Difference between revisions of "Papillary urothelial hyperplasia"

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'''Papillary urothelial hyperplasia''' is a benign lesion of the [[urothelium]] that is associated with the subsequent development of low-grade papillary urothelial carcinoma.
'''Papillary urothelial hyperplasia''', abbreviated '''PUH''', is a benign lesion of the [[urothelium]] that is associated with the subsequent development of low-grade papillary urothelial carcinoma.


==General==
==General==
*Benign.
*Benign.
*Strong association with papillary neoplasms.
*Strong association with papillary neoplasms.
**On follow-up, in one study, >1/3 have a neoplasm; thus, follow-up is recommended.<ref name=pmid20438409>{{Cite journal  | last1 = Readal | first1 = N. | last2 = Epstein | first2 = JI. | title = Papillary urothelial hyperplasia: relationship to urothelial neoplasms. | journal = Pathology | volume = 42 | issue = 4 | pages = 360-3 | month = Jun | year = 2010 | doi = 10.3109/00313021003767322 | PMID = 20438409 }}</ref>
**On follow-up (in one study) >1/4, without prior history of urothelial neoplasia, have urothelial carcinoma; thus, follow-up is recommended.<ref name=pmid20438409>{{Cite journal  | last1 = Readal | first1 = N. | last2 = Epstein | first2 = JI. | title = Papillary urothelial hyperplasia: relationship to urothelial neoplasms. | journal = Pathology | volume = 42 | issue = 4 | pages = 360-3 | month = Jun | year = 2010 | doi = 10.3109/00313021003767322 | PMID = 20438409 }}</ref>


==Microscopic==
==Microscopic==
Features:<ref>URL: [http://pathology.jhu.edu/bladder/definitions.cfm http://pathology.jhu.edu/bladder/definitions.cfm]. Accessed on: 27 January 2014.</ref>
Features:<ref>URL: [http://pathology.jhu.edu/bladder/definitions.cfm http://pathology.jhu.edu/bladder/definitions.cfm]. Accessed on: 27 January 2014.</ref>
*Inflammation.
*Inflammation.
*Rare papillae
*Papillary structures without well-developed fibrovascular cores.
**Do not have a well-developed fibrovascular core.
**Tent-like appearance ''or'' spike-like appearance - short/stubby papillae not longer than the urothelium is thick.<ref>URL: [http://surgpathcriteria.stanford.edu/bladder/tcc-papillary-transitional-urothelial-carcinoma/ http://surgpathcriteria.stanford.edu/bladder/tcc-papillary-transitional-urothelial-carcinoma/]. Accessed on: 27 January 2014.</ref>
*No urothelial cell atypia.
*No urothelial cell atypia.


DDx:
DDx:
*[[Low-grade papillary urothelial carcinoma]].
*[[Low-grade papillary urothelial carcinoma]] - have well-developed fibrovascular core.
<!--
*[[PUNLMP]].
*[[PUNLMP]].
*[[Urothelial papilloma]].
*[[Urothelial papilloma]] - well-developed fibrovascular cores, uniform urothelial thickness.
 
-->
===Image===
===Image===
*[http://pathology.jhu.edu/bladder/image1.cfm?case_number=2&image_number=1 Papillary hyperplasia (jhu.edu)].
*[http://pathology.jhu.edu/bladder/image1.cfm?case_number=2&image_number=1 Papillary hyperplasia (jhu.edu)].
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The urothelium stains as follow:
The urothelium stains as follow:
CK7: positive (patchy).
CK7: positive, patchy (normal).
CK20: very rare superficial cells (normal).
CK20: only rare superficial cells (normal).
Ki-67: rare, focally increased, negative in papillary structures (<10%).
Ki-67: rare, focally increased, negative in papillary structures (<10%).
p53: negative (weak focal <20%), very rare weak in rare papillary structures (<5%).
p53: negative (weak focal <20%), very rare weak in rare papillary structures (<5%).

Latest revision as of 19:56, 27 January 2014

Papillary urothelial hyperplasia, abbreviated PUH, is a benign lesion of the urothelium that is associated with the subsequent development of low-grade papillary urothelial carcinoma.

General

  • Benign.
  • Strong association with papillary neoplasms.
    • On follow-up (in one study) >1/4, without prior history of urothelial neoplasia, have urothelial carcinoma; thus, follow-up is recommended.[1]

Microscopic

Features:[2]

  • Inflammation.
  • Papillary structures without well-developed fibrovascular cores.
    • Tent-like appearance or spike-like appearance - short/stubby papillae not longer than the urothelium is thick.[3]
  • No urothelial cell atypia.

DDx:

Image

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URINARY BLADDER, BIOPSY:
- REACTIVE PAPILLARY HYPERPLASIA, SEE COMMENT.
- NO MUSCULARIS PROPRIA IDENTIFIED.
- CYSTITIS CYSTICA ET GLANDULARIS.
- NO EVIDENCE OF MALIGNANCY.

COMMENT:
The urothelial forms rare papillary structures; these are interpreted as reactive.

The urothelium stains as follow:
CK7: positive, patchy (normal).
CK20: only rare superficial cells (normal).
Ki-67: rare, focally increased, negative in papillary structures (<10%).
p53: negative (weak focal <20%), very rare weak in rare papillary structures (<5%).

Follow-up is recommended.

See also

References

  1. ↑ Readal, N.; Epstein, JI. (Jun 2010). "Papillary urothelial hyperplasia: relationship to urothelial neoplasms.". Pathology 42 (4): 360-3. doi:10.3109/00313021003767322. PMID 20438409.
  2. ↑ URL: http://pathology.jhu.edu/bladder/definitions.cfm. Accessed on: 27 January 2014.
  3. ↑ URL: http://surgpathcriteria.stanford.edu/bladder/tcc-papillary-transitional-urothelial-carcinoma/. Accessed on: 27 January 2014.
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