Bladder
Acquired non-neoplastic anomalies
Endocervicosis

Author: Alcides Chaux, M.D. (see Authors page)

Revised: 21 March 2016, last major update July 2011

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Bladder endocervicosis
Definition / General
  • Rare benign tumor-like lesions characterized by prominent endocervical-type glands in muscularis propria
Epidemiology
  • Women in reproductive years (mean age 39 years, range 34-65 years)
  • Also men receiving estrogen for prostate cancer
Sites
  • Posterior wall or posterior dome preferentially affected
Etiology
Clinical Features
Case Reports
Treatment
  • Excision
Gross Description
  • 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
  • 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

Images hosted on other servers:

Prominent endocervical glands in muscularis propria


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
Differential Diagnosis
  • 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