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Presented by Dr. Andres Matoso and prepared by Dr. Robby Jones.
This is a bladder mass in a 59-year-old man.
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1. Question
This is a bladder mass in a 59-year-old man. Choose the correct diagnosis.
Correct
Answer: Condyloma
Histology: Folds of thickened non-keratinizing squamous epithelium with thin fibrovascular cores with no branching. Cytoplasmic clearing and typical changes of koilocytosis can be observed. The nuclear atypia is mild and mitotic activity is virtually absent unless associated with high-grade dysplasia. A combination of exophitic and inverted growth patterns are common.
Discussion: Condylomas involving the urothelium are rare lesions that could happen anywhere in the urinary tract. The clinical presentation is usually hematuria. More common in patients with anogenital condylomas. HPV 6/11 can be detected using in-situ hybridization techniques. High-risk HPV can be positive in cases with areas of high-grade dysplasia. Immunohistochemistry for p16 is positive in areas of high-grade dysplasia but does not help to differentiate condyloma from low-grade papillary urothelial carcinoma. May be associated with invasive squamous cell carcinoma and patients with condylomas have an increased risk of developing squamous cell carcinoma of the bladder. The differential diagnoses include squamous papilloma (negative HPV and no koilocytic changes) and low-grade papillary urothelial carcinoma (no squamous differentiation, complex branching of papillary fronds, no HPV related changes).
References:
Am J Surg Pathol. 2006 Jul;30(7):883-91.
Pathology. 2005 Apr;37(2):176-8.
Cancer. 2000 Apr 1;88(7):1679-86.Incorrect
Answer: Condyloma
Histology: Folds of thickened non-keratinizing squamous epithelium with thin fibrovascular cores with no branching. Cytoplasmic clearing and typical changes of koilocytosis can be observed. The nuclear atypia is mild and mitotic activity is virtually absent unless associated with high-grade dysplasia. A combination of exophitic and inverted growth patterns are common.
Discussion: Condylomas involving the urothelium are rare lesions that could happen anywhere in the urinary tract. The clinical presentation is usually hematuria. More common in patients with anogenital condylomas. HPV 6/11 can be detected using in-situ hybridization techniques. High-risk HPV can be positive in cases with areas of high-grade dysplasia. Immunohistochemistry for p16 is positive in areas of high-grade dysplasia but does not help to differentiate condyloma from low-grade papillary urothelial carcinoma. May be associated with invasive squamous cell carcinoma and patients with condylomas have an increased risk of developing squamous cell carcinoma of the bladder. The differential diagnoses include squamous papilloma (negative HPV and no koilocytic changes) and low-grade papillary urothelial carcinoma (no squamous differentiation, complex branching of papillary fronds, no HPV related changes).
References:
Am J Surg Pathol. 2006 Jul;30(7):883-91.
Pathology. 2005 Apr;37(2):176-8.
Cancer. 2000 Apr 1;88(7):1679-86.
