title: Histopathologic and clinical features of vesical diverticula.
abstract: OBJECTIVE
  To study the histopathology changes and clinical features of vesical diverticula, focusing on the neoplastic entities.
  
  
  METHODS
  We retrieved data for 108 patients with vesical diverticula from the archives of our institute during the past 15 years (1998 to 2012) and reviewed their clinical and pathologic characteristics.
  
  
  RESULTS
  Diverticula most often involved the lateral wall, followed by the posterolateral and posterior walls of the urinary bladder. Nonneoplastic processes were found in 70 of 108 patients (65%), including inflammation, metaplasia, and urothelial hyperplasia, with or without atypia/dysplasia. Primary carcinomas arising within the diverticula were found in 36 patients (33.3%), of which 33 were urothelial carcinoma, including 5 with divergent differentiation, 2 with squamous carcinoma, and 1 with adenocarcinoma. Patient follow-up for neoplastic diverticula (mean, 59 months; range, 1-108 months) showed that no patients died of disease progression. Concurrent or subsequent urothelial carcinoma was present in the nondiverticular bladder in 19 of 36 patients (53%). Four patients with subsequent extradiverticular urothelial carcinoma showed progression, with pathology upstaging.
  
  
  CONCLUSIONS
  Inflammation, metaplasia, and dysplasia are commonly seen in vesical diverticula. In our series, which includes patients who underwent endoscopic or surgical intervention and microscopic examination, those with vesical diverticula appeared to have a significantly higher risk for development of urothelial carcinoma, which can occur synchronously or precede carcinoma of the nondiverticular bladder. Compared with their non-diverticulum-associated counterparts, a significantly higher percentage of diverticulum-associated bladder carcinomas are high-grade and invasive. Conservative approaches are suggested for tumors confined within diverticula, after extensive investigation of the nondiverticular bladder.
authors.affiliation: Department of Pathology, New York Univeristy Langone Medical Center, New York, NY, USA.
authors.forename: Max X
authors.initials: MX
authors.lastname: Kong
authors.forename: Xiangrong
authors.initials: X
authors.lastname: Zhao
authors.forename: Emil
authors.initials: E
authors.lastname: Kheterpal
authors.forename: Peng
authors.initials: P
authors.lastname: Lee
authors.forename: Samir
authors.initials: S
authors.lastname: Taneja
authors.forename: Herbert
authors.initials: H
authors.lastname: Lepor
authors.forename: Jonathan
authors.initials: J
authors.lastname: Melamed
authors.forename: Fang-Ming
authors.initials: FM
authors.lastname: Deng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology* / Q000628:therapy; D002471:Cell Transformation, Neoplastic; D002648:Child; D002675:Child, Preschool; D004240:Diverticulum / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000150:complications / Q000473:pathology; D008297:Male; D008679:Metaplasia / Q000150:complications / Q000473:pathology; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D012189:Retrospective Studies; D001745:Urinary Bladder Diseases / Q000150:complications / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000628:therapy; D019459:Urothelium / Q000473:pathology*; D055815:Young Adult