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Bladder

Acquired non-neoplastic anomalies

Endometriosis


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

Definition
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● Presence of functional endometrial tissue within bladder

Terminology
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● Endocervicosis: related disorder with mucinous metaplasia - endocervical and not endometrial type glands, often mucin but no endometrial type stroma or hemosiderin (click here for topic)

Epidemiology
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● Women between the second and fifth decades
● Uncommon, occurs in <2% of all patients with endometriosis
● Seen in post menopausal women receiving exogenous estrogen
● Also can occur, very rarely, in men taking estrogens for prostate cancer

Sites
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● Usually posterior wall of bladder above trigone or at dome

Etiology
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● Probably due to retrograde menstruation, which seeds surface of bladder serosa, or post-surgical
● Not due to metaplasia of mullerian remnants or extension from anterior uterine adenomyosis (Am J Obstet Gynecol 2002;187:538)

Clinical features
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● Bladder is the most common site (70-80%) of endometriosis of the urinary tract
● May develop into endocervicosis (mucinous metaplasia), endometrioid adenocarcinoma, clear cell carcinoma, adenosarcoma
● Usually associated with prior surgery or female GU symptoms of urgency, frequency, suprapubic pain, rarely hematuria
● A mass is frequently apparent either by palpation or cystoscopic examination
● Bladder implants typically occur at vesicouterine pouch; may grow through muscularis into submucosa, producing a luminal bulge or rarely a polypoid mucosal mass (Radiographics 2006;26:1847)
● Mucosa may appear blue at cystoscopy

Treatment
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● Hormones, resection (usually no recurrence after partial cystectomy, Hum Reprod 2010;25:884)

Clinical images
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Cystoscopy images (chocolate like content)


Laparoscopic segmental cystectomy


Laparoscopic view of implants overlying the bladder

Gross description
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● Usually serosal
● Palpable mass in 50%
● Rarely polypoid (Am J Surg Pathol 2004;28:285)

Micro description
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● Resembles endometriosis elsewhere: endometrium-like glandular epithelium associated with endometrial stroma cells and recent or old hemorrhage
● Rarely, only glands or stroma are found

Micro images
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Various images

Virtual slides
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Bladder endometriosis with mucinous metaplasia

End of Bladder > Acquired non-neoplastic anomalies > Endometriosis


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