Home   Chapter Home   Jobs   Conferences   Fellowships   Books

Advertisement

Bladder

Acquired non-neoplastic anomalies

Treatment effect

Reviewer: Monika Roychowdhury, M.D., University of Minnesota Medical Center - Fairview (see Reviewers page)
Revised: 14 June 2011, last major update June 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

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

● Histologic changes associated with chemotherapy (systemic or topical), radiation therapy or surgery (J Clin Pathol 2002;55:641)

Terminology
=========================================================================

● See also granulomatis cystitis, radiation cystitis

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

● Cyclophosphamide causes hemorrhagic cystitis, and is associated with high grade bladder carcinoma and sarcoma

Case reports
=========================================================================

● 71 year old man with bladder mass 6 years post-radiation therapy for prostate cancer (Arch Pathol Lab Med 2005;129:1067)

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
=========================================================================

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 (AFIP fig 2-41)


Radiation therapy-related changes: note the markedly narrow lumen (arrows) and thickened intima (AFIP fig 2-42)


Post-radiation therapy for prostate cancer
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

Post-radiation changes mimic dysplasia

Cytology images
=========================================================================

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)

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

● 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

End of Bladder > Acquired non-neoplastic anomalies > Treatment effect

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).