Pathology of Urinary Bladder Squamous Papilloma 

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Squamous papilloma is a rare benign neoplasm seen in the bladder. It is composed of papillary cores with overlying histologically benign squamous epithelium. ^{[1, 2]} It is unclear whether squamous papilloma represents the squamous counterpart of urothelial papilloma.

The risk factors for squamous papilloma are similar to those for other urothelial neoplasms; cigarette smoking and occupational exposure to aromatic amines are among the most important. Specific epidemiologic studies on squamous papilloma are lacking. ^{[1, 2]}

Recent evidence suggests that squamous papilloma of the bladder is unrelated to human papillomavirus (HPV) infection; therefore, it seems to be unrelated to condyloma acuminatum. ^{[1, 3]}

Squamous papilloma has not been reported to have a predilection for a specific location in the bladder. Most cases arise in the dome, the lateral or posterior walls, or the bladder neck. The lesion may occur in the urethra. ^[1]

Squamous papilloma most frequently occurs in elderly women. The disease follows a benign clinical course. Recurrences are uncommon. Irritative symptoms and hematuria may occur. ^[1]

The endoscopic appearance of squamous papilloma is identical to that of low-grade papillary neoplasms. The lesion is delicate and small or has the appearance of a polyp. ^{[1, 2]}

Squamous papilloma is a benign neoplasm seen in the bladder and the urethra. Histologically, it is composed of papillary cores with overlying benign squamous epithelium (see the image below). ^{[1, 2]}

No or minimal basal/parabasal p53 nuclear accumulation has been reported. Epidermal growth factor immunoreactivity has been reported to occur. ^{[1, 3, 2]}

Squamous papilloma is a DNA-diploid lesion; it tests negative for HPV DNA. ^[1]

TNM stage Ta applies (ie, squamous papilloma is noninvasive). As a benign lesion, it does not spread out. ^{[1, 2]}

Squamous papilloma is a benign tumor that may rarely recur but does not progress. Some patients may in time develop bladder cancer. ^[1] In a recent study that included 5 patients with squamous papilloma, 1 patient had low-grade urothelial carcinoma at cystectomy after an interval of 21 months (low-grade urothelial carcinoma preceded the diagnosis of squamous papilloma); 2 patients were free of lesions on follow-up biopsy. Two cases were lost to follow-up. ^[3]

Cheng L, Leibovich BC, Cheville JC, et al. Squamous papilloma of the urinary tract is unrelated to condyloma acuminata. Cancer. 2000 Apr 1. 88(7):1679-86. [Medline].

Lopez-Beltran A, Requena MJ, Alvarez-Kindelan J, Quintero A, Blanca A, Montironi R. Squamous differentiation in primary urothelial carcinoma of the urinary tract as seen by MAC387 immunohistochemistry. J Clin Pathol. 2007 Mar. 60(3):332-5. [Medline].

Guo CC, Fine SW, Epstein JI. Noninvasive squamous lesions in the urinary bladder: a clinicopathologic analysis of 29 cases. Am J Surg Pathol. 2006 Jul. 30(7):883-91. [Medline].

Cheng L, Darson M, Cheville JC, et al. Urothelial papilloma of the bladder. Clinical and biologic implications. Cancer. 1999 Nov 15. 86(10):2098-101. [Medline].

Lopez-Beltran A. Bladder cancer: clinical and pathological profile. Scand J Urol Nephrol Suppl. 2008 Sep. 95-109. [Medline].

Lopez-Beltran A, Montironi R. Non-invasive urothelial neoplasms: according to the most recent WHO classification. Eur Urol. 2004 Aug. 46(2):170-6. [Medline].

Antonio Lopez-Beltran, MD, PhD Professor of Anatomic Pathology, Unit of Anatomic Pathology, Department of Surgery, Cordoba University School of Medicine, Spain

Disclosure: Nothing to disclose.

Liang Cheng, MD Professor of Pathology and Urology, Department of Pathology and Laboratory Medicine, Indiana University School of Medicine; Chief, Genitourinary Pathology Service, Indiana University Health

Liang Cheng, MD is a member of the following medical societies: American Association for Cancer Research, American Urological Association, College of American Pathologists, United States and Canadian Academy of Pathology, International Society of Urological Pathology, Arthur Purdy Stout Society

Disclosure: Nothing to disclose.

Pathology of Urinary Bladder Squamous Papilloma 

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