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Difference between revisions of "Urothelium"
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→Specific entities: re-order
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*PUCC = papillary urothelial carcinoma. | *PUCC = papillary urothelial carcinoma. | ||
= | =Risk factors for urothelial carcinoma= | ||
*[[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> | |||
=Flat lesions= | |||
==Premalignant/Hyperplasic/Reactive changes== | ==Premalignant/Hyperplasic/Reactive changes== | ||
Several different benign/premalignant diagnoses can be made: | Several different benign/premalignant diagnoses can be made: | ||
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*Urothelial carcinoma in situ. | *Urothelial carcinoma in situ. | ||
*Invasive UCC. | *Invasive UCC. | ||
==Urothelial carcinoma in situ== | ==Urothelial carcinoma in situ== | ||
===Microscopic=== | ===Microscopic=== | ||
*Nuclear changes | *Nuclear changes '''key feature'''. | ||
**Enlargement of nuclei (often 4-5x the size of stromal lymphocytes) -- diagnostic.<ref name=Ref_GUP161>{{Ref GUP|161}}</ref> | **Enlargement of nuclei (often 4-5x the size of stromal lymphocytes) -- diagnostic.<ref name=Ref_GUP161>{{Ref GUP|161}}</ref> | ||
***Normal urothelium approx. 2x the size of stromal lymphocytes. | ***Normal urothelium approx. 2x the size of stromal lymphocytes. | ||
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===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Nuclear pleomorphism | *Nuclear pleomorphism - '''key feature'''. | ||
**Compare nuclei to one another. | **Compare nuclei to one another. | ||
*Increased N/C ratio. | *Increased N/C ratio. | ||
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</ref> | </ref> | ||
=Papillary urothelial cell carcinoma= | |||
*[[AKA]] papillary urothelial carcinoma. | *[[AKA]] papillary urothelial carcinoma. | ||
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#Papillae fusion. | #Papillae fusion. | ||
==High grade papillary UCC== | |||
*Abbreviated: ''low grade UCC''. | |||
===Microscopic=== | |||
Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref> | |||
*"High grade nuclear features": | *"High grade nuclear features": | ||
**Nuclear pleomorphism - often 4-5x the size of stromal lymphocytes.<ref name=Ref_GUP161>{{Ref GUP|161}}</ref> | **Nuclear pleomorphism - often 4-5x the size of stromal lymphocytes.<ref name=Ref_GUP161>{{Ref GUP|161}}</ref> | ||
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*Mitoses common. | *Mitoses common. | ||
==Low grade papillary urothelial carcinoma== | |||
*Abbreviated: ''low grade UCC''. | |||
===Microscopic=== | |||
Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref> | |||
*Fused papillae. | *Fused papillae. | ||
*Papillae branch. | *Papillae branch. | ||
*Larger nuclei than PUNLMPs. | *Larger nuclei than PUNLMPs. | ||
===PUNLMP=== | ==Papillary urothelial neoplasm of low malignant potential== | ||
*Abbreviated ''PUNLMP''. | |||
===Microscopic=== | |||
Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref> | |||
*Rare fused papillae. | *Rare fused papillae. | ||
*Infrequent mitoses. | *Infrequent mitoses. | ||
*Nuclei larger than papilloma - but monotonous.<ref name=Ref_GUP170>{{Ref GUP|170}}</ref> | *Nuclei larger than papilloma - but monotonous.<ref name=Ref_GUP170>{{Ref GUP|170}}</ref> | ||
=== | ==Urothelial papilloma== | ||
===General=== | |||
*Very rare diagnosed. | |||
*If the person has a history of UCC... it is UCC. | |||
*These cases are a consensus diagnosis, i.e. you show it to a colleague... if they agree you can call it. | |||
===Microscopic=== | |||
Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref> | |||
*Papillary fronds. | *Papillary fronds. | ||
*Minimal branching or fusion. | *Minimal branching or fusion. | ||
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*No mitoses. | *No mitoses. | ||
==Inverted papilloma== | |||
*Like papillomas... but grow downward.<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref> | *Like papillomas... but grow downward.<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref> | ||
*According to THvdK,<ref>THvdK. 21 June 2010.</ref> ''inverted papillomas'' '''never''' have an exophytic component; if an exophytic component is present it is urothelial carcinoma. This is disputed by one paper from Mexico that examines two cases.<ref name=pmid19433293>{{cite journal |author=Albores-Saavedra J, Chable-Montero F, Hernández-Rodríguez OX, Montante-Montes de Oca D, Angeles-Angeles A |title=Inverted urothelial papilloma of the urinary bladder with focal papillary pattern: a previously undescribed feature |journal=Ann Diagn Pathol |volume=13 |issue=3 |pages=158–61 |year=2009 |month=June |pmid=19433293 |doi=10.1016/j.anndiagpath.2009.02.009 |url=}}</ref> | *According to THvdK,<ref>THvdK. 21 June 2010.</ref> ''inverted papillomas'' '''never''' have an exophytic component; if an exophytic component is present it is urothelial carcinoma. This is disputed by one paper from Mexico that examines two cases.<ref name=pmid19433293>{{cite journal |author=Albores-Saavedra J, Chable-Montero F, Hernández-Rodríguez OX, Montante-Montes de Oca D, Angeles-Angeles A |title=Inverted urothelial papilloma of the urinary bladder with focal papillary pattern: a previously undescribed feature |journal=Ann Diagn Pathol |volume=13 |issue=3 |pages=158–61 |year=2009 |month=June |pmid=19433293 |doi=10.1016/j.anndiagpath.2009.02.009 |url=}}</ref> | ||
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*[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 urothelial lesions= | |||
Brunn nests:<ref name=Ref_PBoD1028>{{Ref PBoD|1028}}</ref> | Brunn nests:<ref name=Ref_PBoD1028>{{Ref PBoD|1028}}</ref> | ||
*Benign inbudding nests of urothelium. | *Benign inbudding nests of urothelium. | ||