Bladder, ureter & renal pelvis

Other nonneoplastic

Treatment effect

Last author update: 1 June 2011
Last staff update: 18 November 2021

Copyright: 2003-2023,, Inc.

PubMed Search: Bladder treatment effect[title]

Monika Roychowdhury, M.D.
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Cite this page: Roychowdhury M. Treatment effect. website. Accessed September 30th, 2023.
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
Microscopic (histologic) 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
Microscopic (histologic) images

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Various images

Postradiation changes mimic dysplasia

Differential diagnosis
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