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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.


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


● No predilection for site

Clinical features

● 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

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


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

Micro description

● 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

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

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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