Home   Chapter Home   Jobs   Conferences   Fellowships   Books



Advertisement

Bladder

Benign tumors

Post-operative spindle cell nodule


Reviewer: Monika Roychowdhury, M.D., University of Minnesota Medical Center (see Reviewers page)
Revised: 3 July 2011, last major update April 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
=========================================================================

● Reactive lesion that occurs weeks to months after transurethral resection of prostate (in men) or bladder lesions 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
=========================================================================

● Also called pseudosarcomatous myofibroblastic proliferation (Am J Surg Pathol 2006;30:787)

Epidemiology
=========================================================================

● Usually women

Clinical features
=========================================================================

● Sometimes incidental
● May present with hematuria or obstructive voiding symptoms

Prognostic factors
=========================================================================

● Excellent prognosis

Treatment
=========================================================================

● Transurethral resection; no recurrences or metastases (Hum Pathol 2007;38:753)

Gross
=========================================================================

● Friable nodule, mean size 1 cm

Micro
=========================================================================

● 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
● May show low to high mitotic activity but no atypical mitotic figures, resembles sarcoma but no atypia
● No necrosis, no significant pleomorphism

Micro images
=========================================================================



Myofibroblastic cells and inflammatory cells in myxoid stroma


Left: muscularis propria, Right: spindle cell nodule


Fascicular growth


Highly cellular with numerous mitoses


AFIP Fig 2-70: interlacing fascicles of myofibroblasts


Uniform cells are mixed with inflammatory cells


Keratin+


Actin+

Cytology
=========================================================================

● May have intracytoplasmic inclusion bodies (Diagn Cytopathol 1992;8:171)

Positive stains
=========================================================================

● Low molecular weight keratin (CAM 5.2, AE1/AE3), vimentin, actin, desmin, ALK1

Negative stains
=========================================================================

● EMA

Molecular
=========================================================================

● May have trisomy 7 (Cancer Genet Cytogenet 2007;174:147)

Differential diagnosis
=========================================================================

Kaposiís sarcoma: no history of recent procedure, primarily a vascular tumor
Myxoid leiomyosarcoma: no history of recent procedure; has smooth muscle morphology, pleomorphism, atypical mitotic figures, necrosis

Additional references
=========================================================================

eMedicine

End of Bladder > Benign tumors > Post-operative spindle cell nodule


This information is intended for physicians and related personnel, who understand that medical information is often imperfect, and must be interpreted in the context of a patient's clinical data using reasonable medical judgment. This website should not be used as a substitute for the advice of a licensed physician.

All information on this website is protected by copyright of PathologyOutlines.com, Inc. Information from third parties may also be protected by copyright. Please contact us at copyrightPathOut@gmail.com with any questions (click here for other contact information).