The spectrum of histopathologic findings in vesical diverticulum: Implications for pathogenesis and staging

Muhammad Idrees, Riley E. Alexander, Jennifer B. Kum, Liang Cheng

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Diverticula are saccular evaginations of urinary bladder mucosa that are encountered in all age groups with a prevalence of 1% to 10%. Intradiverticular neoplasms pose diagnostic and management challenges. The aim of this study was to document the common morphologic changes and neoplasms found in a large series of adult and pediatric vesical diverticula. A total of 174 diverticula from 133 patients were reviewed including 48 pediatric (mean age, 7.1 years) and 85 adult (mean age, 63.93 years); 92% were male. Of the 85 nonneoplastic cases, prominent morphologic findings included significant chronic inflammation (59), granulomatous inflammation including foreign body giant cell reaction (6), acute inflammation (7), squamous metaplasia (9), cystitis glandularis (10), and nephrogenic metaplasia (2). The pediatric cases showed no malignancy. Thirty-three of the 48 neoplastic cases had high-grade urothelial carcinoma, 4 had carcinoma in situ, 7 had low-grade papillary urothelial carcinoma, 2 had primary squamous cell carcinoma, 1 had primary melanoma, and 1 had urothelial dysplasia. Nine of the neoplastic cases had variant morphology. Diverticula from 31 cases were involved by primary tumors, of which 6 had coexisting intravesical neoplasia (3 had carcinoma in situ with invasion elsewhere). In 19 of 33 high-grade urothelial carcinomas, infiltration into adjacent fat was noted. Seven of these cases arose within diverticula. Diverticula may harbor neoplasms, most commonly urothelial carcinoma. Attenuation of the muscle layer associated with diverticulum formation may facilitate tumor invasion into peridiverticular soft tissues. It is emphasized that pT2 stage should be eliminated to avoid the confusion in staging these neoplasms.

Original languageEnglish
Pages (from-to)1223-1232
Number of pages10
JournalHuman Pathology
Volume44
Issue number7
DOIs
StatePublished - Jul 2013

Fingerprint

Diverticulum
Neoplasms
Carcinoma in Situ
Metaplasia
Pediatrics
Inflammation
Carcinoma
Foreign Body Giant Cells
Cystitis
Neoplasm Staging
Papillary Carcinoma
Bladder Diverticulum
Squamous Cell Carcinoma
Melanoma
Mucous Membrane
Urinary Bladder
Age Groups
Fats
Muscles

Keywords

  • Diverticulum
  • Morphologic spectrum
  • Urothelial carcinoma
  • Variant morphology

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

The spectrum of histopathologic findings in vesical diverticulum : Implications for pathogenesis and staging. / Idrees, Muhammad; Alexander, Riley E.; Kum, Jennifer B.; Cheng, Liang.

In: Human Pathology, Vol. 44, No. 7, 07.2013, p. 1223-1232.

Research output: Contribution to journalArticle

@article{51cd6f9988cf49d28418a79f10aff41a,
title = "The spectrum of histopathologic findings in vesical diverticulum: Implications for pathogenesis and staging",
abstract = "Diverticula are saccular evaginations of urinary bladder mucosa that are encountered in all age groups with a prevalence of 1{\%} to 10{\%}. Intradiverticular neoplasms pose diagnostic and management challenges. The aim of this study was to document the common morphologic changes and neoplasms found in a large series of adult and pediatric vesical diverticula. A total of 174 diverticula from 133 patients were reviewed including 48 pediatric (mean age, 7.1 years) and 85 adult (mean age, 63.93 years); 92{\%} were male. Of the 85 nonneoplastic cases, prominent morphologic findings included significant chronic inflammation (59), granulomatous inflammation including foreign body giant cell reaction (6), acute inflammation (7), squamous metaplasia (9), cystitis glandularis (10), and nephrogenic metaplasia (2). The pediatric cases showed no malignancy. Thirty-three of the 48 neoplastic cases had high-grade urothelial carcinoma, 4 had carcinoma in situ, 7 had low-grade papillary urothelial carcinoma, 2 had primary squamous cell carcinoma, 1 had primary melanoma, and 1 had urothelial dysplasia. Nine of the neoplastic cases had variant morphology. Diverticula from 31 cases were involved by primary tumors, of which 6 had coexisting intravesical neoplasia (3 had carcinoma in situ with invasion elsewhere). In 19 of 33 high-grade urothelial carcinomas, infiltration into adjacent fat was noted. Seven of these cases arose within diverticula. Diverticula may harbor neoplasms, most commonly urothelial carcinoma. Attenuation of the muscle layer associated with diverticulum formation may facilitate tumor invasion into peridiverticular soft tissues. It is emphasized that pT2 stage should be eliminated to avoid the confusion in staging these neoplasms.",
keywords = "Diverticulum, Morphologic spectrum, Urothelial carcinoma, Variant morphology",
author = "Muhammad Idrees and Alexander, {Riley E.} and Kum, {Jennifer B.} and Liang Cheng",
year = "2013",
month = "7",
doi = "10.1016/j.humpath.2012.11.005",
language = "English",
volume = "44",
pages = "1223--1232",
journal = "Human Pathology",
issn = "0046-8177",
publisher = "W.B. Saunders Ltd",
number = "7",

}

TY - JOUR

T1 - The spectrum of histopathologic findings in vesical diverticulum

T2 - Implications for pathogenesis and staging

AU - Idrees, Muhammad

AU - Alexander, Riley E.

AU - Kum, Jennifer B.

AU - Cheng, Liang

PY - 2013/7

Y1 - 2013/7

N2 - Diverticula are saccular evaginations of urinary bladder mucosa that are encountered in all age groups with a prevalence of 1% to 10%. Intradiverticular neoplasms pose diagnostic and management challenges. The aim of this study was to document the common morphologic changes and neoplasms found in a large series of adult and pediatric vesical diverticula. A total of 174 diverticula from 133 patients were reviewed including 48 pediatric (mean age, 7.1 years) and 85 adult (mean age, 63.93 years); 92% were male. Of the 85 nonneoplastic cases, prominent morphologic findings included significant chronic inflammation (59), granulomatous inflammation including foreign body giant cell reaction (6), acute inflammation (7), squamous metaplasia (9), cystitis glandularis (10), and nephrogenic metaplasia (2). The pediatric cases showed no malignancy. Thirty-three of the 48 neoplastic cases had high-grade urothelial carcinoma, 4 had carcinoma in situ, 7 had low-grade papillary urothelial carcinoma, 2 had primary squamous cell carcinoma, 1 had primary melanoma, and 1 had urothelial dysplasia. Nine of the neoplastic cases had variant morphology. Diverticula from 31 cases were involved by primary tumors, of which 6 had coexisting intravesical neoplasia (3 had carcinoma in situ with invasion elsewhere). In 19 of 33 high-grade urothelial carcinomas, infiltration into adjacent fat was noted. Seven of these cases arose within diverticula. Diverticula may harbor neoplasms, most commonly urothelial carcinoma. Attenuation of the muscle layer associated with diverticulum formation may facilitate tumor invasion into peridiverticular soft tissues. It is emphasized that pT2 stage should be eliminated to avoid the confusion in staging these neoplasms.

AB - Diverticula are saccular evaginations of urinary bladder mucosa that are encountered in all age groups with a prevalence of 1% to 10%. Intradiverticular neoplasms pose diagnostic and management challenges. The aim of this study was to document the common morphologic changes and neoplasms found in a large series of adult and pediatric vesical diverticula. A total of 174 diverticula from 133 patients were reviewed including 48 pediatric (mean age, 7.1 years) and 85 adult (mean age, 63.93 years); 92% were male. Of the 85 nonneoplastic cases, prominent morphologic findings included significant chronic inflammation (59), granulomatous inflammation including foreign body giant cell reaction (6), acute inflammation (7), squamous metaplasia (9), cystitis glandularis (10), and nephrogenic metaplasia (2). The pediatric cases showed no malignancy. Thirty-three of the 48 neoplastic cases had high-grade urothelial carcinoma, 4 had carcinoma in situ, 7 had low-grade papillary urothelial carcinoma, 2 had primary squamous cell carcinoma, 1 had primary melanoma, and 1 had urothelial dysplasia. Nine of the neoplastic cases had variant morphology. Diverticula from 31 cases were involved by primary tumors, of which 6 had coexisting intravesical neoplasia (3 had carcinoma in situ with invasion elsewhere). In 19 of 33 high-grade urothelial carcinomas, infiltration into adjacent fat was noted. Seven of these cases arose within diverticula. Diverticula may harbor neoplasms, most commonly urothelial carcinoma. Attenuation of the muscle layer associated with diverticulum formation may facilitate tumor invasion into peridiverticular soft tissues. It is emphasized that pT2 stage should be eliminated to avoid the confusion in staging these neoplasms.

KW - Diverticulum

KW - Morphologic spectrum

KW - Urothelial carcinoma

KW - Variant morphology

UR - http://www.scopus.com/inward/record.url?scp=84879203322&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879203322&partnerID=8YFLogxK

U2 - 10.1016/j.humpath.2012.11.005

DO - 10.1016/j.humpath.2012.11.005

M3 - Article

C2 - 23375647

AN - SCOPUS:84879203322

VL - 44

SP - 1223

EP - 1232

JO - Human Pathology

JF - Human Pathology

SN - 0046-8177

IS - 7

ER -