The Biological Behavior of Transitional Cell Papilloma of the Bladder

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Abstract
Of 407 patients with bladder tumors, 109 were classified as benign papillomas. All cases in which the biopsy material or the descrs. of the tumor were inadequate were excluded. A transitional-cell papilloma of the bladder "is a papillomatous tumor with villi covered with transitional epithelial cells similar to the cells of the bladder with a central stalk of fibrous tissue and blood vessels. The epithelial cells are all uniform and regularly arranged on a definite basement membrane that is not infiltrated. Papillomas showing any change in the regularity of the size, shape and the arrangement of the cells, any changes in their nuclei, or fusion of the villi were considered papillary carcinoma." Of the 109 cases of papilloma, 80 (73%) occurred in men and 29 (27%) in women. The youngest man was 23 yrs. old; the youngest woman, 42. About 10% of the tumors in men occurred before 45 yrs. of age, while only 1 woman was less than 45. The avg. age of men was between 60 and 70; of women, between 55 and 65. 56% of the tumors were single; 44%, multiple. Almost half of the tumors were located on the trigone; 7% were more than 5 cm., 73% between 2 and 5 cm., and 20% less than 2 cm., in width. Excluding patients followed less than 3 yrs., patients who died within 3 yrs., and patients with infrequent follow-ups, there were 52 followed 3 or more yrs., and a study of these revealed 4 patterns of growth: (1) 30.8% began as single or multiple tumors, or a few sporadic tumors, occurring during a short interval of time, with no subsequent new growth after treatment; (2) 50% exhibited a slow rate of growth, less than 10 new growths per yr., and the tumor began as a single or multiple tumor with growth-free intervals of 2 to 8 yrs.; (3) 11.5% showed a high rate of new growth averaging more than 10 tumors per yr. over many yrs., (4) 5% were of a mixed type showing both high and low rates of new growth. The pitfalls of biopsy are pointed out. There were 8(7.3%) cases in which carcinoma developed between 3 yrs., 11 mos. and 15 yrs. after the first diagnosis of papilloma. In attempting to detect the cases that will develop carcinoma, changes in the histology of the tumors should be observed by biopsy of each new growth or group of new growths. Of the group of cases exhibiting a fast growth of new tumors, 66.7% developed carcinomas. Further attempts at transplantation of bladder papilloma into the guinea-pig eye indicate that these tumors in general do not have the character of autonomous growth. The symptomatology of papilloma is similar to that of bladder cancer. By cystoscopic fulguration one can expect 83% 3-yr. control,, 66.7% 5-yr. control, 42.5% 10-yr. control, and 30.5% permanent control. For the group of cases developing more than 10 tumors per yr., total cystectomy is advocated. The possible role of hormonal factors in the sex incidence of bladder tumors is pointed out.
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