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Thanks to Dr. Zlatko Marusic, Sestre Milosrdnice Clinical Hospital (Croatia), for contributing this case.
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Case #198
Clinical history:
A 55 year old woman presented with hematuria. A bladder biopsy was obtained.
Microscopic images:
What is your diagnosis?
Diagnosis: Pseudocarcinomatous epithelial hyperplasia of the urinary bladder
Discussion:
There is a characteristic downward proliferation of urothelial nests with focal squamous metaplasia but without atypia. The nests wrap around vessels with fibrin deposition and congestion. One of the photomicrographs shows calcifications next to the biopsy fragment.
In 2000, Baker and Young reported 4 cases of radiation cystitis with pseudocarcinomatous proliferations, which were often confused with invasive carcinoma (Hum Pathol 2000;31:678). 2 subsequent case series describe this entity. The first series, by Chan and Epstein (Am J Surg Pathol 2004;28:909), reported on 20 patients with similar biopsy features and a history of pelvic irradiation or systemic chemotherapy. The second case series, by Lane and Epstein, described 8 patients with ischemia or chronic irritation but no history of irradiation (Am J Surg Pathol 2008;32:92). Pseudocarcinomatous epithelial hyperplasia of the urinary bladder has also been described in reviews of pseudoneoplastic or therapy induced lesions of the urinary bladder (Mod Pathol 2009;22:S37).
In the present case, a pathologist search for prior biopsies revealed a history of radation therapy for uterine cancer 3 years previous.
Despite the pseudoinvasive nests, these lesions have characteristic findings that differentiate these cases from invasive carcinoma. Most cases show no mitotic figures but there is frequently hemorrhage, thickened vessels and other radiation associated vascular changes. Other features include fibrin deposition, fibrin thrombi, fibrosis, inflammation, hemosiderin, ulceration, edema and vascular congestion.
No treatment is required for this reactive condition.
