Malignant lymphoma of the urinary bladder: a clinicopathological study of 11 cases

Abstract

Aim: To report the clinical and histological features and outcome of primary and secondary malignant lymphomas of the urinary bladder.

Methods: Eleven cases of malignant lymphoma of the urinary bladder were obtained from the registry of cases at St Bartholomews and the Royal London Hospitals. The lymphomas were classified on the basis of their morphology and immunophenotype, and the clinical records were reviewed.

Results: There were six primary lymphomas: three extranodal marginal zone lymphomas of mucosa associated lymphoid tissue (MALT) type and three diffuse large B cell lymphomas. Of the five secondary cases, four were diffuse large B cell lymphomas, one secondary to a systemic follicular follicle centre lymphoma, and one nodular sclerosis Hodgkins disease. Four patients with secondary lymphoma for whom follow up was available had died of disease within 13 months of diagnosis. Primary lymphomas followed a more indolent course. In one case, there was evidence of transformation from low grade MALT-type to diffuse large B cell lymphoma. The most common presenting symptom was haematuria. Cystoscopic appearances were of solid, sometimes necrotic tumours resembling transitional cell carcinoma, and in one case the tumours were multiple. These cases represented 0.2% of all bladder neoplasms.

Conclusions: Diffuse large B cell lymphoma and MALT-type lymphoma are the most common primary malignant lymphomas of the bladder. Lymphoepithelial lesions in MALT-type lymphoma involve transitional epithelium, and their presence in high grade lymphoma suggests a primary origin owing to transformation of low grade MALT-type lymphoma. Primary and secondary diffuse large B cell lymphomas of the bladder are histologically similar, but the prognosis of the former is favourable.

Figure 1 A lymphoepithelial lesion of transitional epithelium in mucosa associated lymphoid tissue-type lymphoma of the bladder.

Figure 2 A diffuse infiltrate of centrocyte like cells in mucosa associated lymphoid tissue-type lymphoma of the bladder. Scattered larger cells resemble centroblasts.

Figure 3 Secondary diffuse large B cell lymphoma of the bladder.