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Bladder

Acquired non-neoplastic anomalies

Endocervicosis


Reviewers: Alcides Chaux, M.D., Johns Hopkins University School of Medicine (see Reviewers page)
Revised: 3 July 2011, last major update March 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Rare benign tumor-like lesions characterized by prominent endocervical-type glands in muscularis propria

Epidemiology
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● Women in reproductive years (mean age 39 years, range 34-65 years)
● Also men receiving estrogen for prostate cancer

Sites
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● Posterior wall or posterior dome preferentially affected

Etiology
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● Mullerian origin (Am J Surg Pathol 1992;16:533)

Clinical features
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● Benign behavior (Hum Pathol 1996;27:816)
● Associated with endometriosis and cesarean section

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

Gross description
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● Mass between bladder and uterus in posterior bladder wall, dome or trigone
● Up to 2.5 to 3.0 cm in size
● Spongy cut surface with mucinous / milky fluid

Micro description
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● Irregular proliferation of prominent endocervical-type glands in muscularis propria, less frequently in lamina propria or subserosal connective tissue
● Glands are irregular in size and shape and may be cystically dilated, containing mucinous secretions with neutrophils
● Glands are lined by a single layer of tall mucinous columnar cells, less commonly flat or cuboidal cells, rarely ciliated or goblet-like cells
● Focal glandular rupture leads to mucin accumulation within the stroma with a fibroblastic-histiocytic response
● Absent or mild nuclear atypia, no mitotic figures
● No desmoplasia, no glandular crowding or back-to-back architecture

Micro images
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Prominent endocervical glands in muscularis propria


With mucin extravasation


Complex cystic lesion is embedded in dense stroma and smooth muscle


Lining epithelium has single layer of columnar cells 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


Positive stains
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● ER, PR, HBME1 (Pathol Res Pract 2002;198:115)

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

End of Bladder > Acquired non-neoplastic anomalies > Endocervicosis


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