Inverted Papilloma of the Bladder

 

PPT : Inverted Papilloma Bladder.ppt

Inverted Papilloma

• Rare, ~1% of urothelial neoplasms seen over a wide age range
• Cystoscopy shows small (<3 cm) solitary sessile lesion or may have a short stalk.


• Histology:
  ◦Urothelium invaginates into lamina propria (inverted).
  ◦Characterized by cords or trabeculae with peripheral palisading of basal cells and central streaming cells.
  ◦Cords should be thin (a must, to distinguish from higher grade inverted urothelial neoplasms).
  ◦Bland cytology, but may have scattered degenerative atypia.

• Benign proliferative lesion (associated with chronic inflammation or bladder outlet obstruction)
• Can be located throughout the bladder but most commonly on the trigone, comprising less than 1% of all bladder tumors
• Inverted growth pattern (anastomosing islands of histologically and cytologically normal urothelial cells invaginating from the surface urothelium into the lamina propria but not into the muscularis propria)
• Behave in a benign fashion with only a 1% incidence of tumor recurrence. (Negligible recurrence rate (<1%))
• Occasionally, present with coexistent urothelial cancer elsewhere in the urinary system, occurring more commonly in the upper tract than the bladder
• The use of fluorescent in-situ hybridization (FISH) to evaluate chromosomal changes can distinguish between an inverted papilloma and a urothelial cancer with an inverted growth pattern (Jones et al, 2007).
• Transurethral resection is the treatment of choice.



Referrence

1. Campbell Urology
  Chapter 80 : Urothelial Tumors of the Bladder

 

 

PPT : Inverted Papilloma Bladder.ppt

Leukoplakia of the Bladder (Vesical Leukoplakia) PPT

Leukoplakia of the Bladder (Vesical Leukoplakia)

  Leukoplakia is a clinical term indicating "white plaque."
  And also, leukoplakia is the clinical manifestation of histologically described keratinizing squamous metaplasia.

  Leukoplakia is known to occur in the mucous membranes of the body, including those of the urinary tract, rectum, vagina, uterus, vulva, paranasal sinuses, gallbladder, esophagus, eardrums, and pharynx.

  Currently, the clinical term "leukoplakia" is thought to be synonymous with the histopathologic diagnosis of keratinizing squamous metaplasia.

  It is distinctly different from estrogen-associated squamous metaplasia of the female trigone. (Nonkeratinizing squamous metaplasia)

  Metaplastic changes of the urothelium are associated with chronic inflammation, diverticuli, or stones and should not be confused with squamatization of the trigone (nonkeratinizing glycogenated squamous epithelium), which is a common occurrence in women during estrogen production.

  Hormone-associated squamatization of the trigone demonstrates no keratinization, intercellular bridges, or cellular atypia and is considered a normal anatomic variant.

- Similar to squamous metaplasia with the addition of keratin deposition that appears as a white flaky substance floating in the bladder (Staack et al, 2006).

 - Leukoplakia occurs in other organs that are covered by squamous epithelium and is often premalignant
  However, cytogenetic studies on bladder leukoplakia are consistent with a benign lesion, and no treatment is necessary (Staack et al, 2006).

 

Referrence 

1. Campbell Urology
   Chapter 80 : Urothelial Tumors of the Bladder

2. Staack A, Schlechte H, Sachs M, et al. Clinical value of vesical leukoplakia and evaluation of the neoplastic risk by mutation analyses of the tumor suppressor gene TP53. Int J Urol 2006;13(8):1092–7.

PPT : Vesical Leukoplakia.ppt

Benign Tumors of the Bladder Classification

Benign Tumors of the Bladder

 

Classification 

 

  1) Epithelial Metaplasia

  2) Leukoplakia

  3) Inverted Papilloma

  4) Papilloma

  5) Nephrogenic Adenoma

  6) Cystitis Cystica and Glandularis

  7) Leiomyoma