Bladder
Acquired non-neoplastic anomalies
Endometriosis

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

Revised: 16 March 2016, last major update July 2011

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

PubMed Search: Endometriosis
Cite this page: Endometriosis. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bladderendometriosis.html. Accessed December 7th, 2016.
Definition / General
  • Presence of functional endometrial tissue within bladder
Terminology
  • Endocervicosis: related disorder with mucinous metaplasia - endocervical and not endometrial type glands, often mucin but no endometrial type stroma or hemosiderin
Epidemiology
  • 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
  • Usually posterior wall of bladder above trigone or at dome
Etiology
  • 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
  • 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
Clinical Images

Laparoscopic segmental cystectomy

Gross Description
Micro Description
  • 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

Malacoplakia