1
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Yanagi M, Motoda N, Katsu A, Kono H, Kimata R, Hamasaki T, Kondo Y. Preoperative oral treatment with cyclooxygenase-2 inhibitor for cystitis glandularis. IJU Case Rep 2024; 7:297-300. [PMID: 38966771 PMCID: PMC11221942 DOI: 10.1002/iju5.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/28/2024] [Indexed: 07/06/2024] Open
Abstract
Introduction A previous report has shown that cyclooxygenase-2 inhibitors can prevent the recurrence of cystitis glandularis postoperatively. Herein, we present a case of cystitis glandularis in which the tumor volume was markedly reduced by preoperative oral administration of a cyclooxygenase-2 inhibitor. Case presentation A 45-year-old man with voiding difficulty and lower abdominal pain during urination was referred to our hospital. Cystoscopy revealed multiple cystitis glandularis-like edematous masses on the trigone and the neck of the bladder, completely involving the bilateral ureteral orifices. Cyclooxygenase-2 inhibitor was orally administered at the patient's request. Six weeks later, the tumor volume was markedly reduced, bilateral ureteral orifices were identified, and the voiding difficulty and pain on urination disappeared. Complete transurethral resection of the residual tumor was performed, and the pathological diagnosis was intestinal-type cystitis glandularis. Conclusion Cyclooxygenase-2 inhibition can be considered a useful therapeutic strategy for cystitis glandularis.
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Affiliation(s)
- Masato Yanagi
- Department of UrologyNippon Medical School Musashikosugi HospitalKawasakiKanagawaJapan
| | - Norio Motoda
- Department of PathologyNippon Medical School Musashikosugi HospitalKawasakiKanagawaJapan
| | - Akifumi Katsu
- Department of UrologyNippon Medical School Musashikosugi HospitalKawasakiKanagawaJapan
| | - Hiroyoshi Kono
- Department of UrologyNippon Medical School Musashikosugi HospitalKawasakiKanagawaJapan
| | - Ryoji Kimata
- Department of UrologyNippon Medical School Musashikosugi HospitalKawasakiKanagawaJapan
| | - Tsutomu Hamasaki
- Department of UrologyNippon Medical School Musashikosugi HospitalKawasakiKanagawaJapan
| | - Yukihiro Kondo
- Department of UrologyNippon Medical School HospitalBunkyo‐kuTokyoJapan
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2
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Reis H, Al-Ahmadie H, Szarvas T, Grünwald V, Köllermann J, Koll F, Hadaschik B, Chun F, Wild PJ, Paner GP. [Rare tumors and tumor types of the urinary system in the 5th edition of the WHO classification 2022]. PATHOLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00292-024-01329-2. [PMID: 38639771 DOI: 10.1007/s00292-024-01329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
The 5th edition of the World Health Organization (WHO) classification of tumors of the urinary tract and male genital organs introduced both general and specific changes in structure, classification, and nomenclature. This also applies to rarer tumors and tumor subtypes of the urinary system. Knowledge of these changes is relevant for routine histopathological work. This article provides an overview of the main new features of the rarer tumors and tumor subtypes of the urinary system in the new edition of the WHO classification.
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Affiliation(s)
- Henning Reis
- Dr. Senckenbergisches Institut für Pathologie (SIP), Universitätsklinikum Frankfurt, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Deutschland.
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, USA
| | - Tibor Szarvas
- Klinik für Urologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
- Klinik für Urologie, Semmelweis Universität, Budapest, Ungarn
| | - Viktor Grünwald
- Klinik für Urologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Jens Köllermann
- Dr. Senckenbergisches Institut für Pathologie (SIP), Universitätsklinikum Frankfurt, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Deutschland
| | - Florestan Koll
- Klinik für Urologie, Universitätsklinikum Frankfurt, Goethe Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Boris Hadaschik
- Klinik für Urologie, Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Felix Chun
- Klinik für Urologie, Universitätsklinikum Frankfurt, Goethe Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Peter J Wild
- Dr. Senckenbergisches Institut für Pathologie (SIP), Universitätsklinikum Frankfurt, Goethe Universität Frankfurt, Theodor-Stern-Kai 7, 60596, Frankfurt am Main, Deutschland
| | - Gladell P Paner
- Department of Pathology, University of Chicago, Chicago, USA
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3
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Reis H, Paner GP. Glandular Lesions of the Urinary Bladder: Diagnostic and Molecular Updates. Adv Anat Pathol 2024; 31:88-95. [PMID: 38323607 DOI: 10.1097/pap.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Glandular lesions in the urinary tract or their associated pathologies can pose a diagnostic challenge. There is a variety of benign alterations and tumor types that need to be taken into account in differential diagnostic considerations. In recent times, efforts for better defining these alterations or lesions both on the histopathological and molecular levels have been undertaken. This article will provide an update on current diagnostic and molecular considerations of these lesions.
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Affiliation(s)
- Henning Reis
- University Hospital Frankfurt, Dr. Senckenberg Institute of Pathlogy (SIP), Goethe University Frankfurt, Frankfurt, Germany
| | - Gladell P Paner
- Departments of Pathology and Surgery (Urology), University of Chicago, Chicago, IL
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4
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Taylor AS, Acosta AM, Al-Ahmadie HA, Mehra R. Precursors of urinary bladder cancer: molecular alterations and biomarkers. Hum Pathol 2023; 133:5-21. [PMID: 35716731 DOI: 10.1016/j.humpath.2022.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 01/04/2023]
Abstract
Clinical surveillance and follow-up of patients diagnosed with or at risk for urinary bladder cancers represent long-term, invasive, and costly processes for which supplemental biomarker information could help provide objective, personalized risk assessment. In particular, there are several precursors and possible precursors to urinary bladder cancer for which clinical behavior is heterogenous and interobserver variability in histopathologic diagnosis make it difficult to standardize management. This review seeks to highlight these precursor lesions from a diagnostic perspective (including flat urothelial lesions, papillary urothelial lesions, squamous lesions, and glandular lesions) and qualify known multiomic biomarkers that may help explain their behavior, predict patient risk, and acknowledge the nuance inherent to the question of whether these lesions are "benign" or "preneoplastic."
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Affiliation(s)
- Alexander S Taylor
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Andres M Acosta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Hikmat A Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA; Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI 48109, USA; Michigan Center for Translational Pathology, Ann Arbor, MI 48109, USA.
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5
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Kim JY, Han D, Kim H, Jung M, Ryu HS. The proteomic landscape shows oncologic relevance in cystitis glandularis. J Pathol Transl Med 2023; 57:67-74. [PMID: 36539394 PMCID: PMC9846008 DOI: 10.4132/jptm.2022.10.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The relationship between cystitis glandularis (CG) and bladder malignancy remains unclear. METHODS We identified the oncologic significance of CG at the molecular level using liquid chromatography-tandem mass spectrometry-based proteomic analysis of 10 CG, 12 urothelial carcinoma (UC), and nine normal urothelium (NU) specimens. Differentially expressed proteins (DEPs) were identified based on an analysis of variance false discovery rate < 0.05, and their functional enrichment was analyzed using a network model, Gene Set Enrichment Analysis, and Gene Ontology annotation. RESULTS We identified 9,890 proteins across all samples and 1,139 DEPs among the three entities. A substantial number of DEPs overlapped in CG/NU, distinct from UC. Interestingly, we found that a subset of DEP clusters (n = 53, 5%) was differentially expressed in NU but similarly between CG and UC. This "UC-like signature" was enriched for reactive oxygen species (ROS) and energy metabolism, growth and DNA repair, transport, motility, epithelial-mesenchymal transition, and cell survival. Using the top 10 shortlisted DEPs, including SOD2, PRKCD, CYCS, and HCLS1, we identified functional elements related to ROS metabolism, development, and transport using network analysis. The abundance of these four molecules in UC/CG than in NU was consistent with the oncologic functions in CG. CONCLUSIONS Using a proteomic approach, we identified a predominantly non-neoplastic landscape of CG, which was closer to NU than to UC. We also confirmed a small subset of common DEPs in UC and CG, suggesting that altered ROS metabolism might imply potential cancerous risks in CG.
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Affiliation(s)
- Jun Yong Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul,
Korea
| | - Dohyun Han
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul,
Korea,Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul,
Korea
| | - Hyeyoon Kim
- Proteomics Core Facility, Biomedical Research Institute, Seoul National University Hospital, Seoul,
Korea,Department of Pathology, Seoul National University College of Medicine, Seoul,
Korea
| | - Minsun Jung
- Department of Pathology, Yonsei University College of Medicine, Seoul,
Korea
| | - Han Suk Ryu
- Department of Pathology, Seoul National University College of Medicine, Seoul,
Korea
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6
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Kusumaputra A, Rahman IA, Wirjopranoto S. Severe obstructive symptoms and urinary bladder mass due to cystitis glandularis: A very rare case report in children. Int J Surg Case Rep 2022; 100:107709. [PMID: 36244150 PMCID: PMC9574407 DOI: 10.1016/j.ijscr.2022.107709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/25/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022] Open
Abstract
Cystitis Glandularis (CG) is an unusual proliferative disease of the bladder. This condition was associated with chronic inflammation or chronic obstruction. This condition usually presents as microscopic finding and the presence of large macroscopic lesion is a rare feature. Until now, the course of disease from transitional to cystitis glandularis is still unclear and the uncertainty of CG to potentially develop into adenocarcinoma has once been documented. Herewith, we report our experience with 2 years old boy with cystitis glandularis presenting with LUTS obstructive symptoms, hematuria and bladder mass. Ultrasound examination revealed bilateral hydronephrosis with hydroureter and bladder wall thickness suggesting the sign of obstruction and chronic inflammation. Cystoscopy examination was performed to ensure the diagnosis with the result revealing protruding mass partially obstructing the bladder trigone, both ureteral orifice and posterior urethra. Transurethral resection was performed and the administration of COX-2 inhibitor and oral steroid therapy were given. Post-operative course was uneventful with the improvement in symptom and uroflowmetry revealed promising result. This case represented an entity of rare and interesting case of cystitis glandularis causing severe obstructive symptoms and urinary bladder mass which appropriate therapy of endoscopic intervention, COX-2 inhibitor and oral steroid resulted in promising outcome. Follow up of 1 year resulted in reduced LUTS symptoms such as straining and difficulty of urination. Cystitis Glandularis (CG) is an unusual proliferative disease of the bladder This condition is associated with inflammation or chronic obstruction Manifestation of large visible macroscopic lesion of the urinary bladder is an extremely rare entity Appropriate therapy consisted of endoscopic intervention, COX-2 inhibitor and oral steroid for Cystitis Glandularis resulted in promising outcome.
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Affiliation(s)
- Ahmad Kusumaputra
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Ilham Akbar Rahman
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Soetojo Wirjopranoto
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
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7
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Analysis of Intestinal Metaplasia Without Dysplasia in the Urinary Bladder Reveal Only Rare Mutations Associated With Colorectal Adenocarcinoma. Appl Immunohistochem Mol Morphol 2021; 28:786-790. [PMID: 31876604 DOI: 10.1097/pai.0000000000000812] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intestinal metaplasia (IM) is a rare finding in urinary bladder specimens. It is unclear whether IM without dysplasia is a precursor of malignancy in the urinary system. We retrospectively selected 9 cases of IM of bladder (1 case harboring high-grade dysplasia), and performed mutation analysis for genes frequently mutated in colon cancer including BRAF, APC, KRAS, MET, NRAS, PIK3CA, CTNNB1, FBXW7, and TP53 using validated clinical tests. Control groups included 7 colonic tubular adenomas, 10 high-grade papillary urothelial carcinomas. One IM case revealed an APC mutation and another showed an NRAS mutation. Among the tubular adenomas cases, 6 of 7 (85.7%) harbored KRAS mutations and 3 of 7 (42%) APC mutations. Among urothelial carcinomas cases, 1 revealed a KRAS mutation, 2 had PIK3CA mutations, and all cases were negative for APC mutations. Clinical follow-up for the IM patients was available with a median follow-up of 70 months. One patient-without any mutation in the genes investigated-developed invasive bladder adenocarcinoma with intestinal differentiation with metastasis to the liver and lung. Neither of the 2 patients harboring mutations developed any malignancy. In conclusion, a minority of cases with IM without dysplasia bear mutations in the genes commonly associated with colonic adenocarcinoma, suggesting a premalignant potential for such lesions possibly following the classic multistep chromosomal instability pathway of carcinogenesis. A larger cohort of patients with longer follow-up is needed to better establish whether close follow-up is warranted for mutation-harboring IM of the bladder.
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8
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Garg H, Singh P, Nayak B, Nayyar R, Kaushal S, Kumar R, Seth A. Understanding an unusual urothelial disorder: cystitis cystica et glandularis. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211032819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To study the presentation and natural course of cystitis cystica et glandularis. Methods: A retrospective analysis of patients with histopathologically confirmed cystitis cystica et glandularis from March 2016 to March 2018 who at least completed their 2 years’ follow-up was performed. Perioperative details along with the last available follow-up were included in the analysis. Results: A total of 10 patients were included. The mean age (± standard deviation) was 33.4 (±14.0) years and nine (90%) were men. The most common presentation was storage and voiding lower urinary tract symptoms (80%) along with haematuria (40%) and dysuria (20%). Four patients had the presence of hydronephrosis in preoperative imaging, of which three patients had bilateral mild hydroureteronephrosis. All the patients underwent transurethral resection of the bladder tumour as all were diagnosed with urinary bladder mass on preoperative imaging. All the patients had a trigonal lesion with a bullous appearance partially obstructing the bladder neck. Six patients underwent double J stenting in the perioperative period. The mean (± standard deviation) follow-up duration was 32.8 (±7.5) months. Patients were kept on regular surveillance with imaging and cystoscopy as indicated. Eight patients (80%) developed recurrence in the follow-up period. The mean number of recurrences was 1.5 (±1.1). One of the patients had to undergo augmentation ileocystoplasty with bilateral ureteric reimplantation because of the recurrent lesion with small contracted bladder, while another patient underwent cystectomy with urinary diversion owing to recurrence and refractory lower urinary tract symptoms. Besides, there was no evidence of malignancy after this entity in any of the patients. Conclusion: Cystitis cystica et glandularis is a rare clinic pathological entity which often mimics bladder tumour. Cystitis cystica et glandularis is common in men and often presents with lower urinary tract symptoms. Transurethral resection forms the mainstay of treatment. However, it is often associated with upper tract hydronephrosis. Its controversial premalignant nature compounded with recurrence and risk of upper tract deterioration warrants close surveillance. Level of evidence: 4
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Affiliation(s)
- Harshit Garg
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Seema Kaushal
- Department of Pathology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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9
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Acosta AM, Sholl LM, Fanelli GN, Gordetsky JB, Baniak N, Barletta JA, Lindeman NI, Hirsch MS. Intestinal metaplasia of the urinary tract harbors potentially oncogenic genetic variants. Mod Pathol 2021; 34:457-468. [PMID: 32860003 DOI: 10.1038/s41379-020-00655-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
In the urinary tract, there is an uncertain relationship between intestinal metaplasia (IM), primary adenocarcinoma, and urothelial carcinoma. Although IM is usually found adjacent to concurrent urothelial carcinoma or adenocarcinoma, small retrospective series have shown that most bladder biopsies with only IM do not subsequently develop cancer. However, IM with dysplasia does seem to be associated with a higher risk of concurrent malignancy or progressing to cancer. Since the molecular landscape of these lesions has remained largely unexplored, there are significant uncertainties about the oncogenic potential of IM in the bladder and urethra. This study investigated the presence of potentially oncogenic genetic variants in cases of IM with and without dysplasia. Twenty-three (23) cases of IM (3 urethra, 20 bladder) were sequenced using a solid tumor next-generation sequencing panel. Of these, five contained IM with high-grade dysplasia (including a case with paired IM-adenocarcinoma and another with paired IM-urothelial carcinoma) and 18 lacked dysplasia. Oncogenic genetic variants were found in all cases of IM with high-grade dysplasia and in five non-dysplastic IM cases, including mutations and copy number variants commonly seen in primary adenocarcinoma of the bladder and urothelial carcinoma. This study demonstrates that IM can harbor potentially oncogenic genetic variants, suggesting that it might represent a cancer precursor or a marker of increased cancer risk in a subset of cases.
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Affiliation(s)
- Andres M Acosta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. .,Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA.
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Molecular Pathology Division, Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, Boston, MA, USA
| | - Giuseppe N Fanelli
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padua, Padua, PD, Italy
| | - Jennifer B Gordetsky
- Departments of Pathology and Urology, Vanderbilt University Medical Center and Vanderbilt University, Nashville, TN, USA
| | - Nicholas Baniak
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Justine A Barletta
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA
| | - Neal I Lindeman
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Molecular Pathology Division, Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, Boston, MA, USA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Genitourinary Pathology Division, Brigham and Women's Hospital, Boston, MA, USA
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10
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Samaratunga H, Delahunt B, Yaxley J, Egevad L. Tumour-like lesions of the urinary bladder. Pathology 2020; 53:44-55. [PMID: 33070959 DOI: 10.1016/j.pathol.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 08/24/2020] [Indexed: 12/23/2022]
Abstract
There are a number of benign epithelial proliferations in the bladder that may be difficult to distinguish from carcinomas, including urothelial carcinoma and its variants, squamous cell carcinoma and adenocarcinoma. If misdiagnosed, there is the potential for over treatment, with its attendant risk of complications, as well as errors relating to prognostic assessment. In the case of the misdiagnosis of high grade proliferative lesions that mimic invasive carcinoma, unnecessary radical surgery, chemotherapy and radiotherapy may result. Similarly, the misdiagnosis of lesions that have the appearance of low grade carcinoma can prompt a lifetime of radiological investigation and cystoscopies. In this review, we discuss a variety of entities that may be diagnostically challenging and emphasise the importance of identifying key morphological features that have diagnostic utility. We also highlight the importance of relevant clinical information and the clinical settings in which these lesions may occur. In this review we have divided the lesions on the basis of morphology in order to facilitate discussion relating to the differential diagnosis. The architectural patterns we discuss include papillary lesions (polypoid/papillary cystitis and papillary urothelial hyperplasia), pseudocarcinomatous proliferations (pseudocarcinomatous urothelial hyperplasia, florid proliferation of von Brunn nests and fibroepithelial polyps), glandular lesions (intestinal metaplasia and müllerianosis) and lesions with several different patterns (prostatic type urethral polyps and nephrogenic adenoma or metaplasia).
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Affiliation(s)
- Hemamali Samaratunga
- Aquesta Uropathology, Brisbane, Qld, Australia; University of Queensland, Brisbane, Qld, Australia.
| | - Brett Delahunt
- Aquesta Uropathology, Brisbane, Qld, Australia; Department of Pathology and Molecular Medicine, Wellington School of Medicine and Health Sciences, University of Otago-Wellington, Wellington, New Zealand
| | | | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
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11
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Agrawal A, Kumar D, Jha AA, Aggarwal P. Incidence of adenocarcinoma bladder in patients with cystitis cystica et glandularis: A retrospective study. Indian J Urol 2020; 36:297-302. [PMID: 33376267 PMCID: PMC7759183 DOI: 10.4103/iju.iju_261_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/18/2020] [Accepted: 08/06/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction: Cystitis cystica et glandularis (CCG) is a hyper proliferative condition, likely representing a local immune response to chronic inflammatory stimulus. It has been hypothesized as a potential precursor of adenocarcinoma; however, a definite association has not been demonstrated. We aimed to determine whether CCG is a precursor to malignancy and to study the correlation of its two histological variants: the typical and the intestinal metaplasia (IM) type CCG. Materials and Methods: In this retrospective study, all the cases of CCG diagnosed and treated between January 2012 and December 2019 were analyzed. All the cases were followed up cystoscopically and biopsies were taken if the lesion persisted. The development of adenocarcinoma during the follow-up was noted. The patients were divided into two groups based on the histological subtype, i.e., the typical type and the IM type, and the two groups were also compared in terms of presentation, cystoscopic appearance, and development of adenocarcinoma. Results: A total of 64 patients, with 52 in the typical and 12 in the IM group were analyzed. The commonest symptom was hematuria (59.38%), followed by irritative bladder symptoms (51.56%). The median follow-up period was 5 years and 5 months (range: 7–96 months) and no patient progressed to adenocarcinoma. On comparing the two groups, the lesions weresignificantly more extensive in the IM group (50% vs. 15.38%). However, there were no differences in the symptoms or the development of malignancy between the two groups. Conclusions: At a median of 5 years and 5 months of follow up, CCG (including the IM-type) did not show any increase in the risk of malignancy.
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Affiliation(s)
- Amit Agrawal
- Department of Urology, Command Hospital (Western Command), Panchkula, Haryana, India
| | - Deepak Kumar
- Department of Urology, Command Hospital (Western Command), Panchkula, Haryana, India
| | - Aditya A Jha
- Department of Surgery, Military Hospital, Secundrabad, Telangana, India
| | - Puneet Aggarwal
- Department of Urology, Army Hospital (R and R), New Delhi, India
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12
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Hu J, Li C, Guo X, Zhang H, Li H, Qiu D, Gong G, Liu P, Ren W, Chen J, Zu X. Development and validation of a predictive nomogram for the risk of recurrence in patients with cystitis glandularis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:352. [PMID: 32355796 PMCID: PMC7186700 DOI: 10.21037/atm.2020.02.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Most patients with cystitis glandularis (CG) suffer from recurrence after primary treatment. Therefore, we performed this multicenter study to clarify the recurrent risk factors and constructed a predictive nomogram for the risk of recurrence. Also, we try to investigate the correlation between CG and bladder cancer. Methods Consecutive patients with pathologically confirmed CG were divided into training and validation sets. Clinicopathological characters were collected from electronic medical records. Uni- and multivariate logistic regression analyses were used to identify independent risk factors of CG recurrence in the training set. The predictive nomogram was developed by incorporating these independent factors and histological subtype. The performance of the nomogram was assessed and validated with respects to its calibration, discrimination, and clinical usefulness. The risk of developing subsequent bladder cancer was analyzed from the follow-up data. Results Ultimately, 278 eligible patients were included and were allocated to a training set (n=190) and a validation set (n=88). Of them, 165 (59.35%) patients experienced CG recurrence, and none showed evidence of subsequent bladder carcinoma during a median (IQR) follow-up time of 27 months (14–57 months). Results of multivariate analysis showed that urinary infections, long-term indwelling catheter usage, urinary calculus, squamous metaplasia, and atypical hyperplasia were independent risk factors of CG recurrence. The C-index (95% CI) of the nomogram was 0.76 (0.69–0.83) in the training set and 0.72 (0.61–0.83) in the validation set. A decision curve analysis (DCA) demonstrated that this predictive nomogram was clinically useful. Conclusions We developed and validated a nomogram to predict the individualized risk of CG recurrence. Also, we demonstrated that neither intestinal nor typical CG increased the consequent risk of bladder cancer during the follow-up period.
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Affiliation(s)
- Jiao Hu
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chao Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xi Guo
- Department of Urology, Hunan Provincial People's Hospital, Changsha 410005, China
| | - Huihui Zhang
- Department of Urology, the First Affiliated Hospital of the University of South China, Hengyang 421001, China
| | - Huihuang Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Dongxu Qiu
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Guanghui Gong
- Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Peihua Liu
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Wenbiao Ren
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jinbo Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiongbing Zu
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008, China
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13
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Tränkenschuh W, Biesdorf AS, Papadimas N, Samara S, Hefty R, Stahl PR. Mixed Adenocarcinomatous and Neuroendocrine Tumor of the Urinary Bladder With Concomitant Carcinoma In Situ: A Case Report With a Comprehensive Immunohistochemical Analysis and Review of the Literature. Int J Surg Pathol 2019; 27:684-692. [PMID: 30955388 DOI: 10.1177/1066896919839781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mixed adenoneuroendocrine carcinomas are rare and usually occur in the gastrointestinal tract. Although there have been several investigations regarding their developmental mechanism, the molecular origin of these tumors remains unclear. In this article, we present an exceedingly rare case of a mixed tumor of the urinary bladder with an adenocarcinomatous and a neuroendocrine component and a concomitant urothelial carcinoma in situ (CIS). Due to this extraordinary combination of tumor components, our goal was to extensively examine the 3 tumor components with regard to a representable common origin. Therefore, a comprehensive immunohistochemical analysis and review of the literature was performed. Besides expected outcome, our examination also revealed surprising staining results. Urothelial CIS, like the adenocarcinomatous component, showed strong staining for CDX2. In addition, parts of the adenocarcinoma were positive for synaptophysin like the neuroendocrine tumor component. All 3 components showed a significant overexpression of p53 and a moderate to strong membranous and cytoplasmatic staining for β-catenin. To our knowledge, we are the first to describe a case of a mixed tumor of the urinary bladder with an adenocarcinomatous and a neuroendocrine component and a concomitant CIS. The components share striking molecular features that argue for a common clonal origin and a development of the invasive tumor via the urothelial precursor lesion.
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Affiliation(s)
| | | | | | - Samer Samara
- 2 Klinikum Heidenheim, Heidenheim an der Brenz, Germany
| | - Robert Hefty
- 2 Klinikum Heidenheim, Heidenheim an der Brenz, Germany
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14
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Qin LF, Liang Y, Xing XM, Wu H, Yang XC, Niu HT. Villous adenoma coexistent with focal well-differentiated adenocarcinoma of female urethral orifice: A case report and review of literature. World J Clin Cases 2019; 7:891-897. [PMID: 31024961 PMCID: PMC6473125 DOI: 10.12998/wjcc.v7.i7.891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/10/2019] [Accepted: 01/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Villous adenomas of the urinary tract are uncommon. They are morphologically similar to and difficult to differentiate from their counterpart in the colon. The histogenesis and malignant potential are uncertain.
CASE SUMMARY A 63-year-old woman was admitted to our hospital with a mass in the urethral orifice. Gross and microscopic pathological examination was suggestive of urethral villous adenoma with focal well-differentiated adenocarcinoma. The whole urethra and part of the bladder were excised. No further treatment was offered. Carcinoembryonic antigen, cytokeratin 7, cytokeratin 20, epithelial membrane antigen, and p53 protein were positive, and the ratio of Ki-67 was 60%. After follow-up at 11 mo, the patient was cured and had no recurrence.
CONCLUSION Immunohistochemistry is important for differential diagnosis of villous adenoma of the urinary system. Complete surgical resection of the urinary tract is curative.
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Affiliation(s)
- Lu-Feng Qin
- Department of Medicine, Qingdao University, Qingdao 266003, Shandong Province, China
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Ye Liang
- Key Laboratory of Urinary System Diseases, Qingdao 266003, Shandong Province, China
| | - Xiao-Ming Xing
- Department of Pathology, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Hui Wu
- Department of Medicine, Qingdao University, Qingdao 266003, Shandong Province, China
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Xue-Cheng Yang
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Hai-Tao Niu
- Department of Urology, Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
- Key Laboratory of Urinary System Diseases, Qingdao 266003, Shandong Province, China
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15
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McKenney JK. Precursor lesions of the urinary bladder. Histopathology 2019; 74:68-76. [PMID: 30565304 DOI: 10.1111/his.13762] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 12/19/2022]
Abstract
The classification of neoplastic precursor lesions in the urinary tract has evolved slowly with the gradual accumulation of clinicopathological data. Current nomenclature was codified most recently by the 2016 WHO classification, which is based on primary data with clinical outcome, consensus group statements and considerations of practical utility in routine diagnosis. This review discusses precursor lesions of urothelial, squamous and glandular lineage. For urothelial neoplasia, both flat lesions with atypia and early 'difficult-to-classify' proliferations are considered. Subtypes of squamous metaplasia, florid non-invasive squamous proliferations and frank squamous dysplasia are also addressed. Finally, rare glandular precursors of adenocarcinoma are reviewed, to include intestinal metaplasia, glandular dysplasia and villous adenoma. For each category, morphology (including differential diagnostic considerations), immunohistochemistry and any known molecular correlates are detailed. The goal is to provide a concise, practical up-to-date overview of this complex topic.
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Affiliation(s)
- Jesse K McKenney
- Robert J. Tomsich Institute of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH, USA
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16
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Kryvenko ON, Epstein JI. Mimickers of urothelial neoplasia. Ann Diagn Pathol 2019; 38:11-19. [DOI: 10.1016/j.anndiagpath.2018.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 01/12/2023]
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17
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Nayak A, Depasquale B, Vergara N, Guzzo TA, Lal P. Villous Adenoma Arising in the Native Bladder Mucosa and the Upper Urinary Tract With Coexisting Neuroendocrine Carcinoma Following Augmentation Cystoplasty. Int J Surg Pathol 2019; 27:450-456. [PMID: 30701999 DOI: 10.1177/1066896919826708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Villous adenomas arising in the bladder following augmentation cystoplasty procedures are exceedingly rare. Even rarer is their occurrence in the native bladder mucosa and the upper urinary tract. In this article, we present a unique case of multifocal recurrent villous adenoma involving native bladder mucosa of an augmented bladder, bilateral ureters, and renal pelvis, with coexistent foci of adenocarcinoma and neuroendocrine carcinoma, in a patient with history of augmentation colocystoplasty. We additionally discuss the pathogenesis of development of carcinoma in the setting of augmentation cystoplasty.
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Affiliation(s)
- Anupma Nayak
- 1 University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | - Priti Lal
- 1 University of Pennsylvania, Philadelphia, PA, USA
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18
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Mammadov E, Dervisoglu S, Elicevik M, Emir H, Soylet Y, Buyukunal SNC. Transition to adulthood with a bladder augmentation: histopathologic concerns. Int Braz J Urol 2017; 43:1152-1159. [PMID: 29039896 PMCID: PMC5734080 DOI: 10.1590/s1677-5538.ibju.2016.0548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 03/20/2017] [Indexed: 11/22/2022] Open
Abstract
Aim: To investigate the histopathologic changes in native bladder and gastrointestinal segment, the relation between histopathologic changes, type of operation and the period passed over operation in patients with bladder augmentation. Materials and methods: Twenty consecutive patients were enrolled in this study. Histopathologic evaluation of the cystoscopic mucosal biopsies from native bladder and enteric augment was performed in all patients. Results: Active or chronic non-specific inflammation of various degrees was found in all specimens except two. Metaplastic changes were detected in 3 patients. Two patients had squamous metaplasia (one focal, one extensive) and one patient had intestinal metaplasia. All metaplastic changes were found in native bladder specimens. The type of augmentation in patients with metaplastic changes were ileocystoplasty and sigmoidocystoplasty. No signs of malignancy were detected in any patient. Conclusion: The complexity of the disorders requiring bladder augmentation does not let the surgeons to draw a clear line between different groups of complications including malignancy formation. However, due to challenging course of the augmentation procedure itself, surgeons should be well aware of the possibility of malignancy development.
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Affiliation(s)
- Emil Mammadov
- Department of Pediatric Surgery, Near East University Medical Faculty, Turkey
| | - Sergulen Dervisoglu
- Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Elicevik
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Haluk Emir
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yunus Soylet
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - S N Cenk Buyukunal
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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19
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Giannico GA, Gown AM, Epstein JI, Revetta F, Bishop JA. Role of SATB2 in distinguishing the site of origin in glandular lesions of the bladder/urinary tract. Hum Pathol 2017; 67:152-159. [PMID: 28711650 DOI: 10.1016/j.humpath.2017.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/20/2017] [Accepted: 07/05/2017] [Indexed: 12/26/2022]
Abstract
The differential diagnosis of glandular lesions of the bladder/urinary tract can be challenging because of significant morphologic and immunohistochemical overlap between primary lesions and metastasis/direct extension from adjacent organs. Special AT-rich sequence-binding protein 2 (SATB2), encoded on chromosome 2q32-33, is a recently described DNA-binding protein involved in osteoblast lineage commitment and expressed in colorectal and appendiceal neoplasms. In this study, we hypothesized that immunohistochemistry for SATB2 may be of value in distinguishing primary adenocarcinoma of the bladder/urinary tract and urothelial carcinoma with glandular differentiation from gastrointestinal and endocervical primaries. Intensity and distribution of SATB2 nuclear labeling were semiquantitatively scored and compared with those of CDX2. The study included 43 primary adenocarcinomas of the bladder/urinary tract, 20 urothelial carcinomas with glandular differentiation, 26 adenocarcinomas of the uterine cervix, and 22 colorectal adenocarcinomas involving the bladder. Positive SATB2 immunostaining was observed in 21 of 43 (49%) primary bladder/urinary tract adenocarcinomas, in 17 of 22 (77%) colorectal adenocarcinomas, and in the glandular component of 4 of 18 (22%) urothelial carcinomas with glandular differentiation. SATB2 was negative in 25 of 26 endocervical adenocarcinomas and showed focal weak immunostaining (1+) in 1 of 26 (4%). The results were not significantly different from those seen with CDX2. We conclude that SATB2 immunohistochemistry is not useful in supporting urothelial versus gastrointestinal or endocervical origin in the differential diagnosis of glandular lesions of the bladder/urinary tract.
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Affiliation(s)
- Giovanna Angela Giannico
- Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232.
| | | | - Jonathan I Epstein
- Pathology, Johns Hopkins Medical Institutions, The Weinberg Building, Baltimore, MD 21231; Urology, Johns Hopkins Medical Institutions, The Weinberg Building, Baltimore, MD 21231; Oncology, Johns Hopkins Medical Institutions, The Weinberg Building, Baltimore, MD 21231.
| | - Frank Revetta
- Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232.
| | - Justin A Bishop
- Pathology, UT Southwestern Medical Center, Dallas, TX, 75390.
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20
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Preliminary study of diffusion-weighted MRI in the preoperative diagnosis of cystitis glandularis. Clin Radiol 2016; 71:937.e1-4. [DOI: 10.1016/j.crad.2016.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/04/2016] [Accepted: 05/09/2016] [Indexed: 11/20/2022]
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21
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Xin Z, Zhao C, Huang T, Zhang Z, Chu C, Lu C, Wu M, Zhou W. Intestinal metaplasia of the bladder in 89 patients: a study with emphasis on long-term outcome. BMC Urol 2016; 16:24. [PMID: 27267922 PMCID: PMC4895895 DOI: 10.1186/s12894-016-0142-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 05/22/2016] [Indexed: 12/22/2022] Open
Abstract
Background Intestinal metaplasia of the bladder is an uncommon glandular proliferation. We examined a large series of intestinal metaplasia for the clinicopathological features and discuss the significance of this lesion. Methods All cases of intestinal metaplasia diagnosed in our institution between 1990 and 2014 were retrospectively reviewed. Patients with a history of urothelial carcinoma or concurrent adenocarcinoma were excluded. Patient characteristics, pathological features, and follow-up outcomes were obtained. Results We identified 89 patients with intestinal metaplasia during this period. Sixty seven were men and 22 were women. Mean age at diagnosis was 57 years (range 23–81). Common presenting complaints included haematuria (73 cases), mucosuria (13 cases), and irritative voiding symptoms (seven cases). The majority of intestinal metaplasias located on or near the trigone (67 cases). Eighty-two patients underwent transurethral resection of their lesions. Partial cystectomy was performed in the remaining seven patients. The mean follow-up of 78 patients was 105 months (range 6–255). One case of bladder adenocarcinoma was indentified 6 months later. The initial histologic findings had revealed intestinal metaplasia with severe dysplasia. Four patients presented recurrence during the follow-up, and this occurred 9, 13, 17 and 24 months after the surgery. Conclusions Although intestinal metaplasia can be treated effectively by transurethral resection in most cases, its potential malignancy need to be taken into consideration after the evidence of recurrences and its association with bladder adenocarcinoma. Therefore, it is necessary to perform close surveillance following the surgery, particularly in patients with dysplastic changes.
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Affiliation(s)
- Zhixiang Xin
- Department of Urology, Rui Jin Hospital Lu Wan Branch, School of Medicine, Shanghai Jiaotong University, No.149, South Chongqing Road, Shanghai, 200020, China
| | - Chenhui Zhao
- Department of Urology, Rui Jin Hospital Lu Wan Branch, School of Medicine, Shanghai Jiaotong University, No.149, South Chongqing Road, Shanghai, 200020, China
| | - Tao Huang
- Department of Urology, Rui Jin Hospital Lu Wan Branch, School of Medicine, Shanghai Jiaotong University, No.149, South Chongqing Road, Shanghai, 200020, China
| | - Zhaohui Zhang
- Department of Urology, Rui Jin Hospital Lu Wan Branch, School of Medicine, Shanghai Jiaotong University, No.149, South Chongqing Road, Shanghai, 200020, China
| | - Chenlong Chu
- Department of Urology, Rui Jin Hospital Lu Wan Branch, School of Medicine, Shanghai Jiaotong University, No.149, South Chongqing Road, Shanghai, 200020, China
| | - Caifeng Lu
- Department of Pathology, Rui Jin Hospital Lu Wan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, 200020, China
| | - Min Wu
- Department of Pathology, Rui Jin Hospital Lu Wan Branch, School of Medicine, Shanghai Jiaotong University, Shanghai, 200020, China
| | - Wenlong Zhou
- Department of Urology, Rui Jin Hospital Lu Wan Branch, School of Medicine, Shanghai Jiaotong University, No.149, South Chongqing Road, Shanghai, 200020, China.
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22
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Kathopoulis N, Thomakos N, Mole I, Papaspirou I, Ntai S, Rodolakis A. Anterior pelvic exenteration for exstrophic bladder adenocarcinoma: Case report and review. Int J Surg Case Rep 2016; 25:13-5. [PMID: 27288750 PMCID: PMC4972129 DOI: 10.1016/j.ijscr.2016.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/04/2016] [Accepted: 05/17/2016] [Indexed: 11/24/2022] Open
Abstract
Carcinoma of the exstrophic bladder is an extremely rare condition. We present a case of carcinoma in unreconstructed bladder exstrophy in a patient of 53 years old. Anterior pelvic exenteration is an alternative surgical intervention for this situation in postmenopausal women.
Introduction Bladder exstrophy is a very rare congenital anomaly and is associated with an increased incidence of bladder cancer. Most patients undergo reconstructive operations during childhood. Presentation of case A 53 year-old woman was diagnosed with enteric type mucinous adenocarcinoma of the unreconstructed exstrophic bladder. Preoperative examination revealed no primary site in the gastrointestinal system. The patient underwent an anterior pelvic exenteration with bilateral ureterostomy and repairing of the anterior abdominal wall defect with a mesh. Discussion Carcinoma of the exstrophic bladder is a very rare entity. An overall number of 118 cases of cancer in unreconstructed bladder have been reported in the literature since 1895 with adenocarcinomas consisting of 90–91% and squamous cell carcinomas 8.5%. Mechanical irritation on the bladder mucosa, embryologic origin and urine carcinogens are some o the theories of cancerous metaplasia. Conclusion This is the first case of bladder exstrophy cancer reported that was submitted to anterior pelvic exenteration. We propose this surgical procedure as an appropriate alternative in postmenopausal women and cancer of the unreconstructed bladder exstrophy.
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Affiliation(s)
- Nikolaos Kathopoulis
- Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece.
| | - Nikolaos Thomakos
- Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
| | - Ioanna Mole
- Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
| | | | - Sparti Ntai
- Department of Radiology, Alexandra Hospital, Athens, Greece
| | - Alexandros Rodolakis
- Department of Obstetrics and Gynecology, University of Athens School of Medicine, Alexandra Hospital, Athens, Greece
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23
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Takizawa N, Matsuzaki T, Yamamoto T, Mishima T, Miyasaka C, Tanaka S, Kinoshita H, Uemura Y, Yamada H, Matsuda T. Novel strategy for cystitis glandularis: Oral treatment with cyclooxygenase-2 inhibitor. Int J Urol 2016; 23:706-8. [PMID: 27238955 DOI: 10.1111/iju.13121] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/07/2016] [Indexed: 12/23/2022]
Abstract
Cystitis glandularis, a proliferative disease of the bladder, is resistant to antibiotics, non-steroidal anti-inflammatory drugs, anti-allergy drugs and transurethral resection. Cystectomy or partial cystectomy is occasionally required for refractory cystitis glandularis. It has not been defined if cystitis glandularis is a premalignant lesion. We experienced a case of remission from cystitis glandularis after combination of oral treatment with selective cyclooxygenase-2 inhibitor, celecoxib and transurethral resection. Immunohistochemistry showed positive signals of cyclooxygenase-2 in the epithelium of pretreatment specimens, suggesting the pathophysiological role of cyclooxygenase-2 in cystitis glandularis. Here, we show the effectiveness of celecoxib against cystitis glandularis for the first time. Celecoxib could be one of the therapeutic strategies for cystitis glandularis.
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Affiliation(s)
- Nae Takizawa
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tomoaki Matsuzaki
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Teppei Yamamoto
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takao Mishima
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Chika Miyasaka
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Susumu Tanaka
- Department of Anatomy and Cell Science, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yoshiko Uemura
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hisao Yamada
- Department of Anatomy and Cell Science, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
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24
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Wang J, Manucha V. Villous Adenoma of the Urinary Bladder: A Brief Review of the Literature. Arch Pathol Lab Med 2016; 140:91-3. [DOI: 10.5858/arpa.2014-0198-rs] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Villous adenoma is a rare neoplasm in the urinary tract. It usually occurs in patients older than 50 years with a male predominance. The affected patients typically present with hematuria, irritative voiding symptoms, and mucosuria. The malignant potential of this entity has not been established, but some of the case series studies on bladder villous adenoma do suggest a possible association with malignant tumors. Findings on ultrasonography, computed tomographic scanning, magnetic resonance imaging, or on cystoscopic examination are nonspecific. Therefore, villous adenoma of the bladder is primarily a histologic diagnosis. This review will highlight the current theories on its pathogenesis and discuss its main histologic and immunohistochemical features to aid the diagnosis.
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Affiliation(s)
- Jindong Wang
- From the Department of Pathology and Laboratory Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania. Dr Manucha is now with the Department of Pathology, University of Mississippi Medical Center, Jackson
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25
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Stuhldreher PP, Inouye B, Gearhart JP. Exstrophy-Epispadias Complex. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0306-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Gordetsky J, Epstein JI. Intestinal metaplasia of the bladder with dysplasia: a risk factor for carcinoma? Histopathology 2015; 67:325-30. [PMID: 25640978 DOI: 10.1111/his.12661] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 01/27/2015] [Indexed: 12/19/2022]
Abstract
AIMS Intestinal metaplasia (IM) of the bladder is a benign glandular proliferation, where the urothelium becomes lined by intestinal-type epithelium. There is no association between IM and an increased risk for the development of adenocarcinoma. However, in rare cases IM shows dysplasia, similar to that of the gastrointestinal tract. We evaluated the significance of urothelial IM with dysplasia. METHODS AND RESULTS Consultation cases were searched for IM of the bladder with dysplasia. We identified 20 cases, including 17 males and females, aged 31-85 years (mean 60 years). Twelve (60%) patients had low-grade dysplasia and eight (40%) patients had high-grade dysplasia. Focal dysplasia was found in eight (40%) patients and non-focal dysplasia in 12 (60%) patients. IM with dysplasia was found with concurrent adenocarcinoma in eight (40%) cases. Five of these patients (63%) had disease recurrence and three (38%) patients died from their disease. IM with dysplasia was found with concurrent urothelial carcinoma in one case. Eleven patients had IM with dysplasia without evidence of malignancy. Of these, one went on to develop non-invasive, high-grade papillary urothelial carcinoma. CONCLUSIONS Clinical follow-up is recommended in cases of IM with dysplasia, as a significant number of these cases are associated with concurrent carcinoma.
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Affiliation(s)
- Jennifer Gordetsky
- Departments of Pathology and Urology, The University of Alabama, Birmingham, AL, USA
| | - Jonathan I Epstein
- Departments of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
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27
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Zhou W, Zhong K, Wang J, Gu Y, Huang L, Jiang Z, He L. Intestinal metaplasia of the renal pelvis: A case report and literature review. Oncol Lett 2014; 8:2664-2668. [PMID: 25364445 PMCID: PMC4214433 DOI: 10.3892/ol.2014.2547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 08/22/2014] [Indexed: 11/23/2022] Open
Abstract
Metaplastic changes in the renal pelvis are infrequent and may be malignant transformations to adenocarcinoma. The current study reports a case of intestinal metaplasia in the right renal pelvis, which was associated with staghorn calculi, in a 56-year-old female. The patient underwent a percutaneous nephrolithotomy. Immunohistochemical assessment of the mucosa of the renal pelvis revealed the positive expression of carcinoembryonic antigen, cytokeratin (CK)-7 and CK20, but negative expression for CK5/6 and vimentin. Furthermore, Ki67 expression was diffusely positive, while p53 was negative. Unlike other previously reported cases, the patient opted for active surveillance as opposed to radical nephrectomy, following the removal of the calculi. No evidence of progression was observed after three years of follow-up. Therefore, etiological treatment and close follow-up may be a suitable treatment option for localized intestinal metaplasia.
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Affiliation(s)
- Weimin Zhou
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China ; Department of Abdominal Surgery, Jiangxi Cancer Hospital, Nanchang, Jiangxi 330029, P.R. China
| | - Kuangbiao Zhong
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Jingrong Wang
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Yonghong Gu
- Department of Pathology, Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Lihua Huang
- Center for Medical Experiments, Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Zhiqiang Jiang
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
| | - Leye He
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, P.R. China
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Yi X, Lu H, Wu Y, Shen Y, Meng Q, Cheng J, Tang Y, Wu F, Ou R, Jiang S, Bai X, Xie K. Cystitis glandularis: A controversial premalignant lesion. Oncol Lett 2014; 8:1662-1664. [PMID: 25202387 PMCID: PMC4156188 DOI: 10.3892/ol.2014.2360] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 06/24/2014] [Indexed: 12/14/2022] Open
Abstract
Cystitis glandularis (CG) has been hypothesized as a potential precursor of adenocarcinoma, although this remains controversial. The present study reports data accumulated from 166 cases of cystitis glandularis with follow-up periods ranging between 0.5 and 17 years. The association between intestinal and typical CG and bladder carcinoma was retrospectively evaluated. The patients included in the present study had presented with typical (n=155) or intestinal (n=11) CG between 1994 and 2010. Of those patients, concurrent carcinoma of the bladder was identified in 15 (9.0%) patients, including two cases of squamous cell carcinoma and 1 case of sarcoma. The cases of carcinoma were identified either prior to or concurrently with the diagnosis of CG. Follow-up was available for 9/11 (81.8%) patients with intestinal CG. Nine months following transurethral fulguration, 8/11 (72.7%) patients were in complete remission and 1/11 (9.1%) complained of urgency and dysuria; two patients were lost to follow-up. The follow-up of the patients ranged from 0.7 to 4.5 years (median, 2.67 years; mean, 2.82 years). No evidence of subsequent carcinoma was identified in any of the patients during the follow-up of the intestinal and typical CG groups. In addition, there was no evidence of carcinoma subsequent to CG in either of the typical or intestinal CG groups. The results did not support that CG increases the future risk of malignancy in the short term and repeated cystoscopies over a short period of time are not recommended.
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Affiliation(s)
- Xianlin Yi
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Haoyuan Lu
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Yuexian Wu
- Department of Respiratory Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yang Shen
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Qinggui Meng
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Jiweng Cheng
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Yong Tang
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Fengxue Wu
- Emergency Department, Jingzhou Hospital of Tongji Medical College of Huazhong, Wuhan, Hubei 432020, P.R. China
| | - Rubiao Ou
- Department of Urology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, P.R. China
| | - Shaojun Jiang
- Department of Urology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, P.R. China
| | - Xianzhong Bai
- Department of Urology, Tumor Hospital of Guangxi Medical University and Guangxi Cancer Research Institute, Nanning, Guangxi 530021, P.R. China
| | - Keji Xie
- Department of Urology, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510180, P.R. China
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Modern management of the exstrophy-epispadias complex. Surg Res Pract 2014; 2014:587064. [PMID: 25374956 PMCID: PMC4208497 DOI: 10.1155/2014/587064] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/28/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022] Open
Abstract
The exstrophy-epispadias complex is a rare spectrum of malformations affecting the genitourinary system, anterior abdominal wall, and pelvis. Historically, surgical outcomes were poor in patients with classic bladder exstrophy and cloacal exstrophy, the two more severe presentations. However, modern techniques to repair epispadias, classic bladder exstrophy, and cloacal exstrophy have increased the success of achieving urinary continence, satisfactory cosmesis, and quality of life. Unfortunately, these procedures are not without their own complications. This review provides readers with an overview of the management of the exstrophy-epispadias complex and potential surgical complications.
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Li Z, Ge G, Feng R, Wu D, Shen B, Wang X, Cui Y, Li J, Ju X. Cyclooxygenase-2 and B-cell lymphoma-2 expression in cystitis glandularis and primary vesicle adenocarcinoma. BMC Urol 2014; 14:2. [PMID: 24387269 PMCID: PMC3880845 DOI: 10.1186/1471-2490-14-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 12/27/2013] [Indexed: 12/24/2022] Open
Abstract
Background Although cystitis glandularis (CG) is a common benign urinary bladder epithelial abnormality, it remains unclear whether CG is a premalignant lesion. Cyclooxygenase-2 (COX-2) and B-cell lymphoma-2 (Bcl-2) overexpression has recently been reported as a potential tumor initiator or promoter. We evaluated and compared COX-2 and Bcl-2 expression in CG, chronic cystitis (CC), and primary vesicle adenocarcinoma (ADC) tissues. Methods We conducted a retrospective study to investigate COX-2 and Bcl-2 levels in CG and ADC. We obtained tissue samples from 75 patients (including 11 cases of CC, 30 typical cases of CG (CGTP), 30 cases of intestinal CG (CGIT), and 4 cases of ADC) between 1989 and 2009 from the Surgical Pathology Archives of the No. 2 People’s Hospital of Zhenjiang, affiliated with Jiangsu University. COX-2 and Bcl-2 immunohistochemical staining was performed on all tissues. Nine normal bladder epithelial specimens were evaluated as control samples. Correlations between COX-2 and Bcl-2 expression in CG were also analyzed. Results COX-2 and Bcl-2 expression was higher in the ADC group compared to other groups (p < 0.05). COX-2 and Bcl-2 levels were higher in the CGIT group compared to the CGTP group (p = 0.000 for both). The CGIT and CGTP groups both showed higher COX-2 expression compared to the CC group (p = 0.000 for both). There was no difference in Bcl-2 expression between the CGTP and CC groups (p = 0.452). Additionally, the difference in COX-2 and Bcl-2 expression between the control and CC groups was also insignificant (p = 0.668 and p = 0.097, respectively). Finally, we found that COX-2 and Bcl-2 levels were positively related (r = 0.648, p = 0.000). Conclusion COX-2 and Bcl-2 overexpression in the CG group suggests that CG, particularly the intestinal type, may be a premalignant lesion that converts into a tumor in the presence of carcinogens.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiaobing Ju
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China.
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Clouston D, Lawrentschuk N. Metaplastic conditions of the bladder. BJU Int 2013; 112 Suppl 2:27-31. [PMID: 24127673 DOI: 10.1111/bju.12378] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD? Urologists are often confronted with cystoscopic appearances that at times are abnormal but non-specific, may mimic urothelial carcinoma or in some instances are quite bizarre given the clinical scenarios in which they occur (e.g. changes associated with a catheter will be more obvious than a de-novo presentation of cystitis cystica). Metaplasias of the bladder urothelium make up the majority of such cases. Furthermore, when confronted with a pathological diagnosis of a metaplasia within the bladder- what are the implications for the patient and how should they be followed-up? This review provides a concise summary of the pathological features of the various metaplasias that occur in the bladder and briefly describes their current treatment and requirement for follow-up. Metaplasia of the bladder urothelium occurs commonly in response to local injury. Usually the changes are reversible, but some conditions may be premalignant. This review describes the different metaplastic entities and their clinical significance. Most importantly, keratinising squamous metaplasia is a precursor to the development of bladder cancer, and requires treatment and long term follow up. The role of intestinal metaplasia in the development of cancer is uncertain, and these patients require follow-up until further evidence is obtained on the outcome of this entity.
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Affiliation(s)
- David Clouston
- TissuPath Pathology Service, 96 Ricketts Road, Mount Waverley, Vic, 3149
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Kao CS, Epstein JI. Tubular adenoma of the urinary tract: a newly described entity. Hum Pathol 2013; 44:1890-4. [DOI: 10.1016/j.humpath.2013.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 02/19/2013] [Accepted: 02/20/2013] [Indexed: 01/13/2023]
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The spectrum of histopathologic findings in vesical diverticulum: implications for pathogenesis and staging. Hum Pathol 2013; 44:1223-32. [DOI: 10.1016/j.humpath.2012.11.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 11/19/2012] [Accepted: 11/21/2012] [Indexed: 11/19/2022]
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Inouye BM, Massanyi EZ, Di Carlo H, Shah BB, Gearhart JP. Modern Management of Bladder Exstrophy Repair. Curr Urol Rep 2013; 14:359-65. [DOI: 10.1007/s11934-013-0332-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sanfrancesco J, Jones JS, Hansel DE. Diagnostically challenging cases: what are atypia and dysplasia? Urol Clin North Am 2013; 40:281-93. [PMID: 23540785 DOI: 10.1016/j.ucl.2013.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This article addresses the spectrum of atypia and dysplasia within the bladder epithelium and the diagnostic categories developed to further classify challenging lesions. In addition, the effects of inflammation, specific therapies, and instrumentation on the bladder mucosa as well as the associated difficulty in achieving the appropriate diagnosis are also discussed.
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Affiliation(s)
- Joseph Sanfrancesco
- Pathology and Laboratory Medicine Institute, The Cleveland Clinic, Cleveland, OH 44195, USA
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38
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Rubenwolf PC, Eder F, Ebert AK, Hofstaedter F, Woodhouse CR, Roesch WH. Persistent Histological Changes in the Exstrophic Bladder After Primary Closure—A Cause for Concern? J Urol 2013; 189:671-7. [DOI: 10.1016/j.juro.2012.08.210] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Peter C. Rubenwolf
- Department of Pediatric Urology, University Medical Center Regensburg, Regensburg, Germany
| | - Fabian Eder
- Department of Pathology, University Medical Center Regensburg, Regensburg, Germany
| | - Anne-Karoline Ebert
- Department of Pediatric Urology, University Medical Center Regensburg, Regensburg, Germany
| | | | | | - Wolfgang H. Roesch
- Department of Pediatric Urology, University Medical Center Regensburg, Regensburg, Germany
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Amin MB, McKenney JK, Paner GP, Hansel DE, Grignon DJ, Montironi R, Lin O, Jorda M, Jenkins LC, Soloway M, Epstein JI, Reuter VE. ICUD-EAU International Consultation on Bladder Cancer 2012: Pathology. Eur Urol 2012; 63:16-35. [PMID: 23083804 DOI: 10.1016/j.eururo.2012.09.063] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 09/27/2012] [Indexed: 12/14/2022]
Abstract
CONTEXT To present a summary of the 2nd International Consultation on Bladder Cancer recommendations on the pathology of bladder cancer using an evidence-based strategy. OBJECTIVE To standardize descriptions of the diagnosis and reporting of urothelial carcinoma of the bladder and help optimize uniformity between individual pathology practices and institutions. EVIDENCE ACQUISITION A detailed Medline analysis was performed for original articles addressing bladder cancer with regard to pathology. Proceedings from the last 5 yr of major conferences were also searched. EVIDENCE SYNTHESIS The major findings are presented in an evidence-based fashion. Large retrospective and prospective data were analyzed. CONCLUSIONS Providing the best management for patients with bladder neoplasia relies on close cooperation and teamwork among urologists, oncologists, radiologists, and pathologists.
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Affiliation(s)
- Mahul B Amin
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Villous adenoma of the urinary bladder: rare location. Contemp Oncol (Pozn) 2012; 16:276-7. [PMID: 23788894 PMCID: PMC3687408 DOI: 10.5114/wo.2012.29300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 10/17/2011] [Accepted: 01/18/2012] [Indexed: 01/01/2023] Open
Abstract
Villous adenomas are common lesions of the gastrointestinal tract but they are rarely located in the urinary tract including the urinary bladder. There are a few case reports and series in the literature. Here we report a 43-year-old male patient who had a polypoid lesion located on the left lateral wall of the urinary bladder. Transurethral resection was performed. The diagnosis was ‘villous adenoma of urinary bladder’ with clinical and histopathological findings. Villous adenomas are mostly seen in elderly males. The coexistence of villous adenoma with adenocarcinoma, squamous cell carcinoma, and urothelial carcinoma was observed but there is not clear evidence about progression to carcinoma, in spite of its colonic counterpart. Generally complete surgical resection is accepted as curative but there are no exact data about follow-up and recurrence. By presenting this case, we aim to emphasize that it is a rare but important lesion because of coexistence with malignancies and uncertain malignant potential.
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Srivastava S, Yan B, Chin SY, Muliana T, Salto-Tellez M, Teh M. Nuclear p53 Expression Is Associated With Allelic Imbalance (TP53) in Glandular Dysplasia and Typical Cystitis Glandularis: A LCM-Based Molecular Analysis. Clin Genitourin Cancer 2012; 10:57-9. [DOI: 10.1016/j.clgc.2011.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/31/2011] [Accepted: 09/02/2011] [Indexed: 12/29/2022]
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Flat urothelial carcinoma in situ of the bladder with glandular differentiation. Hum Pathol 2011; 42:1653-9. [DOI: 10.1016/j.humpath.2010.12.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Revised: 12/22/2010] [Accepted: 12/23/2010] [Indexed: 01/15/2023]
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Tatli AM, Uysal M, Goksu SS, Arslan D, Gunduz S, Ozdogan M, Coskun HS, Bozcuk H, Savas B. Primary mucinous adenocarcinoma of the bladder: complete response with FOLFOX-4 regimen. Med Oncol 2011; 29:1935-7. [DOI: 10.1007/s12032-011-0090-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 10/10/2011] [Indexed: 10/15/2022]
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Teo M, Swan NC, McDermott RS. Sustained response of adenocarcinoma of the urinary bladder to FOLFOX plus bevacizumab. Nat Rev Urol 2011; 8:282-5. [PMID: 21487385 DOI: 10.1038/nrurol.2011.48] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 44-year-old patient presented with intermittent macroscopic hematuria on a background of chronic left-sided hydronephrosis and intestinal metaplasia of the bladder. Cystoscopic examination revealed a mass at the dome of the urinary bladder, which was resected. Histopathologic analysis of the specimen confirmed the presence of muscle-invasive adenocarcinoma. Radical cystectomy with curative intent was planned, but review of systems and subsequent CT demonstrated pleural effusion with positive cytology, confirming metastatic disease. Owing to the histologic similarity between this patient's tumor and colorectal cancer, palliative FOLFOX6 (folinic acid, 5-fluorouracil and oxaliplatin) chemotherapy plus bevacizumab was administered. After 3 months of treatment the patient showed a good response, which was sustained for more than 10 months after diagnosis. However, his disease subsequently relapsed, and the patient died shortly thereafter. INVESTIGATION Physical examination, cystoscopy, transurethral resection of bladder tissue, CT, histopathologic, cytopathologic and immunohistochemical analysis. DIAGNOSIS Metastatic adenocarcinoma of the urinary bladder. MANAGEMENT 12 cycles of infused and bolus 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX6) plus bevacizumab.
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Affiliation(s)
- Minyuen Teo
- Department of Medical Oncology, Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland.
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Compérat E, Conort P, Rouprêt M, Camparo P, Mazerolles C. [Pathologic diagnosis and management of flat lesions of urothelium detected with aminolevulinic acid (Hexvix®)]. Prog Urol 2010; 21:157-65. [PMID: 21354032 DOI: 10.1016/j.purol.2010.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 10/23/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aim of the study was to review the most important flat lesions, to demonstrate the difficulty of classifying several lesions, to introduce to urologists the new problems linked to FD and to suggest new models for accurate analysis. MATERIALS AND METHODS Data about urothelial carcinomas and flat lesions and fluorescence were searched on MEDLINE by using the following keywords: cystoscopy; fluorescence; flat lesion; carcinoma in situ; metaplasia; bladder carcinoma. RESULTS No evidence 1 level data was available. Flat lesions are a new challenge in pathology and urology. As urologists have a better sight of bladder lesions with fluorescence diagnosis (Hexvix(®)), pathologists will be asked in the future to evaluate more frequently flat lesions, which are sometimes difficult to classify and for which interobserver agreement is not always evident. CONCLUSION It is essential to determine accurate histologic criteria, able to recognize flat lesions of the bladder and permitting adequate patients' treatment. Further studies with larger cohort of patients are needed to validate preliminary results obtained with fluorescence and to improve our knowledge of the natural history of these tumours.
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Affiliation(s)
- E Compérat
- Assistance publique-hôpitaux de Paris, service d'anatomopathologie de la Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris VI, 47-83, boulevard de l'hôpital, 75013 Paris, France
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Hodges KB, Lopez-Beltran A, MacLennan GT, Montironi R, Cheng L. Urothelial lesions with inverted growth patterns: histogenesis, molecular genetic findings, differential diagnosis and clinical management. BJU Int 2010; 107:532-7. [DOI: 10.1111/j.1464-410x.2010.09853.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Eastman R, Leaf EM, Zhang D, True LD, Sweet RM, Seidel K, Siebert JR, Grady R, Mitchell ME, Bassuk JA. Fibroblast growth factor-10 signals development of von Brunn's nests in the exstrophic bladder. Am J Physiol Renal Physiol 2010; 299:F1094-110. [PMID: 20719973 PMCID: PMC2980411 DOI: 10.1152/ajprenal.00056.2010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 08/16/2010] [Indexed: 12/29/2022] Open
Abstract
von Brunn's nests have long been recognized as precursors of benign lesions of the urinary bladder mucosa. We report here that von Brunn's nests are especially prevalent in the exstrophic bladder, a birth defect that predisposes the patient to formation of bladder cancer. Cells of von Brunn's nest were found to coalesce into a stratified, polarized epithelium which surrounds itself with a capsule-like structure rich in types I, III, and IV collagen. Histocytochemical analysis and keratin profiling demonstrated that nested cells exhibited a phenotype similar, but not identical, to that of urothelial cells of transitional epithelium. Immunostaining and in situ hybridization analysis of exstrophic tissue demonstrated that the FGF-10 receptor is synthesized and retained by cells of von Brunn's nest. In contrast, FGF-10 is synthesized and secreted by mesenchymal fibroblasts via a paracrine pathway that targets basal epithelial cells of von Brunn's nests. Small clusters of 10pRp cells, positive for both FGF-10 and its receptor, were observed both proximal to and inside blood vessels in the lamina propria. The collective evidence points to a mechanism where von Brunn's nests develop under the control of the FGF-10 signal transduction system and suggests that 10pRp cells may be the original source of nested cells.
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Affiliation(s)
- Rocky Eastman
- Program in Human Urothelial Biology, Center for Tissue and Cell Sciences, Seattle Children's Research Institute, 1900 9th Ave., Mailstop C9S-5, Seattle, WA 98101, USA
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Zhang X, Gupta R, Nicastri AD. Bladder adenocarcinoma following gastrocystoplasty. J Pediatr Urol 2010; 6:525-7. [PMID: 20392671 DOI: 10.1016/j.jpurol.2010.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 03/09/2010] [Indexed: 11/27/2022]
Abstract
Bladder augmentation with segments of small bowel (ileocystoplasty), large intestine (colocystoplasty) or stomach (gastrocystoplasty) has been used to treat patients with small or noncompliant bladders by increasing the capacity or compliance. Carcinomas following gastrocystoplasty have been observed in the segments of stomach; however, to our knowledge, carcinoma arising in the residual native bladder has not been reported. We report the first case of adenocarcinoma arising in the residual native bladder in association with intestinal metaplasia and dysplasia of bladder mucosa 17 years following gastrocystoplasty. Intestinal metaplasia secondary to recurrent urinary infection, chronic inflammation, and some form of irritation may potentiate the development of native bladder adenocarcinoma. Patients with gastrocystoplasty are at an increased risk for carcinoma in stomach segments and require close long-term follow up; however, the risk of carcinoma in native bladder is still unclear.
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Affiliation(s)
- Xuchen Zhang
- Department of Pathology, State University of New York, Downstate Medical Center, Brooklyn, New York 11203, USA.
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Taneous M, Ramalingam P, Mode DG, Heiner JG, Terris MK, Lee JR. Primary mucinous adenocarcinoma in a defunctionalized urinary bladder: a case report. J Med Case Rep 2009; 3:9306. [PMID: 20062735 PMCID: PMC2803829 DOI: 10.1186/1752-1947-3-9306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2009] [Accepted: 11/30/2009] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Malignancies are rare in defunctionalized bladders and are thought to arise from metaplasia secondary to chronic inflammation. Transitional cell and squamous cell carcinomas are the most common but there are three reported cases of mucinous adenocarcinoma. CASE PRESENTATION We report a 57-year-old Caucasian man presenting with penile discharge for 30 years following ileal conduit surgery for neurogenic bladder, and who was found to have primary mucinous adenocarcinoma of his defunctionalized bladder. CONCLUSION Although urinary diversion without cystectomy is less common in current urologic practice, there are many patients with longstanding defunctionalized bladders. While there are no established surveillance protocols, defunctionalized bladder patients with urethral discharge should be evaluated.
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Affiliation(s)
- Mary Taneous
- Section of Pathology, Augusta Veterans Affairs Medical Center, 1 Freedom Way, Augusta, GA 30904, USA
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Recurrent villous adenoma with high-grade dysplasia arising in a urethral diverticulum. Case Rep Med 2009; 2009:361212. [PMID: 19718251 PMCID: PMC2729294 DOI: 10.1155/2009/361212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 04/01/2009] [Indexed: 01/26/2023] Open
Abstract
Villous adenomas of the urinary tract are an uncommon, well-recognized entity, described in different locations. However, the occurrence of this lesion in the female urethral diverticulum is very unusual. We present the first case of a recurrent villous adenoma with high-grade dysplasia unassociated with adenocarcinoma, arising from a urethral diverticulum. A 75-year-old African-American female presented with urethral prolapse complaining of mild voiding difficulty, stress incontinence, and mild spotting of blood. Histological examination revealed a papillary lesion with finger-like processes lined by pseudostratified columnar epithelium with abundant goblet cells. There were focal areas with stratification to the luminal surface and loss of nuclear polarity and atypical mitoses, interpreted as villous adenoma with high-grade dysplasia. The lesion
recurred at one year without evidence of malignant transformation. We also present a brief literature review of urothelial villous adenomas.
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