2019-9 / APRIL 15

A 65 year old man presented with a 3 mm nodule in the bladder.


What is the correct diagnosis?

a. Florid cystitis cystica et glandularis

b. Carcinoid tumor

c. Well differentiated adenocarcinoma of the bladder

d. Prostate adenocarcinoma invading the bladder

Carcinoid tumor

Carcinoid tumors of the bladder occur in middle aged adults, range 30-73 years often at the trigone or bladder neck. They are usually small (mean 5 mm., range 2-12 mm) and often appear as a polypoid or smooth-surfaced submucosal nodule. Architecturally, the lesion consists of uniform cuboidal or columnar cells forming pseudoglandular structures, including acini and cribriform glands. Nuclei have finely stippled chromatin with inconspicuous nucleoli. There is a moderate to abundant amount of cytoplasm most often amphophilic but ranging from eosinophilic to basophilic. Mitotic figures are absent. Typically, as in this case, it is accompanied by cystitis glandularis, non-intestinal type. Typically, these small lesions are cured by excision or biopsy. Rarely carcinoid can be large more invasive tumor with a more unpredictable prognosis.

Primary carcinoid tumors of the urinary bladder and prostatic urethra: a clinicopathologic study of 6 cases. Chen YB, Epstein JI. Am J Surg Pathol. 2011 Mar;35(3):442-6.

Jonathan Epstein
Johns Hopkins Hospital