Urinary Bladder Pathology by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030715090
Publisher: Springer International Publishing

Some studies suggest that primary bladder lymphomas may be associated with chronic cystitis [1, 9, 11]. Since there is only scant lymphoid tissue in the normal bladder, it is possible that preexisting chronic inflammation of bladder can induce acquired MALT, which can lead to MALT lymphoma [9]. However, the history of chronic cystitis is only present in approximately 20% of patients with primary bladder lymphomas [4, 5]. Therefore, the relationship between chronic cystitis and primary bladder lymphomas is still uncertain. Primary bladder lymphomas are generally thought to be indolent with a favorable prognosis because they are confined to the bladder and respond well to chemotherapy [1–4].

Secondary bladder lymphomas are much more common and occur in 10–25% of patients with lymphomas, usually in patients with systemic lymphomas of advanced stage [1, 8, 12]. Thus, the prognosis of patients with secondary bladder lymphomas is usually poor. In our institution, chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and diffuse large B-cell lymphoma (DLBCL) are the most common types of bladder lymphomas. Other subtypes of small B-cell lymphomas, such as follicular lymphoma (FL) and mantle cell lymphoma (MCL), are less frequently seen in the bladder [3]. Among the large cell lymphomas, high-grade B-cell lymphoma is not uncommon, but less frequently seen than DLBCL. Extreme rare cases of classic Hodgkin lymphoma [13], Burkitt lymphoma [14], and T-cell lymphomas have also been reported [1, 2, 15–18]. Anaplastic large cell lymphoma is the most commonly reported T-cell lymphoma involving the bladder.

CLL/SLL is the most common type of small B-cell lymphomas involving the bladder in our institution, although only a few cases have been reported in literature [19–21]. This is likely due to the fact that CLL/SLL is the most common leukemia of adults in Western countries [22]. Patients with CLL/SLL have an increased risk of developing subsequent neoplasms of epithelial and mesenchymal origins, likely due to the decreased immunity and B-cell dysfunction [23, 24]. Coexistence of CLL/SLL and urothelial carcinoma has been reported [24]. CLL/SLL is characterized by multiple lymphoid aggregates involving the bladder wall (Fig. 10.2). CLL/SLL lymphoma cells are small, with clumped chromatin and scant cytoplasm.

Fig. 10.2Coexistence of urothelial carcinoma and CLL/SLL. (a) High-grade noninvasive papillary urothelial carcinoma is present (arrow). Multifocal lymphoid aggregates are also identified in the lamina propria, which is overlaid with urothelial carcinoma. (b) The lymphoid aggregates are comprised of predominantly small lymphocytes with scattered histiocytes. (c–f) The CLL/SLL cells are positive for CD5 (large subset, c), CD20 (d), and CD23 (e) and negative for cyclin D1 (f)

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