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Presented by Dr. Andres Matoso and prepared by Dr. Robby Jones
This is a 66-year-old man with a bladder lesion.
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1. Question
This is a 66-year-old man with a bladder lesion. Choose the correct diagnosis.
Correct
Answer: 3. Pseudocarcinomatous urothelial hyperplasia
Histology: Nests of urothelium extending into the lamina propria. Urothelial cells show mild to moderate nuclear atypia. The background stroma shows hemorrhage, dilated vascular spaces, fibrin deposition, edema and inflammation.
Discussion: Pseudocarcinomatous urothelial hyperplasia can be associated to prior radiation or chemotherapy or the result of poor circulation. The main differential diagnosis is invasive urothelial carcinoma. The distinction can be made by identifying changes to the background stroma that include ectatic blood vessels, fibrin deposition, hemorrhage and hemosiderin deposition and inflammation. The lesion is in general small but occasionally can involve the lamina propria extensively but never the muscularis propria (detrusor muscle).
References:
Am J Surg Pathol. 2008 Jan;32(1):92-7.
J Urol. 2013 Dec;190(6):2251-2.Incorrect
Answer: 3. Pseudocarcinomatous urothelial hyperplasia
Histology: Nests of urothelium extending into the lamina propria. Urothelial cells show mild to moderate nuclear atypia. The background stroma shows hemorrhage, dilated vascular spaces, fibrin deposition, edema and inflammation.
Discussion: Pseudocarcinomatous urothelial hyperplasia can be associated to prior radiation or chemotherapy or the result of poor circulation. The main differential diagnosis is invasive urothelial carcinoma. The distinction can be made by identifying changes to the background stroma that include ectatic blood vessels, fibrin deposition, hemorrhage and hemosiderin deposition and inflammation. The lesion is in general small but occasionally can involve the lamina propria extensively but never the muscularis propria (detrusor muscle).
References:
Am J Surg Pathol. 2008 Jan;32(1):92-7.
J Urol. 2013 Dec;190(6):2251-2.
