Bladder
Metaplasia
Intestinal metaplasia

Author: Rugvedita Parakh, M.D. (see Authors page)

Revised: 11 July 2018, last major update February 2013

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Intestinal metaplasia[title]
Cite this page: Parakh, R. Intestinal metaplasia. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bladderintestinalmetaplasia.html. Accessed August 16th, 2018.
Definition / general
Terminology
  • Also called glandular metaplasia, colonic metaplasia or goblet cell metaplasia
Epidemiology
  • Identified in 71 - 90% of bladders at autopsy
  • Incidence increases with age
Sites
  • Trigone is most commonly affected area
  • Also seen in ureter and renal pelvis
  • Affects the bladder mucosa, typically the lamina propria (J Urol 1968;100:462, J Urol 2006;175:1119)
  • Mostly focal but occasionally diffuse
Etiology
  • Variation of normal anatomy
  • Also due to chronic inflammation, ureteral reimplantation, neurogenic bladder, bladder exstrophy (J Urol 1981;126:822, J Urol 1987;137:764), paraplegia, stones, longterm catheterization
Clinical features
  • Incidental finding or associated with hematuria, mucosuria, dysuria, urgency or obstructive symptoms
  • May be confused cystoscopically with carcinoma, particularly if mucin extravasation is present
Prognostic factors
  • Is it a precursor lesion for adenocarcinoma?

Yes:
  • Five large series; associated with 10 - 42% of reported cases of adenocarcinoma
  • If extensive, patient is at high risk for adenocarcinoma (Cancer 1987;59:2086)
  • Molecular findings support the hypothesis that intestinal metaplasia is a precursor lesion to and could be a marker in the development of adenocarcinoma of the urinary bladder (Clin Cancer Res 2007;13:6232)
  • Nuclear beta catenin positivity suggests the potential to progress to malignancy as the signaling mechanism is similar to Barrett esophagus (J Urol 2003;170:1892)

No:
Case reports
Treatment
  • May regress completely if pathogenic factor is removed
Gross description
  • Irregular rounded focal elevations of mucosa
  • Rarely polypoidal with mucinous extravasations
Gross images

Images hosted on other servers:

Cystitis glandularis
intestinal type
(intestinal metaplasia)

Microscopic (histologic) description
  • Replacement of urothelium by colonic mucosa (tall columnar cells)
  • Also goblet cells (single or aggregates) within Brunn nests, variable presence of Paneth cells
  • May coexist with cystitis cystica or cystitis glandularis
  • Mucin may be occasionally extravasated into the stroma
  • No atypia, no involvement of muscularis propria
Microscopic (histologic) images

Images hosted on PathOut server:

Contributed by Rugvedita Parakh, M.D., University of Washington (USA)



Images hosted on other servers:

Cystitis glandularis intestinal type (intestinal metaplasia)

Colonic type glands in the lamina propria

Resembles colonic mucosa


Uniform glands

Abrupt transition from urothelium

Mucin extravasation

Focal intestinal and squamous metaplasia

Cytology description
  • Cuboidal, columnar and mucin secreting cells
  • Intestinal type goblet cells may be seen
  • Bland cytologic features
  • Rare mitoses (Diagn Cytopathol 2008;36:181)
Positive stains
Negative stains
  • CK7 (usually), HEP (100%)
  • Note: in the urinary bladder, intestinal metaplasia and typical cystitis glandularis have sharply contrasting immunoprofiles despite similar morphology (Mod Pathol 2006;19:1395)
Electron microscopy description
    Cystitis cystica:
  • Lining cells: short microvilli on luminal surface
  • Taller cells: numerous membrane bound electron dense secretory granules (Br J Urol 1993;71:28)
Molecular / cytogenetics description
Differential diagnosis