Course Map: Tumor-like Lesions: Endometriosis

Endometriosis
This consists of endometrial glands and stroma in the bladder wall identical to endometriosis as seen elsewhere (Fig. 1). Thickening of the bladder wall (usually the posterior wall), a palpable supra-pubic mass or cystic, hemorrhagic or edematous mucosal changes can cause confusion with bladder neoplasia. Microscopically, some of the glands may lack a stromal element, and some foci may show evidence of recent or remote hemorrhage [5,28,31,94]. The lamina propria, muscularis propria, or serosa may be involved. A similar distribution of glands may show the features of the endocervix (endocervicosis; Fig. 2, Fig. 3, Fig. 5). These glands occur as rounded or stellate-shaped structures scattered randomly in the bladder wall. The epithelium consists of a row of cuboidal or columnar cells with pale, mucin-positive cytoplasm. Least commonly, glandular inclusions may assume a tubal-type morphology with cilia (endosalpingiosis; Fig. 4).
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	Figure 1: Endometriosis within muscularis propria.
	Figure 2: Endocervicosis showing the pale-staining mucinous-type epithelium.
	Figure 3: Endocervicosis showing the pale-staining mucinous-type epithelium.
	Figure 4: Ciliated epithelium denoting endosalpingiosis (arrows).
	Figure 5: This bladder contained both endometriosis (left) and endocervicosis (right). Such combinations have also been referred to as "müllerianosis" of the bladder.