2020 Edition
| Editors: Maria Rosaria Raspollini, Antonio Lopez-Beltran

Inverted Urothelial Papilloma

  • Ronald AranetaIII
  • Maria Rosaria Raspollini
  • Antonio Lopez-Beltran
  • Rodolfo Montironi
  • Liang ChengEmail author
Reference work entry
DOI: https://doi.org/10.1007/978-3-030-41894-6_4833


Inverted Papilloma


Inverted papilloma is a benign urothelial neoplasm that displays an anastomosing inverted growth pattern with absent to minimal cytologic atypia.

Clinical Features

  • Incidence

    Inverted papillomas account for <1% of all bladder urothelial neoplasms. Most tumors are usually solitary but can be multifocal. The incidence of multifocality ranges from 1.3% to 4.4% (Sung et al. 2006; Hodges et al. 2011). Tumors are typically small, with a mean size of 12.8 mm and a common range of 1–50 mm, but rarely, tumors can be as large as 8 cm (Sung et al. 2006).

  • Age

    Most patients are usually in their sixth or seventh decade of life.

  • Sex

    Tumors are typically more common in males; male-to-female ratio is 7:1.

  • Site

    Inverted papillomas are most commonly found in the trigone (41% of cases) followed by the lateral wall, and posterior wall. Less commonly they also occur in the upper urothelial tract and urethra.

  • Treatment

    Complete transurethral resection is the most...

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References and Further Reading

  1. Amin, M. B., Smith, S. C., Reuter, V. E., Epstein, J. I., Grignon, D., Hansel, E. D., et al. (2015). Update for the practicing pathologist: The International Consultation On Urologic Disease-European association of urology consultation on bladder cancer. Modern Pathology, 28, 612–630.CrossRefGoogle Scholar
  2. Brown, A. L., & Cohen R. J. (2011). Inverted papilloma of the urinary tract. BJU International, 107(Suppl 3), 24–26.CrossRefGoogle Scholar
  3. Cheng, C. W., Chan, L. W., Chan, C. K., et al. (2005). Is surveillance necessary for inverted papilloma in the urinary bladder and urethra? ANZ Journal of Surgery, 75, 213–217.CrossRefGoogle Scholar
  4. Cheng, L., Davidson, D. D., Wang, M., et al. (2016). Telomerase reverse transcriptase (TERT) promoter mutation analysis of benign, malignant and reactive urothelial lesions reveals a subpopulation of inverted papilloma with immortalizing genetic change. Histopathology, 69, 107–113.CrossRefGoogle Scholar
  5. Cheville, J. C., Wu, K., Sebo, T. J., et al. (2000). Inverted urothelial papilloma: Is ploidy, MIB-1 proliferative activity, or p53 protein accumulation predictive of urothelial carcinoma? Cancer, 88, 632–636.CrossRefGoogle Scholar
  6. Fine, S. W., & Epstein, J. I. (2006). Inverted urothelial papillomas with foamy or vacuolated cytoplasm. Human Pathology, 37, 1577–1582.  https://doi.org/10.1016/j.humpath.2006.05.014.CrossRefGoogle Scholar
  7. Goertchen, R., Seidenschnur, A., & Stosiek, P. (1994). Clinical pathology of inverted papillomas of the urinary bladder: A complex morphologic and catamnestic study. Der Pathologe, 15, 279–285.CrossRefGoogle Scholar
  8. Hodges, K. B., Lopez-Beltran, A., MacLennan, G. T., et al. (2011). Urothelial lesions with inverted growth patterns: histogenesis, molecular genetic findings, differential diagnosis and clinical management. BJU International, 107, 532–537.CrossRefGoogle Scholar
  9. Jones, T. D., Zhang, S., Lopez-Beltran, A., et al. (2007). Urothelial carcinoma with an inverted growth pattern can be distinguished from inverted papilloma by fluorescence in-situ hybridization, immunohistochemistry, and morphologic analysis. The American Journal of Surgical Pathology, 31, 1861–1867.CrossRefGoogle Scholar
  10. Junker, K., Boerner, D., Schulze, W., et al. (2003). Analysis of genetic alterations in normal bladder urothelium. Urology, 62, 1134–1138.CrossRefGoogle Scholar
  11. Kunze, E., Schauer, A., & Schmitt, M. (1983). Histology and histogenesis of two different types of inverted urothelial papillomas. Cancer, 51, 348–358.CrossRefGoogle Scholar
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  13. Montironi, R., Cheng, L., Lopez-Beltran, A., et al. (2011). Inverted (endophytic) noninvasive lesions and neoplasms of the urothelium: The Cinderella group has yet to be fully exploited. European Urology, 59, 225–230.CrossRefGoogle Scholar
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  15. Sun, J. J., Wu, Y., Lu, Y. M., Zhang, H. Z., Wang, T., Yang, X. Q., et al. (2015). Immunohistochemistry and fluorescence in situ hybridization can inform the differential diagnosis of low-grade noninvasive urothelial carcinoma with an inverted growth pattern and inverted urothelial papilloma. PLoS ONE, 10(7), e0133530.  https://doi.org/10.1371/journal.pone.0133530.CrossRefGoogle Scholar
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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ronald AranetaIII
    • 1
  • Maria Rosaria Raspollini
    • 2
  • Antonio Lopez-Beltran
    • 3
    • 4
  • Rodolfo Montironi
    • 5
  • Liang Cheng
    • 6
    Email author
  1. 1.Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisUSA
  2. 2.Histopathology and Molecular DiagnosticsUniversity Hospital CareggiFlorenceItaly
  3. 3.Pathology ServiceChampalimaud Clinical CenterLisbonPortugal
  4. 4.Unit of Anatomic Pathology, Department of SurgeryCordoba University Medical SchoolCordobaSpain
  5. 5.Institute of Pathological Anatomy and HistopathologyPolytechnic University of the Marche Region (Ancona), United Hospitals AnconaAnconaItaly
  6. 6.Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisUSA