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Presented by Dr. Andres Matoso and prepared by Dr. Yembur Ahmad
This case talks about an adult male with a bladder tumor.
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1. Question
An adult male presents with a bladder tumor.
What is the diagnosis?
Correct
Correct: C
Histology: Proliferation of nests and cords of urothelium with an endophytic growth and covered by normal or flattened urothelium.
Discussion: Inverted urothelial papillomas (IUP) are rare and account for approximately 1% of bladder tumors and can occur at any age (average age at presentation is 60). The most common location is the bladder neck and trigone. Painless gross hematuria is the most common presenting symptom. The majority of the tumors are smaller than 5 cm. Histologically, the tumor is composed of anastomosing nest and thin cords of urothelium growing endophytically from the superficial urothelium. An exophytic component should be absent. Tumor cells are bland and often streaming towards the center of the cords and with peripheral palisading. Some cases show focal squamous metaplasia. The main differential diagnosis is with low grade papillary urothelial carcinoma with inverted growth pattern, which is characterized by the presence of larger nests and/or cytologic atypia. Any stromal reaction/desmoplasia or involvement of the muscularis propria are not features of IUP and are suggestive of invasive carcinoma. Mitotic activity is usually low. The recurrence rate is ~5%.
References:
Can Urol Assoc J. 2017 Jan-Feb; 11(1-2): 66–69.Incorrect
Correct: C
Histology: Proliferation of nests and cords of urothelium with an endophytic growth and covered by normal or flattened urothelium.
Discussion: Inverted urothelial papillomas (IUP) are rare and account for approximately 1% of bladder tumors and can occur at any age (average age at presentation is 60). The most common location is the bladder neck and trigone. Painless gross hematuria is the most common presenting symptom. The majority of the tumors are smaller than 5 cm. Histologically, the tumor is composed of anastomosing nest and thin cords of urothelium growing endophytically from the superficial urothelium. An exophytic component should be absent. Tumor cells are bland and often streaming towards the center of the cords and with peripheral palisading. Some cases show focal squamous metaplasia. The main differential diagnosis is with low grade papillary urothelial carcinoma with inverted growth pattern, which is characterized by the presence of larger nests and/or cytologic atypia. Any stromal reaction/desmoplasia or involvement of the muscularis propria are not features of IUP and are suggestive of invasive carcinoma. Mitotic activity is usually low. The recurrence rate is ~5%.
References:
Can Urol Assoc J. 2017 Jan-Feb; 11(1-2): 66–69.
