Aim: All cases of urethelial carcinoma of the bladder undergoing radical cystectomy between 1997 January and 2005 December were retriewed from the files of İzmir Ataturk Training Hospital, Pathology department and reviewed. The aim of this study was to evaluate the histopathological features (such as tumor size, presence of carcinoma in-situ, infiltration of vesicula seminalis and prostatic gland, vascular invasion, perineural invasion, and lymph node status) of these 191 radical cystectomy specimens and to detect if there was a relation between these parameters.
Material and Method: The tumours were staged according the TNM staging system and graded according to grading schema proposed by World Heath Organization. The relationship between pathologic stage and grade was analysed by Spearman correlation test. Mann Whitney U tests were used to determine the relation between stage and other parameters. Grade 1 and grade 2 tumors were gathered as one group and chi-square tests were performed to determine the relation between grade and other parameters. The relationship of the other parameters with each other were analysed by chi-square tests.
Results: The male/ female ratio was 13/178, and the mean age was 61,3. The pathologic stages of the cases was as follows: 15% (n=29) pTa; 12% (n=23) pT1; 26,7% (n=51) pT2; 26,2% (n= 50) pT3; 19,9% (n=38) pT4. The grades of the tumors were as follows: 3% (n=6) grade I; 12% (n=23) grade II; 84,8 % (n=162) grade III. Lymphovascular invasion was seen in 33% (n=63) of patients and perineural invasion in 8% (n=15). Lymph node metastases was observed in 29,4% (n=35) of the 119 lymph nodes extracted cases. Cases with lymphovascular
invasion, perineural invasion, vesicula seminalis infiltration or lymph node metastases were composed of muscle invasive and grade III tumors. Among 178 male patients, prostatic infiltration and vesicula seminalis infiltration was present in 13% (n=23) and %9,6 (n=17) of the cases respectively. Incidental adenocarcinoma of prostat was detected in 9% (n=16) of the specimens.
Conclusions: There was a statistically significant relationship between tumoral pathologic stage and grade. High pathologic stage or grade III tumors had statistically significant correlation with the presence of lymphovascular invasion and lymph node metastases. Presence of lymphovascular invasion was found to be a risk factor for the lymph node metastases. All the tumors which showed vesicula seminalis infiltration were grade III and these tumors were statistically associated with the presence of lymphovascular invasion.
Key Words: Bladder carcinomas, Cystectomy, Urothelial carcinoma
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