Relevance of inflammatory pseudotumor associated with bladder tumor

Inflammatory pseudotumors (IPT) are sometimes seen in the follow-up bladder biopsies of patients with transitional cell carcinoma. The relevance of this finding was studied in 809 patients who were on surveillance after the initial definitive treatment for superficial transitional cell carcinoma of the bladder. During this period, there were 16 (2%) patients who had bladder mass but without evidence of malignancy. They had histological evidence of only IPT.spindle cells and Inflammatory infiltrate. In all these patients, the primary tumor was a high-grade transitional cell carcinoma.Fifteen of these patients had received adjuant intravesical therapy during the initial treatment. This included intravesical immunotherapy with bacillus Calmette-Guerin (BCG) in 13, intravesical chemotherapy in one and chemoradiation in one. The median follow-up period was 26 months after the diagnosis of IPT. Twelve patients (75%) showed tumor recurrence within a median period of 16 months. All the recurrences were high-grade urothelial carcinoma. Nine (56%) progressed to a higher stage with a median time to progression of seven months from the diagnosis of IPT. Four patients (25%) had evidence of metastases upon diagnosis of recurrence and two more patients developed metastatic disease later. Eventually 12 patients died within a median period of 26 months after the diagnosis of IPT.