Mimickers of urothelial neoplasia

Oleksandr Kryvenko, Jonathan I. Epstein

Research output: Contribution to journalReview article

Abstract

Management of malignant urothelial tumors is often associated with extended costly treatments, some with significant morbidity. Advanced tumors are treated with radical cystectomy with neoadjuvant or adjuvant radiation or chemotherapy. Over and under interpretation of histological findings from biopsies and transurethral resections of urothelial lesions may either incur treatments with significant side effects or miss a possible window of cure, respectively. Herein we reflect our approaches and common diagnostic challenges of urothelial tumors and their mimickers, and highlight the diagnostic pitfalls and key histological and immunohistochemical differentiating features. It is useful to separate mimickers of bladder adenocarcinoma and mimics of urothelial carcinoma as the former can involve the muscularis propria, whereas the latter do not. Glandular mimickers discussed herein include cystitis cystica et glandularis with intestinal (colonic) metaplasia, endocervicosis and endometriosis, and nephrogenic adenoma. Common mimickers of urothelial carcinoma include polypoid cystitis, pseudocarcinomatous urothelial neoplasia, inverted urothelial papilloma, florid proliferation of von Brunn nests, and reactive urothelial metaplasia associated with prostatic infarction. We emphasize where clinical impression and history are important for the correct diagnosis. In some entities assessment of the entire histological picture is critical rather than focusing on isolated findings that out of context may be indistinguishable from cancer.

LanguageEnglish (US)
Pages11-19
Number of pages9
JournalAnnals of Diagnostic Pathology
Volume38
DOIs
StatePublished - Feb 1 2019

Fingerprint

Urothelium
Urinary Bladder
Carcinoma
Cystitis
Metaplasia
Neoplasms
Inverted Papilloma
Cystectomy
Endometriosis
Adenoma
Infarction
Adenocarcinoma
History
Radiation
Morbidity
Biopsy
Drug Therapy
Therapeutics

Keywords

  • Bladder
  • Carcinoma
  • Mimickers
  • Neoplasia
  • Urothelium

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Mimickers of urothelial neoplasia. / Kryvenko, Oleksandr; Epstein, Jonathan I.

In: Annals of Diagnostic Pathology, Vol. 38, 01.02.2019, p. 11-19.

Research output: Contribution to journalReview article

Kryvenko, Oleksandr ; Epstein, Jonathan I. / Mimickers of urothelial neoplasia. In: Annals of Diagnostic Pathology. 2019 ; Vol. 38. pp. 11-19.
@article{3139e51359094ffcbc558d2da819a191,
title = "Mimickers of urothelial neoplasia",
abstract = "Management of malignant urothelial tumors is often associated with extended costly treatments, some with significant morbidity. Advanced tumors are treated with radical cystectomy with neoadjuvant or adjuvant radiation or chemotherapy. Over and under interpretation of histological findings from biopsies and transurethral resections of urothelial lesions may either incur treatments with significant side effects or miss a possible window of cure, respectively. Herein we reflect our approaches and common diagnostic challenges of urothelial tumors and their mimickers, and highlight the diagnostic pitfalls and key histological and immunohistochemical differentiating features. It is useful to separate mimickers of bladder adenocarcinoma and mimics of urothelial carcinoma as the former can involve the muscularis propria, whereas the latter do not. Glandular mimickers discussed herein include cystitis cystica et glandularis with intestinal (colonic) metaplasia, endocervicosis and endometriosis, and nephrogenic adenoma. Common mimickers of urothelial carcinoma include polypoid cystitis, pseudocarcinomatous urothelial neoplasia, inverted urothelial papilloma, florid proliferation of von Brunn nests, and reactive urothelial metaplasia associated with prostatic infarction. We emphasize where clinical impression and history are important for the correct diagnosis. In some entities assessment of the entire histological picture is critical rather than focusing on isolated findings that out of context may be indistinguishable from cancer.",
keywords = "Bladder, Carcinoma, Mimickers, Neoplasia, Urothelium",
author = "Oleksandr Kryvenko and Epstein, {Jonathan I.}",
year = "2019",
month = "2",
day = "1",
doi = "10.1016/j.anndiagpath.2018.09.012",
language = "English (US)",
volume = "38",
pages = "11--19",
journal = "Annals of Diagnostic Pathology",
issn = "1092-9134",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Mimickers of urothelial neoplasia

AU - Kryvenko, Oleksandr

AU - Epstein, Jonathan I.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Management of malignant urothelial tumors is often associated with extended costly treatments, some with significant morbidity. Advanced tumors are treated with radical cystectomy with neoadjuvant or adjuvant radiation or chemotherapy. Over and under interpretation of histological findings from biopsies and transurethral resections of urothelial lesions may either incur treatments with significant side effects or miss a possible window of cure, respectively. Herein we reflect our approaches and common diagnostic challenges of urothelial tumors and their mimickers, and highlight the diagnostic pitfalls and key histological and immunohistochemical differentiating features. It is useful to separate mimickers of bladder adenocarcinoma and mimics of urothelial carcinoma as the former can involve the muscularis propria, whereas the latter do not. Glandular mimickers discussed herein include cystitis cystica et glandularis with intestinal (colonic) metaplasia, endocervicosis and endometriosis, and nephrogenic adenoma. Common mimickers of urothelial carcinoma include polypoid cystitis, pseudocarcinomatous urothelial neoplasia, inverted urothelial papilloma, florid proliferation of von Brunn nests, and reactive urothelial metaplasia associated with prostatic infarction. We emphasize where clinical impression and history are important for the correct diagnosis. In some entities assessment of the entire histological picture is critical rather than focusing on isolated findings that out of context may be indistinguishable from cancer.

AB - Management of malignant urothelial tumors is often associated with extended costly treatments, some with significant morbidity. Advanced tumors are treated with radical cystectomy with neoadjuvant or adjuvant radiation or chemotherapy. Over and under interpretation of histological findings from biopsies and transurethral resections of urothelial lesions may either incur treatments with significant side effects or miss a possible window of cure, respectively. Herein we reflect our approaches and common diagnostic challenges of urothelial tumors and their mimickers, and highlight the diagnostic pitfalls and key histological and immunohistochemical differentiating features. It is useful to separate mimickers of bladder adenocarcinoma and mimics of urothelial carcinoma as the former can involve the muscularis propria, whereas the latter do not. Glandular mimickers discussed herein include cystitis cystica et glandularis with intestinal (colonic) metaplasia, endocervicosis and endometriosis, and nephrogenic adenoma. Common mimickers of urothelial carcinoma include polypoid cystitis, pseudocarcinomatous urothelial neoplasia, inverted urothelial papilloma, florid proliferation of von Brunn nests, and reactive urothelial metaplasia associated with prostatic infarction. We emphasize where clinical impression and history are important for the correct diagnosis. In some entities assessment of the entire histological picture is critical rather than focusing on isolated findings that out of context may be indistinguishable from cancer.

KW - Bladder

KW - Carcinoma

KW - Mimickers

KW - Neoplasia

KW - Urothelium

UR - http://www.scopus.com/inward/record.url?scp=85055663569&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055663569&partnerID=8YFLogxK

U2 - 10.1016/j.anndiagpath.2018.09.012

DO - 10.1016/j.anndiagpath.2018.09.012

M3 - Review article

VL - 38

SP - 11

EP - 19

JO - Annals of Diagnostic Pathology

T2 - Annals of Diagnostic Pathology

JF - Annals of Diagnostic Pathology

SN - 1092-9134

ER -