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Difference between revisions of "Urothelium"
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**If the terminology in the urinary bladder were applied to the colon, we'd call all ''adenomas'', i.e. pre-malignant lesions, ''carcinomas''. | **If the terminology in the urinary bladder were applied to the colon, we'd call all ''adenomas'', i.e. pre-malignant lesions, ''carcinomas''. | ||
= | =Overview in tables= | ||
==General categorization== | |||
Urothelial lesions can broadly be divided into: | Urothelial lesions can broadly be divided into: | ||
#Flat lesions. | #Flat lesions. | ||
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#*More often benign/indolent. | #*More often benign/indolent. | ||
== | ===Flat urothelial lesions=== | ||
Comparison urothelial changes - flat epithelium - benign/premalignant/cancerous:<ref>{{Ref GUP|155-163}}</ref> | Comparison urothelial changes - flat epithelium - benign/premalignant/cancerous:<ref>{{Ref GUP|155-163}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
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|} | |} | ||
The '''bold''' entry is considered the key feature. | The '''bold''' entry is considered the key feature. | ||
===Papillary urothelial lesions=== | |||
Urothelial cells in papillae - benign/premalignant/cancerous:<ref>{{Ref GUP|166-175}}</ref><ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref> | |||
{| class="wikitable" | |||
| ||'''Papilloma''' ||'''PUNLMP''' ||'''low grade PUCC''' ||'''high grade PUCC''' | |||
|- | |||
|papillae features ||'''fat papillae''', <br>'''thick FV core''' ||'''slender FV core''' ||slender FV core, <br>'''thick epithelium''' ||mixed population | |||
|- | |||
|papillae branching ||rare ||uncommon ||frequent ||common | |||
|- | |||
|papillae fusion ||none ||rare ||some ||common | |||
|- | |||
|nuclear size ||normal (2x lymphocyte) ||'''enlarged - uniform''' ||'''enlarged with variation''' ||'''4-5x lymphocyte,'''<br>'''marked pleomorphism''' | |||
|- | |||
|mitoses ||very rare basal || rare basal only ||infreq., usually basal ||common, everywhere | |||
|- | |||
|DDx ||PUNLMP, low gr. PUCC ||papilloma, low gr. ||PUNLMP, high gr. ||low gr., invasive UCC | |||
|- | |||
|IHC ||p53-, CK20+ umbrella cells ||CK20+ umbrella ||-/+ p53, CK20+ umbrella ||'''diffuse CK20+''', p53+ in 50% | |||
|- | |||
|Other ||cytologically normal ||low cellular density (@ low power) vs. low gr.<ref>GAG. 26 February 2009.</ref> ||+/- small nucleoli ||nucleoli prominent | |||
|- | |||
|Key feature ||normal cells,<br>fat papillae ||uniformly enlarged cell pop., <br>slender papillae ||nuc. pleomorphism, <br> thick epithelium ||marked nuclear pleomorphism | |||
|- | |||
|} | |||
Notes: | |||
*FV core = fibrovascular core. | |||
*PUCC = papillary urothelial carcinoma. | |||
=Specific entities= | |||
==Premalignant/Hyperplasic/Reactive changes== | |||
Several different benign/premalignant diagnoses can be made: | |||
*Reactive atypia. | |||
*Flat urothelial hyperplasia. | |||
*Urothelial dysplasia. | |||
Cancer: | |||
*Urothelial carcinoma in situ. | |||
*Invasive UCC. | |||
==Risk factors for UCC== | ==Risk factors for UCC== | ||
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*[http://commons.wikimedia.org/wiki/File:Inverted_papilloma_high_mag.jpg Inverted papilloma - high mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Inverted_papilloma_high_mag.jpg Inverted papilloma - high mag. (WC)]. | ||
*[http://commons.wikimedia.org/wiki/File:Inverted_papilloma_intermed_mag.jpg Inverted papilloma - intermed. mag. (WC)]. | *[http://commons.wikimedia.org/wiki/File:Inverted_papilloma_intermed_mag.jpg Inverted papilloma - intermed. mag. (WC)]. | ||
==Benign== | ==Benign== | ||