biopsy results of bladder

I'm asking for my fiance' who has had blood in his urine off and on for about a year.  He's been on multiple antibiotic treatments.  He has one diverticula in his bladder.  The urologist did a scope and biopsy of the diverticula with the following results:

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(O) "Bladder Biopsy, bladder bx":  Denuded bladder mucosa with underlying chronic inflammation and minute area of residual urothelium with reactive features.  The deepest biopsy layer is the lamina propria.  Comments:  Cytospin slides of bladder biopsy fixative sediment reveal few sheets of benign urothelium with reactive nuclear features"

(O) Bladder Biopsy, bladder bx:  The specimen consists of one portion of tan-white, soft, ill-defined tissue measuring 0.10 cm x 0.10 cm x 0.10 cm.  Totally submitted
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Questions:    are the "reactive nuclear features" of the urothelium a sign of "atypical" or precancerous cells?   He has been on Cipro without resolution - he's now being prescribed another antibiotic - is this the proper course of action?

Thank you

[Fernando Roque, MD]

Hi.  The "reactive (nuclear) features" mean that changes in appearance, particularly of the nucleus, have been noted in the bladder lining cells (urothelium).  These changes are seen by the pathologist as a reaction of the cells to the ongoing chronic inflammation.  Reactive nuclear features are different from "atypia" because the changes in appearance undergone by atypical cells imply that they have acquired characteristics which are deemed as "cancer-like", and not indicative of an inflammatory state.

If your fiance has been on several antibiotics with no improvement, maybe a urine culture should be done first to determine what the offending microorganism is.  The antibiotic regimen could then be changed to one which the cultured organism is sensitive to.

[utahmomma]

Thank you so very much!