14 July I had urine cytology done which turned out negative (some good news at last). However, cysto and biopsies done that same day and pathology just to hand has left me hanging yet again. Report from pathologist goes as follows (extract)

Macroscopy
Bladder biopsy – 18 x 15mm in aggregate

Microscopy
There are multiple fragments of bladder mucosa lined in part by epithelium showing regenerative change, however, in areas there is thickening of the epithelium associated with moderate cytologic atypia and scattered mitoses. The underlying stroma contains a patchy predominantly chronic inflammatory cell infiltrate with scattered non-necrotizing granulomas, consistent with previous BCG therapy.

The cytological atypia is difficult to interpret. In areas, the atypia is full thickness but in the vast majority of these regions, there is an intact umbrella cell layer on the surface. Immunostaining for cytokeratin 20 shows full thickness staining in these regions, which is of concern. The biopsy has also been compared with the previous biopsy and has a very similar appearance. The changes are consistent with carcinoma – in – situ, however, the slides will be reviewed by Dr R Cohen (the Chief Pathologist) and a supplementary report issued.

Provisional Conclusion
Bladder biopsy – urothelial atypia consistent with carcinoma – in -situ; supplementary report to follow.

This report is as confusing as the previous one and I am unsure what it is trying to say other than evrything is inconclusive and that the Immunostaining raised some issues of concern??

Although I have great faith in my Uro and Path I am wondering if I should get a second opinion on either or both as I have this nagging feeling that sinister things are afoot and I should be doing more to address these. Go back to the Uro on 2 August and should have further Path report then so maybe I will get a better understanding of what is happening inside my body.