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1:
Bladder - Maltoma
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Comments: Primary lymphoma of the bladder accounts for only 0.2% of extranodal lymphomas where as secondary bladder involvement is seen in approximately 13% of extranodal lymphomas. The most common type of primary bladder lymphoma is MALTOMA (shown here) Am J Surg Pathol 1997; 21:1324-1333.
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2:
Bladder - Maltoma
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Comments: There is a diffuse infilterate of uniform lymphoid cells proliferating in the lamina propria. The overlying mucosa is usually intact (as seen in the previous image). Lymphoepithelial lesions may be seen.
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3:
Bladder - Maltoma
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Comments: The lymphoid infiltrate may permeate muscularis propria and cause diffuse thickening of the bladder wall as seen here. In many cases, the lymphoma produces sessile or polypoid masses projecting into the lumen.
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4:
Bladder - Maltoma
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Comments: Another example of MALTOMA arising in bladder. The cells have abundant clear cytoplasm. Most bladder lymphomas are of B-cell type. Rare examples of T-cell lymphoma and even Hodgkin’s Disease have been encountered in the bladder.
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5:
Bladder - Metastatic Melanoma
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Comments: Primary melanoma of urinary bladder is exceedingly rare. In contrast, between 15% and 20% of patients dying of melanoma have bladder involvement. This image represents metastases to urinary bladder in a patient with known history of malignant melanoma.
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6:
Bladder - Metastatic Melanoma
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Comments: Distinction of malignant melanoma from high-grade urothelial carcinoma may be difficult. Immunoreactivity for HMB-45 (as shown here) may help in pointing towards the right direction.
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7:
Bladder - Paraganglioma
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Comments: Paraganglioma of the urinary bladder is an uncommon neoplasm with uncertain biologic behavior. The histologic features are indistinguishable from those arising in other locations.
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8:
Bladder - Paraganglioma
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Comments: The tumor is characterized by epithelioid cells arranged in zellballen separated by delicate fibrovascular septa. The tumor cells have abundant eosinophilic cytoplasm and often show pleomorphic nuclei.
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9:
Bladder - Paraganglioma
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Comments: The immunostain for S-100 protein highlights the sustentacular cells that partially surround cell nests. Patients with advanced stage tumors (Stage T3 or greater) often have adverse outcome due to increased risk of recurrence and metastasis (Cancer 2000; 88:844-852).
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10:
Bladder : Metastatic Seminoma
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Comments: The patient had history of classic seminoma and underwent orchiectomy 18 months prior to presenting with gross hematuria. Cystoscopy revealed a large mass protruding into the bladder. Note the classis histologic features including the lymphoid infiltrate.
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12:
Bladder - Direct extension from Rectosigmoid Adenocarcinoma
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Comments: This 64-year old patient underwent sigmoid colectomy for moderately-differentiated adenocarcinoma. Seven years later, he developed recurrence in the pelvis and liver metastases. He presented with gross hematuria and was found to have an ulcerated mass in the urinary bladder which was biopsied (shown here). The sections show moderately-differentiated adenocarcinoma consistent with direct extension from rectosigmoid primary.
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13:
Bladder - Direct extension from Rectosigmoid Adenocarcinoma
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Comments: Rectosigmoid adenocarcinoma extending to urinary bladder (same case a previous slide). Note the junction between normal urothelium and adenocarcinoma. Distinction of metastatic colonic adenocarcinoma (to the bladder) from primary adenocarcinoma of bladder may be extremely difficult due to shared histologic features. The presence of extensive intestinal metaplasia favors bladder primary.
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