Difference between revisions of "Urothelial dysplasia"

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{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Urothelial dysplasia - alt -- high mag.jpg
| Width      =
| Caption    = Urothelial dysplasia. [[H&E stain]].
| Synonyms  = low-grade urothelial dysplasia
| Micro      = mild nuclear enlargement (~3x a resting lymphocyte) and hyperchromasia, mild disorganization of the architecture (some maturation), occasional mitotic figures - none atypical
| Subtypes  =
| LMDDx      = reactive changes, urothelial atypia of unknown significance, [[urothelial carcinoma in situ]]
| Stains    =
| IHC        = CK20 +ve/-ve (esp. non-umbrella cells), Ki-67 +ve/-ve (>10%), p53 +ve/-ve (>20%)
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[urothelium]] (renal pelvis, [[urinary bladder]], [[ureters]], [[urethra]])
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = pre-malignant
| Other      =
| ClinDDx    =
| Tx        =
}}
'''Urothelial dysplasia''', also '''low-grade (urothelial) dysplasia''', is a lesion of the [[urothelium]] in the ISUP/WHO 2004 classification.<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>
'''Urothelial dysplasia''', also '''low-grade (urothelial) dysplasia''', is a lesion of the [[urothelium]] in the ISUP/WHO 2004 classification.<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>
It is precursor lesion to [[urothelial carcinoma]] that is less worrisome than [[urothelial carcinoma in situ]] (also known as ''high-grade (urothelial) dysplasia'').
It is precursor lesion to [[urothelial carcinoma]] that is less worrisome than [[urothelial carcinoma in situ]] (also known as ''high-grade (urothelial) dysplasia'').


==General==
==General==
The ISUP/WHO classification of flat urothelial lesions 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>
The [[ISUP]]/WHO classification of flat urothelial lesions 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.
*Reactive urothelial atypia.
*Flat urothelial hyperplasia.
*Flat urothelial hyperplasia.
Line 15: Line 47:
*Mild nuclear enlargement (~3x a resting lymphocyte) and hyperchromasia.
*Mild nuclear enlargement (~3x a resting lymphocyte) and hyperchromasia.
*Slight disorganization of the architecture.
*Slight disorganization of the architecture.
**Some maturation to the surface.
**Some maturation to the surface - '''important'''.
*Mitotic figures - occasional, none atypical.
*Mitotic figures - occasional, none atypical.
Notes:
*It is probably not a good idea to make this diagnosis without immunohistochemistry.
*This diagnosis '''not''' made on [[frozen section]].


DDx:
DDx:
*[[Urothelial carcinoma in situ]].
*Benign urothelium with reactive changes.
*[[Urothelial carcinoma in situ]] - no maturation to the surface or marked atypia - as in pagetoid [[UCIS]] and undermining UCIS.<ref name=pmid11224606>{{Cite journal  | last1 = McKenney | first1 = JK. | last2 = Gomez | first2 = JA. | last3 = Desai | first3 = S. | last4 = Lee | first4 = MW. | last5 = Amin | first5 = MB. | title = Morphologic expressions of urothelial carcinoma in situ: a detailed evaluation of its histologic patterns with emphasis on carcinoma in situ with microinvasion. | journal = Am J Surg Pathol | volume = 25 | issue = 3 | pages = 356-62 | month = Mar | year = 2001 | doi =  | PMID = 11224606 }}</ref>


===Images===
===Images===
<gallery>
Image: Urothelial dysplasia -- low mag.jpg | UD - low mag. (WC)
Image: Urothelial dysplasia -- intermed mag.jpg | UD - intermed. mag. (WC)
Image: Urothelial dysplasia -- high mag.jpg | UD - high mag. (WC)
Image: Urothelial dysplasia - alt -- high mag.jpg | UD - high mag. (WC)
Image: Urothelial dysplasia -- very high mag.jpg | UD - very high mag. (WC)
Image: Urothelial dysplasia - CK20 -- intermed mag.jpg | UD - intermed. mag. (WC)
Image: Urothelial dysplasia - CK20 -- high mag.jpg | UD - high mag. (WC)
</gallery>
www:
*[http://pathology.jhu.edu/bladder/image1.cfm?case_number=10&image_number=1 Urothelial dysplasia (jhu.edu)].
*[http://pathology.jhu.edu/bladder/image1.cfm?case_number=10&image_number=1 Urothelial dysplasia (jhu.edu)].


==IHC==
==IHC==
Benign/dysplasia/CIS - a comparison:<ref name=pmid12640096>{{Cite journal  | last1 = Mallofré | first1 = C. | last2 = Castillo | first2 = M. | last3 = Morente | first3 = V. | last4 = Solé | first4 = M. | title = Immunohistochemical expression of CK20, p53, and Ki-67 as objective markers of urothelial dysplasia. | journal = Mod Pathol | volume = 16 | issue = 3 | pages = 187-91 | month = Mar | year = 2003 | doi = 10.1097/01.MP.0000056628.38714.5D | PMID = 12640096 }}</ref>
A comparison between benign, dysplasia and [[UCIS]]:<ref name=pmid12640096>{{Cite journal  | last1 = Mallofré | first1 = C. | last2 = Castillo | first2 = M. | last3 = Morente | first3 = V. | last4 = Solé | first4 = M. | title = Immunohistochemical expression of CK20, p53, and Ki-67 as objective markers of urothelial dysplasia. | journal = Mod Pathol | volume = 16 | issue = 3 | pages = 187-91 | month = Mar | year = 2003 | doi = 10.1097/01.MP.0000056628.38714.5D | PMID = 12640096 }}</ref>
{| class="wikitable sortable"  
{| class="wikitable sortable"  
! Diagnosis
! Diagnosis
Line 31: Line 80:
! Ki-67
! Ki-67
! p53
! p53
! p63 ‡
|-
|-
| Benign
| Benign (reactive)
| +ve -- umbrella cells only
| umbrella cells +ve only
| +/-basal <10%
| -ve <=10% of cells (+/-rare basal cells)
| +/-basal weak
| -ve <20% of cells (+/-weak staining)
| -ve surface cells
|-
|-
| Urothelial dysplasia
| Urothelial dysplasia
| +ve ~30% of cases
| +ve non-umbrella cells +ve (~30% of cases)
| +ve ~40% of cases
| +ve >10% of cells (~40% of cases)
| +ve ~70% of cases
| +ve >=20% of cells (~70% of cases)
| -ve surface cells<ref name=pmid19690775>{{Cite journal  | last1 = Stepan | first1 = A. | last2 = Mărgăritescu | first2 = C. | last3 = Simionescu | first3 = C. | last4 = Ciurea | first4 = R. | title = E-cadherin and p63 immunoexpression in dysplastic lesions and urothelial carcinomas of the bladder. | journal = Rom J Morphol Embryol | volume = 50 | issue = 3 | pages = 461-5 | month =  | year = 2009 | doi =  | PMID = 19690775 }}</ref><ref name=OJP>{{Cite journal | last1 = Raheem| first1 = Sayad A.| last2 = Saied | first2 = Abdel N. | last3 = Al Shaer | first3 =  Rabee | last4 =  Mustafa | first4 = Osama | last5 = Ali | first5 = Ali H.  | title = The Role of CK20, p53 and p63 in Differentiation of Some Urothelial Lesions of Urinary Bladder, Immunohistochemical Study  | journal = [http://www.scirp.org/journal/ojpathology Open Journal of Pathology] | volume = | issue = 4| pages = 181-193 | month = | year = 2014 | doi = 10.4236/ojpathology.2014.44024 | PMID = | PMC = | url = }}</ref>
|-
|-
| [[Urothelial carcinoma in situ|Carcinoma in situ]]
| [[Urothelial carcinoma in situ|Urothelial carcinoma in situ]] (UCIS)
| full thickness ~70% of cases
| +ve non-umbrella cells (~70% of cases)
| >10% ~95% of cases
| +ve >10% of cells (~95% of cases)
| +ve ~80% of cases
| +ve >=20% of cells (~80% of cases)
| +ve surface cells<ref name=pmid19690775/><ref name=OJP/>
|}
|}
Note:
*‡ Morphology is considered the gold standard for UCIS versus urothelial dysplasia;<ref name=pmid25029121>{{cite journal |authors=Amin MB, Trpkov K, Lopez-Beltran A, Grignon D |title=Best practices recommendations in the application of immunohistochemistry in the bladder lesions: report from the International Society of Urologic Pathology consensus conference |journal=Am J Surg Pathol |volume=38 |issue=8 |pages=e20–34 |date=August 2014 |pmid=25029121 |doi=10.1097/PAS.0000000000000240 |url=}}</ref> however, there is a small literature on [[p63]] for dysplasia versus UCIS that is published in lesser known journals.
==Sign out==
<pre>
Urinary Bladder, Biopsy:
    - Urothelial dysplasia, see comment.
    - Giant cell reaction and chronic inflammation.
Comment:
The urothelium has moderate CK20 staining that extends to the basement membrane. A p53 stain is negative (<10% staining). A Ki-67 stain shows increased staining (marks 20% of urothelium). A p63 stain shows weak/negative surface staining.
</pre>
===Block letters===
<pre>
RIGHT URETER (MARGIN), EXCISION:
    - UROTHELIAL DYSPLASIA, SEE COMMENT.
    - NEGATIVE FOR UROTHELIAL CARCINOMA.
COMMENT:
There is focal non-umbrella cell CK20 staining, 10% (focal) urothelial
p53 staining, and 30% (focal) urothelial Ki-67 staining. The findings
are that of (low-grade) urothelial dysplasia.
</pre>


==See also==
==See also==

Latest revision as of 19:38, 31 December 2020

Urothelial dysplasia
Diagnosis in short

Urothelial dysplasia. H&E stain.
Synonyms low-grade urothelial dysplasia
LM mild nuclear enlargement (~3x a resting lymphocyte) and hyperchromasia, mild disorganization of the architecture (some maturation), occasional mitotic figures - none atypical
LM DDx reactive changes, urothelial atypia of unknown significance, urothelial carcinoma in situ
IHC CK20 +ve/-ve (esp. non-umbrella cells), Ki-67 +ve/-ve (>10%), p53 +ve/-ve (>20%)
Site urothelium (renal pelvis, urinary bladder, ureters, urethra)
Prevalence common
Prognosis pre-malignant

Urothelial dysplasia, also low-grade (urothelial) dysplasia, is a lesion of the urothelium in the ISUP/WHO 2004 classification.[1]

It is precursor lesion to urothelial carcinoma that is less worrisome than urothelial carcinoma in situ (also known as high-grade (urothelial) dysplasia).

General

The ISUP/WHO classification of flat urothelial lesions is:[1]

  • Reactive urothelial atypia.
  • Flat urothelial hyperplasia.
  • Urothelial atypia of unknown significance.
  • Urothelial dysplasia (low-grade dysplasia).
  • Urothelial carcinoma in situ (high-grade dysplasia).
  • Invasive urothelial carcinoma.

Microscopic

Features:[2]

  • Mild nuclear enlargement (~3x a resting lymphocyte) and hyperchromasia.
  • Slight disorganization of the architecture.
    • Some maturation to the surface - important.
  • Mitotic figures - occasional, none atypical.

Notes:

  • It is probably not a good idea to make this diagnosis without immunohistochemistry.
  • This diagnosis not made on frozen section.

DDx:

Images

  • UD - low mag. (WC)

  • UD - intermed. mag. (WC)

  • UD - high mag. (WC)

  • UD - high mag. (WC)

  • UD - very high mag. (WC)

  • UD - intermed. mag. (WC)

  • UD - high mag. (WC)

www:

IHC

A comparison between benign, dysplasia and UCIS:[4]

Diagnosis CK20 Ki-67 p53 p63 ‡
Benign (reactive) umbrella cells +ve only -ve <=10% of cells (+/-rare basal cells) -ve <20% of cells (+/-weak staining) -ve surface cells
Urothelial dysplasia +ve non-umbrella cells +ve (~30% of cases) +ve >10% of cells (~40% of cases) +ve >=20% of cells (~70% of cases) -ve surface cells[5][6]
Urothelial carcinoma in situ (UCIS) +ve non-umbrella cells (~70% of cases) +ve >10% of cells (~95% of cases) +ve >=20% of cells (~80% of cases) +ve surface cells[5][6]

Note:

  • ‡ Morphology is considered the gold standard for UCIS versus urothelial dysplasia;[7] however, there is a small literature on p63 for dysplasia versus UCIS that is published in lesser known journals.

Sign out

Urinary Bladder, Biopsy:
     - Urothelial dysplasia, see comment.
     - Giant cell reaction and chronic inflammation.

Comment:
The urothelium has moderate CK20 staining that extends to the basement membrane. A p53 stain is negative (<10% staining). A Ki-67 stain shows increased staining (marks 20% of urothelium). A p63 stain shows weak/negative surface staining.

Block letters

RIGHT URETER (MARGIN), EXCISION: 
     - UROTHELIAL DYSPLASIA, SEE COMMENT.
     - NEGATIVE FOR UROTHELIAL CARCINOMA.

COMMENT:
There is focal non-umbrella cell CK20 staining, 10% (focal) urothelial 
p53 staining, and 30% (focal) urothelial Ki-67 staining. The findings 
are that of (low-grade) urothelial dysplasia.

See also

References

  1. ↑ 1.0 1.1 Hodges, KB.; Lopez-Beltran, A.; Davidson, DD.; Montironi, R.; Cheng, L. (Feb 2010). "Urothelial dysplasia and other flat lesions of the urinary bladder: clinicopathologic and molecular features.". Hum Pathol 41 (2): 155-62. doi:10.1016/j.humpath.2009.07.002. PMID 19762067.
  2. ↑ URL: http://pathology.jhu.edu/bladder/image1.cfm?case_number=10&image_number=1. Accessed on: 31 December 2013.
  3. ↑ McKenney, JK.; Gomez, JA.; Desai, S.; Lee, MW.; Amin, MB. (Mar 2001). "Morphologic expressions of urothelial carcinoma in situ: a detailed evaluation of its histologic patterns with emphasis on carcinoma in situ with microinvasion.". Am J Surg Pathol 25 (3): 356-62. PMID 11224606.
  4. ↑ Mallofré, C.; Castillo, M.; Morente, V.; Solé, M. (Mar 2003). "Immunohistochemical expression of CK20, p53, and Ki-67 as objective markers of urothelial dysplasia.". Mod Pathol 16 (3): 187-91. doi:10.1097/01.MP.0000056628.38714.5D. PMID 12640096.
  5. ↑ 5.0 5.1 Stepan, A.; Mărgăritescu, C.; Simionescu, C.; Ciurea, R. (2009). "E-cadherin and p63 immunoexpression in dysplastic lesions and urothelial carcinomas of the bladder.". Rom J Morphol Embryol 50 (3): 461-5. PMID 19690775.
  6. ↑ 6.0 6.1 Raheem, Sayad A.; Saied, Abdel N.; Al Shaer, Rabee; Mustafa, Osama; Ali, Ali H. (2014). "The Role of CK20, p53 and p63 in Differentiation of Some Urothelial Lesions of Urinary Bladder, Immunohistochemical Study". Open Journal of Pathology (4): 181-193. doi:10.4236/ojpathology.2014.44024.
  7. ↑ Amin MB, Trpkov K, Lopez-Beltran A, Grignon D (August 2014). "Best practices recommendations in the application of immunohistochemistry in the bladder lesions: report from the International Society of Urologic Pathology consensus conference". Am J Surg Pathol 38 (8): e20–34. doi:10.1097/PAS.0000000000000240. PMID 25029121.
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