2019-35 / OCTOBER 21

72 y/o male with hematuria, bladder lesion found on cystoscopy.


What is the correct diagnosis?

a. florid von brun nests

b. nested variant invasive urothelial carcinoma

c. radiation cystitis with pseudoepithelial hyperplasia

d. pseudoangiosarcomatous variant invasive urothelial carcinoma

1.  c

1. radiation cystitis with pseudoepithelial hyperplasia

The characteristic changes includes rounded urothelial nests wrapping around blood vessels, associated with fibrin deposition, reactive nuclear features, and squamoid cytoplasm. Examination of background tissues typically reveals stromal hemorrhage, fibrin thrombi, fibrosis, and edema. Characteristic stellate fibroblasts and vessels with intimal hyalization are often seen in patient’s with a prior history of radiation. However, these latter changes are often absent in cases lacking radiation history, and are not required for the diagnosis. In this case, further chart review inquiry revealed a history of radiation for prostate cancer. The differential diagnosis includes invasive urothelial carcinoma (including nested pattern) and florid von Brunn nests.

Chan TY, Epstein JI. Radiation or chemotherapy cystitis with “pseudocarcinomatous” features.
Am J Surg Pathol. 2004 Jul;28(7):909-13.

Lane Z, Epstein JI. Pseudocarcinomatous epithelial hyperplasia in the bladder unassociated with prior irradiation or chemotherapy.
Am J Surg Pathol. 2008 Jan;32(1):92-7.

Ankur Sangoi
El Camino Hospital, Mountain View, CA USA


bladder, cystitis, radiation, pseudocarcinomatous