1-21-09 Cytology of bladder wash (procuded from Cystoscopy on 1-20-09)
Atypical urothelial (lining) cells highly suspicious for tumor are seen
1-22-09 surgical support
Pan cystoscopy was performed with a 70- and 30-degree lens. There was a large 5- to 6-cm bladder tumor on the left lateral wall just next to the ureteral orifice. There was tumor growing around the ureteral orifice, but nothing emanating from the ureteral orifice. There was clear efflux (stream) from the ureteral orifice. There were no other bladder tumors seen or other valvular erythematous(redness or inflamation) or suspicious patches throughout the urinary bladder. A Pollack catheter was advanced into the left ureteral orifice, then under direct vision for guidance during the resection of the bladder tumor. At this point the cystoscope was removed and a resectoscope was placed. The bladder tumor was resected in its entirety, taking deep bites to determine muscle invasive status. Great care was taken to resect around the ureteral orifice with the Pollack catheter in place. Hemostasis (stopping of the bleeding) was execellent. The bladder chips were Ellik'ed out in their entirety, and we inspected for hemostasis again, and again, hemostasis was excellent after cauterization of the large base of the tumor. There was a sessile (broad base or firmly attached) component to the tumor. All visibile tumor was resected. At this point a wire was advanced into the Pollack catheter which had been placed with a good curl into the renal pelvic on the left side. A 6 x 28 stent was then advanced with a good curl in the renal pelvis and a good curl in the bladder with the string left in place and secured. The Foley catheter, then 20-French Coude, was placed without difficulty with return of clear irrigant.
Mitomycin C was then injected into the patient's bladder and the catheter clamped off.
The tissue code had me a bit confused, but a surgeon told me that since the basement tissue was not breached then it is definitely NOT a T1 tumor. Hope that's right.
1-23-09 Anatomic Pathology
Family history of bladder cancer (mother)
Urinary bladder biopsies: Papillary urothelial carcinoma (malignant tumor), high grade, without evidence of invasion.
Gross description: "bladder tumor" is a 3.5 x 3.0 x 0.4 cm aggregate of pink-tan to tan-brown irregular tissue fragment.
Microscopic description: The specimen shows a papillary transitional(epithelium, as in the urinary bladder, that consists of several layers of soft cuboidal cells) cell neoplasm (new growth of tissue serving no physiological function). It is seated on an intact lamina propria (highly vascular layer of connective tissue under the basement membrane lining a layer of epithelium). Small portions of muscle are included and are not involved by the neoplasm. The surface of the neoplasm shows markedly thickened layers of transitional cells. Some areas are fairly well differentiated but other fairly extensive areas show moderate cytologic atypia (uncharacteristic or lacking uniformity) and there are occasional areas that show marked cytologic atypia with numerous mitosis (cell division). Tissue code: T1.