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Bladder
Acquired non-neoplastic anomalies
Author: Nat Pernick, M.D. (see Authors page)
Editor: name, affiliation
Revised: 13 February 2010, last major update - February 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Histologic changes associated with chemotherapy (systemic or topical), radiation therapy or surgery (J Clin Pathol 2002;55:641)
Terminology
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● See also granulomatous cystitis, radiation cystitis
Epidemiology
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Sites
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Etiology
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Clinical features
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● Cyclophosphamide causes hemorrhagic cystitis, and is associated with high grade bladder carcinoma and sarcoma
Prognostic factors
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Case reports
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● 71 year old man with bladder mass 6 years post-radiation therapy for prostate cancer (Arch Pathol Lab Med 2005;129:1067)
Treatment
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Clinical images
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Gross description (Macroscopy)
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● Chemotherapy may destroy tips of papillae in papillary tumors
Gross images
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Micro description (Histopathology)
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● 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
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Various images
Chemotherapy related changes:
This is a characteristic but non pathognomonic reaction of superficial cells exposed to alkylating agents like TTP/MMC. (AFIP fig 2-38)
bCG related changes:
There is denudation of the urothelium and a chronic inflammation with poorly formed granulomas in the lamina propria #1. (AFIP fig 2-41); #2
Radiation therapy related changes:
Note the markedly narrow lumen (arrows) and thickened intima. (AFIP fig 2-42)
Fig 1: Bladder mucosa with dilated vascular spaces, hemorrhage, acute inflammation, fibrinous exudate and focal fibrosis in the lamina propria
Fig 2/3: Rounded and irregular tufts of bland urothelium, some in lamina propria suggestive of invasion but no mitotic activity
Fig 4: Focal urothelium surrounds dilated blood vessels containing fibrinous deposit
No thumbnails: post-radiation changes mimic dysplasia
Cytology description
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Cytology images
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Post-MITOMYCIN C THERAPY: the tumor cell (T) can be easily distinguished from the normal (N) and reactive superficial (R) cells. (AFIP fig 2-39)
Positive stains
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Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● Pseudocarcinomatous epithelial hyperplasia: similar changes may occur due to ischemia and chronic irritation, not treatment (Am J Surg Pathol 2008;32:92)
● Urothelial carcinoma: usually no history of treatment; definite invasive changes, mitotic figures present
Additional references
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End of Bladder > Acquired non-neoplastic anomalies > Treatment effect
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