Urinary bladder carcinoma

Answer is ‘c’ i.e. Transitional cell carcinoma

There are 3 common histological types of bladder cancer

a)         Transitional (urothelial) cell ca      —  90%

b)         Squamous cell ca       —   5-10%

c)          Adenocarcinoma         —  2%

Answer is ‘a’ i.e. Urolithiasis & ‘c’ i.e. Schistosomiasis

Persistent urachus is a risk factor for adenocarcinoma of bladder .

Answer is ‘a’ i.e. Smoking predisposes; ‘b’ i.e. Schistosoma infection predisposes; ‘c’ i.e. Aniline dye workers

Ans is ‘a’ ie haematuria

Ans. is ‘b’ i.e., Occurs more often in aniline dye workers ‘c’ i.e. it is located most frequently in the trigone 

Ans. is ‘a’ i.e. Schistosomiasis 

Now here, is confusion in the question itself. There are two opinions among students

(a) One group of students say that the question was small contracted bladder with calcified lesion in the kidney

(b)  Others opinion there is that the question was – small contracted bladder with calcification in the wall of bladder itself

• Ans to (a) is Tuberculosis [Ref Bailey & Love, 24th/e p1327 (23/e p1194)]
• Ans to (b) is Schistosomiasis

Schistosomiasis of the bladder

• The common species of Schistosoma are

– S. Japonicum (affecting mainely liver, S. intestine)*

– S mansoni (affecting mainly large intestine)*

– S. haematobium (affecting mainly the bladder)*

• The adult S. haematobium worm lives in the prostatovesical plexus of veins. The female worm lays her eggs in the subepithelial layers of the affected viscus.
• Massive egg deposition leads to severe local reaction with granuloma formation.these are later replaced by fibrous tissue that causes contraction of different parts of the bladder and stricture of ureter.

Fibrosis and massive egg deposition interfere with the blood supply of area causing chronic bilharzial ulcerations.

• Epithelial metaplasia is common and squamous cell is a frequent sequela.
• Secondary inf. of the urinary tract is a common complication.
• The trapped dead ova become impregnated with calcium salts and forms sheets of subepithelial calcified layer in the bladder wall. This appear on X-rays as dense concentric ring of calcification (may resemble fetal head in pelvis).

Profuse hematuria occurs in patients initially due to penetration of the urothelium by living ova (which are extruded in the urine) and later due to ulceration.

• Both renal and vesical calculi may form.
• Advanced ds. leads to small contracted bladder (having a capacity of only few millilitres) with varying degrees of dilatation of the upper urinary tract (hydroureteronephrosis)
• S. haematobium also involves ureters, seminal vesicles (and to a lesser extent male urethra and prostate gland) leading to strictures and extensive calcifications in these structures.

Tuberculosis of kidney and bladder

• In TB of kidney, a group of tuberculous granulomas form in the renal pyramid. They coalesce and form an ulcer. Untreated the lesion enlarges and a tuberculous abscess may form in the parenchyma. Gradually the kidney is replaced by caseous material (putty kidney*), it may be calcified (cement kidney). Calcifications may appear on the x-ray as calculi (pseudocalculi)
• Renal tuberculosis is often associated with tuberculosis of the baldder. TB of bladder leads to fibrosis and thus contracture of bladder.
• Golf-hole ureters* are seen in TB bladder*.

Ans. B: Human papilloma virus infection

Answer- B. Complete transurethral resection with intravesical chemotherapy

Treatment-

T1

• Complete TUR followed by intravesical chemo- or immunotherapy or radical cystectomy

Answer- D. Radical Cystectomy

Tumor extending into muscle is stage T2 → Radical cystectomy is advised.

Treatment-

• T2- T4
• Radical cystectomy
• Neoadjuvant chemotherapy followed by radical cystectomy
• followed by adjuvant chemotherapy
• Concomitant chemotherapy and irradiation