Benign Polypoid and Papillary Lesions



Urologic patients who have symptoms of hematuria, frequency, urgency, or recurrent urinary tract infections are often advised to undergo cystoscopic examination. Although malignant lesions of the bladder typically have a fairly characteristic appearance, there are a number of benign lesions of the bladder that may be encountered and occasionally confused with a malignant process.

In this chapter, we describe a number of nonneoplastic lesions of the bladder. We describe the clinical presentation and the pathogenesis of these lesions. In addition, we describe their cystoscopic appearance, the histologic features of the lesions, and their medical or surgical management. Through this chapter, the reader should be familiar with benign lesions of the bladder and their associated pathologic features.


Lamina Propria Intestinal Metaplasia Urothelial Carcinoma Prostatic Adenocarcinoma Bladder Perforation 
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  1. 1.
    Young RH. Tumor-like lesions of the urinary bladder. Mod Pathol. 2009;22 Suppl 2:S37–52.PubMedCrossRefGoogle Scholar
  2. 2.
    Volmar KE, Chan TY, De Marzo AM, Epstein JI. Florid von Brunn nests mimicking urothelial carcinoma: a morphologic and immunohistochemical comparison to the nested variant of urothelial carcinoma. Am J Surg Pathol. 2003;27(9):1243–52.PubMedCrossRefGoogle Scholar
  3. 3.
    Smith AK, Hansel DE, Jones JS. Role of cystitis cystica et glandularis and intestinal metaplasia in development of bladder carcinoma. Urology. 2008;71(5):915–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Montironi R, Lopez-Beltran A, Scarpelli M, Mazzucchelli R, Cheng L. Morphological classification and definition of benign, preneoplastic and non-­invasive neoplastic lesions of the urinary bladder. Histopathology. 2008;53(6):621–33.PubMedCrossRefGoogle Scholar
  5. 5.
    Wiener DP, Koss LG, Sablay B, Freed SZ. The prevalence and significance of Brunn’s nests, cystitis ­cystica and squamous metaplasia in normal bladders. J Urol. 1979;122(3):317–21.PubMedGoogle Scholar
  6. 6.
    Pantuck AJ, Bancila E, Das KM, Amenta PS, Cummings KB, Marks M, et al. Adenocarcinoma of the urachus and bladder expresses a unique colonic epithelial epitope: an immunohistochemical study. J Urol. 1997;158(5):1722–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Sung MT, Lopez-Beltran A, Eble JN, MacLennan GT, Tan PH, Montironi R, et al. Divergent pathway of intestinal metaplasia and cystitis glandularis of the urinary bladder. Mod Pathol. 2006;19(11):1395–401.PubMedGoogle Scholar
  8. 8.
    Yalla SV, Ivker M, Burros HM, Dorey F. Cystitis glandularis with perivesical lipomatosis. Frequent association of two unusual proliferative conditions. Urology. 1975;5(3):383–6.CrossRefGoogle Scholar
  9. 9.
    Thrasher JB, Rajan RR, Perez LM, Humphrey PA, Anderson EE. Cystitis glandularis. Transition to adenocarcinoma of the urinary bladder. N C Med J. 1994;55(11):562–4.PubMedGoogle Scholar
  10. 10.
    Paulhac P, Maisonnette F, Bourg S, Dumas JP, Colombeau P. Adenocarcinoma in the exstrophic bladder. Urology. 1999;54(4):744.PubMedCrossRefGoogle Scholar
  11. 11.
    Bryan RT, Nicholls JH, Harrison RF, Jankowski JA, Wallace DM. The role of beta-catenin signaling in the malignant potential of cystitis glandularis. J Urol. 2003;170(5):1892–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Corica FA, Husmann DA, Churchill BM, Young RH, Pacelli A, Lopez-Beltran A, et al. Intestinal metaplasia is not a strong risk factor for bladder cancer: study of 53 cases with long-term follow-up. Urology. 1997;50(3):427–31.PubMedCrossRefGoogle Scholar
  13. 13.
    Jost SP, Dixon JS, Gosling JA. Ultrastructural observations on cystitis cystica in human bladder urothelium. Br J Urol. 1993;71(1):28–33.PubMedCrossRefGoogle Scholar
  14. 14.
    Kaya C, Akpinar IN, Aker F, Turkeri LN. Large Cystitis glandularis: a very rare cause of severe obstructive urinary symptoms in an adult. Int Urol Nephrol. 2007;39(2):441–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Navarro JE, Huggins TJ. Cystitis glandularis: an unusual cause of ureteral obstruction. Urol Radiol. 1984;6(1):27–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Melicow MM, Hollowell JW. Intra-urothelial cancer: carcinoma in situ, Bowen’s disease of the urinary ­system: discussion of thirty cases. J Urol. 1952;68(4):763–72.PubMedGoogle Scholar
  17. 17.
    Dhall D, Al-Ahmadie H, Olgac S. Nested variant of urothelial carcinoma. Arch Pathol Lab Med. 2007;131(11):1725–7.PubMedGoogle Scholar
  18. 18.
    Wasco MJ, Daignault S, Bradley D, Shah RB. Nested variant of urothelial carcinoma: a clinicopathologic and immunohistochemical study of 30 pure and mixed cases. Hum Pathol. 2010;41(2):163–71.PubMedCrossRefGoogle Scholar
  19. 19.
    Murphy WM, Deana DG. The nested variant of ­transitional cell carcinoma: a neoplasm resembling proliferation of Brunn’s nests. Mod Pathol. 1992;5(3):240–3.PubMedGoogle Scholar
  20. 20.
    Lin O, Cardillo M, Dalbagni G, Linkov I, Hutchinson B, Reuter VE. Nested variant of urothelial carcinoma: a clinicopathologic and immunohistochemical study of 12 cases. Mod Pathol. 2003;16(12):1289–98.PubMedCrossRefGoogle Scholar
  21. 21.
    Oberg TN, Kipp BR, Campion MB, Voss JS, Jimenez RE, Sebo TJ, et al. Utilization of FISH to distinguish urothelial carcinoma with nested variant growth pattern from von Brunn’s nests [Abstract]. Mod Pathol. 2010;23 Suppl 1:934.Google Scholar
  22. 22.
    Jimenez RE, Keane TE, Hardy HT, Amin MB. pT1 urothelial carcinoma of the bladder: criteria for diagnosis, pitfalls, and clinical implications. Adv Anat Pathol. 2000;7(1):13–25.PubMedCrossRefGoogle Scholar
  23. 23.
    Mukhopadhyay S, Taylor W. Pathologic quiz case: bladder tumor in a 41-year-old man. Cystitis glandularis of intestinal type with mucin extravasation. Arch Pathol Lab Med. 2004;128(7):e89–90.PubMedGoogle Scholar
  24. 24.
    Davis TA. Hamartoma of the urinary bladder. Northwest Med. 1949;48(3):182–5.PubMedGoogle Scholar
  25. 25.
    Friedman NB, Kuhlenbeck H. Adenomatoid tumors of the bladder reproducing renal structures (nephrogenic adenomas). J Urol. 1950;64(5):657–70.PubMedGoogle Scholar
  26. 26.
    Kontothanassis D, Christophis J, Tamvakis N, Becopoulos T. Bladder washing flow cytometry assessment of nephrogenic adenoma of the bladder. Int Urol Nephrol. 1996;28(4):495–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Tse V, Khadra M, Eisinger D, Mitterdorfer A, Boulas J, Rogers J. Nephrogenic adenoma of the bladder in renal transplant and non-renal transplant patients: a review of 22 cases. Urology. 1997;50(5):690–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Mazal PR, Schaufler R, Altenhuber-Muller R, Haitel A, Watschinger B, Kratzik C, et al. Derivation of nephrogenic adenomas from renal tubular cells in kidney-transplant recipients. N Engl J Med. 2002;347(9):653–9.PubMedCrossRefGoogle Scholar
  29. 29.
    Ingelfinger JR. Nephrogenic adenomas as renal tubular outposts. N Engl J Med. 2002;347(9):684–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Strand WR, Alfert HJ. Nephrogenic adenoma occurring in an ileal conduit. J Urol. 1987;137(3):491–2.PubMedGoogle Scholar
  31. 31.
    Fournier G, Menut P, Moal MC, Hardy E, Volant A, Mangin P. Nephrogenic adenoma of the bladder in renal transplant recipients: a report of 9 cases with assessment of deoxyribonucleic acid ploidy and long-term followup. J Urol. 1996;156(1):41–4.PubMedCrossRefGoogle Scholar
  32. 32.
    Tong GX, Melamed J, Mansukhani M, Memeo L, Hernandez O, Deng FM, et al. PAX2: a reliable marker for nephrogenic adenoma. Mod Pathol. 2006;19(3):356–63.PubMedCrossRefGoogle Scholar
  33. 33.
    Porcaro AB, D’Amico A, Ficarra V, Balzarro M, Righetti R, Martignoni G, et al. Nephrogenic adenoma of the urinary bladder: our experience and review of the literature. Urol Int. 2001;66(3):152–5.PubMedCrossRefGoogle Scholar
  34. 34.
    Weiss MA. Bladder lesion in a young man. Contemp Urol. 2001;13(3):15–9.Google Scholar
  35. 35.
    McIntire TL, Soloway MS, Murphy WM. Nephrogenic adenoma. Urology. 1987;29(3):237–41.PubMedCrossRefGoogle Scholar
  36. 36.
    Oliva E, Young RH. Nephrogenic adenoma of the urinary tract: a review of the microscopic appearance of 80 cases with emphasis on unusual features. Mod Pathol. 1995;8(7):722–30.PubMedGoogle Scholar
  37. 37.
    Young RH, Scully RE. Nephrogenic adenoma. A report of 15 cases, review of the literature, and comparison with clear cell adenocarcinoma of the urinary tract. Am J Surg Pathol. 1986;10(4):268–75.PubMedCrossRefGoogle Scholar
  38. 38.
    Rahemtullah A, Oliva E. Nephrogenic adenoma: an update on an innocuous but troublesome entity. Adv Anat Pathol. 2006;13(5):247–55.PubMedCrossRefGoogle Scholar
  39. 39.
    Skinnider BF, Oliva E, Young RH, Amin MB. Expression of alpha-methylacyl-CoA racemase (P504S) in nephrogenic adenoma: a significant immunohistochemical pitfall compounding the differential diagnosis with prostatic adenocarcinoma. Am J Surg Pathol. 2004;28(6):701–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Xiao GQ, Burstein DE, Miller LK, Unger PD. Nephrogenic adenoma: immunohistochemical evaluation for its etiology and differentiation from prostatic adenocarcinoma. Arch Pathol Lab Med. 2006;130(6):805–10.PubMedGoogle Scholar
  41. 41.
    Tong GX, Weeden EM, Hamele-Bena D, Huan Y, Unger P, Memeo L, et al. Expression of PAX8 in nephrogenic adenoma and clear cell adenocarcinoma of the lower urinary tract: evidence of related histogenesis? Am J Surg Pathol. 2008;32(9):1380–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Lane Z, Epstein JI. Polypoid/papillary cystitis: a series of 41 cases misdiagnosed as papillary urothelial neoplasia. Am J Surg Pathol. 2008;32(5):758–64.PubMedCrossRefGoogle Scholar
  43. 43.
    Melchior S, Cudovic D, Jones J, Thomas C, Gillitzer R, Thuroff J. Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis. J Urol. 2009;182(3):978–82.PubMedCrossRefGoogle Scholar
  44. 44.
    Najjar SF, Jamal MK, Savas JF, Miller TA. The ­spectrum of colovesical fistula and diagnostic paradigm. Am J Surg. 2004;188(5):617–21.PubMedCrossRefGoogle Scholar
  45. 45.
    McKenney JK, Desai S, Cohen C, Amin MB. Discriminatory immunohistochemical staining of urothelial carcinoma in situ and non-neoplastic urothelium: an analysis of cytokeratin 20, p53, and CD44 antigens. Am J Surg Pathol. 2001;25(8):1074–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Tsuzuki T, Epstein JI. Fibroepithelial polyp of the lower urinary tract in adults. Am J Surg Pathol. 2005;29(4):460–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Remick Jr DG, Kumar NB. Benign polyps with prostatic-type epithelium of the urethra and the urinary bladder. A suggestion of histogenesis based on histologic and immunohistochemical studies. Am J Surg Pathol. 1984;8(11):833–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Anjum MI, Ahmed M, Shrotri N, Azzopardi A, Mufti GR. Benign polyps with prostatic-type epithelium of the urethra and the urinary bladder. Int Urol Nephrol. 1997;29(3):313–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Young RH, Clement PB. Mullerianosis of the urinary bladder. Mod Pathol. 1996;9(7):731–7.PubMedGoogle Scholar
  50. 50.
    Denes FT, Pompeo AC, Montelatto NI, Lopes RN. Ureteral endometriosis. Int Urol Nephrol. 1980;12(3):205–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Westney OL, Amundsen CL, McGuire EJ. Bladder endometriosis: conservative management. J Urol. 2000;163(6):1814–7.PubMedCrossRefGoogle Scholar
  52. 52.
    Batler RA, Kim SC, Nadler RB. Bladder endometriosis: pertinent clinical images. Urology. 2001;57(4):798–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Fedele L, Bianchi S, Raffaelli R, Portuese A. Pre-operative assessment of bladder endometriosis. Hum Reprod. 1997;12(11):2519–22.PubMedCrossRefGoogle Scholar
  54. 54.
    Young RH. Pseudoneoplastic lesions of the urinary bladder and urethra: a selective review with emphasis on recent information. Semin Diagn Pathol. 1997;14(2):133–46.PubMedGoogle Scholar
  55. 55.
    Traxer O, Pasqui F, Gattegno B, Pearle MS. Technique and complications of transurethral surgery for bladder tumours. BJU Int. 2004;94(4):492–6.PubMedCrossRefGoogle Scholar
  56. 56.
    Holzbeierlein JM, Smith JA, Jr. Surgical management of noninvasive bladder cancer (stages Ta/T1/CIS). Urol Clin North Am. 2000;27(1):15–24, vii-viii.Google Scholar
  57. 57.
    Smith Jr JA, Landau S. Neodymium: YAG laser specifications for safe intravesical therapy. J Urol. 1989;141(5):1238–9.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Department of Laboratory Medicine and PathologyMayo ClinicRochesterUSA
  2. 2.Department of UrologyUniversity of Kansas HospitalKansas CityUSA

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