Course Map: Epithelial Abnormalities: Treatment Effects

Treatment Effects
Topical and certain systemic chemotherapeutic agents produce epithelial changes that can be mistaken for in-situ carcinoma. Mitomycin C and thiotepa produce similar alterations. Figure 1 shows Thiotepa effect: the nuclei are quite pleomorphic but there is also an abundance of cytoplasm and it shows prominent vacuolar degeneration. Figure 2 shows thiotepa effect on von Brunn nests. BCG therapy does not produce epithelial changes other than those related to chronic inflammation (reactive atypia). BCG typically is associated with small subepithelial epithelioid granulomas [64, 66]. Figure 3 shows two granulomas and Figure 4 shows one granuloma and proliferative cystitis. Radiation effect shows features similar to thiotepa: pleomorphic nuclei with abundant cytoplasm (Fig. 5). Figure 6 shows radiation effect with bizarre nuclei but many other cells are normal. Such cases may need correlation with history and other findings.
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	Figure 1: Thiotepa effects: pleomorphic nuclei, abundant cytoplasm and vacuolar degeneration.
	Figure 2: Shows Thiotepa effects on von Brunn nests.
	Figure 3: Two granulomas resulting from BCG treatment (circles).
	Figure 4: Shows one granuloma (circle) and proliferative cystitis.
	Figure 5: Radiation effect. The celluar changes are similar to those seen with Thiotepa.
	Figure 6: Radiation effect resulting in bizarre nuclei. The nuclei have a smudged, degenerative apprearance but distinction from pagetoid CIS could be difficult without a proven history of radiation therapy.