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Bladder
Benign tumors
Post-operative spindle cell nodule
Author: Nat Pernick, M.D. (see Authors page)
Revised: 27 February 2010, last major update February 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Reactive lesion that occurs weeks to months after transurethral resection of bladder tumor in area of surgery
● Similar features as inflammatory myofibroblastic tumor, but with a history of surgery
● First described in 1990 (Urology 1990;35:342, J Urol 1990;143:824)
Terminology
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● Also called pseudosarcomatous myofibroblastic proliferation (Am J Surg Pathol 2006;30:787)
Epidemiology
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● Usually women
Sites
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Etiology
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Clinical features
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● Excellent prognosis
Prognostic factors
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Case reports
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Treatment
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● Transurethral resection; no recurrences or metastases (Hum Pathol 2007;38:753)
Clinical images
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Gross description (Macroscopy)
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● Friable nodule, mean size 1 cm
Gross images
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Micro description (Histopathology)
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● Cellular, fascicular growth pattern of plump or elongated spindle cells which infiltrate the bladder wall and may focally destroy muscle
● Delicate network of small blood vessels in edematous or myxoid stroma with red blood cell extravasation
● Ulcerated surface with acute and chronic inflammatory infiltrate
● High mitotic activity but no atypical mitotic figures, resembles sarcoma but no atypia
● No necrosis, no significant pleomorphism
Micro images
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Myofibroblastic cells and inflammatory L: muscularis propria, R: spindle cell nodule
cells in myxoid stroma
Fascicular growth Highly cellular with Keratin+ Actin+
numerous mitoses
AFIP Fig 2-70: interlacing fascicles Uniform cells are mixed with
of myofibroblasts inflammatory cells
Cytology description
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● May have intracytoplasmic inclusion bodies (Diagn Cytopathol 1992;8:171)
Cytology images
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Positive stains
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● Low molecular weight keratin, vimentin, actin, desmin, ALK1
Negative stains
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● EMA
Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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● May have trisomy 7 (Cancer Genet Cytogenet 2007;174:147)
Molecular / cytogenetics images
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Differential Diagnosis
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● Kaposi’s sarcoma: no history of recent procedure, primarily a vascular tumor
● Myxoid leiomyosarcoma: no history of recent procedure, smooth muscle morphology, pleomorphism, atypical mitotic figures, necrosis
Additional references
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End of Bladder > Benign tumors > Post-operative spindle cell nodule
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