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Bladder

Urothelial benign lesions

Papillary hyperplasia


Reviewer: Andreas Gaumann, M.D. (see Reviewers page)
Revised: 9 February 2013, last major update June 2010
Copyright: (c) 2003-2013, PathologyOutlines.com, Inc.

Definition
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● Asymptomatic lesion often found on routine follow-up cystoscopy of papillary urothelial neoplasms

Sites
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● No predilection for site

Clinical features
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● Appears to be a precursor lesion to papillary urothelial neoplasms, predominantly low grade lesions (Pathology 2010;42:360, Am J Surg Pathol 1996;20:1481)
● In patient with prior urothelial neoplasm, may indicate early recurrence

Papillary hyperplasia with atypia
● Architectural pattern of papillary hyperplasia with atypia of overlying urothelium
● 80% male, age range 55 to 92 years
● Atypia is usually due to flat carcinoma in situ (50%) or dysplasia (30%), and lesion is associated with CIS and high-grade papillary cancer (Hum Pathol 2002;33:512)

Prognostic factors
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● Presence of atypia is poor prognostic factor (see above)

Treatment
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● Follow up is indicated, particularly if history of urothelial neoplasm

Micro description
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● Slight tenting, undulating or papillary growth lined by urothelium of varying thickness, without atypia
● May also have tent-shaped broader folds
● Often has small dilated capillaries at base, but no well defined fibrovascular core
● Lacks discrete papillary fronds associated with papillary neoplasm

Micro images
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Thicker urothelium which is thrown into undulating folds


Urothelium with multiple undulating folds yet no true papillary fibrovascular cores


Tall papillary folds


Thickened mucosa towards center of biopsy


Tent-like configuration of urothelium

Differential diagnosis
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Low grade papillary urothelial neoplasm: has true papillary stalk (central fibrovascular core in an exophytic lesion; recommended to be aggressive in diagnosis in presence of known neoplasia)

End of Bladder > Urothelial benign lesions > Papillary hyperplasia


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