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Presented by Dr. Jonathan Epstein and prepared by Dr. Harsimar Kaur.
A 55 year-old man underwent a TURB for a polypoid lesion in the bladder.
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1. Question
A 55 year-old man underwent a TURB for a polypoid lesion in the bladder.
Correct
Answer: B
Histological Description: The tumor consists predominantly of anastomosing thin columns of urothelium extending into the lamina propria. In some areas there is continuity with the surface but in most there is not. The periphery of the columns are lined by cells with a palisading appearance with cells streaming parallel to the basement membrane in center of nests. There is no cytological atypia and mitotic figures rare and when present only at the periphery of columns. Focally, there is an exophytic papillary component, where the lining is the same as the rest of the lesion. There is cyst formation filled with eosinophilic secretions common with intervening stroma lacking inflammation.
Discussion: The morphology of >95% of the lesion is typical of inverted papilloma. What makes this case somewhat unusual and more difficult is that there are rare exophytic papillary fronds raising the possibility of a low grade papillary urothelial carcinoma or PUNLMP with an inverted growth pattern. As long as the cytology in the fronds are identical to the rest of the lesion, and the lesion is otherwise classical for inverted papilloma, the diagnosis remain inverted papilloma. There is no risk of recurrence, and no risk of progression to urothelial carcinoma.Incorrect
Answer: B
Histological Description: The tumor consists predominantly of anastomosing thin columns of urothelium extending into the lamina propria. In some areas there is continuity with the surface but in most there is not. The periphery of the columns are lined by cells with a palisading appearance with cells streaming parallel to the basement membrane in center of nests. There is no cytological atypia and mitotic figures rare and when present only at the periphery of columns. Focally, there is an exophytic papillary component, where the lining is the same as the rest of the lesion. There is cyst formation filled with eosinophilic secretions common with intervening stroma lacking inflammation.
Discussion: The morphology of >95% of the lesion is typical of inverted papilloma. What makes this case somewhat unusual and more difficult is that there are rare exophytic papillary fronds raising the possibility of a low grade papillary urothelial carcinoma or PUNLMP with an inverted growth pattern. As long as the cytology in the fronds are identical to the rest of the lesion, and the lesion is otherwise classical for inverted papilloma, the diagnosis remain inverted papilloma. There is no risk of recurrence, and no risk of progression to urothelial carcinoma.
