Difference between revisions of "Urothelial dysplasia"
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DDx: | DDx: | ||
*Benign urothelium with reactive changes. | *Benign urothelium with reactive changes. | ||
*[[Urothelial carcinoma in situ]] - no maturation to the surface or marked atypia | *[[Urothelial carcinoma in situ]] - no maturation to the surface or marked atypia - as in pagetoid spread, 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=== | ||
Revision as of 20:35, 28 August 2015
| Urothelial dysplasia | |
|---|---|
| Diagnosis in short | |
 Urothelial dysplasia. H&E stain. | |
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| Synonyms | low-grade urothelial dysplasia |
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| 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) |
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| |
| 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:
- Benign urothelium with reactive changes.
- Urothelial carcinoma in situ - no maturation to the surface or marked atypia - as in pagetoid spread, undermining UCIS.[3]
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 |
|---|---|---|---|
| Benign (reactive) | umbrella cells +ve only | -ve <=10% of cells (+/-rare basal cells) | -ve <20% of cells (+/-weak staining) |
| Urothelial dysplasia | +ve non-umbrella cells +ve (~30% of cases) | +ve >10% of cells (~40% of cases) | +ve >=20% of cells (~70% of cases) |
| 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) |
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A. 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
- ↑ 1.0 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.
- ↑ URL: http://pathology.jhu.edu/bladder/image1.cfm?case_number=10&image_number=1. Accessed on: 31 December 2013.
- ↑ 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.
- ↑ 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.