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Presented by Dr. Andres Matoso and prepared by Dr. Harsimar Kaur
56 yo Male with bladder neck tumor.
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1. Question
56 yo Male with bladder neck tumor.
Correct
Correct answer B.
Histology: Low power view shows bladder mucosa with nests of urothelium with central lumina and areas with intestinal differentiation and mucin extravasation. There is no dysplasia or invasion into the muscularis propria.
Discussion: Intestinal (mucinous) metaplasia (IM), or metaplastic replacement of urothelium by intestinal type epithelium, is an uncommon finding in the urinary bladder. It is far less common than cystitis cystica et glandularis, which is a benign condition usually related to inflammation or infection. Occasionally, both cystitis cystica et glandularis (CCG) and intestinal metaplasia coexist in the same patient/specimen. When the epithelium manifests colonic phenotype with goblet cell metaplasia, it also acquires an intestinal immunoprofile and may show dysplasia or adenocarcinoma.1 It is controversial if IM acts as a precursor of malignancy in the urinary system. IM can show mucin extravasation but that does not equal malignancy. In contrast to IM, well differentiated mucinous adenocarcinoma shows an irregular invasive frond, may involve the detrusor muscle and the strips of epithelium show dark dysplastic nuclei.
References:
1. Clouston D, Lawrentschuk N. Metaplastic conditions of the bladder. BJU Int. 2013;112 Suppl 2:27-31.
2. Xin Z, Zhao C, Huang T, et al. Intestinal metaplasia of the bladder in 89 patients: a study with emphasis on long-term outcome. BMC Urol. 2016;16:24.
3. Gordetsky J, Epstein JI. Intestinal metaplasia of the bladder with dysplasia: a risk factor for carcinoma? Histopathology. 2015;67:325-330.Incorrect
Correct answer B.
Histology: Low power view shows bladder mucosa with nests of urothelium with central lumina and areas with intestinal differentiation and mucin extravasation. There is no dysplasia or invasion into the muscularis propria.
Discussion: Intestinal (mucinous) metaplasia (IM), or metaplastic replacement of urothelium by intestinal type epithelium, is an uncommon finding in the urinary bladder. It is far less common than cystitis cystica et glandularis, which is a benign condition usually related to inflammation or infection. Occasionally, both cystitis cystica et glandularis (CCG) and intestinal metaplasia coexist in the same patient/specimen. When the epithelium manifests colonic phenotype with goblet cell metaplasia, it also acquires an intestinal immunoprofile and may show dysplasia or adenocarcinoma.1 It is controversial if IM acts as a precursor of malignancy in the urinary system. IM can show mucin extravasation but that does not equal malignancy. In contrast to IM, well differentiated mucinous adenocarcinoma shows an irregular invasive frond, may involve the detrusor muscle and the strips of epithelium show dark dysplastic nuclei.
References:
1. Clouston D, Lawrentschuk N. Metaplastic conditions of the bladder. BJU Int. 2013;112 Suppl 2:27-31.
2. Xin Z, Zhao C, Huang T, et al. Intestinal metaplasia of the bladder in 89 patients: a study with emphasis on long-term outcome. BMC Urol. 2016;16:24.
3. Gordetsky J, Epstein JI. Intestinal metaplasia of the bladder with dysplasia: a risk factor for carcinoma? Histopathology. 2015;67:325-330.
