Endocervicosis of the urinary bladder. Immunohistochemical comparative study between a new case and normal uterine endocervices

Bladder endocervicosis: Recurrent presentations during pregnancy

Bladder endocervicosis describes the ectopic presence of endocervical tissue within the bladder. It is a rare condition with an unclear aetiology. We report the case of a 29-year-old woman who presented with bladder endocervicosis during her first pregnancy with recurrence during her second pregnancy. On both occasions, the patient was treated with transurethral resection and the lesion recurred. This is the first case in the literature of bladder endocervicosis presenting during pregnancy and suggests a hormonal stimulus is important in its development.

The applicability and utility of immunohistochemical biomarkers in bladder pathology

Urinary bladder specimens are frequently encountered in the daily practice of surgical pathologists. The spectrum of pathologic entities encountered in bladder specimens is extraordinarily broad, and in some instances, immunohistochemical stains are used to help characterize challenging bladder lesions. Cost-effective biomarker selection tailored to the differential diagnosis facilitates an accurate diagnosis. This comprehensive review is prepared as a reference guide for the use of immunohistochemistry to categorize primary and secondary bladder neoplasms and to evaluate metastatic cancers for possible bladder origin.

Müllerianosis, Endocervicosis, and Endosalpingiosis of the Urinary Tract: A Literature Review

INTRODUCTION AND HYPOTHESIS

We reviewed reported cases of endocervicosis, endosalpingiosis, and müllerianosis of the bladder or ureters in women in order to highlight these conditions as distinct from endometriosis or adenomyosis.

METHODS

Medline and Scopus searches of all cases published till the October 1, 2017. All retrieved references were searched manually to identify relevant articles.

RESULTS

Twenty-six articles reported endocervicosis. These included 37 cases described by the authors as endocervicosis of the bladder. We identified 7 case reports of bladder endosalpingiosis. There were 26 publications including 27 cases of müllerianosis of the bladder and 3 cases affecting the lower ureter. Literature descriptions are limited but available accounts do not point to features that uniquely distinguished these conditions. Affected women tended to be older, and in many cases, there was a possible relation to past surgery and particularly to hysterectomy and caesarean sections. Many cases were reported in postmenopausal women. Local excision was sufficient in most cases.

CONCLUSION

The etiology of these conditions remains speculative, but case reports raise a possible link to pelvic surgery. There is a need for more detailed accounts of these lesions, which should be considered in the differential diagnosis of pre- and postmenopausal women with pelvic pain, dyspareunia, lower abdominal pain or discomfort, dysuria, frequency, or hematuria.

Unusual finding of endocervical-like mucinous epithelium in continuity with urothelium in endocervicosis of the urinary bladder

Endocervicosis in the urinary bladder is a rare benign condition. We present a case in a 37-year-old woman with classical clinical and pathological features of endocervicosis. The unusual observation of endocervical-like mucinous epithelium in continuity with the urothelium in addition to fully developed endocervicosis prompted immunohistochemical profiling of the case using antibodies to cytokeratins (AE1/AE3, CK19, CK7, CK5/6, CK20), HBME-1, estrogen receptor (ER) and progesterone receptor (PR) to assess the relationship of the surface mucinous and endocervicosis glandular epithelia. The surface mucinous epithelium, urothelium and endocervicosis glands were immunopositive for AE1/AE3, CK7 and CK19 while CK20 was only expressed by few urothelial umbrella cells. The surface mucinous epithelium was CK5/6 and HBME-1 immunonegative but showed presence of ER and PR. This was in contrast to the urothelium's expression of CK5/6 but not ER and PR. In comparison, endocervicosis glands expressed HBME-1, unlike the surface mucinous epithelium. The endocervicosis epithelium also demonstrated the expected presence of ER and PR and CK5/6 immunonegativity. The slightly differing immunohistochemical phenotypes of the surface mucinous and morphologically similar endocervicosis glandular epithelium is interesting and requires further clarification to its actual nature. The patient has remained well and without evidence of disease 18-months following transurethral resection of the lesion.

Immunohistochemical phenotype of the urinary bladder endocervicosis: comparison with normal endocervix and well-differentiated mucinous adenocarcinoma of uterine cervix

Endocervicosis of the urinary bladder is a very rare tumor-like benign lesion. In the present report, a case in a 34-year-old woman, who has a prior Caesarean section at the age of 30 and 2-years history of dysuria, is described. Transvaginal ultrasound, cystoscopy and magnetic resonance imaging demonstrated a solid mass in the posterior wall of the bladder. The mass was removed and histology revealed a haphazard proliferation of endocervical-type mucinous glands scattered through the muscularis propria of bladder wall. Immunohistochemical phenotype of these glands was compared with three normal uterine endocervices and two cases of well-differentiated mucinous adenocarcinoma of the uterine cervix. Endocervicosis glands displayed positive reaction for antibodies against estrogen receptor, progesterone receptor, CAM 5.2, cytokeratin 7, CA125, HBME-1 and carcinoembryonic antigen, which showed positivity in normal endocervices. On the other hand, only glands of well-differentiated mucinous adenocarcinoma expressed human gastric mucin and showed high proliferative index of Ki-67. These results supported the hypothesis of its Müllerian origin. Furthermore, diffuse distribution of estrogen and progesterone receptors, lack of human gastric mucin and low proliferative activity were distinct features for endocervicosis compared to well-differentiated mucinous adenocarcinoma.

Symptomatic Bladder Endocervicosis: Does It Need Surgery?

Endocervicosis of the urinary bladder is a rare benign condition exclusively seen in women, usually of reproductive age. To the best of our knowledge there are only about twenty cases reported so far. It causes non-specific symptoms and is seen as a submucosal lesion on cystoscopy. On histological examination one finds endocervical glands embedded deep within the muscle layers. It can be confused with an adenocarcinoma of the bladder. Unless the correct diagnosis is made these patients can undergo potentially debilitating surgery. As demonstrated in our patient even symptomatic endocervicosis can be managed conservatively.

Endocervicosis vesical: excepcional causa de masa vesical

We report a case of a 32 year-old woman with bladder endocervicosis and ovarian endometriosis. Association of endocervicosis with endometriosis is feasible due to a müllerian origin of both entitties. Bladder endocervicosis is an exceptional entity that can be present in young women as a bladder mass like a bladder cancer.