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(→Nephrogenic metaplasia: +alt name) |
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The '''urothelium''' lines the upper portion of the genitourinary tract... and a bit of the lower part. | The '''urothelium''' lines the upper portion of the genitourinary tract... and a bit of the lower part. | ||
=Normal histology= | |||
*Maturation (cuboidal at base - squamoid at surface). | |||
**Surface cells called 'umbrella cells' (umbrella cells CK20+). | |||
*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== | ==Extent of urothelium== | ||
*Ureters. | |||
*Renal pelvis. | |||
*Bladder. | |||
*Part of the urethra. | |||
===Urethra in males=== | ===Urethra in males=== | ||
*Pre-prostatic urethra - transistional epithelium. | *Pre-prostatic urethra - transistional epithelium. | ||
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*Spony urethra - pseudostratified columnar epi. (proximal) & strat. squamous (distal). | *Spony urethra - pseudostratified columnar epi. (proximal) & strat. squamous (distal). | ||
== | =Approach= | ||
==Where to start== | ==Where to start== | ||
July 1st PGY-2: | July 1st PGY-2: | ||
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#Fibrovascular cores = papillae... may be cancer! | #Fibrovascular cores = papillae... may be cancer! | ||
= | ==A checklist-like approach== | ||
# Papillary structure - with fibrovascular cores? | # Papillary structure - with fibrovascular cores? | ||
#* Nuclear pleomorphism? | #* Nuclear pleomorphism? | ||
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**Way to differentiate: paraganglioma = ''stippled chromatin'', UCC = ''single nucleoli''. | **Way to differentiate: paraganglioma = ''stippled chromatin'', UCC = ''single nucleoli''. | ||
== | ===Note about terminology=== | ||
*The bladder is rather unique in that "carcinoma" is a label used for things that are non-invasive. | |||
**It has been suggested that many things that are called ''papillary urothelial carcinoma'', would be better described as ''papillary intraurothelial neoplasia''.<ref name=pmid19160695>{{Cite journal | last1 = Van der Kwast | first1 = TH. | last2 = Zlotta | first2 = AR. | last3 = Fleshner | first3 = N. | last4 = Jewett | first4 = M. | last5 = Lopez-Beltran | first5 = A. | last6 = Montironi | first6 = R. | title = Thirty-five years of noninvasive bladder carcinoma: a plea for the use of papillary intraurothelial neoplasia as new terminology. | journal = Anal Quant Cytol Histol | volume = 30 | issue = 6 | pages = 309-15 | month = Dec | year = 2008 | doi = | PMID = 19160695 }}</ref> | |||
* | **If the terminology in the urinary bladder were applied to the colon, we'd call all ''adenomas'', i.e. pre-malignant lesions, ''carcinomas''. | ||
* | |||
=Specific entities= | |||
* | Urothelial lesions can broadly be divided into: | ||
#Flat lesions. | |||
#*Lack papillae. | |||
#*Tend to be more aggressive. | |||
#Papillary lesions. | |||
#*Must have true papillae. | |||
#*Very common. | |||
#*More often benign/indolent. | |||
==Premalignant/Hyperplasic/Reactive changes== | ==Premalignant/Hyperplasic/Reactive changes== | ||
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*Urothelial dysplasia. | *Urothelial dysplasia. | ||
Cancer | Cancer: | ||
*Urothelial carcinoma in situ. | *Urothelial carcinoma in situ. | ||
*Invasive UCC. | *Invasive UCC. | ||
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|} | |} | ||
The '''bold''' entry is considered the key feature. | The '''bold''' entry is considered the key feature. | ||
==Risk factors for UCC== | |||
Risk factors for UCC: | |||
*[[Smoking]]. | |||
*Toxins. | |||
*Drugs, e.g. cyclophosphamide. | |||
*Marijuana.<ref name=pmid16413342>PMID 16413342.</ref> | |||
*Chinese Herbs.<ref>URL: [http://content.nejm.org/cgi/content/full/343/17/1268 http://content.nejm.org/cgi/content/full/343/17/1268]. Accessed on: 27 May 2010.</ref> | |||
==Urothelial carcinoma in situ== | ==Urothelial carcinoma in situ== | ||
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*+/-Enlarged nucleoli. | *+/-Enlarged nucleoli. | ||
==Urothelial cell carcinoma UCC | ==Urothelial cell carcinoma== | ||
*Abbreviated ''UCC''. | |||
===General=== | |||
*These lesions lack papillae and are typical flat. | |||
===Microscopic=== | |||
Features: | |||
*Nuclear pleomorphism. | *Nuclear pleomorphism. | ||
**Most important feature. | **Most important feature. | ||
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</ref> | </ref> | ||
== | ==Papillary urothelial cell carcinoma== | ||
*[[AKA]] papillary urothelial carcinoma. | |||
Papillary urothelial lesions are grouped into one of five categories (listed from bad to good prognosis):<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref> | Papillary urothelial lesions are grouped into one of five categories (listed from bad to good prognosis):<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref> | ||
*High grade papillary. | *High grade papillary. | ||
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*[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> | *[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> | ||
=See also= | |||
*[[Prostate]]. | *[[Prostate]]. | ||
*[[Genitourinary pathology]]. | *[[Genitourinary pathology]]. | ||
*[[Kidney tumours]]. | |||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Uropathology]] | [[Category:Uropathology]] |
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