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Presented by Jonathan Epstein, MD and prepared by Armen Khararjian, MD
This case talks about:
A 30 year old female with hematuria underwent cystoscopy and was found to have the entire bladder filled with papillary lesions.
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Question 1 of 1
1. Question
Week 614: Case 1
A 30 year old female with hematuria underwent cystoscopy and was found to have the entire bladder filled with papillary lesions.
Correct
Answer: Condyloma
Histology: The lesion consists of a papillary squamous tumor that has a spiky surface. Overlying the lesion is hyperkeratosis with hypergranulosis and underlying squamous epithelium that is in general cytologically bland with occasional multinucleated cells with crinkly degenerative atypia. Some of the nuclei are associated with koilocytosis.
Discussion: The histological features in this case are typical of a condyloma occurring in an unusual site. This patient had a history of condylomas occurring on the external genitalia and now the lesions have extended up the urethra and into the bladder. In this case, they were so extensive that they could not be totally excised, fulgurated, or lasered and it was unclear how the patient was going to be managed as cystectomy in such a young person for benign tumors is not a good option. An additional concern is that condylomas in the bladder are associated with an increased risk of developing squamous cell carcinoma. In many cases the diagnosis of condylomas must be established on the H&E morphology as low risk HPV cannot always be identified using in-situ hybridization (ISH). Whereas all condylomas are associated with HPV even if they cannot be demonstrated with ISH, urothelial tumors are not related to HPV.
Incorrect
Answer: Condyloma
Histology: The lesion consists of a papillary squamous tumor that has a spiky surface. Overlying the lesion is hyperkeratosis with hypergranulosis and underlying squamous epithelium that is in general cytologically bland with occasional multinucleated cells with crinkly degenerative atypia. Some of the nuclei are associated with koilocytosis.
Discussion: The histological features in this case are typical of a condyloma occurring in an unusual site. This patient had a history of condylomas occurring on the external genitalia and now the lesions have extended up the urethra and into the bladder. In this case, they were so extensive that they could not be totally excised, fulgurated, or lasered and it was unclear how the patient was going to be managed as cystectomy in such a young person for benign tumors is not a good option. An additional concern is that condylomas in the bladder are associated with an increased risk of developing squamous cell carcinoma. In many cases the diagnosis of condylomas must be established on the H&E morphology as low risk HPV cannot always be identified using in-situ hybridization (ISH). Whereas all condylomas are associated with HPV even if they cannot be demonstrated with ISH, urothelial tumors are not related to HPV.
