Difference between revisions of "Urothelium"

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→‎High grade papillary urothelial carcinoma: split-out
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{{Main|Low-grade papillary urothelial carcinoma}}
{{Main|Low-grade papillary urothelial carcinoma}}


==High grade papillary urothelial carcinoma==
==High-grade papillary urothelial carcinoma==
*Abbreviated ''HGPUC''.
*Abbreviated ''HGPUC''.
*[[AKA]] ''high grade papillary urothelial cell carcinoma'', abbreviated ''HGPUCC''.  
*[[AKA]] ''high-grade papillary urothelial cell carcinoma'', abbreviated ''HGPUCC''.
 
{{Main|High-grade papillary urothelial carcinoma}}
===General===
*Aggressive.
 
===Microscopic===
Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>
*"High grade nuclear features":
**Nuclear pleomorphism - often 4-5x the size of stromal lymphocytes.<ref name=Ref_GUP161>{{Ref GUP|161}}</ref>
*Architectural complexity.
**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.
*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:
*[[Low grade papillary urothelial carcinoma]].
 
===IHC===
*Ki-67:
**Rajcani ''et al.'':<ref name=pmid23944616>{{Cite journal  | last1 = Rajcani | first1 = J. | last2 = Kajo | first2 = K. | last3 = Adamkov | first3 = M. | last4 = Moravekova | first4 = E. | last5 = Lauko | first5 = L. | last6 = Felcanova | first6 = D. | last7 = Bencat | first7 = M. | title = Immunohistochemical characterization of urothelial carcinoma. | journal = Bratisl Lek Listy | volume = 114 | issue = 8 | pages = 431-8 | month =  | year = 2013 | doi =  | PMID = 23944616 }}</ref> <25% of tumour cells for low-grade versus >50% tumour cell for high-grade.
**Pich ''et al.'':<ref name=pmid7910097>{{Cite journal  | last1 = Pich | first1 = A. | last2 = Chiusa | first2 = L. | last3 = Comino | first3 = A. | last4 = Navone | first4 = R. | title = Cell proliferation indices, morphometry and DNA flow cytometry provide objective criteria for distinguishing low and high grade bladder carcinomas. | journal = Virchows Arch | volume = 424 | issue = 2 | pages = 143-8 | month =  | year = 1994 | doi =  | PMID = 7910097 }}</ref> 11%/17% for G1/G2 versus 34% for G3.
*p53 +ve - more common in pT2 than pT1 and HGPUC than LGPUC... but not useful to definitively separate.<ref name=pmid23924551>{{Cite journal  | last1 = Koyuncuer | first1 = A. | title = Immunohistochemical expression of p63, p53 in urinary bladder carcinoma. | journal = Indian J Pathol Microbiol | volume = 56 | issue = 1 | pages = 10-5 | month =  | year =  | doi = 10.4103/0377-4929.116141 | PMID = 23924551 }}</ref>
 
===Molecular===
Molecular changes:<ref name=pmid19468362>{{Cite journal  | last1 = Ehdaie | first1 = B. | last2 = Theodorescu | first2 = D. | title = Molecular markers in transitional cell carcinoma of the bladder: New insights into mechanisms and prognosis. | journal = Indian J Urol | volume = 24 | issue = 1 | pages = 61-7 | month = Jan | year = 2008 | doi = 10.4103/0970-1591.38606 | PMID = 19468362 | PMC = 2684226}}</ref>
*p53.
*p21.
*RB.
*E-cadherin - decreased bad.
*RhoGD12 - increased bad.
*VEGF - increased bad.
 
===Sign out===
<pre>
URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION:
- HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMA.
- NO LAMINA PROPRIA INVASION APPARENT.
- NEGATIVE FOR LYMPHOVASCULAR INVASION.
- NO MUSCULARIS PROPRIA IDENTIFIED.
</pre>
 
====Invasion into the lamina propria====
<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>
 
====Low-grade versus high-grade====
<pre>
URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION URINARY BLADDER TUMOUR (TURBT):
- HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMA, SEE COMMENT.
- NEGATIVE FOR LAMINA PROPRIA INVASION.
- NO MUSCULARIS PROPRIA PRESENT.
 
COMMENT:
The sections show papillary branching, papillary fusion and scattered large cells (~4-5 a
resting lymphocyte). Atypical for a high-grade lesion is that mitotic activity is scarce
and prominent nucleoli are not present.
</pre>
 
=====Micro=====
The sections show a small fragment of urothelial mucosa with two papillary structures,
enlarged nuclei (~3-4x resting lymphocyte) and moderate nuclear size variation.  Mitotic activity is seen focally. Umbrella
cells are seen only focally.
 
A mild lymphocyte-predominant inflammatory infiltrate is present. The lamina propria
contains a nest with smaller cells, cystic spaces and no appreciable mitoses
(cystitis cystica).


=Benign urothelial lesions=
=Benign urothelial lesions=
Michael
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