Difference between revisions of "Urinary bladder"

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The '''urinary bladder''' stores urine until one has to go wee-wee.
The '''urinary bladder''' stores urine between urination, i.e. trips to the washroom to go pee. It gets the urine from the [[ureter]]s and exspells it via the [[urethra]].


It is commonly afflicted by cancer.
It is commonly afflicted by [[cancer]]. A well-know mimicker of cancer is ''[[malakoplakia]]''.<ref name=pmid17102055>{{cite journal |author=Wong-You-Cheong JJ, Woodward PJ, Manning MA, Davis CJ |title=From the archives of the AFIP: Inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation |journal=Radiographics |volume=26 |issue=6 |pages=1847–68 |year=2006 |pmid=17102055 |doi=10.1148/rg.266065126 |url=}}</ref>
 
A well-know mimicker of cancer is ''[[malakoplakia]]''.<ref name=pmid17102055>{{cite journal |author=Wong-You-Cheong JJ, Woodward PJ, Manning MA, Davis CJ |title=From the archives of the AFIP: Inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation |journal=Radiographics |volume=26 |issue=6 |pages=1847–68 |year=2006 |pmid=17102055 |doi=10.1148/rg.266065126 |url=}}</ref>


=Normal=
=Normal=
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Note:
Note:
*On TURBT - don't ever call T3.
*On TURBT - don't ever call pT3.
 
=Grossing=
:[[AKA]] ''cut-up''.
{{Main|Partial cystectomy}}
{{Main|Radical cystectomy}}
{{Main|Cystoprostatectomy}}


=Urinary bladder cancer=
=Urinary bladder cancer=
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*[[Urothelial carcinoma]] - most common in the Western world.
*[[Urothelial carcinoma]] - most common in the Western world.
*[[Squamous cell carcinoma of the urinary bladder]] - most common in areas with ''Schistosoma''.
*[[Squamous cell carcinoma of the urinary bladder]] - most common in areas with ''Schistosoma''.
*Adenocarcinoma - see ''[[urachal carcinoma]]''.
*Adenocarcinoma.
**[[Urachal adenocarcinoma]].
**[[Primary adenocarcinoma of the urinary bladder]].
**Metastatic adenocarcinoma - usu. [[colorectal adenocarcinoma]].
*Other tumours - rare.
**Rhabdomyosarcomatous tumour.
**[[Rhabdomyosarcoma]].<ref name=pmid21762516>{{Cite journal  | last1 = Bing | first1 = Z. | last2 = Zhang | first2 = PJ. | title = Adult urinary bladder tumors with rhabdomyosarcomatous differentiation: clinical, pathological and immunohistochemical studies. | journal = Diagn Pathol | volume = 6 | issue =  | pages = 66 | month =  | year = 2011 | doi = 10.1186/1746-1596-6-66 | PMID = 21762516 }}</ref>


==Squamous cell carcinoma of the urinary bladder==
==Squamous cell carcinoma of the urinary bladder==
{{Main|Squamous cell carcinoma}}
{{Main|Squamous cell carcinoma of the urinary bladder}}
===General===
*Rare type of bladder cancer.
*Strong association with ''Schistosoma haematobium''.<ref name=pmid17483025>{{Cite journal  | last1 = Michaud | first1 = DS. | title = Chronic inflammation and bladder cancer. | journal = Urol Oncol | volume = 25 | issue = 3 | pages = 260-8 | month =  | year =  | doi = 10.1016/j.urolonc.2006.10.002 | PMID = 17483025 }}</ref>
*''Urothelial carcinoma with squamous differentiation'' is much more common.
**Common in areas with ''S. haematobium''.
**Uncommon in areas without ''S. haematobium''.


===Microscopic===
==Urachal carcinoma==
Features:
{{Main|Urachal carcinoma}}
*See ''[[squamous cell carcinoma]]'' article.


==Urachal carcinoma==
==Rhabdomyosarcoma of the urinary bladder==
{{Main|Rhabdomyosarcoma}}
===General===
===General===
*Very rare<ref name=pmid16826585>{{Cite journal  | last1 = Ashley | first1 = RA. | last2 = Inman | first2 = BA. | last3 = Sebo | first3 = TJ. | last4 = Leibovich | first4 = BC. | last5 = Blute | first5 = ML. | last6 = Kwon | first6 = ED. | last7 = Zincke | first7 = H. | title = Urachal carcinoma: clinicopathologic features and long-term outcomes of an aggressive malignancy. | journal = Cancer | volume = 107 | issue = 4 | pages = 712-20 | month = Aug | year = 2006 | doi = 10.1002/cncr.22060 | PMID = 16826585 }}</ref>~ 0.2% of bladder cancers.<ref name=pmid22901574>{{Cite journal  | last1 = Bruins | first1 = HM. | last2 = Visser | first2 = O. | last3 = Ploeg | first3 = M. | last4 = Hulsbergen-van de Kaa | first4 = CA. | last5 = Kiemeney | first5 = LA. | last6 = Witjes | first6 = JA. | title = The clinical epidemiology of urachal carcinoma: results of a large, population based study. | journal = J Urol | volume = 188 | issue = 4 | pages = 1102-7 | month = Oct | year = 2012 | doi = 10.1016/j.juro.2012.06.020 | PMID = 22901574 }}</ref>
*Considered extremely rare in adults.<ref name=pmid21762516>{{Cite journal  | last1 = Bing | first1 = Z. | last2 = Zhang | first2 = PJ. | title = Adult urinary bladder tumors with rhabdomyosarcomatous differentiation: clinical, pathological and immunohistochemical studies. | journal = Diagn Pathol | volume = 6 | issue = | pages = 66 | month = | year = 2011 | doi = 10.1186/1746-1596-6-66 | PMID = 21762516 }}</ref>
*Younger <55 years-old.
 
Treatment:
*Partial cystectomy +/- umbilectomy.
 
===Gross===
*Lesion must be in urachus or dome of urinary bladder.


===Microscopic===
===Microscopic===
Features:
:See ''[[rhabdomyosarcoma]]''.
*Usually adenocarcinoma.
*Adjacent urothelium typically benign.


DDx:<ref name=Ref_Amin2-143>{{Ref Amin|2-143}}</ref>
DDx:
*[[Adenocarcinoma of the urinary bladder]].
*Rhabdomyosarcomatous sarcomatoid carcinoma - more common than RMS in adults.
*Invasive [[urothelial carcinoma]] with glandular differentiation.
**Requires the identification of a carcinoma component.
*Metastatic adenocarcinoma/adenocarcinoma extending from another structure, e.g. [[colorectal adenocarcinoma]].
*Rhabdomyomatous tumour.<ref name=pmid21762516>{{Cite journal  | last1 = Bing | first1 = Z. | last2 = Zhang | first2 = PJ. | title = Adult urinary bladder tumors with rhabdomyosarcomatous differentiation: clinical, pathological and immunohistochemical studies. | journal = Diagn Pathol | volume = 6 | issue =  | pages = 66 | month =  | year = 2011 | doi = 10.1186/1746-1596-6-66 | PMID = 21762516 }}</ref>
 
**Used if no carcinomatous component is identified with extensive sampling.
====Patterns====
*[[Small cell carcinoma of the urinary bladder]].
*Enteric - looks like colonic adenocarcinoma.
**Should be positive for [[keratins]] and chromogranin A.
*Mucinous.
*Signet ring.
 
====Images====
<gallery>
Image:Urachal_carcinoma_-_very_low_mag.jpg | UC - very low mag. (WC)
Image:Urachal_carcinoma_-_low_mag.jpg | UC - low mag. (WC)
Image:Urachal_carcinoma_-_high_mag.jpg | UC - high mag. (WC)
</gallery>


===IHC===
===IHC===
Features:<ref name=pmid19252435>{{Cite journal  | last1 = Gopalan | first1 = A. | last2 = Sharp | first2 = DS. | last3 = Fine | first3 = SW. | last4 = Tickoo | first4 = SK. | last5 = Herr | first5 = HW. | last6 = Reuter | first6 = VE. | last7 = Olgac | first7 = S. | title = Urachal carcinoma: a clinicopathologic analysis of 24 cases with outcome correlation. | journal = Am J Surg Pathol | volume = 33 | issue = 5 | pages = 659-68 | month = May | year = 2009 | doi = 10.1097/PAS.0b013e31819aa4ae | PMID = 19252435 }}</ref>
Features:<ref name=pmid21762516>{{Cite journal  | last1 = Bing | first1 = Z. | last2 = Zhang | first2 = PJ. | title = Adult urinary bladder tumors with rhabdomyosarcomatous differentiation: clinical, pathological and immunohistochemical studies. | journal = Diagn Pathol | volume = 6 | issue = | pages = 66 | month = | year = 2011 | doi = 10.1186/1746-1596-6-66 | PMID = 21762516 }}</ref>
*CK20 +ve.
*Desmin +ve.
*CK7 +ve/-ve.
*Myogenin +ve.
*CK34betaE12 +ve/-ve.
*Keratins -ve.
*Beta-catenin -- usu cytoplasmic/membranous +ve.


Others:<ref name=pmid21572312>{{Cite journal  | last1 = Paner | first1 = GP. | last2 = McKenney | first2 = JK. | last3 = Barkan | first3 = GA. | last4 = Yao | first4 = JL. | last5 = Frankel | first5 = WL. | last6 = Sebo | first6 = TJ. | last7 = Shen | first7 = SS. | last8 = Jimenez | first8 = RE. | title = Immunohistochemical analysis in a morphologic spectrum of urachal epithelial neoplasms: diagnostic implications and pitfalls. | journal = Am J Surg Pathol | volume = 35 | issue = 6 | pages = 787-98 | month = Jun | year = 2011 | doi = 10.1097/PAS.0b013e3182189c11 | PMID = 21572312 }}</ref>
==Metastasis to the urinary bladder==
*p63 -ve (+ve in only 3%).
{{Main|Urinary bladder metastasis}}
 
UC versus [[CRC]] -- not absolute but useful:
*CK34betaE12 +ve in UC (-ve in CRC).
*Beta-catenin -ve nuclei in UC (+ve nuclei in CRC).
 
===Sign out===
*The diagnosis is clinicopathologic; one needs imaging.<ref name=Ref_Amin2-143>{{Ref Amin|2-143}}</ref>


=Other=
==Urinary bladder infarct==
==Urinary bladder infarct==
{{Main|Infarction}}
{{Main|Infarction}}
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*Liquefaction implies an infectious etiology.<ref name=pmid3394185/>
*Liquefaction implies an infectious etiology.<ref name=pmid3394185/>


==Rhabdomyosarcoma==
==Urinary bladder amyloidosis==
{{Main|Rhabdomyosarcoma}}
{{Main|Urinary bladder amyloidosis}}
 
==Tubular adenoma of the urinary bladder==
{{Main|Tubular adenoma of the urinary tract}}
 
==Keratinising squamous metaplasia of the urinary bladder==
{{Main|Keratinising squamous metaplasia of the urinary bladder}}
 
==Leiomyoma of the urinary bladder==
{{Main|Leiomyoma of the urinary bladder}}
 
==Cystitis==
:See ''[[urothelium]]''.


=See also=
=See also=
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[[Category:Genitourinary pathology]]
[[Category:Genitourinary pathology]]
[[Category:Urinary bladder]]

Latest revision as of 03:23, 17 January 2017

The urinary bladder stores urine between urination, i.e. trips to the washroom to go pee. It gets the urine from the ureters and exspells it via the urethra.

It is commonly afflicted by cancer. A well-know mimicker of cancer is malakoplakia.[1]

Normal

Microscopic

  • Muscularis mucosae - thin, discontinuous.
  • Fat - many be in lamina propria.

Note:

  • On TURBT - don't ever call pT3.

Grossing

AKA cut-up.
Main article: Partial cystectomy
Main article: Radical cystectomy
Main article: Cystoprostatectomy

Urinary bladder cancer

The most common type of cancer to affect the bladder is urothelial carcinoma. This is covered in the urothelium article.

Risk factors for bladder cancer SEX LIC:

  • Schistomsoma haematobium - esp. squamous cell carcinoma.[2]
  • EXtrophy of the bladder.
  • Lithiasis.
  • Indwelling catheter or chronic Inflammation.[2]
  • Cyclophosphamide.

DDx:

Squamous cell carcinoma of the urinary bladder

Main article: Squamous cell carcinoma of the urinary bladder
  • Rare type of bladder cancer.
  • Urothelial carcinoma with squamous differentiation is much more common.

Urachal carcinoma

Main article: Urachal carcinoma

Rhabdomyosarcoma of the urinary bladder

Main article: Rhabdomyosarcoma

General

  • Considered extremely rare in adults.[3]

Microscopic

See rhabdomyosarcoma.

DDx:

  • Rhabdomyosarcomatous sarcomatoid carcinoma - more common than RMS in adults.
    • Requires the identification of a carcinoma component.
  • Rhabdomyomatous tumour.[3]
    • Used if no carcinomatous component is identified with extensive sampling.
  • Small cell carcinoma of the urinary bladder.
    • Should be positive for keratins and chromogranin A.

IHC

Features:[3]

  • Desmin +ve.
  • Myogenin +ve.
  • Keratins -ve.

Metastasis to the urinary bladder

Main article: Urinary bladder metastasis

Other

Urinary bladder infarct

Main article: Infarction

General

Microscopic

Features:[4]

  • Necrosis without liquefaction.
    • Outlines of cells visible.
    • No nuclei present.

Note:

  • Liquefaction implies an infectious etiology.[4]

Urinary bladder amyloidosis

Main article: Urinary bladder amyloidosis

Tubular adenoma of the urinary bladder

Main article: Tubular adenoma of the urinary tract

Keratinising squamous metaplasia of the urinary bladder

Main article: Keratinising squamous metaplasia of the urinary bladder

Leiomyoma of the urinary bladder

Main article: Leiomyoma of the urinary bladder

Cystitis

See urothelium.

See also

References

  1. ↑ Wong-You-Cheong JJ, Woodward PJ, Manning MA, Davis CJ (2006). "From the archives of the AFIP: Inflammatory and nonneoplastic bladder masses: radiologic-pathologic correlation". Radiographics 26 (6): 1847–68. doi:10.1148/rg.266065126. PMID 17102055.
  2. ↑ 2.0 2.1 Michaud, DS.. "Chronic inflammation and bladder cancer.". Urol Oncol 25 (3): 260-8. doi:10.1016/j.urolonc.2006.10.002. PMID 17483025.
  3. ↑ 3.0 3.1 3.2 3.3 Bing, Z.; Zhang, PJ. (2011). "Adult urinary bladder tumors with rhabdomyosarcomatous differentiation: clinical, pathological and immunohistochemical studies.". Diagn Pathol 6: 66. doi:10.1186/1746-1596-6-66. PMID 21762516.
  4. ↑ 4.0 4.1 4.2 Nino-Murcia, M.; Friedland, GW. (1988). "Bladder infarct.". Urol Radiol 9 (4): 234-6. PMID 3394185.
  5. ↑ Kryvenko, ON.; Epstein, JI. (Jun 2013). "Pseudocarcinomatous urothelial hyperplasia of the bladder: clinical findings and followup of 70 patients.". J Urol 189 (6): 2083-6. doi:10.1016/j.juro.2012.12.005. PMID 23228381.
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