Bladder resections (PG040)

Pathomorphological examination during bladder resection — is a histological analysis of a part of the organ wall removed by an open or laparoscopic method. Unlike transurethral resection (TUR), this operation involves the removal of the entire mass of tissues of the affected area along with the subpancreatic layer and surrounding tissue. The study under the code PG040 allows you to obtain complete information about the structure of the tumor and the radicality of the intervention.

Research objective: The main task is to confirm the final diagnosis and establish the exact stage of the disease. The pathologist examines the sample in detail to determine how deep the tumor has penetrated the bladder wall and whether it has been completely removed within the healthy tissue.

What does the pathologist evaluate:

• Histological form of cancer: verification of tumor type (urothelial carcinoma, squamous cell carcinoma, adenocarcinoma).

• Degree of differentiation (Grade): assessment of the aggressiveness of malignant cells (from G1 to G3).

• Depth of invasion (pT stage): precise determination of germination into the submucosal base, muscle layer, or exit into the perivesical tissue.

• Cleanliness of resection margins (R status): Microscopic examination of tissue cut lines for the absence of tumor cells (critical to rule out recurrence).

• Condition of surrounding tissues: detection of signs of background inflammation, metaplasia, or carcinoma in situ (CIS) in adjacent areas of the mucosa.

Clinical significance: For the urologist, the results of this study are decisive in choosing further tactics. If the resection margins are clear (R0) and the tumor has no signs of deep invasion, the patient can remain under observation. If tumor cells are detected at the resection margins or deep muscle invasion, the question of radical cystectomy or chemotherapy may arise.

When is it prescribed:

• after partial (segmental) resection of the bladder for tumors of a certain localization;

• removal of a bladder diverticulum with a neoplasm;

• treatment of non-invasive tumors that are technically impossible to remove by TUR;

• verification of the nature of non-neoplastic lesions (e.g., bladder endometriosis or deep ulcers).