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1:
Cystitis cystica
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Comments: Cystitis cystica arises when the urothelial cells in the center of solid clusters of Brunn’s nests undergo degenerative changes. The cysts may be large enough to be seen on cystoscopy and in gross specimens.
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2:
Cystitis glandularis
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Comments: This image shows typicalcystitis glandularis – the more commonly seen form - consisting of glands in the lamina propria lined by columnar or cuboidal cells.
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3:
Cystitis glandularis
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Comments: The lining epithelial cells are columnar and appear to be surrounded at least focally by urothelial cells. There is no evidence of mucin production.
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4:
Intestinal metaplasia
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Comments: This bladder biopsy shows typical or non-mucinous cystitis glandularis on the mucosal surface and intestinal type of cystitis glandularis (intestinal metaplasia) in the lamina propria.
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5:
Intestinal metaplasia
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Comments: Another example of cystitis glandularis intestinal type (intestinal metaplasia). Diffuse intestinal metaplasia has long been considered to be a risk factor for bladder
adenocarcinoma. However, according to at least one study, the risk may be small (UROLOGY 50:427-431, 1997).
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6:
Intestinal metaplasia
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Comments: Note the resemblance to colonic mucosa. Occasionally, even paneth cells may also be seen.
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7:
Intestinal metaplasia
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Comments: These glands are lined by tall columnar epithelium with plenty of goblet cells and were present deep within the lamina propria; however, the glands are uniform, lack cytologic atypia, and are not accompanied by desmoplastic response
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8:
Intestinal metaplasia
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Comments: Note the abrupt transition (arrows) from urothelium to intestinal-type epithelium in this example of intestinal metaplasia seen in a bladder biopsy.
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9:
Intestinal metaplasia: Mucin extravasation
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Comments: Mucin extravasation into the surrounding stroma from glands of intestinal metaplasia can create diagnostic confusion with adenocarcinoma. However, even at low magnification, one can appreciate lack of cytologic atypia
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10:
Intestinal metaplasia: Mucin extravasation
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Comments: These glands are surrounded by pools of mucin. The nuclei of lining epithelial cells are small, hyperchromatic and basally located. There is no histologic evidence to suggest malignancy.
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11:
Ureteritis cystica
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Comments: In this example of ureteritis cystica, the ureteral lumen has been opened longitudinally. Several fluid-filled vesicles are seen on the urothelial surface.
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12:
Nephrogenic metaplasia
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Comments: Nephrogenic metaplasia is a metaplastic process seen after surgical manipulation of the urinary tract, or in association with trauma, stones, and inflammation. Papillary, polypoid, or cystic structures lined by cuboidal epithelium are seen here.
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13:
Nephrogenic metaplasia
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Comments: The papillary and polypoid structures contain inflammatory cells in their cores.
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14:
Nephrogenic metaplasia
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Comments: The lining epithelial cells are cuboidal or columnar with moderate amount of cytoplasm. Some cells have hobnail appearance. Significant cytologic atypia is occasionally seen in this entity (atypical nephrogenic metaplasia). It has no apparent clinical significance Cancer 2000 Feb; 88(4):853-861.
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15:
Pseudomembranous trigonitis
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Comments: This bladder biopsy from an adult female is lined by non-keratinizing squamous epithelium with resemblance to vaginal mucosa. The association of this finding with urinary urgency and frequency is sometimes referred to as Pseudomembranous trigonitis.
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16:
Pseudomembranous trigonitis
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Comments: Pseudomembranous trigonitis usually involves trigone and bladder neck. It may represent a normal histologic variant and is not associated with increased risk for carcinoma. Estrogen and progesterone receptors have been documented in the metaplastic epithelium suggesting an endocrine role in its pathogenesis. Pacchioni D, et al. J Endocrinol Invest 1992; 15(10):719-25.
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17:
Bladder : Keratinizing Squamous Metaplasia
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Comments: Squamous metaplasia can arise in the bladder secondary to chronic cystitis (shown here), schistosomiasis, diverticulum, or non-functioning bladder. Keratinizing squamous metaplasia is a risk factor for subsequent development of carcinoma (mostly squamous cell carcinoma) and other complications such as bladder contracture and obstruction. Khan MS, et al. Eur Urol 2002; 42(5):469-74.
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18:
Bladder : Keratinizing Squamous Metaplasia
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Comments: In a Mayo Clinic study of 78 patients with keratinizing squamous metaplasia (leukoplakia) of urinary bladder, a total of 42% of patients had concurrent or subsequent carcinoma of the bladder.Benson RC, Swanson RK, Farrow GM. J Urol 1984; 131(3):507-11.
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