Bladder & ureters
Acquired nonneoplastic anomalies
Endocervicosis
Copyright: 2003-2019, PathologyOutlines.com, Inc.
PubMed Search: Bladder endocervicosis
Acquired nonneoplastic anomalies
Endocervicosis
Author: Alcides Chaux, M.D.
Topic Completed: 1 July 2011
Minor changes: 12 June 2019
Copyright: 2003-2019, PathologyOutlines.com, Inc.
PubMed Search: Bladder endocervicosis
Table of Contents
Definition / general | Epidemiology | Sites | Etiology | Clinical features | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Differential diagnosisCite this page: Chaux A. Endocervicosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bladderendocervicosis.html. Accessed May 29th, 2020.
Definition / general
- Rare benign tumor-like lesions characterized by prominent endocervical-type glands in muscularis propria
Epidemiology
- Women in reproductive years (mean age 39 years, range 34-65 years)
- Also men receiving estrogen for prostate cancer
Sites
- Posterior wall or posterior dome preferentially affected
Etiology
- Müllerian origin (Am J Surg Pathol 1992;16:533)
Clinical features
- Benign behavior (Hum Pathol 1996;27:816)
- Associated with endometriosis and cesarean section
Case reports
- 36 year old woman with chronic pelvic pain (Arch Pathol Lab Med 2005;129:e109)
- 67 year old woman with solid bladder wall mass (Int J Clin Exp Pathol 2009;2:91)
Treatment
- Excision
Gross description
- Mass between bladder and uterus in posterior bladder wall, dome or trigone
- Up to 2.5 to 3.0 cm in size
- Spongy cut surface with mucinous / milky fluid
Microscopic (histologic) description
- Irregular proliferation of prominent endocervical-type glands in muscularis propria, less frequently in lamina propria or subserosal connective tissue
- Glands are irregular in size and shape and may be cystically dilated, containing mucinous secretions with neutrophils
- Glands are lined by a single layer of tall mucinous columnar cells, less commonly flat or cuboidal cells, rarely ciliated or goblet-like cells
- Focal glandular rupture leads to mucin accumulation within the stroma with a fibroblastic-histiocytic response
- Absent or mild nuclear atypia, no mitotic figures
- No desmoplasia, no glandular crowding or back-to-back architecture
Microscopic (histologic) images
Images hosted on other servers:
Prominent
endocervical
glands in
muscularis propria
Complex cystic lesion
is embedded in
dense stroma and
smooth muscle
Lining epithelium has single layer of columnar cells with granular mucinous apical cytoplasm identical to endocervix
Fig 1: Pelvic ultrasound showed 1.4 cm mural nodule in posterior bladder wall at level of trigone
Fig 2: Extensive involvement of bladder by mucous glands that penetrate into muscularis propria
Fig 3: Glands are haphazard, many have expanded into mucus filled cysts
Fig 4: Cyst lining varies from single layer of columnar cells with abundant pale cytoplasm to ciliated cuboidal and flattened cells
Positive stains
- ER, PR, HBME1 (Pathol Res Pract 2002;198:115)
Differential diagnosis
- Adenocarcinoma: marked atypia, mitotic figures
- Adenoma malignum from uterine cervix: infiltration of bladder serosa, deep cervical involvement, glands are variable in shape or size with irregular or claw-shaped outlines
