Bladder
Acquired non-neoplastic anomalies
Treatment effect

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 21 March 2016, last major update June 2011

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Bladder treatment effect[title]
Cite this page: Treatment effect. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bladdertreatmenteffect.html. Accessed December 7th, 2016.
Definition / General
  • Histologic changes associated with chemotherapy (systemic or topical), radiation therapy or surgery (J Clin Pathol 2002;55:641)
Clinical Features
  • Cyclophosphamide causes hemorrhagic cystitis, and is associated with high grade bladder carcinoma and sarcoma
Case Reports
Gross Description
  • Chemotherapy may destroy tips of papillae in papillary tumors
Micro Description
  • General characteristics include pseudoinvasive urothelial nests wrapping around vessels associated with fibrin deposition; also hemorrhage, fibrin thrombi, fibrosis, acute and chronic inflammation; usually edema and vascular congestion; occasionally ulceration; no mitotic figures (Am J Surg Pathol 2004;28:909)
  • Radiation therapy: causes endothelial swelling and necrosis, mural thickening and hyalinization with late luminal narrowing; also pseudoinfiltrative epithelial cords and nests extending into lamina propria and wrapping around dilated blood vessels containing fibrin; radiation fibroblasts with cytoplasmic or nuclear vacuoles and prominent nucleoli, stromal edema, extravasated red blood cells, destruction of bladder tumor papillae (Hum Pathol 2000;31:678)
  • Surgery: associated with granulomatous reaction, postoperative spindle cell nodules, trapping of epithelial cells by inflammatory reaction resembling invasive disease, regenerative atypia resembling carcinoma in situ, reactive bone / osteoid
  • Systemic chemotherapy: nuclear atypia, hemorrhagic cystitis, polyoma virus related changes
  • Topical (intravesicular) Mitomycin C / ThioTEPA: may cause exfoliation of normal and abnormal urothelial cells, degeneration, multinucleation and bizarre reactive nuclear changes
  • Topical bCG (immunotherapy): causes focal epithelial denudation with granulomatous inflammation of lamina propria
Micro Images

Images hosted on other servers:

Various images

Post-radiation therapy for prostate cancer



Post-radiation changes mimic dysplasia
Differential Diagnosis