Encyclopedia of Pathology

Living Edition
| Editors: J.H.J.M. van Krieken

Postsurgical Necrobiotic Granuloma of Urinary Bladder

  • Antonio Galzerano
  • Antonio Lopez-Beltran
  • Maria Rosaria RaspolliniEmail author
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-28845-1_4899-1



Lesion composed of spindle and epithelioid histiocytes arranged in a palisaded pattern with central necrosis, in which multinucleated giant cells are also present.

Clinical Features

  • Incidence

    It is a common finding in bladders following transurethral tumor resection.

  • Age

    Fifth to sixth decade

  • Sex

    Male preponderance

  • Site

    Common in bladders following transurethral bladder resections of urothelial carcinoma (Spagnolo and Waring 1986; Eble and Banks 1990)

    Most cases reported in the prostate follow transurethral resection of the prostate due to benign prostatic hyperplasia (Eyre et al. 1986). This type of granulomas is, therefore, rare, in other genitourinary locations.

  • Treatment

    The lesion when properly diagnosed microscopically does not require treatment.

  • Outcome



Lesions measuring 0.5–2 cm, single or multiple


It shows of a central core of amorphous necrosis around of which are palisades of spindled and epithelioid histiocytes and multinucleated giant cells (Yamada 1986) (Fig. 1).


CD68-positive immunohistochemical staining of palisaded histiocytes

Differential Diagnosis

The lesions may mimic cancer clinically. Lesions with epithelioid histiocytes with nuclear atypia and prominent nucleoli mimicking carcinoma are rare. The positivity to CD68 and the negativity with cytokeratins reveal the correct diagnosis, in particular in small biopsies.
Fig. 1

Core of amorphous necrosis surrounded by palisades of spindled and epithelioid histiocytes and multinucleated giant cells

References and Further Reading

  1. Eble, J. N., & Banks, E. R. (1990). Post-surgical necrobiotic granulomas of urinary bladder. Urology, 35, 454–457.CrossRefGoogle Scholar
  2. Eyre, R. C., Aaronson, A. G., & Weinstein, B. J. (1986). Palisading granulomas of the prostate associated with prior prostatic surgery. The Journal of Urology, 136, 121–122.CrossRefGoogle Scholar
  3. Spagnolo, D. V., & Waring, P. M. (1986). Bladder granulomata after bladder surgery. American Journal of Clinical Pathology, 86, 430–437.CrossRefGoogle Scholar
  4. Yamada, Y. (1986). Focal palisading granuloma in the prostate and bladder: A clinicopathologic study of 88 total cystectomy specimens. Acta Pathologica Japonica, 36, 1813–1822.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Antonio Galzerano
    • 1
  • Antonio Lopez-Beltran
    • 1
    • 2
  • Maria Rosaria Raspollini
    • 3
    Email author
  1. 1.Pathology Service, Champalimaud Clinical CenterLisbonPortugal
  2. 2.Department of Surgery and PathologyUniversity of Cordoba Medical SchoolCordobaSpain
  3. 3.Histopathology and Molecular DiagnosticsUniversity Hospital CareggiFlorenceItaly