Abstract
BackgroundTo examine histopathologic features and clinical outcomes of intradiverticular bladder carcinomas.MethodsTwenty-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.ConclusionIntradiverticular 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
Highlights
To examine histopathologic features and clinical outcomes of intradiverticular bladder carcinomas
Bladder diverticula are caused by congenital or acquired defects which cause an outpouching of bladder wall and it usually lacks the muscularis propria layer [1]
Twenty-two consecutive cases of intradiverticular carcinoma were identified from institutional surgical pathology archive spanning from 08/1995 to 12/2011
Summary
To examine histopathologic features and clinical outcomes of intradiverticular bladder carcinomas. Intradiverticular bladder carcinoma is defined as a malignant epithelial neoplasm arising within a diverticulum of urinary bladder. The histopathologic features and clinical outcomes of intradiverticular bladder carcinoma are not well investigated, with only three studies of notable size in the current literature, each including less than 40 patients [2,3,7,8]. While absence of muscularis propria layer may in theory predispose intradiverticular tumors to a greater risk for bladder wall infiltration and possibly spreading into adjacent organs, the aggressiveness of these tumors and their clinical outcomes remain poorly characterized. We aimed to expand current understanding of this unique neoplasm presentation by characterizing the histopathologic features and clinical outcomes of 22 patients with intradiverticular bladder carcinoma
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