Bladder full abstract lab

68-year-old with two episodes of painless gross hematuria, negative urine culture, no prior cancer. Former smoker, 30 pack-years. Examination: no palpable abdominal mass; performance status 0. CT urogram reviewed. Cystoscopy shows a solitary approximately 2 cm papillary lesion on left lateral bladder wall; other mucosa looks normal. Plan complete transurethral resection with deep base, then discuss pathology.

TECHNIQUE: Noncontrast, nephrographic and delayed excretory images. FINDINGS: 2.1 cm enhancing polypoid lesion left lateral bladder wall. No hydronephrosis, upper tract lesion, perivesical fat abnormality, pelvic or retroperitoneal adenopathy, or suspicious lesion in imaged abdomen. IMPRESSION: suspicious bladder lesion; cystoscopy and tissue sampling recommended. Imaging cannot resolve lamina propria versus muscle invasion. Signed radiologist.

Under anesthesia, single left lateral wall papillary tumor resected to visible base. Tumor chips and separately labeled deep base submitted. Surgeon describes complete visible removal, hemostasis and no perforation. No lymph nodes removed. The procedure is therapeutic resection of bladder tumor; pathology is pending. Repeat resection planned if T1 is confirmed.

SPECIMENS A left lateral wall tumor, aggregate 2.3 cm; B deep base, aggregate 0.8 cm. MICROSCOPY: A high-grade papillary urothelial carcinoma with destructive invasion of lamina propria. No carcinoma in situ or lymphovascular invasion identified. B muscularis propria present, uninvolved. FINAL DIAGNOSIS: invasive high-grade papillary urothelial carcinoma, left lateral bladder wall, pT1 in sampled tissue. Signed pathologist.

Prior tumor scar resected, deep muscle sampled; no other visible lesion. Pathology: reactive urothelium, fibrosis and muscularis propria, negative for residual carcinoma. Negative re-resection does not erase the documented January lamina propria invasion. No pelvic nodes sampled. Urologist confirms non-muscle-invasive T1 disease and recommends induction BCG.

Intravesical BCG instilled by catheter weekly on 19, 26 March and 2, 9, 16, 23 April; nursing records verify six of six doses delivered. No intravenous chemotherapy or external beam radiation. April 27 note: induction completed, surveillance cystoscopy planned; maintenance discussed without an administration date in this packet. Use delivered records. 2026 bladder guideline instructs coding BCG as surgery and immunotherapy; verify exact surgery code for complete first-course sequence in Appendix C.

64-year-old with six weeks of hematuria and urgency. No previous reportable cancer. CT shows a right posterior wall lesion; cystoscopy identifies a broad-based 3.4 cm mass away from ureteral orifices. Urologist plans TURBT, discusses possibility of muscle invasion and need for staging. No antineoplastic treatment has yet been given.

IV contrast study: irregular enhancing right posterior bladder wall mass, 3.5 cm, without gross perivesical extension. Chest without suspicious nodules. No enlarged pelvic or retroperitoneal nodes; liver and bones without suspicious lesions. Impression: bladder mass, no radiographic metastatic disease. Imaging does not determine microscopic depth.

Broad-based right posterior wall tumor resected to deep base in separately labeled jars. A: high-grade urothelial carcinoma with invasion through lamina propria into muscularis propria; focal squamous differentiation, less than 10%. B: deep muscularis propria involved. Lymphovascular invasion absent. No CIS in submitted tissue. Final diagnosis: muscle-invasive urothelial carcinoma. Histology selection requires 2026 Urinary Solid Tumor Rules, not a casual choice from minor differentiation.

Clinical cT2N0M0 based on TURBT and CT. Multidisciplinary plan: four cycles of cisplatin and gemcitabine before radical cystectomy. Discussed renal function, hearing and neuropathy; patient consents. Planned radiation is not part of initial course. The plan itself is not proof of administration.

Pharmacy and nursing records confirm cisplatin/gemcitabine cycles beginning 3 March, 24 March, 14 April and 5 May, with last scheduled day 8 dose on 20 May. Restaging CT 2 June shows decreased right wall thickening, no new node or distant lesion. Oncologist documents completed neoadjuvant regimen. These are systemic IV agents, not intravesical therapy.

Robotic radical cystoprostatectomy with ileal conduit and bilateral pelvic lymphadenectomy. Bladder opened: 1.8 cm fibrotic right posterior wall tumor bed. Microscopy: residual high-grade urothelial carcinoma invades inner half muscularis propria, treatment effect; margins negative. Twenty-two pelvic nodes negative (0/22); prostate uninvolved by carcinoma. Final ypT2a ypN0. No external beam radiation delivered. Surgeon documents conduit creation as reconstruction accompanying cystectomy.

72-year-old with gross hematuria, no prior malignancy. Cystoscopy reveals a solitary 3 cm right lateral wall mass. Patient desires bladder preservation if appropriate. No other visible mucosal lesions. CT urogram and staging CT ordered. Discussion of trimodality approach is a proposal pending pathology and multidisciplinary review.

Enhancing 3.1 cm right lateral bladder wall mass without gross extension into perivesical fat. No hydronephrosis, pelvic adenopathy, chest mass, liver lesion or suspicious osseous finding. Report notes that microscopic invasion requires pathology. Signed diagnostic radiologist.

Surgeon resects all visible right lateral wall mass to deep base, no perforation. Separate superficial and deep specimens. High-grade urothelial carcinoma invades muscularis propria in deep sample; no CIS or lymphovascular invasion in submitted fragments. Final invasive urothelial carcinoma with muscle invasion. No lymph node tissue in TURBT. Urologist considers resection macroscopically complete.

Clinical cT2N0M0. Multidisciplinary recommendation is maximal TURBT followed by concurrent weekly cisplatin and external beam radiation to bladder; patient agrees. Cystectomy remains a salvage option if residual or recurrent disease develops. This chart does not document cystectomy. Radiation planning, prescription and delivery must be kept distinct.

CT simulation on 27 March. Photon VMAT plan: phase I whole bladder and selected pelvic nodes 4500 cGy in 25 fractions; sequential phase II bladder tumor-bed boost 1440 cGy in 8 fractions, total tumor-bed dose 5940 cGy. Daily machine logs document first delivered fraction 6 April, 25th phase I on 8 May, boost 11–20 May, all 33 fractions completed. Signed completion note verifies target, technique, dose and dates. Simulation is not the treatment start.

Weekly IV cisplatin administered during radiation on 6, 13, 20, 27 April and 4, 11 May; final planned dose held for renal function. Pharmacy and nursing logs confirm six delivered doses. Cystoscopy 2 July: healing scar without gross tumor; biopsy shows reactive change, no viable carcinoma. Initial highest extent remains muscle invasion at diagnosis. No radical cystectomy or intravesical BCG delivered.

59-year-old presents with intermittent gross hematuria; no earlier cancer. CT identifies a solitary dome mass distant from trigone. Cystoscopy confirms dome lesion and no second visible focus. Patient is a candidate for segmental surgery after workup. Physical examination has no palpable nodes or mass.

3.0 cm bladder dome mass with focal thickening through wall and minimal outer contour irregularity. A 1.2 cm right external iliac node is indeterminate. No liver, lung or bone lesion. Imaging impression favors localized bladder malignancy with indeterminate pelvic node, recommends tissue evaluation. External iliac chain is a pelvic regional nodal basin for bladder.

Specimen dome tumor, aggregate 2.7 cm. Invasive high-grade urothelial carcinoma extends into muscularis propria; deep tissue has tumor at cauterized edge. No CIS identified in sampled mucosa. No node submitted. Multidisciplinary team proceeds with partial cystectomy and bilateral pelvic node dissection.

Open partial cystectomy removes dome segment with a rim of grossly normal bladder and bilateral pelvic lymphadenectomy. Primary closure; no urinary diversion. Operative note: no visible peritoneal implants, no adherent bowel; external iliac node removed. This is partial, not radical, cystectomy. No radiation delivered at surgery.

Bladder dome 3.1 cm high-grade urothelial carcinoma invades microscopic perivesical soft tissue; serosal surface free, negative inked margins. Right external iliac node 1/7 involved, deposit 0.4 cm; left pelvic nodes 0/8. No extranodal extension. Final pT3a pN1. Metastatic pelvic regional node is not distant metastasis. Signed pathologist.

Medical oncology documents and infusion logs confirm adjuvant cisplatin/gemcitabine cycles initiated 18 June and completed 1 September. Radiation oncology consultation discusses possible postoperative radiation but no simulation or treatment log exists; completion summary explicitly says radiation not given. No intravesical BCG. Surveillance CT 15 September shows no new distant lesion.

66-year-old with persistent irritative voiding and microscopic hematuria; culture negative. No prior bladder or other reportable cancer. Cystoscopy shows a flat erythematous patch across posterior wall, no papillary mass. Cytology suspicious for high-grade urothelial carcinoma. Biopsies and upper-tract evaluation planned; cytology alone does not locate invasive disease.

No focal upper-tract filling defect, hydronephrosis, perivesical mass, pelvic adenopathy or suspicious distant lesion in imaged abdomen. Mild posterior bladder mucosal enhancement correlates with cystoscopy. Impression: correlate with biopsy. Negative CT cannot exclude flat mucosal CIS.

Posterior wall biopsy A: flat high-grade urothelial carcinoma in situ, confined to urothelium, 8120/2. Lamina propria present without invasion. Muscularis propria present in B deep posterior wall biopsy and uninvolved. Right/left lateral wall and trigone biopsies negative. No invasive focus. Final: urothelial CIS of posterior bladder wall, signed pathologist.

Physician explains in situ lesion and risk of progression; recommends six-week induction intravesical BCG with later cystoscopic reassessment. No cystectomy, IV chemotherapy or external beam radiation planned. The plan date is distinct from first administration. No other lifetime reportable primary in record.

Six weekly BCG instillations into bladder by catheter administered 18, 25 June; 2, 9, 16, 23 July. Nursing verifies medication, dose and completion; no missed course. BCG is immunotherapy and also surgery per 2026 bladder guidelines, though no TURBT was performed. Code the actual first-course sequence with Appendix C rather than treating biopsies as tumor removal.

Cystoscopy shows scar and a new small erythematous patch. 27 August biopsy signed 4 September: chronic inflammation only, no carcinoma. A 20 August CT mentions an indeterminate 4 mm lung nodule, below confident characterization; physician plans interval imaging and does not diagnose metastasis. Do not upstage from an unresolved incidental nodule or make it a new primary.