|
|
Line 91: |
Line 91: |
|
| |
|
| ===Muscularis propria invasion=== | | ===Muscularis propria invasion=== |
| The presence or absence of muscularis propria invasion is a '''very important''' determination, as the clinical management changes between T1 and T2:
| | {{Main|Muscularis propria invasion in the urinary bladder}} |
| *T1: usually conservative treatment (local excision).
| |
| *T2: radical treatment (cystectomy or cystoprostatectomy).
| |
| | |
| A thin layer of discontinous muscularis mucuosae (MM) is present and, especially if hypertrophic, may be confused with muscuaris propria (MP).
| |
| | |
| ====Comparing MM and MP====
| |
| A comparison between muscularis propria and muscularis mucosae - adapted from Paner ''et al.'':<ref name=pmid17721199>{{Cite journal | last1 = Paner | first1 = GP. | last2 = Ro | first2 = JY. | last3 = Wojcik | first3 = EM. | last4 = Venkataraman | first4 = G. | last5 = Datta | first5 = MW. | last6 = Amin | first6 = MB. | title = Further characterization of the muscle layers and lamina propria of the urinary bladder by systematic histologic mapping: implications for pathologic staging of invasive urothelial carcinoma. | journal = Am J Surg Pathol | volume = 31 | issue = 9 | pages = 1420-9 | month = Sep | year = 2007 | doi = 10.1097/PAS.0b013e3180588283 | PMID = 17721199 }}</ref>
| |
| {| class="wikitable sortable"
| |
| ! Feature
| |
| ! Muscularis mucosae
| |
| ! Muscularis propria
| |
| |-
| |
| | Outline/border
| |
| | typically irregular (frayed edges)
| |
| | usually regular (circumscribed)
| |
| |-
| |
| | Size of bundles ‡
| |
| | classically "small", often "large" (hypertrophic)
| |
| | usually "large"
| |
| |-
| |
| | Isolated fibres
| |
| | yes
| |
| | no
| |
| |-
| |
| | Location in bladder
| |
| | less common in trigone, dome very common
| |
| | everywhere
| |
| |-
| |
| | Depth †
| |
| | superficial, occ. deep
| |
| | deep
| |
| |}
| |
| | |
| Notes:
| |
| *† The lamina propria thickness varies with location. It is thinnest in the trigone (0.5-1.6 mm) and thickest in the dome (1.0-3.1 mm).
| |
| *‡ Small is defined as <4 muscle fibres; large >= 4 muscle fibres.
| |
| **The presence of hyperplastic bundles ranges from ~20% in the trigone to ~70% in the dome.
| |
| | |
| =====Images=====
| |
| <gallery>
| |
| Image: Urinary bladder muscularis mucosae -- intermed mag.jpg | MM - intermed. mag. (wc)
| |
| Image: Urinary bladder muscularis mucosae -- high mag.jpg | MM - high mag. (WC)
| |
| Image: Urinary bladder muscularis mucosae -- very high mag.jpg | MM - very high mag. (WC)
| |
| </gallery>
| |
| | |
| ====Rational assessment of muscularis propria invasion====
| |
| To call muscularis propria invasion:
| |
| #Definite tumour must be between muscle.
| |
| #Muscle bundles must be thick.
| |
| #Multiple bundles must be adjacent to one another.
| |
| #Should '''not''' be superficial - surface epithelium if present should be distant.
| |
|
| |
|
| ==Images== | | ==Images== |