Difference between revisions of "Low-grade papillary urothelial carcinoma"

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Low-grade papillary urothelial carcinoma
Diagnosis in short

Low-grade papillary urothelial carcinoma. H&E stain.
LM papillae (fibrovascular cores covered by urothelium) -- usually with fusion and branching, small nuclei (~3x a resting lymphocyte), +/-invasion into the lamina propria (rare), +/-mitoses (uncommon)
LM DDx PUNLMP, urothelial papilloma, inverted papilloma, high-grade papillary urothelial carcinoma
IHC Ki-67 low (<25% of cells)
Gross exophytic lesion, frond-like appearance, friable
Site urothelium
Syndromes Lynch syndrome
Signs hematuria
Prevalence very common
Prognosis very good
Clin. DDx high-grade papillary urothelial carcinoma, urothelial papilloma

Low-grade papillary urothelial carcinoma, abbreviated LGPUC,[1] is a very common indolent form of cancer that arises from the urothelium.

It is also known as low-grade papillary urothelial cell carcinoma, abbreviated LGPUCC.

General

  • Very common.
  • Very good prognosis - if it is non-invasive.
  • Usually non-invasive.[2]

Note:

Gross

  • Exophytic lesion.
  • Frond-like appearance.

Microscopic

Features:[3]

  • Papillae = fibrovascular cores covered by urothelium.
    • Usually with fusion of papillae and branching of papillae.
  • Small nuclei (~3x a resting lymphocyte).
  • +/-Invasion into the lamina propria (rare).
  • Rare mitoses.
    • Usually difficult to find.
    • Basal location.

Criteria for invasion:[2]

  • Stromal reaction.
  • Infiltrating single cells.
  • Small nests.
  • Retraction artifact.
  • Paradoxical differentiation.

Note:

  • Nuclei slightly larger than in PUNLMPs.
  • The presence/absence of muscle should be commented on in biopsy specimens.
  • Adipose tissue may be seen in the lamina propria; tumour adjacent to adipose tissue on a biopsy does not imply invasion deep to the muscularis propria.[4]

DDx:

IHC

  • Ki-67:
    • Rajcani et al.:[7] <25% of tumour cells for low-grade versus >50% tumour cell for high-grade.
    • Pich et al.:[8] 11%/17% for G1/G2 versus 34% for G3.

Molecular

Molecular changes:[9]

  • FGFR3
  • HRAS
  • Loss of heterozygosity - chromosome 9.

Note:

  • Not currently used diagnostically.

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 URINARY BLADDER LESION ("TUMOUR"), RESECTION:
- LOW-GRADE PAPILLARY UROTHELIAL CARCINOMA.
-- NEGATIVE FOR LAMINA PROPRIA INVASION.
- NO MUSCULARIS PROPRIA IDENTIFIED.

URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION OF BLADDER TUMOUR (TURBT):
- LOW-GRADE PAPILLARY UROTHELIAL CARCINOMA.
- NEGATIVE FOR LAMINA PROPRIA INVASION.
- NO MUSCULARIS PROPRIA IDENTIFIED.

URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION OF BLADDER TUMOUR (TURBT):
- LOW-GRADE PAPILLARY UROTHELIAL CARCINOMA.
- NEGATIVE FOR LAMINA PROPRIA INVASION.
- MUSCULARIS PROPRIA PRESENT.

See also

References

  1. ↑ Watts, KE.; Montironi, R.; Mazzucchelli, R.; van der Kwast, T.; Osunkoya, AO.; Stephenson, AJ.; Hansel, DE. (Aug 2012). "Clinicopathologic characteristics of 23 cases of invasive low-grade papillary urothelial carcinoma.". Urology 80 (2): 361-6. doi:10.1016/j.urology.2012.04.010. PMID 22857755.
  2. ↑ 2.0 2.1 2.2 Toll, AD.; Epstein, JI. (Jul 2012). "Invasive low-grade papillary urothelial carcinoma: a clinicopathologic analysis of 41 cases.". Am J Surg Pathol 36 (7): 1081-6. doi:10.1097/PAS.0b013e318253d6e0. PMID 22510761.
  3. ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 310. ISBN 978-0781765275.
  4. ↑ Bochner, BH.; Nichols, PW.; Skinner, DG. (Mar 1995). "Overstaging of transitional cell carcinoma: clinical significance of lamina propria fat within the urinary bladder.". Urology 45 (3): 528-31. doi:10.1016/S0090-4295(99)80030-2. PMID 7879346.
  5. ↑ Miyamoto, H.; Brimo, F.; Schultz, L.; Ye, H.; Miller, JS.; Fajardo, DA.; Lee, TK.; Epstein, JI. et al. (Aug 2010). "Low-grade papillary urothelial carcinoma of the urinary bladder: a clinicopathologic analysis of a post-World Health Organization/International Society of Urological Pathology classification cohort from a single academic center.". Arch Pathol Lab Med 134 (8): 1160-3. doi:10.1043/2009-0403-OA.1. PMID 20670136.
  6. ↑ Isfoss, BL.; Majak, B.; Busch, C.; Braathen, GJ. (Apr 2011). "Simplification of grading papillary urothelial neoplasia using a reduced set of diagnostic features.". Anal Quant Cytol Histol 33 (2): 68-74. PMID 21980608.
  7. ↑ Rajcani, J.; Kajo, K.; Adamkov, M.; Moravekova, E.; Lauko, L.; Felcanova, D.; Bencat, M. (2013). "Immunohistochemical characterization of urothelial carcinoma.". Bratisl Lek Listy 114 (8): 431-8. PMID 23944616.
  8. ↑ Pich, A.; Chiusa, L.; Comino, A.; Navone, R. (1994). "Cell proliferation indices, morphometry and DNA flow cytometry provide objective criteria for distinguishing low and high grade bladder carcinomas.". Virchows Arch 424 (2): 143-8. PMID 7910097.
  9. ↑ Ehdaie, B.; Theodorescu, D. (Jan 2008). "Molecular markers in transitional cell carcinoma of the bladder: New insights into mechanisms and prognosis.". Indian J Urol 24 (1): 61-7. doi:10.4103/0970-1591.38606. PMC 2684226. PMID 19468362. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684226/.
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