Histopathological study of 110 cystectomy specimens for bladder cancer by an original mapping method.

The management of cystectomy specimens represents the first and most important step in the study of bladder cancer and related lesions. We carried out a study on 110 patients, applying an original mapping protocol which allowed to determine the exact topography of lesions, recognizing even the smallest ones and putting in evidence some rare histotype. A prevalence of high-grade, high-stage tumors was noted, as well as a remarkable frequency of precancerous lesions, mostly found in Brunn's nests. This latter finding could mean that in many cases a flat carcinoma becomes invasive within a Brunn's nest rather than in surface urothelium. We were also able to accurately evaluate prostatic pathology, finding incidental malignant lesions of this gland in 24.2% of the cystectomized males. The apparently worst prognosis of the patients who underwent chemotherapy depends on the fact that they had grades and stages higher than the untreated subjects. In conclusion, we believe that a more extensive sampling of cystectomy specimens gives highly reliable prognostic data and represents an unreplaceable tool in understanding bladder neoplasms.