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Intraoperative Appearance of Endosalpingiosis: A Single-Center Experience of Laparoscopic Findings and Systematic Review of Literature. J Clin Med 2022; 11:jcm11237006. [PMID: 36498581 PMCID: PMC9738105 DOI: 10.3390/jcm11237006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Endosalpingiosis is assumed to be the second most common benign peritoneal pathology after endometriosis in women. Although recent studies indicate a significant association with gynecologic malignancies, many underlying principles remain unclear. This work aimed to systematically describe the intraoperative appearance of endosalpingiosis. Methods: Data and intraoperative videos of patients with histologically verified endosalpingiosis were retrospectively reviewed. The main outcome measures were macroscopic phenotype and anatomical distribution. Additionally, a systematic review searching PubMed (Medline) and Embase was conducted. Results: In the study population (n = 77, mean age 40.2 years (SD 16.4)), the mean size of lesions was 3.6 mm and the main visual pattern was vesicular (62%). The most frequent localization was the sacrouterine ligaments (24.7%). In the systematic review population (n = 1174 (210 included studies overall), mean age 45.7 years (SD 14.4)), there were 99 patients in 90 different studies with adequate data to assess the appearance of the lesions. The mean size of the lesions was 48.5 mm, mainly with a cystic visual pattern (49.5%). The majority of the lesions affected the ovaries (23.2%), fallopian tubes (20.4%), or lymph nodes (18.5%). Comparing this study to the literature population, the main differences concerned the size (p < 0.001) and main visual patterns (p < 0.001) of lesions. Conclusions: The usual intraoperative findings of endosalpingiosis appeared less impressive than described in the literature. In our study population, lesions of a few millimeters in size with a vesicular appearance were mostly seen, most frequently in the sacrouterine ligament area. Intraoperative recognition by the gynecologic surgeon and histologic diagnosis should play an important role in further understanding this entity, scientifically and clinically.
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2
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Gao H, Chen J, Li G, Cui X, Sun F. Pediatric laparoscopic partial cystectomy for the treatment of benign bladder tumors and urachal cysts. BMC Urol 2021; 21:128. [PMID: 34526006 PMCID: PMC8444363 DOI: 10.1186/s12894-021-00893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/08/2021] [Indexed: 11/12/2022] Open
Abstract
Objective To investigate the feasibility and efficacy of carrying out pediatric laparoscopic partial cystectomies (LPC) when treating benign bladder tumors and urachal cysts. Methods Retrospectivey analyzing 4 clinical cases involving children with bladder tumors, which were collected from October 2017 to December 2018. In these clinical cases, there were 3 male children and 1 female child, aged from 4.5 to 9.4 years old, with an average age of 6.5 years. An intraperitoneal laparoscopic partial cystectomy was performed in the treatment of 3 of these patients with benign bladder tumors and in 1 patient with an urachal cyst. The surgical procedures included a partial cystectomy and a complete intracavitary bladder suture. Results All 4 cases were successful and no operation was transferred to opensurgery. The operation time was 100–120 min, with an average time of 108 min. The intraoperative blood loss was 10–20 ml, with an average loss of 15 ml. 6 h after the operation, the patients still maintained a fluid diet and 1 case of hematuria had occurred, with the catheter removed 12 days after the operation. No postoperative urine leakage, intestinal adhesion or intestinal obstruction occurred, and the average postoperative hospitalization time was 14 days. Conclusion Laparoscopic partial cystectomy is a safe and feasible method to be used for the treatment of benign bladder tumors and urachal cysts. It presents the advantages of being minimally invasive, and having a quick recovery and short hospitalization time. It is an alternative surgical method for the treatment of pediatric benign bladder tumors.
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Affiliation(s)
- Hongjie Gao
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, China
| | - Jiawei Chen
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Guowei Li
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xinhai Cui
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Fengyin Sun
- Department of Pediatric Surgery, Qilu Hospital of Shandong University, Jinan, China.
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Sancheti S, Somal PK, Chaudhary D, Khandelwal S. Mullerianosis of urinary bladder: The great impersonator. INDIAN J PATHOL MICR 2021; 63:627-629. [PMID: 33154321 DOI: 10.4103/ijpm.ijpm_726_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Müllerianosis of the urinary bladder is a rare entity with less than 30 cases reported. It encompasses a mixture of different types of Mullerian lesions like endometriosis, endocervicosis, and endosalpingiosis. It typically affects the women of reproductive age group. The symptoms vary from hematuria and dysuria, to pelvic pain, which may be associated with menstruation. It can mimic a malignant tumor clinically and radiologically; hence, it is important that a correct diagnosis is rendered in these cases to avoid unnecessary radical procedures. Herein we report a case of mullerianosis of the urinary bladder in a young female and discuss the important differential diagnosis and various treatment modalities.
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Affiliation(s)
- Sankalp Sancheti
- Department of Pathology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Puneet Kaur Somal
- Department of Pathology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Debashish Chaudhary
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
| | - Sachin Khandelwal
- Department of Surgical Oncology, Homi Bhabha Cancer Hospital, Sangrur, Punjab, India
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Fakhralddin SS, Mahmood SN, Qader DK, Ali AA, Kakamad FH, Salih AM, Abdullah HO. Mullerianosis of the urinary bladder; A case report. Int J Surg Case Rep 2021; 83:106040. [PMID: 34102604 PMCID: PMC8187240 DOI: 10.1016/j.ijscr.2021.106040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Mullerianosis is a sporadic condition of the urinary bladder. The study aims to present a case of mullerianosis with a brief literature review. CASE PRESENTATION A 52-year-old lady presented with hematuria for one-year duration. A general urine examination showed microscopic hematuria. Abdominal and transvaginal ultrasonography revealed a soft tissue mass (13 * 10 mm) within the base of the urinary bladder. Cystoscopy showed 1.0 * 1.3 cm benign-looking mass bulging into the posterior bladder wall covered by a normal bladder mucosa. Transurethral resection was done. The histopathological examination was consistent with mullerianosis. DISCUSSION Two hypotheses have been proposed; the first one (implantation theory) believing that at the time of pelvic surgery and caesarian delivery Mullerian tissues become implanted inside the bladder. The second theory (metaplastic theory) holds the probability of differentiation of Mullerian epithelium to endometrial, endocervical, and tubal components and proliferation in the bladder. CONCLUSION mullerianosis is a very infrequent entity that mainly affects the urinary bladder and is mainly reported in females during the reproductive period, medical and surgical treatment are both regarded as the management options.
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Affiliation(s)
- Saman Salih Fakhralddin
- Sulaymaniyah General Teaching Hospital, Urology Department, Sulaymaniyah, Iraq; Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq
| | - Sarwar Noori Mahmood
- Department of Surgery, College of Medicine, University of Sulaymaniyah, Sulaymaniyah, Iraq
| | - Deedar Kamaran Qader
- Sulaymaniyah General Teaching Hospital, Urology Department, Sulaymaniyah, Iraq; Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq
| | - Alaa Abbas Ali
- Department of Pathology, University of Sulaimani College of Medicine, Sulaimani, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq.
| | - Abdulwahid M Salih
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; College of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Hiwa O Abdullah
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan, Iraq
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5
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Ghosh S, Onol F, Vasquez J, Parikh J. Müllerianosis of the Urinary Bladder: A Rare Condition Which Mimics Neoplasia. Cureus 2021; 13:e15147. [PMID: 34178484 PMCID: PMC8216577 DOI: 10.7759/cureus.15147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Müllerianosis of the urinary bladder is an extremely rare, benign condition defined by the presence of at least two of the three müllerian-derived components (endosalpinx, endometrium, and endocervix) in the lamina propria and muscularis propria of the urinary bladder. It frequently mimics neoplastic condition, either malignant or benign. Here, we present a case of cystic müllerianosis of urinary bladder, which was clinically thought to be a urinary bladder neoplasm.
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Affiliation(s)
- Somshukla Ghosh
- Internal Medicine, University of Central Florida-HCA Healthcare Graduate Medical Education, Greater Orlando, USA
| | - Fikret Onol
- Urology, Orlando Veterans Affairs Medical Center, Orlando, USA
| | - Jonathan Vasquez
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
| | - Jignesh Parikh
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
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Rajaian S, Murugasen L, Jain D, Chakravarthy Narasimhachar S. Müllerianosis of the urinary bladder with unilateral complete renal agenesis: a rare coincidental finding causing delayed presentation. BMJ Case Rep 2020; 13:13/7/e235217. [PMID: 32675120 DOI: 10.1136/bcr-2020-235217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Müllerianosis is a rare benign lesion of the urinary bladder, which is constituted by two or more of the Müllerian-duct-derived tissues. We report a 45-year-old perimenopausal multiparous woman presenting with occasional episodes of dysuria and lower abdominal discomfort of recent duration. Ultrasound examination revealed a well-defined lesion in urinary bladder and the absence of left kidney. Contrast-enhanced CT of the abdomen confirmed the findings. During diagnostic cystoscopy, haemorrhagic polypoidal lesions were noted in the left side of the posterolateral wall and dome of urinary bladder along with the absence of left ureteric orifice. Transurethral resection of the bladder lesions was done and histology examination confirmed the diagnosis of Müllerianosis. She was administered Luteinizing hormone-releasing hormone (LHRH) agonist monthly. At 1 year of follow-up, cystoscopy showed only scar tissue. The case was reported for the rarity of Müllerianosis noted in a patient with unilateral agenesis of kidney, a possible cause of delayed presentation.
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Affiliation(s)
| | | | - Deepti Jain
- Department of Pathology, MIOT International, Chennai, India
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7
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Jhang S, Chen M, Chen LC. Concurrent müllerianosis of the urinary bladder and the umbilicus presenting with umbilical bleeding: a rare case report and review of the literature. BMC WOMENS HEALTH 2020; 20:66. [PMID: 32245454 PMCID: PMC7119285 DOI: 10.1186/s12905-020-00929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/18/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Müllerianosis is a very rare neoplasm composed of two or three Müllerian derived tissues (endosalpinx, endometrium and endocervix). We report the first case of concurrent müllerianosis of the urinary bladder and the umbilicus presenting with umbilical bleeding. CASE PRESENTATION A 43-year-old Asian premesopausal female, gravida 1, para 1, presented with intermittent umbilical bleeding. An umbilical nodule and a bladder tumor on the posterior wall of the urinary bladder were identified. She underwent transurethral resection of the bladder tumor and excision of the umbilical nodule successively. Diagnosis of müllerianosis was confirmed by the histological and immunological features. No tumor recurrence was noted at 6 months of follow-up. CONCLUSIONS Müllerianosis is extremely rare and mainly reported in the urinary bladder, and generally affects women of reproductive age. Despite the common presentations of müllerianosis of the urinary bladder including irritative voiding symptoms, abdominal/pelvic pain and gross hematuria, our rare case had no symptom except umbilical bleeding. The possibility of concurrent bladder müllerianosis should be considered when müllerianosis is found at other location. We suggest a surgical intervention to establish the correct pathological diagnosis because it is essential to exclude malignant neoplasms of the urinary bladder. The majority of patients have a favorable prognosis.
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Affiliation(s)
- Syu Jhang
- Department of Urology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 10449, Taiwan.,School of Medicine, Mackay Medical College, Sanzhi, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Marcelo Chen
- Department of Urology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 10449, Taiwan.,School of Medicine, Mackay Medical College, Sanzhi, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Li-Chen Chen
- Department of Urology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd, Taipei, 10449, Taiwan. .,School of Medicine, Mackay Medical College, Sanzhi, Taiwan. .,Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
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8
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Habiba M, Brosens I, Benagiano G. Müllerianosis, Endocervicosis, and Endosalpingiosis of the Urinary Tract: A Literature Review. Reprod Sci 2018; 25:1607-1618. [PMID: 29739266 DOI: 10.1177/1933719118773441] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We reviewed reported cases of endocervicosis, endosalpingiosis, and müllerianosis of the bladder or ureters in women in order to highlight these conditions as distinct from endometriosis or adenomyosis. METHODS Medline and Scopus searches of all cases published till the October 1, 2017. All retrieved references were searched manually to identify relevant articles. RESULTS Twenty-six articles reported endocervicosis. These included 37 cases described by the authors as endocervicosis of the bladder. We identified 7 case reports of bladder endosalpingiosis. There were 26 publications including 27 cases of müllerianosis of the bladder and 3 cases affecting the lower ureter. Literature descriptions are limited but available accounts do not point to features that uniquely distinguished these conditions. Affected women tended to be older, and in many cases, there was a possible relation to past surgery and particularly to hysterectomy and caesarean sections. Many cases were reported in postmenopausal women. Local excision was sufficient in most cases. CONCLUSION The etiology of these conditions remains speculative, but case reports raise a possible link to pelvic surgery. There is a need for more detailed accounts of these lesions, which should be considered in the differential diagnosis of pre- and postmenopausal women with pelvic pain, dyspareunia, lower abdominal pain or discomfort, dysuria, frequency, or hematuria.
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Affiliation(s)
- Marwan Habiba
- 1 Department of Health Sciences, University of Leicester, Women and Perinatal Services, University Hospitals of Leicester, Leicester, United Kingdom
| | - Ivo Brosens
- 2 Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
| | - Giuseppe Benagiano
- 3 Department of Gynecology, Obstetrics and Urology, Sapienza University of Rome, Rome, Italy
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9
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Diagnostic dilemma in cervical endocervicosis. Obstet Gynecol Sci 2017; 60:396-400. [PMID: 28791275 PMCID: PMC5547091 DOI: 10.5468/ogs.2017.60.4.396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/15/2017] [Accepted: 03/17/2017] [Indexed: 11/26/2022] Open
Abstract
Müllerianosis is an embryonic Müllerian disease, resulting in the formation of the benign diseases adenomyosis, endometriosis, endosalpingiosis, and endocervicosis. Endocervicosis primarily affects the bladder, and rarely the cervix. Cervical endocervicosis, which is also a pseudoneoplastic glandular lesion, could be misinterpreted as a premalignant or even a malignant lesion. Because the treatment of these diseases is very different, early clinical diagnosis is important. Unfortunately, however, this lesion is difficult to diagnose preoperatively using clinical and radiological information, and pathological confirmation is needed. Herein, we report a rare case of cervical endocervicosis that was difficult to diagnosis preoperatively.
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10
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Patel A, Desai P, Malczewski F, Stephens D. Müllerianosis of the urinary bladder: a rare and problematic bladder tumour. BMJ Case Rep 2017; 2017:bcr-2016-218772. [PMID: 28275021 DOI: 10.1136/bcr-2016-218772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Müllerianosis of the bladder is an extremely rare and highly symptomatic bladder tumour comprising of at least two types of Müllerian derived tissues. We present the case of a 59-year-old woman presenting with painful macroscopic haematuria associated with urgency, frequency and incontinence. She is a nulliparous postmenopausal woman without malignancy risk factors or previous abdominal surgery. Initially identified on ultrasound scan, she was taken for transurethral resection of bladder tumour (TURBT). Histology confirms the diagnosis. Repeat TURBT was required for non-resolution of symptoms. Despite a thorough resection, symptoms recurred within months necessitating partial cystectomy. Although a 'benign' lesion, this lesion proved a difficult condition to treat requiring partial cystectomy.
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Affiliation(s)
- Amit Patel
- Department of Urology, Queen Elizabeth II Jubilee Hospital, Acacia Ridge, Queensland, Australia.,Griffith University, Gold Coast, Australia
| | - Pranali Desai
- Department of Gynaecology, Queen Elizabeth II Jubilee Hospital, Acacia Ridge, Queensland, Australia
| | - Frances Malczewski
- Department of Pathology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Daryl Stephens
- Department of Urology, Mackay Base Hospital, Mackay, Queensland, Australia
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11
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Bladder endometriosis and endocervicosis: presentation of 2 cases with endoscopic management and review of literature. Case Rep Urol 2014; 2014:296908. [PMID: 25184072 PMCID: PMC4145742 DOI: 10.1155/2014/296908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 07/28/2014] [Indexed: 11/18/2022] Open
Abstract
Urinary tract endometriosis and endocervicosis are an uncommon pathologic finding, with a common embryological origin. We present 2 cases of female patients with bladder mass. The first one was a finding of a nodular formation in the bladder during study of a nonviable foetus and the second was an incidental finding of a neoformation in the fundus of the bladder during the realization of an ultrasound. In both cases, we performed a surgical management with transurethral resection. Histopathological examination revealed a bladder endometrioma in the first case and endocervicosis with associated endometriosis in the second.
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12
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Branca G, Barresi V. Müllerianosis of the Urinary Bladder: A Rare Tumorlike Lesion. Arch Pathol Lab Med 2014; 138:432-6. [DOI: 10.5858/arpa.2012-0681-rs] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Müllerianosis was first described as a rare entity consisting of an admixture of cervical, tubaric, or endometrial epithelium within the lamina propria and muscularis propria of the urinary bladder. This lesion occurs mainly in the dome or posterior wall of the urinary bladder in women of fertile age. Its clinical presentation is characterized by hematuria, pelvic pain, and dysuria, nonspecific symptoms that are related to the responsiveness of müllerian glands to hormonal stimuli. The major interest of müllerianosis resides in its similarity, from clinical, cytologic, and histologic viewpoints, to more threatening conditions, such as neoplasias. The clinical context and the identification of periglandular endometrial stroma at histologic examination with conventional hematoxylin-eosin stain, as well as the immunohistochemical demonstration of estrogen and progesterone receptors in the glands, are of diagnostic utility in the differential diagnosis. Müllerianosis may be responsive to gonadotropin-releasing hormone agonists. Surgical resection may be justified in the case of clinical symptoms refractory to hormone therapy.
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Affiliation(s)
- Giovanni Branca
- From the Department of Pathology, University of Messina, Messina, Italy
| | - Valeria Barresi
- From the Department of Pathology, University of Messina, Messina, Italy
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13
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Rajakumar C, Vilos GA, Vilos AG, Marks JL, Ettler HC, Pautler SS. Combined Transurethral and Laparoscopic Partial Cystectomy and Robotically Assisted Bladder Repair for the Treatment of Bladder Endocervicosis: Case Report and Review of the Literature. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014; 36:141-145. [DOI: 10.1016/s1701-2163(15)30660-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Abstract
Endometriosis is an ectopic occurrence of tissue morphologically and functionally resembling endometrial tissue in regions outside the uterine cavity. Although scar endometriosis after surgery has been shown to be most common among all the extrapelvic forms of endometriosis, endometriosis after bladder exstrophy surgery has not been reported, and here we present the first known case. A 26-year-old woman with a history of bladder exstrophy was aware of a painful induration at the operative scar located in the left lower abdominal wall, and presented at our hospital. Although the symptoms resolved, recurring exacerbation was observed after 9 months. Abdominal magnetic resonance imaging showed a heterogeneous mass 16 mm in diameter in the left abdominal wall with high signal intensity on T1W1 and T2W1 images. She underwent excisional biopsy of the lesion under general anesthesia. Histopathology confirmed the diagnosis of endometriosis. Eighteen months after surgery, she was well and free from recurrence.
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Zhong M, Gersbach E, Rohan SM, Yang XJ. Primary adenocarcinoma of the urinary bladder: differential diagnosis and clinical relevance. Arch Pathol Lab Med 2013; 137:371-81. [PMID: 23451748 DOI: 10.5858/arpa.2012-0076-ra] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Glandular lesions of the urinary bladder include a broad spectrum of entities ranging from completely benign glandular lesions to primary and secondary malignancies. Common benign bladder lesions that exhibit glandular differentiation include cystitis cystica, cystitis glandularis, von Brunn nests, nephrogenic adenoma, intestinal metaplasia, urachal remnant, endometriosis, and prostatic-type polyp. The World Health Organization defines primary adenocarcinoma of the bladder as an epithelial malignancy with pure glandular differentiation without evidence of typical urothelial carcinoma. Malignant lesions that should be included in the differential diagnosis of a primary adenocarcinoma of the bladder include noninvasive and invasive urothelial carcinoma with glandular differentiation and secondary malignancies involving the bladder by direct extension or metastasis. The recognition and distinction of these different entities may be a challenge for pathologists, but they are of great clinical importance. OBJECTIVE To review features of primary bladder adenocarcinoma as well as those entities that need to be differentiated from primary bladder adenocarcinoma, with emphasis on clinical findings, pathologic characteristics, and immunoprofiles. DATA SOURCES Selected original articles published in the PubMed service of the US National Library of Medicine. CONCLUSIONS The accurate diagnosis of adenocarcinoma of the urinary bladder is important and challenging. It has to prompt an extensive clinical workup to rule out other glandular lesions in the urinary bladder, especially the possibility of secondary involvement of the bladder by an adenocarcinoma from a different site.
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Affiliation(s)
- Minghao Zhong
- Department of Pathology, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
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17
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Ndokera R, Brewster S, Dhar S. Mullerianosis: a rare cause of acute renal colic. BMJ Case Rep 2012; 2012:bcr-2012-006704. [PMID: 23097575 DOI: 10.1136/bcr-2012-006704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old woman presented to the urology department with an acute history suggestive of left-sided renal colic. There were no other associated symptoms, but urine dipstick revealed non-visible haematuria. CT-KUB revealed a soft tissue mass at the left vesico-ureteric junction. Flexible cystoscopy demonstrated a mass intruding into the posterior bladder. A transurethral resection of the bladder 'tumour' was undertaken, and it was noted that the mass was not macroscopically consistent with transitional cell carcinoma. Histology demonstrated Müllerianosis, a rare lesion characterised by locally invasive growth of tissue originating from the Müllerian (paramesonephric) duct. The patient was seen by gynaecologist who initiated hormone treatment with an lutenising hormone--releasing hormone (LH-RH) analogue. Urological follow-up 3 months later highlighted ongoing pelvic pain but no further colicky loin pain. Repeat cystoscopy showed the mass had become smaller and the left ureter was laterally displaced. Further gynaecological input is planned if symptoms are ongoing.
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