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Non-neoplastic lesions

Reviewer: Rugvedita Parakh, M.D. (see Reviewers page)
Revised: 9 February 2013, last major update May 2010
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

See also description under individual bladder topics

Infection / bacterial cystitis

● See also acute cystitis
● Women in the reproductive age group
● Abundant neutrophils, few enlarged urothelial cells with vacuolated cytoplasm; N/C ratio is maintained with fine chromatin pattern of nuclei; also urothelial cells with degenerative changes

Human Polyomavirus infection

● See also BK virus
● Due to reactivation of infection in immunosuppressed states; e.g. chemotherapy, diabetes, organ transplantation or AIDS
● Single dense basophilic homogeneous intra-nuclear inclusions, pale nuclear inclusions creating a homogeneous space or clearing of the nuclei with a network of chromatin filaments
● "Decoy” cells: nuclear hyperchromasia mimicking carcinoma cells; polyomavirus infected cells show filaments of chromatin


● See also schistosomiasis
Trichomonas vaginalis, Schistosoma hematobium and Filariasis
Schistosoma hematobium: most common in Egypt and elsewhere in Africa; abundant squamous cells and anucleated squames due to squamous metaplasia induced by the infection
● Bladder infection by Schistosoma hematobium is strongly associated with squamous cell carcinoma

Lithiasis (stones)

● See also lithiasis
● Increased cellularity
● Urothelial cell clusters with or without cellular atypia
● Hyperchromasia and prominent nucleoli
● Differential diagnosis includes a low grade papillary lesion; clinical history is paramount in interpreting these specimens


● See also malakoplakia
● Middle aged women
● Histiocytes with eosinophilic cytoplasm containing basophilic inclusions that are PAS+; also calcium and iron positive concentric laminations (Michaelis-Guttmann bodies)
● Background of granular debris
● Urothelial cells display reactive changes

Vesico-enteric fistula

● Due to colon cancer, diverticulitis, inflammatory bowel disease, radiation therapy or surgery
● Urine contains fecal material including vegetable cells or degenerated striated cells associated with amorphous debris and bacilli

Cystitis glandularis /cystitis cystica

● See also cystitis cystica / glandularis
● A few cohesive groups of bland columnar cells are present, which are occasionally associated with goblet cells
● Clean background
● Differential diagnosis includes adenocarcinoma; dirty background and nuclear atypia with coarse chromatin, pleomorphism and nucleoli

Squamous metaplasia

● See also squamous metaplasia
● Premenopausal women
● The presence of keratinized epithelium, particularly with atypia, warrants further evaluation

Nephrogenic adenoma

● See also nephrogenic metaplasia
● Cuboidal or columnar shaped cells with fine chromatin pattern and fine vacuolated cytoplasm
● Differential diagnoses include urothelial carcinoma, clear cell adenocarcinoma and gastric adenocarcinoma; differentiate based on clinical history and careful evaluation of the nucleoli; also nephrogenic adenoma and clear cell adenocarcinoma are PAX2+ or PAX8+ (Am J Surg Pathol 2008;32:1380)

End of Bladder > Cytology > Non-neoplastic lesions

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