiated carcinoma According to the degree of invasion Carcinoma in situ- CIS Superficial bladder tumors Invasive bladder tumors According to growth pattern Papillary (villous tumor) Solid (nodular, fungating, ulcerative) Fibrillary (verrocus carcinoma-SCC)
grade dysplasia Types: primary-secondary-concomitant Histology: TCC- SCC- adenocarcinoma Treatment: - primary focal CIS: fulguration, TUR+ intravesial immunochemotherapy Phototherapy Laser - primary diffuse CIS TUR+ intravesical imunochemotherapy Cystourethrectomy and high diversion of the ureters - concomitant CIS: treatment of the main tumor
RHABDOMYOSARCOMA (RMS)
Malignant tumor arising from the embryonal mesenchyme giving rise to striated skeletal muscles The most common soft tissue sarcoma of childhood Genitourinary RMS-15-20% of all RMS Common genitourinary sites: bladder; prostate; paratestes Uncommon sites: vagina and uterus Types: embryonal; alveolar and undifferentiated Two peaks: 2-6 Y 15-19 Y Presentation: irritative and obstructive LUTS; hematuria, urine retention, bilateral renal obstruction with uremia Treatment: chemotherapy +/- radiotherapy according to the response If failure : surgical intervention