Benign bladder lesions

Question 1

Finding inverted papilloma should alert you to what?

Answer 1

possible upper tract TCC

Question 2

this is a benign, metaplastic response to irritation/trauma/radiation/BCG; it is a relatively rare lesion composed of primitive renal tubular cells, and after resection has a high recurrence rate

Answer 2

nephrogenic adenoma

Question 3

This is a benign finding, arising from and merging with von Brunn’s nests to form glandular Goblet cells, as is secondary to chronic inflammation; however, there are some cases showing association with adenocarcinoma

Answer 3

Cystitis glandularis

Question 4

This is a benign extension of von Brunn’s nests with cystic spaces and many fluid filled cells within the lamina propria, secondary to any irritation or UTI’s

Answer 4

Cystitis cystica

Question 5

This is a finding that is secondary to chronic UTI, described as soft yellowish plaques in the bladder. The vast majority are coliform in nature. They may be associated with defective microtubular assembly and decreased cGMP levels may impair phagocytosis of local cells.

Answer 5

Malakoplakia

• usually gram negative infections
• bacteria accumulate in phagocytes, leading to deposition of iron and calcium (plaques) and infection rages on, creating an ulcer

Question 6

What are the basophilic inclusions of iron and calcium seen in malakoplakia called?

The cells that contain these inclusions are called?

Answer 6

Michaelis-Gutmann bodies

von Hansemann cells

Question 7

Treatment of malakoplakia?

Answer 7

long term antibiotics
vitamin C and bethanechol (cholinergic)
- these increase the cGMP to cAMP ration (helps with phagocytosis)

Question 8

This is a benign metaplasia of the urothelium to non-keratinizing squamous type due to chronic inflammation, UTIs, or estrogen exposure (hence, most common in young women). Appears as a white patch in the trigone on cystoscopy, and can be associated with very mild UTI-like symptoms

Answer 8

Squamous metaplasia (Pseudomembranous trigonitis)