@@ Line 1: / Line 1: @@
 The '''urothelium''' lines the upper portion of the genitourinary tract, i.e. [[ureter]]s, [[urinary bladder]]), and a bit of the lower part.
-=Normal histology=
+=Normal urothelium=
-*Maturation (cuboidal at base - squamoid at surface).
+===Gross===
-**Surface cells called 'umbrella cells' (umbrella cells CK20+).
+====Extent of urothelium====
-*Urothelium should be 4-5 cell layers thick.
-*+/-Prominent nucleoli.
-*Should NOT have papillary architecture -- if it does it is likely [[cancer]]!
-**If it is 'papillary' -- it must have fibrovascular cores.
-==Extent of urothelium==
 *[[Ureters]].
 *Renal pelvis.
@@ Line 16: / Line 9: @@
 *Part of the urethra.
-===Urethra in males===
+=====Urethra in males=====
+{{Main|Urethra}}
 *Pre-prostatic urethra - transitional epithelium.
 *[[Prostate gland|Prostatic]] urethra - transitional epithelium.
+**Cancer arising at this site is ''[[prostatic urothelial carcinoma]]''.
 *Membranous urethra (from apex of prostate to bulb of penis (bulb of the corpus spongiosusm)) - pseudostratified columnar epithelium.
 *Spongy urethra - pseudostratified columnar epithelium (proximal) & stratified squamous (distal).
+===Microscopic===
+Features:
+*Maturation (cuboidal at base - squamoid at surface).
+**Surface cells called 'umbrella cells' (umbrella cells CK20 +ve).
+*Urothelium should be 4-5 cell layers thick.
+*+/-Prominent [[nucleoli]].
+Note:
+*Should '''not''' have a papillary architecture -- if it does it is likely [[cancer]]!
+**If it is 'papillary' -- it must have fibrovascular cores.
+===IHC===
+*Rare superficial [[CK20]] staining.
+====Image====
+<gallery>
+Image: Benign urothelium - CK20 -- high mag.jpg | Benign urothelium - CK20 - high mag. (WC)
+</gallery>
+===Sign out===
+<pre>
+URINARY BLADDER LESION, TRANSURETHRAL RESECTION:
+- UROTHELIAL MUCOSA WITHIN NORMAL LIMITS.
+- NEGATIVE FOR MALIGNANCY.
+</pre>
+====Micro====
+The sections shows urothelium with underlying tissue.  The urothelium is 4-5 cells thick.  Umbrella cells are present. Few mononuclear inflammatory cells are seen in the subepithelial tissue.
+The urothelium has no nuclear hyperchromasia and no significant nuclear enlargement.  Mitotic activity is not identified. No papillary structures are present.
 =Approach=
@@ Line 47: / Line 73: @@
 #* Normal is 4-5 cell layers.
 # Nests of glandular cells
-#* Consider ''cystitis cystica'', ''cystitis glandularis'', ''cystitis cystica et glandularis'', ''Brunn's nest'', ''inverted papilloma''.
+#* Consider ''[[cystitis cystica]]'', ''[[cystitis glandularis]]'', ''cystitis cystica et glandularis'', ''[[von Brunn's nest]]'', ''[[inverted urothelial papilloma|inverted papilloma]]''.
 # Inflammation?
 #* Michaelis-Gutman bodies?
@@ Line 114: / Line 140: @@
 | -
 |-
-| '''Urothelial dysplasia'''
+| '''[[Urothelial dysplasia]]'''
 | moderate (3x)
 | small, some multiple
@@ Line 124: / Line 150: @@
 | -
 |-
-| '''UCC in situ'''
+| '''[[Urothelial carcinoma in situ]]'''
 | '''signif. (4-5x)'''
 | +/-large
@@ Line 134: / Line 160: @@
 | -
 |-
-| '''Invasive UCC'''
+| '''[[Urothelial carcinoma|Invasive UCC]]'''
 | signif. (4-5X)
 | +/-large
@@ Line 223: / Line 249: @@
 =Flat urothelial lesions=
 ==Overview==
-Several different benign & pre-malignant diagnoses can be made:
+Several different benign & pre-malignant diagnoses can be made.
-*Reactive atypia.
+The World Health Organization classification is:<ref name=pmid19762067>{{Cite journal  | last1 = Hodges | first1 = KB. | last2 = Lopez-Beltran | first2 = A. | last3 = Davidson | first3 = DD. | last4 = Montironi | first4 = R. | last5 = Cheng | first5 = L. | title = Urothelial dysplasia and other flat lesions of the urinary bladder: clinicopathologic and molecular features. | journal = Hum Pathol | volume = 41 | issue = 2 | pages = 155-62 | month = Feb | year = 2010 | doi = 10.1016/j.humpath.2009.07.002 | PMID = 19762067 }}</ref>
+*Reactive urothelial atypia.
 *Flat urothelial hyperplasia.
-*Urothelial dysplasia.
+*Urothelial atypia of unknown significance.
-*Urothelial carcinoma in situ.
+*[[Urothelial dysplasia]] (low-grade dysplasia).
+*Urothelial carcinoma in situ (high-grade dysplasia).
 *Invasive urothelial carcinoma.
-==Urothelial carcinoma in situ==
+==Mild urothelial atypia in normal urothelium==
-*Abbreviated ''CIS''.
 ===General===
-*Lack papillae.
+*May be confused with [[urothelial carcinoma in situ]].<ref name=Ref_Amin2-57>{{Ref Amin|2-57}}</ref>
+*Uncommon.
+*Considered to be [[normal urothelium]].
 ===Microscopic===
-Features:
+Features:<ref name=Ref_Amin2-57>{{Ref Amin|2-57}}</ref>
-*Nuclear changes '''key feature'''.
+*Umbrella cells have:
-**Enlargement of nuclei (often 4-5x the size of stromal lymphocytes) -- diagnostic.<ref name=Ref_GUP161>{{Ref GUP|161}}</ref>
+**Mild nuclear enlargement ~3-4x lymphocyte.
-***Normal urothelium approx. 2x the size of stromal lymphocytes.
+**Round/regular nuclear membranes.
-**Nuclear pleomorphism - marked variation in size of nuclei.
+**+/-Multi-nucleation.
-*+/-Disordered arrangement/crowding of cells.
+**Focally clear cytoplasm with cobwebs.
-**In normal urothelium the cell line-up on the basement membrane.
+***Clear cytoplasm with eosinophilic reticulations.
-*Umbrella cells often absent.
+*+/-Inflammation.
-*+/-Mitoses present.
+*No mitotic activity.
-*+/-Enlarged nucleoli.
+DDx:<ref>URL: [http://pathology.jhu.edu/bladder/definitions.cfm http://pathology.jhu.edu/bladder/definitions.cfm]. Accessed on: 8 January 2014.</ref>
+*[[Urothelial carcinoma in situ]].
+*[[Urothelial dysplasia]].
+====Images====
+<gallery>
+Image: Benign urothelium with large superficial cells -- intermed mag.jpg | Benign large superf. cells - intermed. mag. (WC)
+Image: Benign urothelium with large superficial cells -- high mag.jpg | Benign large superf. cells - high mag. (WC)
+Image: Benign urothelium with large superficial cells -- very high mag.jpg | Benign large superf. cells - very high mag. (WC)
+</gallery>
-Note:
+===IHC===
-*The urothelium may be "depleted", i.e. exist only of rare large cells on the basement membrane.
+*Ki-67 low.
-**This is known as ''clinging urothelial carcinoma in situ''.<ref>{{Ref Amin|2-55}}</ref>
+*p53 -ve.
 ===Sign out===
 <pre>
-URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION URINARY BLADDER TUMOUR (TURBT):
+URINARY BLADDER, TRANSURETHRAL BIOPSY:
-- UROTHELIAL CARCINOMA IN SITU.
+- UROTHELIAL MUCOSA WITH MILD CHRONIC INFLAMMATION.
-- MUSCULARIS PROPRIA PRESENT.
+- NO EVIDENCE OF MALIGNANCY.
+COMMENT:
+Levels were cut and show large benign umbrella cells.
 </pre>
+====Micro====
+The sections show small fragments of urothelial mucosa with enlarged benign superficial epithelial cells.  The lamina propria has a mild lymphocytic infiltrate.  No papillary structures are identified.  There is no significant nuclear atypia.  Superficial small blood vessels appear congested.
+==Urothelial dysplasia==
+*[[AKA]] ''low-grade (urothelial) dysplasia''.
+{{Main|Urothelial dysplasia}}
+==Urothelial carcinoma in situ==
+*Abbreviated ''CIS''.
+*[[AKA]] ''high-grade (urothelial) dysplasia''.
+{{Main|Urothelial carcinoma in situ}}
 ==Urothelial cell carcinoma==
@@ Line 262: / Line 317: @@
 *Abbreviated ''UCC''.
 *[[AKA]] ''urothelial carcinoma''.
+{{Main|Urothelial carcinoma}}
-===General===
-*These lesions lack papillae and are typical flat.
-*Clinically, it may not be possible to differentiate renal pelvis urothelial carcinoma and [[renal cell carcinoma]].
-===Microscopic===
-Features:
-*Nuclear pleomorphism - '''key feature'''.
-**Compare nuclei to one another.
-*Increased N/C ratio.
-*Lack of maturation to surface (important).
-*Cells become dyscohesive.
-**Mostly useless in my experience.
-Invasion vs. in situ:
-Useful features - present in invasion:<ref>Sternberg, SE. Histology for Pathologists. P.2047.</ref>
-*Thin-walled vessels.
-*Stromal reaction (hypercellularity).
-*Retraction artefact around the tumour cell nests.
-Note:
-*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.<ref name=pmid7879346>{{Cite journal  | last1 = Bochner | first1 = BH. | last2 = Nichols | first2 = PW. | last3 = Skinner | first3 = DG. | title = Overstaging of transitional cell carcinoma: clinical significance of lamina propria fat within the urinary bladder. | journal = Urology | volume = 45 | issue = 3 | pages = 528-31 | month = Mar | year = 1995 | doi = 10.1016/S0090-4295(99)80030-2 | PMID = 7879346 }}</ref>
-====Staging====
-*T1 - lamina propria.
-**Several subdivisions of T1 exist:
-***T1a - superficial or in muscularis mucosae.
-***T1b - beyond muscularis mucosae - into submucosa.
-*T2 - muscularis propria.
-====Subtypes====
-There are numerous subtypes:<ref>URL: [http://www.nature.com/modpathol/journal/v22/n2s/full/modpathol200926a.html http://www.nature.com/modpathol/journal/v22/n2s/full/modpathol200926a.html]. Accessed on: 19 August 2011.</ref>
-*Squamous differentiation.
-*Clear cell.
-*Plasmacytoid.
-*Micropapillary.
-**Small nests (< ~10 cells/nest).
-*Sarcomatoid.
-**Images: [http://path.upmc.edu/cases/case615.html UCC with sarcomatoid differentiation (upmc.edu)].
-*Many others...
-Benign patterns - mnemonic ''Much GIN'':
-*'''M'''icrocystic.
-*Small tubular/'''g'''landular.
-*'''I'''nverted.
-*'''N'''ested.
-=====Plasmacytoid urothelial cell carcinoma=====
-Features:
-*Abundant gray cytoplasm, eccentric nucleus.
-Images:
-*[http://path.upmc.edu/cases/case267.html Plasmacytoid UCC - several images (upmc.edu)].
-=====Nested urothelial cell carcinoma=====
-*[[AKA]] ''nested variant urothelial cell carcinoma''.
-Features:<ref name=pmid2712189>{{Cite journal  | last1 = Talbert | first1 = ML. | last2 = Young | first2 = RH. | title = Carcinomas of the urinary bladder with deceptively benign-appearing foci. A report of three cases. | journal = Am J Surg Pathol | volume = 13 | issue = 5 | pages = 374-81 | month = May | year = 1989 | doi =  | PMID = 2712189 }}</ref>
-*High density of well-circumscribed nests.
-*Mild-to-moderate nuclear atypia.
-*+/-Foci of unequivocal conventional urothelial carcinoma.
-**Focally solid or gland fusion.
-**Moderate-to-severe nuclear atypia +/- abundant mitoses.
-*+/-Extension into the muscularis propria.
-DDx:
-*[[von Brunn nests]].
-Images:
-*[http://commons.wikimedia.org/wiki/File:Nested_variant_of_urothelial_carcinoma_-_intermed_mag.jpg Nested variant of urothelial carcinoma - intermed. mag. (WC)].
-*[http://commons.wikimedia.org/wiki/File:Nested_variant_of_urothelial_carcinoma_-_high_mag.jpg Nested variant of urothelial carcinoma - high mag. (WC)].
-*[http://commons.wikimedia.org/wiki/File:Nested_variant_of_urothelial_carcinoma_-_very_high_mag.jpg Nested variant of urothelial carcinoma - very high mag. (WC)].
-*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282447/figure/F2/ Several images of NUCC (nih.gov)].<ref name=pmid22355497>{{Cite journal  | last1 = Terada | first1 = T. | title = Nested variant of urothelial carcinoma of the urinary bladder. | journal = Rare Tumors | volume = 3 | issue = 4 | pages = e42 | month = Oct | year = 2011 | doi = 10.4081/rt.2011.e42 | PMID = 22355497 | PMC = 3282447 }}</ref>
-===[[IHC]]===
-Features:
-*CK7 +ve CK20 +ve.
-**CK20 may be negative.
-UCC vs. Prostate:
-*UCC: p63+, PSA-, PSAP-, CK7+, CK20+.
-*Prostate: p63-, PSA+, PSAP+, CK7-, CK20-.
-UCC vs. RCC:
-*UCC: p63+.<ref>{{Cite journal  | last1 = Langner | first1 = C. | last2 = Ratschek | first2 = M. | last3 = Tsybrovskyy | first3 = O. | last4 = Schips | first4 = L. | last5 = Zigeuner | first5 = R. | title = P63 immunoreactivity distinguishes upper urinary tract transitional-cell carcinoma and renal-cell carcinoma even in poorly differentiated tumors. | journal = J Histochem Cytochem | volume = 51 | issue = 8 | pages = 1097-9 | month = Aug | year = 2003 | doi =  | PMID = 12871991 }}
-</ref>
-===Molecular===
-Not used for diagnosis.
-Changes:
-*9p deletion -- site of CDKN2A<ref name=omim600160>{{OMIM|600160}}</ref> (AKA p16).
-*17p deletion -- site of PT53 (AKA p53).
-===Sign out===
-====High grade UCC====
-<pre>
-URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION URINARY BLADDER TUMOUR (TURBT):
-- INVASIVE HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMA WITH SQUAMOUS DIFFERENTIATION AT LEAST INTO MUSCULARIS PROPRIA.
-- LYMPHOVASCULAR INVASION PRESENT.
-</pre>
 =Papillary urothelial lesions=
@@ Line 382: / Line 334: @@
 ==Urothelial papilloma==
-===General===
+{{Main|Urothelial papilloma}}
-*Very rare diagnosed.
-**If the person has a history of a low grade papillary urothelial carcinoma... it is a low grade papillary urothelial carcinoma.
-**These cases are a consensus diagnosis, i.e. you show it to a colleague... if they agree you can call it.
-===Microscopic===
-Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>
-*Papillary fronds.
-*Minimal branching or fusion.
-*Cytological features of normal urothelium.
-**Normal urothelium approx. 2x the size of stromal lymphocytes.<ref name=Ref_GUP161>{{Ref GUP|161}}</ref>
-*No mitoses.
-*Thickness < 7 cells.{{fact}}
-DDx:
-*[[Low grade papillary urothelial carcinoma]].
-*[[PUNLMP]].
 ==Inverted urothelial papilloma==
 *[[AKA]] ''[[inverted papilloma]]''.
+{{Main|Inverted urothelial papilloma}}
-===General===
-*May be confused with papillary urothelial carcinoma with an inverted growth pattern.
-===Microscopic===
-Features:
-*Like papillomas... but grow downward.<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>
-*According to THvdK,<ref>THvdK. 21 June 2010.</ref> ''inverted papillomas'' '''never''' have an exophytic component; if an exophytic component is present it is urothelial carcinoma.  This is disputed by one paper from Mexico that examines two cases.<ref name=pmid19433293>{{cite journal |author=Albores-Saavedra J, Chable-Montero F, Hernández-Rodríguez OX, Montante-Montes de Oca D, Angeles-Angeles A |title=Inverted urothelial papilloma of the urinary bladder with focal papillary pattern: a previously undescribed feature |journal=Ann Diagn Pathol |volume=13 |issue=3 |pages=158–61 |year=2009 |month=June |pmid=19433293 |doi=10.1016/j.anndiagpath.2009.02.009 |url=}}</ref>
-*Nests have peripheral palisading of nuclei - '''important'''.
-DDx:
-*[[Low grade papillary urothelial carcinoma]] with an inverted growth pattern.
-Images:
-*[http://commons.wikimedia.org/wiki/File:Inverted_papilloma_high_mag.jpg Inverted papilloma - high mag. (WC)].
-*[http://commons.wikimedia.org/wiki/File:Inverted_papilloma_intermed_mag.jpg Inverted papilloma - intermed. mag. (WC)].
 ==Papillary urothelial neoplasm of low malignant potential==
 *Abbreviated ''PUNLMP''.
+**This is pronounced ''pun-lump''.
+{{Main|Papillary urothelial neoplasm of low malignant potential}}
-===General===
+==Low-grade papillary urothelial carcinoma==
-*Uncommon: prevalence ~ 0-3.5%.<ref name=pmid19346063>{{cite journal |author=May M, Brookman-Amissah S, Roigas J, ''et al.'' |title=Prognostic Accuracy of Individual Uropathologists in Noninvasive Urinary Bladder Carcinoma: A Multicentre Study Comparing the 1973 and 2004 World Health Organisation Classifications |journal=Eur. Urol. |volume= 57|issue= 5|pages= 850|year=2009 |month=March |pmid=19346063 |doi=10.1016/j.eururo.2009.03.052 |url=}}</ref>
-*PUNLMP vs. [[low grade papillary urothelial carcinoma]] has a poor inter-rater reliability.<ref name=pmid17095142>{{cite journal |author=MacLennan GT, Kirkali Z, Cheng L |title=Histologic grading of noninvasive papillary urothelial neoplasms |journal=Eur. Urol. |volume=51 |issue=4 |pages=889–97; discussion 897–8 |year=2007 |month=April |pmid=17095142 |doi=10.1016/j.eururo.2006.10.037 |url=}}</ref>
-Treatment:
-*Excision and on-going follow-up - like non-invasive [[low grade papillary urothelial carcinoma]].<ref name=pmid16697785>{{cite journal |author=Jones TD, Cheng L |title=Papillary urothelial neoplasm of low malignant potential: evolving terminology and concepts |journal=J. Urol. |volume=175 |issue=6 |pages=1995–2003 |year=2006 |month=June |pmid=16697785 |doi=10.1016/S0022-5347(06)00267-9 |url=}}</ref>
-===Microscopic===
-Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>
-*Rare fused papillae.
-*Infrequent mitoses.
-*Nuclei larger than papilloma - but monotonous.<ref name=Ref_GUP170>{{Ref GUP|170}}</ref>
-DDx:
-*[[Low grade papillary urothelial carcinoma]].
-*[[Urothelial papilloma|Papilloma]].
-Images:
-*[http://en.wikipedia.org/wiki/File:Punlmp1.jpg PUNLMP - low mag. (WC)].
-*[http://en.wikipedia.org/wiki/File:Punlmp2.jpg PUNLMP - high mag. (WC)].
-==Low grade papillary urothelial carcinoma==
 *Abbreviated ''LGPUC''.<ref name=pmid22857755>{{Cite journal  | last1 = Watts | first1 = KE. | last2 = Montironi | first2 = R. | last3 = Mazzucchelli | first3 = R. | last4 = van der Kwast | first4 = T. | last5 = Osunkoya | first5 = AO. | last6 = Stephenson | first6 = AJ. | last7 = Hansel | first7 = DE. | title = Clinicopathologic characteristics of 23 cases of invasive low-grade papillary urothelial carcinoma. | journal = Urology | volume = 80 | issue = 2 | pages = 361-6 | month = Aug | year = 2012 | doi = 10.1016/j.urology.2012.04.010 | PMID = 22857755 }}</ref>
-*[[AKA]] ''low grade papillary urothelial cell carcinoma''.
+*[[AKA]] ''low-grade papillary urothelial cell carcinoma''.
+{{Main|Low-grade papillary urothelial carcinoma}}
-===General===
-*Very common.
-*Very good prognosis - if it is non-invasive.
-===Microscopic===
-Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>
-*Fused papillae.
-*Papillae branch.
-*Larger nuclei than PUNLMPs.
-*+/-Invasion into the lamina propria.
-Note:
-*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.<ref name=pmid7879346>{{Cite journal  | last1 = Bochner | first1 = BH. | last2 = Nichols | first2 = PW. | last3 = Skinner | first3 = DG. | title = Overstaging of transitional cell carcinoma: clinical significance of lamina propria fat within the urinary bladder. | journal = Urology | volume = 45 | issue = 3 | pages = 528-31 | month = Mar | year = 1995 | doi = 10.1016/S0090-4295(99)80030-2 | PMID = 7879346 }}</ref>
-DDx:
-*[[PUNLMP]].
-*[[High grade papillary urothelial carcinoma]] - "often" under-diagnosed (~15% in one series) when reassessed by experts.<ref name=pmid20670136>{{Cite journal  | last1 = Miyamoto | first1 = H. | last2 = Brimo | first2 = F. | last3 = Schultz | first3 = L. | last4 = Ye | first4 = H. | last5 = Miller | first5 = JS. | last6 = Fajardo | first6 = DA. | last7 = Lee | first7 = TK. | last8 = Epstein | first8 = JI. | last9 = Netto | first9 = GJ. | title = 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. | journal = Arch Pathol Lab Med | volume = 134 | issue = 8 | pages = 1160-3 | month = Aug | year = 2010 | doi = 10.1043/2009-0403-OA.1 | PMID = 20670136 }}</ref>
-===Sign out===
-<pre>
-URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION OF BLADDER TUMOUR (TURBT):
-- LOW-GRADE PAPILLARY UROTHELIAL CARCINOMA.
-- NEGATIVE FOR LAMINA PROPRIA INVASION.
-- NO MUSCULARIS PROPRIA IDENTIFIED.
-</pre>
-<pre>
-URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION OF BLADDER TUMOUR (TURBT):
-- LOW-GRADE PAPILLARY UROTHELIAL CARCINOMA.
-- NEGATIVE FOR LAMINA PROPRIA INVASION.
-- MUSCULARIS PROPRIA PRESENT.
-</pre>
-==High grade papillary urothelial carcinoma==
+==High-grade papillary urothelial carcinoma==
 *Abbreviated ''HGPUC''.
-*[[AKA]] ''high grade urothelial cell carcinoma'', abbreviated ''high grade UCC''.
+*[[AKA]] ''high-grade papillary urothelial cell carcinoma'', abbreviated ''HGPUCC''.
+{{Main|High-grade papillary urothelial carcinoma}}
-===General===
+==Papillary urothelial hyperplasia==
-*Aggressive.
+*[[AKA]] ''papillary hyperplasia''.
+*[[AKA]] ''reactive papillary hyperplasia''.
+{{Main|Papillary urothelial hyperplasia}}
-===Microscopic===
+=Benign urothelial lesions=
-Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>
+===Cystitis===
-*"High grade nuclear features":
+*Inflammation of the [[urinary bladder]].
-**Nuclear pleomorphism - often 4-5x the size of stromal lymphocytes.<ref name=Ref_GUP161>{{Ref GUP|161}}</ref>
+*Comes in many forms (see below).
-*Architectural complexity.
+*Typically a [[clinical diagnosis]] under the more general term [[urinary tract infection]].
-**Fused papillary common.
-**Papillae branch.
-*Mitoses common.
-*+/-Invasion into the lamina propria.
 Note:
-*The presence/absence of muscle should be commented on in biopsy specimens.
+*So called "[[giant cell cystitis]]" is dealt with separately; it is a benign non-pathologic change that may or may not be associated with inflammation.<ref name=Ref_Amin2_6>{{Ref Amin|2:6}}</ref>
-*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.<ref name=pmid7879346>{{Cite journal  | last1 = Bochner | first1 = BH. | last2 = Nichols | first2 = PW. | last3 = Skinner | first3 = DG. | title = Overstaging of transitional cell carcinoma: clinical significance of lamina propria fat within the urinary bladder. | journal = Urology | volume = 45 | issue = 3 | pages = 528-31 | month = Mar | year = 1995 | doi = 10.1016/S0090-4295(99)80030-2 | PMID = 7879346 }}</ref>
-DDx:
+===The big table of cystitis===
-*[[Low grade papillary urothelial carcinoma]].
-===Sign out===
-<pre>
-URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION URINARY BLADDER TUMOUR (TURBT):
-- INVASIVE HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMA WITH LAMINA PROPRIA INVASION.
-- MUSCULARIS PROPRIA NEGATIVE FOR INVASIVE MALIGNANCY.
-- NEGATIVE FOR LYMPHOVASCULAR INVASION.
-</pre>
-====Invasion into the muscularis propria====
-<pre>
-URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION URINARY BLADDER TUMOUR (TURBT):
-- INVASIVE HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMA AT LEAST INTO MUSCULARIS PROPRIA.
-- LYMPHOVASCULAR INVASION PRESENT.
-</pre>
-=Benign urothelial lesions=
-The big table of cystitis:
 {| class="wikitable sortable"
 ! Type
@@ Line 548: / Line 396: @@
 | <ref name=Ref_GUP120>{{Ref GUP|120}}</ref>
 |-
-|Interstitial cystitis
+|[[Interstitial cystitis]]
 | +/-ulceration (uncommon) - requires clinical correlation
 | urothelial CIS
@@ Line 575: / Line 423: @@
 ==Interstitial cystitis==
-*[[AKA]] ''painful bladder syndrome''.<ref name=pmid21609485>{{Cite journal  | last1 = Tanaka | first1 = T. | last2 = Nitta | first2 = Y. | last3 = Morimoto | first3 = K. | last4 = Nishikawa | first4 = N. | last5 = Nishihara | first5 = C. | last6 = Tamada | first6 = S. | last7 = Kawashima | first7 = H. | last8 = Nakatani | first8 = T. | title = Hyperbaric oxygen therapy for painful bladder syndrome/interstitial cystitis resistant to conventional treatments: long-term results of a case series in Japan. | journal = BMC Urol | volume = 11 | issue =  | pages = 11 | month =  | year = 2011 | doi = 10.1186/1471-2490-11-11 | PMID = 21609485 }}</ref><ref name=pmid21568251>{{Cite journal  | last1 = French | first1 = LM. | last2 = Bhambore | first2 = N. | title = Interstitial cystitis/painful bladder syndrome. | journal = Am Fam Physician | volume = 83 | issue = 10 | pages = 1175-81 | month = May | year = 2011 | doi =  | PMID = 21568251 }}</ref>
+{{Main|Interstitial cystitis}}
-===General===
-*Chronic cystitis, culture negative.
-*Treatment difficult.<ref name=pmid21609485/>
-Epidemiology:<ref name=pmid21568251/>
-*Women > men.
-Symptoms:<ref name=pmid21568251/>
-*Urgency.
-*Frequency.
-*Pain.
-===Microscopic===
-Features:<ref name=Ref_GUP124>{{Ref GUP|124}}</ref>
-*+/-Ulceration (uncommon).
-Note:
-*[[Diagnosis]] requires clinical correlation.
-DDx:
-*Urothelial CIS.
 ==Follicular cystitis==
@@ Line 648: / Line 475: @@
 *[[Nested urothelial cell carcinoma]].<ref name=pmid12960809>{{Cite journal  | last1 = Volmar | first1 = KE. | last2 = Chan | first2 = TY. | last3 = De Marzo | first3 = AM. | last4 = Epstein | first4 = JI. | title = Florid von Brunn nests mimicking urothelial carcinoma: a morphologic and immunohistochemical comparison to the nested variant of urothelial carcinoma. | journal = Am J Surg Pathol | volume = 27 | issue = 9 | pages = 1243-52 | month = Sep | year = 2003 | doi =  | PMID = 12960809 }}</ref>
 *[[Inverted urothelial papilloma|Inverted papilloma]].
+*[[Cystitis cystica]] - have lumens, may be focal.
 ===IHC===
@@ Line 655: / Line 483: @@
 ==Cystitis cystica==
-===General===
+{{Main|Cystitis cystica}}
-*Benign.
-*Can be thought of as [[von Brunn nests]] with cystic change.<ref name=Ref_WMSP304>{{Ref WMSP|304}}</ref>
-*Called ''[[ureteritis cystica]]'' if it happens in a [[ureter]].
-===Microscopic===
-Features:<ref name=Ref_PBoD1028>{{Ref PBoD|1028}}</ref>
-*Nests of urothelium within the lamina propria with cyst formation, i.e. lumens are present.
-Note:
-*Nests should '''not''' extend into the muscularis propria.
 ==Cystitis glandularis==
-:''Cystitis cystica et glandularis'' redirects to here.
+{{Main|Cystitis glandularis}}
-===General===
-*Benign.
-*Can be thought of as [[cystitis cystica]] with mucin-secreting cells lining the cystic spaces.<ref name=Ref_WMSP304>{{Ref WMSP|304}}</ref>
-*When seen in conjunction with ''cystitis cystica'' it is called ''cystitis cystica et glandularis''.
-Note:
-*There are case reports of ''urethritis glandularis'' - the same lesion in the [[urethra]].<ref name=pmid11104631>{{Cite journal  | last1 = Chan | first1 = YM. | last2 = Ka-Leung Cheng | first2 = D. | last3 = Nga-Yin Cheung | first3 = A. | last4 = Yuen-Sheung Ngan | first4 = H. | last5 = Wong | first5 = LC. | title = Female urethral adenocarcinoma arising from urethritis glandularis. | journal = Gynecol Oncol | volume = 79 | issue = 3 | pages = 511-4 | month = Dec | year = 2000 | doi = 10.1006/gyno.2000.5968 | PMID = 11104631 }}</ref><ref name=pmid17825180>{{Cite journal  | last1 = Yin | first1 = G. | last2 = Liu | first2 = YQ. | last3 = Gao | first3 = P. | last4 = Wang | first4 = XH. | title = Male urethritis glandularis: case report. | journal = Chin Med J (Engl) | volume = 120 | issue = 16 | pages = 1460-1 | month = Aug | year = 2007 | doi =  | PMID = 17825180 }}</ref>
-===Microscopic===
-Features:<ref name=Ref_PBoD1028>{{Ref PBoD|1028}}</ref>
-*Nests of urothelium within the lamina propria with cyst formation, i.e. lumens are present.
-*Cyst lining cells are cuboidal and/or columnar epithelium.
-**Produce mucin.
-*+/-Goblet cells, i.e. intestinal metaplasia.<ref name=Ref_WMSP304>{{Ref WMSP|304}}</ref>
-Note:
-*Nests should '''not''' extend into the muscularis propria.
-===Sign out===
-<pre>
-URINARY BLADDER NECK, BIOPSY:
-- CYSTITIS CYSTICA ET GLANDULARIS.
-- NEGATIVE FOR MALIGNANCY.
-</pre>
 ==Malakoplakia==
@@ Line 698: / Line 492: @@
 ==Nephrogenic adenoma==
-*[[AKA]] ''mesonephric adenoma'',<ref name=pmid21716880>{{Cite journal  | last1 = Singh | first1 = KJ. | title = Mesonephric adenoma in remnant ureteric stump: A rare entity. | journal = Indian J Urol | volume = 27 | issue = 1 | pages = 140-1 | month = Jan | year = 2011 | doi = 10.4103/0970-1591.78414 | PMID = 21716880 }}</ref> [[AKA]] ''nephrogenic metaplasia''.
+*[[AKA]] ''mesonephric adenoma''.
+*[[AKA]] ''nephrogenic metaplasia''.
-===General===
+{{Main|Nephrogenic adenoma}}
-Features:<ref name=pmid12118115>{{Cite journal  | last1 = Gokaslan | first1 = ST. | last2 = Krueger | first2 = JE. | last3 = Albores-Saavedra | first3 = J. | title = Symptomatic nephrogenic metaplasia of ureter: a morphologic and immunohistochemical study of four cases. | journal = Mod Pathol | volume = 15 | issue = 7 | pages = 765-70 | month = Jul | year = 2002 | doi = 10.1097/01.MP.0000019578.51568.24 | PMID = 12118115 | url = http://www.nature.com/modpathol/journal/v15/n7/full/3880603a.html }}</ref>
-*Benign.
-**May mimic adenocarcinoma!
-*Classic location is the [[urinary bladder]].
-**Also reported in ureter and prostatic urethra.
-*It is thought to result from displacement of renal tubular cells, as this entity in renal transplant recipients is graft derived.<ref>{{Cite journal  | last1 = Mazal | first1 = PR. | last2 = Schaufler | first2 = R. | last3 = Altenhuber-Müller | first3 = R. | last4 = Haitel | first4 = A. | last5 = Watschinger | first5 = B. | last6 = Kratzik | first6 = C. | last7 = Krupitza | first7 = G. | last8 = Regele | first8 = H. | last9 = Meisl | first9 = FT. | title = Derivation of nephrogenic adenomas from renal tubular cells in kidney-transplant recipients. | journal = N Engl J Med | volume = 347 | issue = 9 | pages = 653-9 | month = Aug | year = 2002 | doi = 10.1056/NEJMoa013413 | PMID = 12200552 }}</ref>
-===Microscopic===
-Features:<ref name=pmid12118115>{{Cite journal  | last1 = Gokaslan | first1 = ST. | last2 = Krueger | first2 = JE. | last3 = Albores-Saavedra | first3 = J. | title = Symptomatic nephrogenic metaplasia of ureter: a morphologic and immunohistochemical study of four cases. | journal = Mod Pathol | volume = 15 | issue = 7 | pages = 765-70 | month = Jul | year = 2002 | doi = 10.1097/01.MP.0000019578.51568.24 | PMID = 12118115 | url = http://www.nature.com/modpathol/journal/v15/n7/full/3880603a.html }}</ref>
-*Tubular structures - '''key feature'''.
-**Hobnailed cells.
-**+/-Thick eosinophilic basement membrane.
-**Microcystic appearance.
-*Usually associated with chronic inflammation.
-Notes:
-*May mimic vascular/lymphatic channels - can be sorted-out with IHC.
-DDx:
-*[[Urothelial carcinoma]], microcystic and nested variants.
-*[[Prostatic adenocarcinoma]].
-*[[Clear cell adenocarcinoma]].
-Images:
-*www:
-**[http://www.archivesofpathology.org/action/showFullPopup?id=i1543-2165-134-10-1455-f01&doi=10.1043%2F2010-0226-CR.1 NA (archivesofpathology.org)].<ref name=pmid20923300>{{Cite journal  | last1 = Kunju | first1 = LP. | title = Nephrogenic adenoma: report of a case and review of morphologic mimics. | journal = Arch Pathol Lab Med | volume = 134 | issue = 10 | pages = 1455-9 | month = Oct | year = 2010 | doi = 10.1043/2010-0226-CR.1 | PMID = 20923300 }}</ref>
-*[[WC]]:
-**[http://commons.wikimedia.org/wiki/File:Nephrogenic_adenoma_-_intermed_mag.jpg Nephrogenic adenoma - intermed. mag. (WC)].
-**[http://commons.wikimedia.org/wiki/File:Nephrogenic_adenoma_-_very_high_mag.jpg Nephrogenic adenoma - very high mag. (WC)].
-===IHC===
-Features:<ref name=pmid22415059>{{Cite journal  | last1 = Alexiev | first1 = BA. | last2 = Levea | first2 = CM. | title = Nephrogenic Adenoma of the Urinary Tract: A Review. | journal = Int J Surg Pathol | volume =  | issue =  | pages =  | month = Mar | year = 2012 | doi = 10.1177/1066896912439095 | PMID = 22415059 }}</ref>
-*CK7 +ve.
-*PAX2 +ve.
-*PAX8 +ve.
-*AMACR +ve/-ve.
-Others:<ref name=pmid12118115>{{Cite journal  | last1 = Gokaslan | first1 = ST. | last2 = Krueger | first2 = JE. | last3 = Albores-Saavedra | first3 = J. | title = Symptomatic nephrogenic metaplasia of ureter: a morphologic and immunohistochemical study of four cases. | journal = Mod Pathol | volume = 15 | issue = 7 | pages = 765-70 | month = Jul | year = 2002 | doi = 10.1097/01.MP.0000019578.51568.24 | PMID = 12118115 }}</ref>
-*p53 -ve.
-*CEA -ve.
-*Ki-67 low (<5%).
 =See also=

Difference between revisions of "Urothelium"

Urothelium (view source)

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