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Bladder

Benign tumors

Solitary fibrous tumor


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

Definition
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● Rare tumor in bladder, similar to counterparts elsewhere

Epidemiology
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● Men ages 50-67 years
● < 50 cases reported

Clinical features
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● Often misdiagnosed (Hum Pathol 2000;31:63)
● Benign behavior (usually)
● Slow growing, painless, well-delineated mass, may lead to compression symptoms
● Rarely causes paraneoplastic syndrome (hypoglycemia secondary to insulin-like growth factor, known as Doege-Potter Syndrome)

Prognostic factors
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● Unpredictable behavior
● Malignant transformation and large size associated with poor outcome
● Atypical cytologic features, increased mitotic activity (>4/10hpf), size >10cm and resectability are important prognostic factors to predict recurrence or metastatic behavior

Case reports
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● 24 year old woman with gross hematuria (Eur Urol 2008;54:1188)
● 50 year old man with hematuria (Eur Urol 2001;39:484)
● 60 year old man with bladder wall mass (Int Braz J Urol 2004;30:406)
● 74 year old man with abdominal pain and hematuria (Rare Tumors 2010;2:e64)

Treatment
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● Excision, usually do not recur but follow up recommended

Gross description (Macroscopy)
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● Often very large, well-circumscribed, tan-colored mass which often has a pedicle

Gross images
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Well circumscribed tumors


Solid, tan, fibrotic tumor

Micro description
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● Resembles pleural counterpart: haphazard (patternless) spindle cells with hypo- and hypercellular areas, and deposition of dense collagen
● Spindly to oval epithelioid cells form short fascicles or clusters
● May have hemangiopericytoma-like vascular pattern
● Generally scarce mitoses - usually less than 3 mitoses per 10 high power fields

Micro images
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Plump spindled cells with prominent vasculature


Short spindle cells with delicate cytoplasm, no atypia


CD34+

Positive stains
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● CD34 (Hum Pathol 1997;28:1204), bcl2, vimentin

Negative stains
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● Cytokeratin, EMA, smooth muscle markers

Differential diagnosis
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● Sarcoma
● Sarcomatoid carcinoma

End of Bladder > Benign tumors > Solitary fibrous tumor


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