Tuesday, June 11, 2013

The pathology report has been made accessible to us ~ it is High Grade "papillary urothelial carcinoma".

The news is mixed (good news and not so good news) - the pathology report shows that the tumor was high grade, but that the cancer has not invaded the muscle tissue within the bladder wall.

In 2004 the World Health Organization developed a new grading system for early bladder cancer, which is increasingly being used. This system divides bladder cancers into the following groups
  • Urothelial papilloma – non cancerous (benign) tumor
  • Papillary urothelial neoplasm of low malignant potential (PUNLMP) – very slow growing and unlikely to spread
  • Low grade papillary urothelial carcinoma – slow growing and unlikely to spread
  • High grade papillary urothelial carcinoma – more quickly growing and more likely to spread
According to Penny's pathology report, she is in the 4th group.   :-(

Here is a diagram of a Bladder (and the different types of non invasive and invasive cancers):


Here is the pathology report below:

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4 Specimen(s) Received  - Diagnosis

A: Bladder tumor
  • URINARY BLADDER TUMOR, TRANSURETHRAL RESECTION: -   PAPILLARY UROTHELIAL CARCINOMA, HIGH GRADE.
    -   NO MUSCULARIS PROPRIA INVASION IDENTIFIED.
  • Note: The TUR specimen shows a high grade papillary urothelial carcinoma. It's very difficult to evaluate stromal invasion due to cauterized artifact.  Fragments of muscularis propria are present, and there is no evidence of invasion.
  • Gross description: Specimen part A labeled "Bladder Tumor" is received in formalin and consists of more than 15 pieces of pink-tan soft tissue ranging from 0.1 to 0.8 cm in diameter, aggregating 2.5 x 2 x 0.3 cm. All are submitted in cassette A1.
B: Bladder biopsy posterior wall
  • URINARY BLADDER, POSTERIOR WALL, BIOPSY:
    -   UROTHELIAL MUCOSA WITH NO DIAGNOSTIC ABNORMALITY. 
  • Note: Nothing to note
  • Gross description: Specimen part B labeled "Bladder Biopsy Posterior Wall" is received in formalin on a Telfa pad and consists of a single piece of pink-tan soft tissue measuring 0.2 x 0.2 x 0.1 cm. The entire specimen is submitted in cassette B1.
C: Bladder biopsy right wall
  • URINARY BLADDER, RIGHT WALL, BIOPSY: -   UROTHELIAL MUCOSA WITH NO DIAGNOSTIC ABNORMALITY.
  • Note: Nothing to note.
  • Gross description: Specimen part C labeled "Bladder Biopsy Right Wall" is received in formalin on a Telfa pad and consists of a single piece of pink-pale tan soft tissue measuring
    0.3 x 0.1 x 0.1 cm. The entire specimen is submitted in cassette C1.
D: Bladder biopsy left wall
  • URINARY BLADDER, LEFT WALL, BIOPSY: -   UROTHELIAL MUCOSA WITH NO DIAGNOSTIC ABNORMALITY (see comment).
  • Note: The biopsy reveals rare enlarged cells on the mucosal surface. There is no evidence of malignancy, confirmed by immunohistochemical stains of CK7, CK20 and Ki-67.
  • Gross description: Specimen part D labeled "Bladder Biopsy Left" is received in formalin on a Telfa pad and consists of a single piece of pink-pale tan soft tissue measuring 0.2 x 0.2 x 0.1 cm. The entire specimen is submitted in cassette D1.
Specimens Taken: 5/31/2013
Specimens Received by Lab: 5/31/2013
Specimens Lab Pathology Report: 6/4/2013
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As you can tell, we'll have much to talk about with the Urologist and Oncologist this Friday. As the tumor keeps reoccurring at the entrance of the Ureter going into the left Kidney (5 out of the last 6 Cystoscopies), we may have to get more aggressive in our treatment plan. The thing is, Cancer Treatment Center of America believes the previous pathology (their interpretation) was that her previous biopsies should have noted the cancer as being "High Grade", not "Low Grade" based on their review of the specimen stains done previously. So we are pretty upset as our treatment plan may have been different during the previous 18 months of treatment.

~ Steinar

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