Endocervicosis of the Urinary Bladder A Report of Six Cases of a Benign Müllerian Lesion That May Mimic Adenocarcinoma

Clement PB, P B Clement, Philip B. Clement, R H Young, Robert H. Young, Young RH
The American journal of surgical pathology · 1992 · vol. 16(6) , pp. 533–542 · doi:10.1097/00000478-199206000-00001 · PMID:1318002 · W2086256085
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This report details six cases of benign endocervicosis in the urinary bladder of reproductive-aged women, presenting as tumor-like lesions that microscopically mimic adenocarcinoma but are müllerian in origin.

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This report describes six cases of endocervicosis in the urinary bladder of women aged 31 to 44, presenting as benign Müllerian lesions that frequently mimic adenocarcinoma histologically. Patients typically exhibited bladder symptoms such as pain and hematuria, with microscopic examination revealing endocervical-type glands often surrounded by smooth muscle or rare rims of endometriotic stroma. The authors identify these findings as the mucinous analogue of endometriosis, emphasizing the importance of recognizing this entity to avoid misdiagnosis as malignancy. Relevance to endometriosis: listed as a benign Müllerian lesion described as the mucinous analogue of endometriosis, with one patient having documented pelvic endometriosis.

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Abstract

Six tumor-like glandular lesions characterized by a prominent component of endocervical-type epithelium involved the wall of the urinary bladder in women of reproductive age (31 to 44 years; mean, 37). All of the lesions posed problems in histologic diagnosis; indeed, a diagnosis of adenocarcinoma was initially rendered in three cases. Five patients presented with bladder symptoms, including--alone or in combination--suprapubic pain, dysuria, frequency, and hematuria. There was catamenial exacerbation of the symptoms in one case. The sixth patient--the only one with documented pelvic endometriosis--presented with dysmenorrhea, dyspareunia, and lower abdominal tenderness. In each patient, a mass that ranged from 2 to 5 cm in maximum dimension was typically located in the posterior wall or posterior dome of the urinary bladder. A partial cystectomy (five cases) or transurethral resection (one case) was performed. In one patient, extravesical pelvic soft tissue was involved, precluding complete resection of the lesion. Microscopic examination revealed extensive involvement of the bladder wall by irregularly disposed, benign-appearing, or mildly atypical endocervical-type glands, some of which were cystically dilated. Other findings included occasional ciliated cells, typically interspersed with the endocervical-type cells (four cases), a minor component of endometrioid glands (three cases), and glands lined by nonspecific cuboidal or flattened cells with eosinophilic cytoplasm (all cases). Some of the glands were surrounded only by the smooth muscle of the muscularis propria, but in other areas, the periglandular tissue was fibrous or edematous. In three cases, rare glands were surrounded by thin rims of endometriotic stroma. Gland rupture resulted in stromal extravasation of mucin in all cases and was a prominent feature in one. All patients had uneventful postoperative follow-up periods ranging from 1.5 to 14 years. The findings indicate that these bladder lesions are müllerian in nature and represent examples of endocervicosis, the mucinous analogue of endometriosis. Awareness of the lesion, which with one possible exception is hitherto undescribed in the bladder, and attention to its typical histologic features should facilitate its crucial distinction from adenocarcinoma.
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Endocervicosis of the Urinary Bladder A Report of Six Cases of a Benign Müllerian Lesion That May Mimic Adenocarcinoma - Philip B. Clement - Robert H. Young Six tumor-like glandular lesions characterized by a prominent component of endocervical-type epithelium involved the wall of the urinary bladder in women of reproductive age (31 to 44 years; mean, 37). All of the lesions posed problems in histologic diagnosis; indeed, a diagnosis of adenocarcinoma was initially rendered in three cases. Five patients presented with bladder symptoms, including—alone or in combination—suprapubic pain, dysuria, frequency, and hematuria. There was catamenial exacerbation of the symptoms in one case. The sixth patient—the only one with documented pelvic endometriosis—presented with dysmenorrhea, dyspareunia, and lower abdominal tenderness. In each patient, a mass that ranged from 2 to 5 cm in maximum dimension was typically located in the posterior wall or posterior dome of the urinary bladder. A partial cystectomy (five cases) or transurethral resection (one case) was performed. In one patient, extravesical pelvic soft tissue was involved, precluding complete resection of the lesion. Microscopic examination revealed extensive involvement of the bladder wall by irregularly disposed, benign-appearing, or mildly atypical endocervical-type glands, some of which were cystically dilated. Other findings included occasional ciliated cells, typically interspersed with the endocervicaltype cells (four cases), a minor component of endometrioid glands (three cases), and glands lined by nonspecific cuboidal or flattened cells with eosinophilic cytoplasm (all cases). Some of the glands were surrounded only by the smooth muscle of the muscularis propria, but in other areas, the periglandular tissue was fibrous or edematous. In three cases, rare glands were surrounded by thin rims of endometriotic stroma. Gland rupture resulted in stromal extravasation of mucin in all cases and was a prominent feature in one. All patients had uneventful postoperative follow-up periods ranging from 1.5 to 14 years. The findings indicate that these bladder lesions are müllerian in nature and represent examples of endocervicosis, the mucinous analogue of endometriosis. Awareness of the lesion, which with one possible exception is hitherto undescribed in the bladder, and attention to its typical histologic features should facilitate its crucial distinction from adenocarcinoma.

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Condition tags

endometriosisdysmenorrheadyspareunia

MeSH descriptors

Adenocarcinoma Urinary Bladder Urinary Bladder Diseases Urinary Bladder Neoplasms Adenocarcinoma Adenocarcinoma Adult Cystectomy Diagnosis, Differential Female Follow-Up Studies Humans Neoplasms, Germ Cell and Embryonal Neoplasms, Germ Cell and Embryonal Time Factors Urinary Bladder Urinary Bladder Diseases Urinary Bladder Diseases Urinary Bladder Diseases Urinary Bladder Neoplasms

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