Pseudocarcinomatous Urothelial Hyperplasia (PCUH) of the Bladder: Clinincal Findings and Follow-Up of 70 Patients
Oleksandr N Kryvenko, Jonathan I Epstein. Johns Hopkins Hospital, Baltimore, MD
Background: PCUH is an infrequent entity with its clinical presentation and morphology mimicking invasive urothelial carcinoma. In smaller series it has typically been described to occur many years following chemotherapy or pelvic radiation. Knowledge of its relation to concurrent and subsequent carcinoma is relatively limited.
Design: We reviewed 70 cases over a 9.5-year period.
Results: 68 specimens were sent in consultation and 2 were biopsied at our institution. 60 patients were men and 10 women, with an average age of 67 years (median 69; range 33 to 86). Of 68 with information, 52 (76.5%) had prior pelvic irradiation (3 also with prior chemotherapy); 2 chemotherapy only; 3 indwelling bladder catheter; 1 status post-radical prostatectomy; 2 intravesical chemotherapy; and 6 miscellaneous factors that could be associated with bladder ischemia. Only 2 (2.9%) had no identifiable possible contributing factors. In 39/52 cases with prior irradiation, the date of therapy was known. PCUH developed on average 54.6 months (median 36 months; range 9 months to 13 years) after prior irradiation. Of 53 patients with data, hematuria was the clinical presentation in 45, dysuria in 4, lower abdominal pain in 2, and discovered on surveillance cystoscopy for prior urothelial carcinoma in 2. Of 48 patients with data, endoscopy discovered flat reddish areas (n=20), papillary / polypoid lesion (n=12), broad-based elevated erythematous lesion (n=6), erythematous bullous edema (n=5), shallow bleeding ulcer (n=4), and prominent trabeculation (n=1). Hyperemia and telangiectasia were frequently reported cystoscopically. Additional findings in adjacent urothelium not involved by PCUH were CIS (n=3), dysplasia (n=1), low grade papillary urothelial carcinoma (n=1), and papillary urothelial hyperplasia (n=1). Of 24 urine cytology analyses, 1 was described as positive (also positive by FISH), 1 atypical and the rest negative. Of 40 patients with average follow-up of 27.0 months (median 16.5; range 1 - 94), 3 patients had subsequent urothelial carcinoma: 1 with prior positive cytology and FISH; 1 with prior high grade papillary urothelial carcinoma; and 1 with unknown history.
Conclusions: Although clinically and histologically the findings in PCUH are worrisome for invasive urothelial carcinoma, our data demonstrate that PCUH is a mimicker and not related to urothelial neoplasia. Almost all patients have reasons for bladder ischemia, most commonly a history of remote prior pelvic irradiation, which is typically not provided to pathologists.
Category: Genitourinary (including renal tumors)
Tuesday, March 5, 2013 1:15 PM
Proffered Papers: Section A, Tuesday Afternoon