[Clinical pathology of inverted papillomas of the urinary bladder. A complex morphologic and catamnestic study (2)]

The histopathology, ultrastructure, pathological status and clinical course are described in a total of 29 cases of inverted papilloma of the urinary bladder (IP). The IP was isolated in 16 cases and occurred in combination with a papillary urothelial carcinoma in 13 cases. Histologically, a trabecular, a glandular and a mixed type can be differentiated. The trabecular form predominates in a ratio of 4:1. The glandular form is further subdivided into a cystic form and an adenomatous form containing cylindrical cells. Contrary to earlier assumptions, dysplasia and malignant transformation also occur in IP. Amongst the 16 isolated IP observed, four showed slight and four showed moderate dysplasia. One isolated IP was malignant and invasive. In IP in combination with papillary urothelial carcinomas, malignant transformation is somewhat more frequent. Four malignant IP and up to 85% dysplasias were found among the 13 cases. The ultrastructure of IP reveals two cell types: a light cell form which corresponds to a slightly dysplastic urothelium and a darker cell form with or without microvilli which is observed in the glandular type. A frequent characteristic is a thickening of the basement membrane besides abundant "tight junctions". The immunohistochemistry is relatively uncharacteristic. This also applies to the blood group isoantigens, which showed irregular and relative uninformative results in the SCRA test. IP is observed in all age groups and the sex ratio (M/F) is 3:1. The average age of manifestation is 56 years, about 10 years earlier than bladder carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)