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Bladder

Acquired non-neoplastic anomalies

Diverticula

Reviewers: Alcides Chaux, M.D., Johns Hopkins University School of Medicine (see Reviewers page)
Revised: 5 July 2011, last major update March 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Outpouchings of urothelial mucosa through bladder muscular wall

Epidemiology
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● >90% in men, age range 1-81 years
● For cases with pathologic sampling, mean age is 55 years (Arch Pathol Lab Med 2009;133:791)

Sites
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● Most diverticula are solitary lesions located in lateral walls of bladder

Etiology
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● Congenital cases are due to bladder outlet obstruction or failure of muscle development (eMedicine)
● Acquired cases are more common, and usually due to prostatic enlargement causing muscular hypertrophy and focal mucosal herniation without muscularis propria in areas of weakness, often near ureteral orifices, bladder dome or urethral orifice

Clinical features
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● Most bladder diverticula are small and asymptomatic
● When symptomatic, usually associated with infections and stones (due to urine stasis), urinary retention or perforation
● Some cases are associated with additional GU anomalies (urethral strictures, neurogenic bladder, duplicated collecting system) or hereditable syndromes (Ehlers-Danlos, others)
● Malignancy occurs in 1-10% of bladder diverticula
● Tumors are often large because location is hidden
● All variants of urothelial carcinoma have been reported in bladder diverticula, with a relatively higher frequency of unusual subtypes when compared to the general population

Case reports
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● 57 year old man with distended diverticulum causing colonic obstruction (World J Gastroenterol 2009;15:3957)
● 62 year old man with diverticulum due to chronic catheterization (Cases J 2009 Jan 9;2(1):36)
● 65 year old man with sarcomatoid carcinoma / carcinosarcoma in diverticulum (Arch Pathol Lab Med 2002;126:853, full text)
● 90 year old woman with gastric metastasis to diverticulum (World J Surg Oncol 2005 Aug 24;3:55)

Treatment
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● Varies by patient - nonoperative treatment, surgical bladder outlet reduction or removal of the diverticulum

Gross description
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● Narrow necks, round/ovoid pouch from 1-18 cm (average 5.0 cm)

Gross images
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Image with case history


Diverticulum containing sarcomatoid carcinoma

   
Nodular prostatic hypertrophy and diverticula

Micro description
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Nonneoplastic findings
● Wall consists of fibrous tissue with no/scant muscularis propria
● Common findings include inflammation, granulation tissue formation, erosion, cystitis cystica et glandularis, nonkeratinizing squamous metaplasia, reactive urothelial atypia

Neoplastic findings
● Most neoplastic lesions that arise in bladder diverticula are urothelial carcinomas, mainly noninvasive papillary (high/low grade) or invasive

Micro images
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Histologic features


Subtypes of invasive bladder cancer arising in bladder diverticula


Diverticulum containing sarcomatoid carcinoma

End of Bladder > Acquired non-neoplastic anomalies > Diverticula

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