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Bladder
Acquired non-neoplastic anomalies
Author: Nat Pernick, M.D. (see Authors page)
Revised: 13 December 2009, last major update – December 2009, UPDATE IN PROGRESS
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● Almost always primary (amyloid tumor); rarely part of systemic disease
Terminology
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Epidemiology
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● Very rare
● Urinary dysfunction found in 50% with familial amyloidotic polyneuropathy (Neurourol Urodyn 2009;28:26)
Sites
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Etiology
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Clinical features
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● Usually AL type (immunoglobulin light chains, Urology 2006;67:904)
● Patients present with gross painless hematuria
● May clinically resemble bladder cancer (Indian J Pathol Microbiol 2008;51:415)
Case reports
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Treatment
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● Transurethral resection and fulguration of amyloid tumor is usually curative (and controls bleeding), since not associated with myeloma
Gross description (Macroscopy)
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● Nodular mucosal lesions resembling carcinoma
● Rarely is diffuse involvement of bladder wall
Gross images
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AMYLOIDOSIS OF URINARY BLADDER (Courtesy of Dr. George M. Farrow, Rochester, MN.), link
Micro description (Histopathology)
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● Large masses of eosinophilic proteinaceous material with hemorrhage in lamina propria
● Variable foreign body giant cell reaction to amyloid
● May have associated atypical epithelium due to attenuation of urothelium
● Rarely perivascular amyloid deposits
● Rare/no inflammatory cells
Micro images
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Eosinophilic proteinaceous material in lamina propria
Amyloid in the urinary bladder, in contrast to other sites, usually occurs as globular masses of amorphous acidophilic material.
Subepicardial deposition of amyloid, link
Laryngeal amyloidosis; link
Cytology description
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Cytology images
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Positive stains
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● Congo red shows apple green birefringence when exposed to polarized light
Negative stains
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Electron microscopy descriptions
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● Non-branching fibrils and associated ground substance
Electron microscopy images
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Differential Diagnosis
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● (link to topic)
Additional references
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● Mod Pathol 2005;18:451, Am J Surg Pathol 1978;2:141
End of Bladder > Acquired non-neoplastic anomalies > Amyloidosis
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