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Bladder

Benign urothelial lesions

Flat lesions with reactive atypia


Reviewer: Monika Roychowdhury, M.D., University of Minnesota Medical Center (see Reviewers page)
Revised: 20 April 2011, last major update April 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Inflammatory atypia characterized by mild nuclear abnormalities in acutely or chronically inflamed urothelium
● Uniformly enlarged and vesicular nuclei, central prominent nucleoli
● May have frequent mitotic figures involving the lower layers of urothelium

Clinical features
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● May have history of cystitis, infection, instrumentation, stones or therapy
● Not neoplastic but may coexist with dysplasia or carcinoma in situ
● Most patients present with hematuria or irritative symptoms (frequency, urgency, dysuria)

Prognostic factors
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● No premalignant potential in limited clinical studies (Cancer 2000;88:625)

Gross description
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● Erythematous or inflamed urothelium cystoscopically

Micro description
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● Urothelium is normal to slightly thickened and shows morphologic evidence of maturation
● Cells have abundant cytoplasm, nuclei may be enlarged and may have prominent nucleoli
● Lamina propria is usually inflamed with inflammation extending to the mucosa
● No nuclear hyperchromasia, no pleomorphism, no coarse chromatin pattern

Micro images
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Series of images


Reactive atypia

Positive stains
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● CK20 (limited to umbrella cells), CD44 (stains all cell layers)

Negative stains
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● p53

Differential diagnosis
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Dysplasia

Additional references
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Hum Pathol 2010;41:155, Mod Pathol 2009;22:S60

End of Bladder > Benign urothelial lesions > Flat lesions with reactive atypia


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