Bladder
Other tumors
Lymphoma (primary)

Author: Gillian Levy, M.D. (see Authors page)

Revised: 8 August 2016, last major update December 2014

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Bladder lymphoma [title]
Definition / General
  • Either primary (rare, originating in bladder with no known lymphoma elsewhere) or secondary (much more common)
Epidemiology
  • Female predominance, most cases are in middle aged women
  • Secondary bladder involvement occurs in 10-25% of leukemias / lymphomas and in advanced stage systemic lymphoma
  • 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
  • Bladder, lower ureteral tract
Clinical Features
  • Comprises 5% of non-urothelial tumors of urothelial tract
  • Long median survival for either primary lymphoma of bladder or lymphoma with initial presentation in bladder but other coexisting disease (Am J Surg Pathol 1997;21:1324)
  • Recurrent lymphoma in bladder is associated with widely disseminated disease and poor prognosis
  • Presents with gross hematruia, dysuria, urinary frequency, nocturia, and abdominal or back pain

  • Low grade MALT lymphoma: most common lymphoma subtype in bladder; much more common as secondary tumor than primary tumor; history of chronic cystitis common (Arch Pathol Lab Med 2001;125:332)
Prognostic Factors
  • Histologic subtype, stage
Case Reports
Treatment
  • MALT: radiation therapy, usually no recurrences
Radiology Description
  • Submucosal masses: 70% of cases are solitary mass, 20% of cases are multiple masses, and 10% of cases show diffuse wall thickening
Gross Description
  • Discrete tumors, usually large and centered in dome or lateral walls
Micro Description
  • MALT: sheets of low grade, uniform cells that surround and separate, but don't destroy muscle fascicles
Micro Images

Images hosted on other servers:
Missing Image

Bland lymphocytes fill lamina propria but don’t involve urothelium

Missing Image

Lymphocytes permeate muscle fascicles

Missing Image

Monocytoid cells with clear cytoplasm

Missing Image

Fig 1: MALT involving lamina propria



EBV+ B cell lymphoproliferative disorder:

Missing Image

Left: diffuse infiltrate of atypical lymphocytes; right: CD20+

Missing Image

Left: CD30+; right: EBER+

Cytology Description
  • MALT: monomorphic small to medium sized lymphocytes
Positive Stains
Negative Stains
Molecular / Cytogenetics Description
  • MALT Lymphoma: t(11;18) (q21:21)