Histopathologic features and clinical outcomes in 71 cases of bladder diverticula.
ABSTRACT Bladder diverticula often come to clinical attention when complications or malignancy occur, although limited information is available regarding histopathologic features and clinical outcomes.
To identify the morphologic findings, neoplastic subtypes, and clinical outcomes by reviewing all bladder diverticula that underwent pathologic sampling for primary diverticular processes at the Cleveland Clinic.
Hematoxylin-eosin slides from 71 cases of bladder diverticula were reviewed. Clinicopathologic features and patient outcomes were obtained from a retrospective review of patient records.
Patient ages ranged from 1 to 81 years (mean, 55 years), and the ratio of males to females was 68:3. Diverticular size ranged from 1 to 18 cm (mean, 5.3 cm) and often involved the lateral walls (38/71; 54%). Neoplastic changes were present in half of cases (36/71; 51%), including both noninvasive (16/36; 44%) and invasive (20/ 36; 56%) carcinoma. Of the invasive carcinomas, less-common subtypes included small cell carcinoma (n = 3), squamous cell carcinoma (n = 2), and adenocarcinoma (n = 1); 9 cases were pT1 (45%) and 11 cases were pT3 (55%). Follow-up for patients with benign findings demonstrated no subsequent neoplastic bladder disease. Patient follow-up for neoplastic diverticula (median, 27 months) demonstrated 4 cases of local recurrence and 3 cases of subsequent metastases. Of 9 patients with pT1 disease, only 1 patient (11%) developed subsequent metastases, whereas patients with pT3 disease demonstrated a higher rate of both local recurrence (3/11; 27%) and subsequent metastases (2/11; 18%).
Patients with invasive carcinoma in diverticula have an increased frequency of less-common bladder cancer subtypes, and those with pT3 disease are at increased risk for subsequent progression.
The Journal of urology 04/2014; 192(1). DOI:10.1016/j.juro.2014.04.044 · 3.75 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Background To examine histopathologic features and clinical outcomes of intradiverticular bladder carcinomas.Methods Twenty-two consecutive patients with intradiverticular bladder carcinoma treated with either endoscopic transurethral resection or partial or radical cystectomy at a single institution between years of 1995 to 2011. Clinicopathologic characteristics and oncologic outcomes of patients were retrospectively analyzed, including tissue histology re-review by genitourinary pathologists.ResultsHistologically, 9 cases (41%) were non-invasive papillary urothelial carcinoma, 13 cases (59%) were invasive urothelial carcinoma, including three cases of small cell carcinoma. Final pathology revealed synchronous extradiverticular urothelial carcinomas in 6 out of 9 cases (67%) of non-invasive and 2 out of 10 cases (20%) invasive intradiverticular urothelial carcinoma, respectively. More than half of cases (13/22, 59%) showed a distinctive hypertrophic layer of muscularis mucosae. There was no statistical difference in disease free survival or overall survival between non-invasive and invasive tumors within approximately 3 years of follow up (mean 38 months, median 32 months). While stage T3 patients generally did poorly, oncologic outcomes for stage T1 patients were no different than those of stage Ta.Conclusion Intradiverticular carcinomas are often associated with a hypertrophic layer of muscularis mucosae that can potentially confound tumor staging. Non-invasive intradiverticular urothelial carcinomas are more likely to have coexisting synchronous extradiverticular lesions. The absence of a muscularis propria layer may not necessarily predispose T1 tumors to more aggressive disease.Virtual SlidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_222.Diagnostic Pathology 11/2014; 9(1):222. DOI:10.1186/s13000-014-0222-8 · 2.41 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Intradiverticular bladder tumours (IDBT) account for approximately 1% of all urinary bladder tumours. The risk of developing a tumour within a bladder diverticulum is considered to be greater than in the main bladder, possibly owing to prolonged contact of potential carcinogens with the mucosal lining from urinary stasis. Patients with these tumours most commonly present with visible haematuria. Diagnostic tests include urine cytology, cystoscopy, ultrasonography, CT, MRI, and biopsy. Lack of muscle in the diverticula increases the risk of bladder perforation during biopsy and makes pathological staging difficult as there is no T2 stage; instead, data suggest that any invasion beyond the lamina propria should be described as T3. IDBT can be managed by transurethral resection and adjuvant intravesical therapy, diverticulectomy, or cystectomy (partial or radical), as outlined by the only guidelines to specifically address the management of IDBT, which were published by the Cancer Committee of the French Association of Urology (CCAFU) in 2012. The prognosis of patients with intradiverticular bladder tumours has always been perceived to be worse than those with intravesical tumours; however, the only study of 5-year survival rates for patients with IDBT suggests that prognosis might be comparable for these conditions.Nature Reviews Urology 06/2014; DOI:10.1038/nrurol.2014.131 · 4.52 Impact Factor