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Bladder

Other tumors

Lymphoma (primary)

 

Author: Nat Pernick, M.D. (see Authors page)

Revised: 27 December 2009, last major update - December 2009

Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.

 

Definition

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● Either primary (rare, originating in bladder with no known lymphoma elsewhere) or secondary (much more common)

 

Terminology

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Epidemiology

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● Secondary bladder involvement occurs in 10-25% of leukemias / lymphomas

Rare as primary; <100 cases

MALT is most common subtype in bladder; typically affects adults > 60 years, 75% female

● Diffuse large B cell lymphoma is also common, and may arise from transformation of MALT (J Clin Pathol 2000;53:458)

 

Sites

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Etiology

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Clinical features

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Recurrent lymphoma in bladder is associated with widely disseminated disease and poor prognosis (AJSP 1997;21:1324)

 

Low grade MALT lymphoma

Most common lymphoma subtype in bladder

Much more common as secondary tumor than primary tumor

History of chronic cystitis common (Archives 2001;125:332)

Long median survival for either primary lymphomas of bladder or lymphomas with initial presentation in bladder but other coexisting disease (AJSP 1997;21:1324)

 

Prognostic factors

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● Histologic subtype, stage

 

Case reports

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● 52 year old man with schistosomiasis and T cell lymphoma (AJSP 1998;22:373)

● 67 year old woman with EBV+ B cell lymphoproliferative disorder (Indian J Urol 2009;25:129)

● 72 year old woman with exophytic mass at bladder base and MALT lymphoma (Mod Path 1993;6:145)

● 75 year old woman with diffuse large B cell lymphoma (Intern Med 2009;48:1403)

● Elderly woman with B cell lymphoma with signet-ring cells (Arch Pathol Lab Med 1991;115:635)

 

Treatment

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● MALT: radiation therapy, usually no recurrences

 

Clinical images

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Gross description (Macroscopy)

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● Discrete tumors, usually large and centered in dome or lateral walls

 

Gross images

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Micro description (Histopathology)

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● MALT: sheets of low grade, uniform cells that surround and separate, but don’t destroy muscle fascicles

 

Micro images

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MALT

Tumor cells separate and surround rather than destroy the smooth muscle fascicles of the bladder wall

 

Bland lymphocytes fill lamina propria but don’t involve urothelium #1#2

 

Lymphocytes permeate muscle fascicles

 

Monocytoid cells with clear cytoplasm

 

Fig 1: MALT involving lamina propria; fig 2: focal lymphoepithelial lesions in area of cystitis glandularis

 

EBV+ B cell lymphoproliferative disorder

 

Diffuse infiltrate of atypical lymphocytesCD20+CD30+EBER+

 

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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Urothelial carcinoma with prominent lymphoid infiltrate: See AJSP 1991;15:569

 

Additional references

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End of Bladder > Other tumors > Lymphoma

 

 

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