Benign polyps with prostatic-type epithelium of the urethra and the urinary bladder

The clinico-pathological features of nine urethral and urinary bladder polyps with prostate-type epithelium are described. The average age of the patients was 46 years. Three patients previously had cystoscopy and the lesion was not noticed on the initial examination. The commonest presentation in this series was haematuria, dysuria and frequency of micturition. One patient presented with postmicturition dribble and another with haemospermia. The polyps contained acini and papillae lined by prostate-type epithelium which was confirmed by immunohistochemical tests for prostate specific antigen and prostate acid phosphatase. In this series no age versus location relationship could be established. Symptoms resolved following resection or initial biopsy followed by fulguration. Recurrence is extremely rare.     

Benign polyp with prostatic-type epithelium of the urinary bladder: a case report.

We report a case of benign polyp with prostatic-type epithelium of the urinary bladder. A 58-year-old male presented with gross hematuria. Cystoscopic examination revealed a 2-mm polypoid lesion in the mid trigone. Immunohistochemical demonstration of prostatic acid phosphatase and prostatic specific antigen in the urothelial cells as well as the prostatic-type epithelial cells suggested the histogenesis of this polyp to be metaplasia of the urothelium.     

Prostatic-type epithelium in urinary bladder. Clinical, histologic, and immunohistochemical study.

Six cases of urinary bladder mucosa with prostate-type epithelium were studied clinically, morphologically, and immunohistochemically. All patients were male with an average age of fifty-three years; most presented with painless hematuria. Histologically, two types of lesions were observed, the polypoid located in various sites of the bladder wall and the flat lesion found in the bladder neck. Both lesions shared in common a prostatic-type and transitional surface epithelium while prostatic-type glands were prominent in the polypoid lesion. The prostatic-type epithelium was confirmed immunohistochemically by detection of prostatic specific antigen and prostatic acid phosphatase. Based on specific findings we considered the metaplasia as the most reliable histogenetic aspect.     

A case of benign polyp with prostatic-type epithelium in the bulbar urethra

We report a case of benign polyp with prostatic-type epithelium in the bulbar urethra. A 77-year-old man was admitted to our hospital with voiding disturbance. Cystourethroscopy revealed a papillary tumor with a stalk in the 10 o'clock direction of the bulbar urethra. Transurethral resection of the urethral tumor was performed. Histopathological examination of the polypoid lesions showed papillary proliferative tissue. Immunohistochemical staining of prostate specific antigen was positive. The urethral tumor was diagnosed as benign polyp with prostatic-type epithelium.     

Clinical manifestations of 25 patients with prostatic-type polyps in the prostatic urethra

To clarify the clinical manifestations of prostatic-type polyps (PP) in the prostatic urethra, a sample of 25 patients with PP who presented themselves to our hospital with hematuria or hematospermia was reviewed with respect to their symptoms and endoscopic findings. Recurrence of the conditions was also investigated. The patients were 26 to 68 years old, with a mean age of 48.5 years. Sixteen patients (64%) had hematuria and 8 (32%) had hematospermia. A bloody urethral discharge was observed in 6 patients (24%). Analysis of the character of the hematuria showed that total hematuria occurred in 44% of the patients. In 38% of the patients with hematospermia there was the additional symptom of post-ejaculatory hematuria. PP developed beside the verumontanum in 18 patients (72%), on the posterior urethral wall lateral to the verumontanum in 4 patients (16%), and on the verumontanum in 7 patients (28%). The prognosis could be investigated only in 22 (88%) of the 25 patients. Two patients (9%) experienced reccurrence during the follow-up period (1 to 5.8 years, mean: 3.7 years). Consequently, special attention should be paid to the possibility of PP in the prostatic urethra, particularly the verumontanum and nearby area, during endoscopic examination, when diagnosing patients with hematuria, hematospermia or with bloody urethral discharge.     

Benign fibroblastic polyps of the colon: a histologic, immunohistochemical, and ultrastructural study

Mesenchymal proliferations presenting as mucosal polyps are relatively uncommon and are represented by gastrointestinal stromal tumors, smooth muscle and neural tumors, and inflammatory fibroid polyps. In this report, we describe the clinicopathologic features of a distinctive type of mucosal polyp composed of cytologically bland spindled cells with fibroblastic features. Fourteen cases with histologic features of"fibroblastic polyps" were identified from our case files from January 2000 to December 2003. The clinical and endoscopic findings were reviewed. Immunohistochemistry using a panel of antibodies (vimentin, smooth muscle actin, desmin, CD31, CD34, Bcl-2, c-Kit, S-100, and epithelial membrane antigen) was performed in all cases, and electron microscopy was performed in two cases. The lesions were solitary in all cases and not associated with an identifiable polyposis syndrome. Associated adenomata and/or hyperplastic polyps at different sites were present in 10 cases and hyperplastic polyps were seen in close association in 3 cases. These polyps were characterized by a monomorphic spindle cell proliferation in the lamina propria, without necrosis or mitotic activity. The lesions were intimately associated with the muscularis mucosae and resulted in wide separation and disorganization of the colonic crypts. Immunohistochemical analysis revealed strong and diffuse positivity for vimentin only. Weak and focal reactivity was noted in 2 cases for CD34 and smooth muscle actin, while staining for other antibodies was negative. Electron microscopy revealed sparse cytoplasmic organelles and many intermediate filaments. The histology and ultrastructural and immunohistochemical findings are suggestive of fibroblastic differentiation of these spindle cells. In summary, these lesions represent a distinctive type of colonic mucosal polyp that should be distinguished from other stromal polyps of the gastrointestinal tract.     

Benign villous polyp with prostatic type epithelium of the penile urethra

We report a case of a benign polyp of the penile urethra composed of prostatic type epithelial tissue. The etiology, pathology, diagnosis and treatment of these uncommon lesions are discussed.     

A successfully treated case of condyloma acuminatum of the urethra and urinary bladder.

Condyloma acuminatum very seldom affects the urinary bladder, but if it does conservative treatment has been considered of little value and cystourethrectomy will eventually be required. A case with urethrovesical condyloma is presented, where repeated transurethral resections cured the patient.     

A clinico-pathological study of inverted papilloma of the urinary bladder. Analysis of histogenesis]

A clinico-pathological study was conducted on 9 cases with inverted papilloma of the urinary bladder. 1. Clinical study: The incidence of inverted papillomas, when compared with transitional cell carcinoma of the urinary bladder, was much higher in men than in women in our study and in the literature dealing with this subject as well. Eight of 9 inverted papillomas were localized in the bladder neck. Cystoscopic examination revealed that all tumors were pedunculated and 8 of the 9 tumors had non-papillary surfaces. These clinical findings suggest that inverted papillomas localized in the bladder neck are very similar to posterior urethral polyps with prostatic type epithelium. Transurethral resection (TUR) was performed in all cases. Recurrence was not observed. 2. Pathological study: Inverted papillomas were classified into two types according to their histological patterns, determined by Hematoxylin-Eosin (H-E) staining. One pattern was glandular and the another was trabecular. Of the 9 cases, 2 were glandular, 5 were trabecular and the remaining 2 were a mixed type. Immunohistochemical staining with anti-prostate specific antigen antibody revealed 3 of the 9 tumors were stained positively, and these tumors were classified a glandular type. Inverted papilloma were classified into two patterns according to their histological patterns, determined by immunohistochemical staining with anti-keratin antibody, namely a bladder tumor pattern and a urethral tumor pattern. Inverted papillomas with a urethral tumor pattern were of the glandular type and included anti-PSA antibody positive staining tumors. These findings suggest that a portion of inverted papillomas may have arisen from neoplastic transformation of prostatic tissue.     

Leiomyosarcoma of the urinary bladder. A clinicopathologic and immunohistochemical study of 15 cases

We present the clinicopathologic and immunohistochemical features of 15 vesical leiomyosarcomas. The nine male and six female patients ranged in age from 16 to 72 years (median: 49 years). Gross hematuria was the most common complaint. The tumors most often arose in the dome of the bladder (50%) and ranged in size from 1 to 10 cm (median: 5 cm). Five patients underwent total cystectomy, nine had a partial cystectomy or local excision, and one was only biopsied. Based on the highest of five sets of mitotic counts per case, eight tumors had one or fewer mitotic figures per 10 high-power fields (MF/10HPF); none of these patients developed metastases during a follow-up interval of 1 month to 20 years (mean: 62 months). Five tumors showed three to six MF/10HPF; one patient in this group died after 6 years with unresectable metastases, whereas the others are disease free with follow-up of 8 months to 8 years (mean: 62 months). Two tumors contained 10-15 MF/10HPF; one produced widespread metastases and was fatal after 3 months, whereas the other has not recurred or metastasized after 9 months. All tumors had infiltrating margins and invaded the bladder musculature--important features in their distinction from vesical leiomyoma. Nine leiomyosarcomas had zones of myxoid intercellular material; six of these were predominantly or exclusively myxoid. The myxoid foci often closely resembled inflammatory pseudotumor, particularly in superficial portions of the neoplasms. In two cases, an intense superficial plasma cell infiltrate mimicked a plasma cell granuloma. All 12 leiomyosarcomas studied immunohistochemically were negative for epithelial markers (cytokeratins and epithelial membrane antigen); staining for muscle-specific actin and vimentin was uniformly positive, and eight neoplasms also expressed desmin.     

Injuries to the urethra and urinary bladder associated with fractures of the pelvis

The posterior urethra or urinary bladder may be injured in patients who sustain fractures of the bony pelvis. It is important to assess the urethra radiologically by retrograde urethrography before introducing a urethral catheter to avoid missing a urethral injury or causing further damage. The author's approach to the immediate management of urethral injury is suprapubic cystostomy. The urethra may be repaired later after other injuries have healed. With this approach the incidence of permanent impotence and incontinence will be low and the stricture cure rate high. If the urethra has not been injured, a catheter is introduced and cystography performed to rule out bladder injuries. If the bladder is ruptured, the area is explored, the perivesical space drained and urinary drainage is provided by either a suprapubic cystostomy or a urethral catheter.     

Angiosarcoma of the bladder: a case report with regard to histologic and immunohistochemical findings.

Bladder angiosarcoma is an extremely rare neoplasia whose aggressive biological behavior follows that of other angiosarcomas. The second case of primary angiosarcoma of the bladder is reported pointing out the immunohistochemical characteristics of these neoplasias. Using immunoperoxidase staining techniques, Ulex lectin has proved to be a more sensitive marker for endothelial cells than factor VIII-related antigen, and it should be used as an additional marker for endothelial cell-derived tumors.     

Pheochromocytoma of the urinary bladder. Report of 2 cases with ultrastructural and immunohistochemical analyses

Two cases of primary pheochromocytoma of the urinary bladder are reported. Ultrastructural demonstration of neuroendocrine granules and immunoreactivity for neuron-specific enolase and synoptophysin, and the absence of cytokeratin, an epithelial marker, are useful features for distinguishing pheochromocytomas from carcinomas of the bladder.     

Combined dynamic studies of the bladder and urethra. Report of a method

The authors report a method of complex urodynamic investigation. The intravesical pressure, the intrarectal pressure, the electronically computed detrusor pressure, the urinary flow and the electromyography of the anal and urethral striated sphincters are recorded simultaneously with the fluoroscopic image on 16 mm film using the kinescopic procedure. The intravesical pressure is measured per urethram. The routine examination method is described. The authors consider that the use of 16 mm film has advantages in comparison to videotape recordings. The installation was made out of existing materials except for the electronic mixing device, which was created in the research laboratory. Radiation dosis measurements show that even by extensive examination the received radiation dosis does not exceed the exposure of a standard voiding cystourethrogram.     

Morphology and function of the bladder and urethra in female urinary incontinence

The conventional investigations, gynaecological examination and cystoscopy give very little information about the causes of incontinence. History taking makes it possible to divide the symptoms into either stress- or urge incontinence. Cystometry, lateral voiding cysto-urethrography and urodynamic examination including sphincter EMG enable us to divide the pathological conditions into suspension defects and bladder dysfunctions. The suspension defects are bladder base insufficiency, vesical descensus and trigonocele. The operation of choice for these conditions depends on whether the suspension defect is anterior or posterior. The bladder dysfunctions are supranuclear and infranuclear neurogenic dysfunctions. The treatment in these cases will ordinarily be medical.