These areas were rebiopsied 1 and 3 years after the initial biopsy, without significant change in the pathologic findings. Four years after initial presentation, the patient was again taken to the operating room for cystoscopy and biopsy. On this examination, multiple papillary tumors were noted and biopsied. The largest was approximately 5 cm in diameter with several satellite Ulixertinib lesions. Representative biopsy revealed squamous papillomas. After counseling the patient regarding these findings, we recommended continuing follow-up with cystoscopy and periodic rebiopsy. A review of the urologic literature reveals

only 12 reported cases of squamous papilloma. Current literature suggests that although the appearance and presentation may mimic urothelial carcinoma, squamous papilloma is benign and not thought to be a risk factor for bladder cancer.2 Extensive keratinization of the bladder has been associated with bladder contracture and risk

of development of metachronous bladder cancer.4 For this reason, we suggest that it is prudent to continue surveillance with periodic rebiopsy in patients with keratinizing squamous metaplasia that does not resolve with conservative therapy. To our knowledge, this is the first published case of keratinizing squamous metaplasia with melanotic deposits of an unknown material with synchronous development of squamous papilloma. “
“Primary signet ring cell adenocarcinoma of the urinary bladder, also called linitis plastica urinary bladder, is rare, accounting for only 0.24% of all GSI-IX malignant tumors of the urinary bladder.1 A 72-year-old patient consulted for intermittent painless total gross hematuria, urgency, and pollakiuria. The medical and familial histories were unremarkable. Physical examination was normal. The abdominal and pelvic ultrasound showed a bilateral hydroureteronephrosis with thickening of the urinary bladder wall. Cystoscopy visualized a solid mass in the left-side wall of the urinary bladder. Histologic examination of cystoscopic biopsy showed a proliferation through of

round-cell aspect of signet ring. An immunohistochemical study demonstrated positivity for cytokeratin 7 and negativity for cytokeratin 20. The diagnosis of signet ring cell adenocarcinoma of the bladder was established. Abdominal computed tomography (CT) showed no locoregional lymph nodes, metastases, or a primary tumor in other abdominal or pelvic organs. We performed a complete gastrointestinal endoscopic evaluation to exclude an extravesical primary tumor site, but no other primary site was found. The tumor was therefore treated as a primary signet ring cell carcinoma (SRCC) of the urinary bladder. The patient underwent a radical cystoprostatectomy. The intraoperative examination found a budding tumor inserted to the left-side wall. Histologic examination concluded to a signet ring cell adenocarcinoma with a colloid component estimated about 40%.