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Bladder
Acquired non-neoplastic anomalies
Author: Nat Pernick, M.D. (see Authors page)
Editor: name, affiliation
Revised: 11 February 2010, last major update - February 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Rare benign disorder of prominent endocervical type glands in muscularis propria
Terminology
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Epidemiology
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● Women, mean age 39 years, range 34-65 years
● Also men receiving estrogen for prostate cancer
Sites
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Etiology
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● Mullerian origin (Am J Surg Pathol 1992;16:533)
Clinical features
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● Benign behavior (Hum Path 1996;27:816)
● Associated with endometriosis and cesarean section
Prognostic factors
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Case reports
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● 36 year old woman with chronic pelvic pain (Arch Pathol Lab Med 2005;129:e109)
● 67 year old woman with solid bladder wall mass (Int J Clin Exp Pathol 2009;2:91)
Treatment
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● Excision
Clinical images
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Gross description (Macroscopy)
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● Mass between bladder and uterus in posterior bladder wall, dome or trigone
Gross images
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Micro description (Histopathology)
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● Prominent endocervical-type glands in muscularis propria
● Glands may be cystically dilated and contain mucinous secretions with neutrophils
● Glands are usually lined by tall mucinous columnar cells, less commonly flat or cuboidal cells, rarely ciliated cells
● Usually no nuclear atypia
● No desmoplasia, no mitotic figures
Micro images
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Prominent endocervical glands in muscularis propria With mucin extravasation
Complex cystic lesion is embedded in Lining epithelium has single layer of columnar cells
dense stroma and smooth muscle with granular mucinous apical cytoplasm identical
to endocervix
Fig 1: Pelvic ultrasound showed 1.4 cm mural nodule in posterior bladder wall at level of trigone
Fig 2: Extensive involvement of bladder by mucous glands that penetrate into muscularis propria
Fig 3: Glands are haphazard, many have expanded into mucus filled cysts
Fig 4: Cyst lining varies from single layer of columnar cells with abundant pale cytoplasm to ciliated cuboidal and flattened cells
Cytology description
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Cytology images
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Positive stains
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● ER, PR, HBME1 (Pathol Res Pract 2002;198:115)
Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● Adenocarcinoma: marked atypia, mitotic figures
● Adenoma malignum from uterine cervix: infiltration of bladder serosa, deep cervical involvement, glands are variable in shape or size with irregular or claw-shaped outlines;
Additional references
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End of Bladder > Acquired non-neoplastic anomalies > Endocervicosis
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