Pseudocarcinomatous epithelial
hyperplasia in the bladder is a little known phenomenon, recognized to be associated with prior irradiation and/or
chemotherapy. Whether this process can occur outside of this setting has not been studied. We identified 8 of these cases mimicking invasive urothelial
carcinoma from our consultation files from 07/04 to 07/06 with no prior history of radiation or
chemotherapy. The mean age at diagnosis was 65 years (range, 42 to 81 y), with 5 of the 8 males. Seven patients had a potential etiology for these changes that could either have resulted in localized
ischemia or injury to the urothelium. These included case 1:
atrial fibrillation,
hypertension,
congestive heart failure, gastrointestinal
bleeding, and coronary artery
vascular disease; case 2: coronary angioplasty,
atrial fibrillation,
hyperlipidemia, and
amputation of arm for
ischemia; case 3:
hypertension, uncontrolled diabetes,
hyperlipidemia, and
atrial fibrillation; case 4: underlying
arteriovenous malformation of the bladder; cases 5 to 6: history of indwelling Foley
catheter; and case 7: history of radical
prostatectomy for
prostate cancer but no radiation. One patient had no potential contributing factors. All 8 patients presented with gross
hematuria. At cystoscopy, 7 patients had polypoid lesions with 1 appearing nonpolypoid. Histologically, all cases showed epithelial proliferation of urothelium with cells having prominent eosinophilic cytoplasm. This process that mimicked invasive
cancer within the lamina propria was marked in 3 cases (38%). Moderate nuclear pleomorphism was seen in 6 cases (75%). Only 1 case revealed mitotic figures. Ulceration was seen in 1 case. All cases showed some degree of
hemorrhage with
hemosiderin deposition identified in 3 cases (38%).
Fibrin deposition was present in 1 case within the stroma, 3 cases in the vessels, and 4 cases in both. Five cases show stromal
fibrosis.
Edema and vascular congestion were common features (90% and 100%, respectively). Six out of 8 cases were accompanied by moderate to marked acute and chronic
inflammation. The original diagnosis included nested variant urothelial
carcinoma (1 case), atypical suspicious for invasive
carcinoma (5 cases),
hemangioma (1 case), and eosinophilic
cystitis (1 case). Patients were followed for a mean of 16.5 months (range, 10 to 34 mo), and none developed
bladder cancer. As a rare response to
ischemia and chronic irritation, pseudocarcinomatous epithelial proliferations in the bladder may be confused with invasive urothelial
carcinoma. Pathologists must be aware of the histologic changes mimicking
cancer, and recognize that it can occur outside of the setting of prior irradiation or
chemotherapy.