Bladder, ureter & renal pelvis
Other nonneoplastic
Intestinal metaplasia


Topic Completed: 1 February 2013

Minor changes: 7 February 2020

Copyright: 2003-2019, PathologyOutlines.com, Inc.

PubMed Search: Intestinal metaplasia[title]

Rugvedita Parakh, M.D.
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Cite this page: Parakh R. Intestinal metaplasia. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bladderintestinalmetaplasia.html. Accessed October 26th, 2020.
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 von 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

Contributed by Rugvedita Parakh, M.D.



Images hosted on other servers:

Intestinal metaplasia

Colonic type glands in the lamina propria

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
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