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Bladder
Acquired non-neoplastic anomalies
Author: Nat Pernick, M.D. (see Authors page)
Revised: 11 February 2010, last major update February 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Presence of endometrial glands, stroma and hemosiderin 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
Epidemiology
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● Rare; bladder is most common site of endometriosis in urinary tract, but occurs in < 2% of all patients with endometriosis
● Also occurs in men taking estrogen 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 surgery; 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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● Usually associated with prior surgery or female GU symptoms
● May develop into endocervicosis (mucinous metaplasia), endometrioid adenocarcinoma, clear cell carcinoma, adenosarcoma
● 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
Prognostic factors
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Case reports
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Treatment
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● Hormones, resection (usually no recurrence after partial cystectomy, Hum Reprod 2010 Feb 3 [Epub ahead of print])
Clinical images
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Cystoscopy image #1; #2 (chocolate like content)
Laparoscopic segmental cystectomy
Laparoscopic view of implants overlying the bladder
Gross description (Macroscopy)
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● Usually serosal
● Palpable mass in 50%
● Rarely polypoid (Am J Surg Pathol 2004;28:285)
Gross images
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Micro description (Histopathology)
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● Endometrial glands, endometrial stroma, hemosiderin
Micro images
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Endometrial glands (arrows) surrounded by endometrial stromal cells, deep within muscularis propria #1; #2; #3
Various images
Virtual slides
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Bladder endometriosis with mucinous metaplasia
Cytology description
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Cytology images
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Positive stains
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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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Additional references
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End of Bladder > Acquired non-neoplastic anomalies > Endometriosis
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