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Difference between revisions of "High-grade papillary urothelial carcinoma"
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High-grade papillary urothelial carcinoma (view source)
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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = High-grade papillary urothelial carcinoma -- intermed mag.jpg | |||
| Width = | |||
| Caption = High-grade papillary urothelial carcinoma. [[H&E stain]]. | |||
| Micro = papillae with "architectural complexity" (fused papillae, branching of papillae), +/-nuclear pleomorphism, nuclear enlargement - often 4-5x the size of stromal lymphocytes, mitoses (common), +/-invasion into the lamina propria (common) | |||
| Subtypes = subtype of [[urothelial carcinoma]] | |||
| LMDDx = [[low-grade papillary urothelial carcinoma]], [[urothelial carcinoma in situ]], [[squamous cell carcinoma]] | |||
| Stains = | |||
| IHC = Ki-67 high (>35% of cells), PAX8 -ve | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = exophytic mass, frond-like appearance, friable | |||
| Grossing = | |||
| Site = [[urothelium]] - usu. [[urinary bladder]] | |||
| Assdx = | |||
| Syndromes = [[Lynch syndrome]] | |||
| Clinicalhx = | |||
| Signs = hematuria | |||
| Symptoms = | |||
| Prevalence = common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = dependent on stage, usu. moderate | |||
| Other = | |||
| ClinDDx = [[low-grade papillary urothelial carcinoma]] | |||
}} | |||
'''High-grade papillary urothelial carcinoma''', abbreviated '''HGPUC''', is a common form of [[cancer]] that arises from the [[urothelium]]. | '''High-grade papillary urothelial carcinoma''', abbreviated '''HGPUC''', is a common form of [[cancer]] that arises from the [[urothelium]]. | ||
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==General== | ==General== | ||
*Aggressive. | *Aggressive. | ||
*May be associated with [[Lynch syndrome]].<ref name=pmid12673555>{{Cite journal | last1 = Hartmann | first1 = A. | last2 = Dietmaier | first2 = W. | last3 = Hofstädter | first3 = F. | last4 = Burgart | first4 = LJ. | last5 = Cheville | first5 = JC. | last6 = Blaszyk | first6 = H. | title = Urothelial carcinoma of the upper urinary tract: inverted growth pattern is predictive of microsatellite instability. | journal = Hum Pathol | volume = 34 | issue = 3 | pages = 222-7 | month = Mar | year = 2003 | doi = 10.1053/hupa.2003.22 | PMID = 12673555 }}</ref> | |||
==Gross== | ==Gross== | ||
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*"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> | ||
* | *Papillae with "architectural complexity": | ||
**Fused | **Fused papillae - common. | ||
** | **Branching of papillae common. | ||
*Mitoses common. | *Mitoses - common. | ||
*+/-Invasion into the lamina propria. | *+/-Invasion into the lamina propria - relatively common. | ||
Note: | Note: | ||
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DDx: | DDx: | ||
*[[Low grade papillary urothelial carcinoma]]. | *[[Low grade papillary urothelial carcinoma]]. | ||
**Stanford criteria has a 5% rule -- if the high-grade component is <5% it is low-grade.<ref>URL: [http://surgpathcriteria.stanford.edu/bladder/tcc-papillary-transitional-urothelial-carcinoma/ http://surgpathcriteria.stanford.edu/bladder/tcc-papillary-transitional-urothelial-carcinoma/]. Accessed on: 27 January 2014.</ref> | |||
***There is some evidence to suggest low-grade with <5% high-grade behaves similar to low-grade.<ref name=pmid26520419>{{Cite journal | last1 = Reis | first1 = LO. | last2 = Taheri | first2 = D. | last3 = Chaux | first3 = A. | last4 = Guner | first4 = G. | last5 = Mendoza Rodriguez | first5 = MA. | last6 = Bivalacqua | first6 = TJ. | last7 = Schoenberg | first7 = MP. | last8 = Epstein | first8 = JI. | last9 = Netto | first9 = GJ. | title = Significance of a minor high-grade component in a low-grade noninvasive papillary urothelial carcinoma of bladder. | journal = Hum Pathol | volume = 47 | issue = 1 | pages = 20-5 | month = Jan | year = 2016 | doi = 10.1016/j.humpath.2015.09.007 | PMID = 26520419 }}></ref> | |||
*[[Prostate carcinoma]] with pseudopapillae<ref name=pmid24503758>{{cite journal |author=Gordetsky J, Epstein JI |title=Pseudopapillary features in prostatic adenocarcinoma mimicking urothelial carcinoma: a diagnostic pitfall |journal=Am. J. Surg. Pathol. |volume=38 |issue=7 |pages=941–5 |year=2014 |month=July |pmid=24503758 |doi=10.1097/PAS.0000000000000178 |url=}}</ref> - see ''[[urothelial carcinoma-like prostatic carcinoma]]''. | |||
**Should be considered if a [[urethra]]l tumour. | |||
===Images=== | |||
<gallery> | |||
Image: High-grade papillary urothelial carcinoma -- low mag.jpg | HGPUC - low mag. | |||
Image: High-grade papillary urothelial carcinoma -- intermed mag.jpg | HGPUC - intermed. mag. | |||
Image: High-grade papillary urothelial carcinoma -- high mag.jpg | HGPUC - high mag. | |||
Image: High-grade papillary urothelial carcinoma - alt -- high mag.jpg | HGPUC - high mag. | |||
Image: High-grade papillary urothelial carcinoma - inv -- low mag.jpg | HGPUC - low mag. | |||
Image: High-grade papillary urothelial carcinoma - inv -- intermed mag.jpg | HGPUC - intermed. mag. | |||
Image: High-grade papillary urothelial carcinoma - inv -- high mag.jpg | HGPUC - high mag. | |||
</gallery> | |||
==IHC== | ==IHC== | ||
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**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. | **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. | **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. | ||
**Mai ''et al.'' suggest there is overlap:<ref name=pmid23913166>{{Cite journal | last1 = Mai | first1 = KT. | last2 = Flood | first2 = TA. | last3 = Williams | first3 = P. | last4 = Kos | first4 = Z. | last5 = Belanger | first5 = EC. | title = Mixed low- and high-grade papillary urothelial carcinoma: histopathogenetic and clinical significance. | journal = Virchows Arch | volume = 463 | issue = 4 | pages = 575-81 | month = Oct | year = 2013 | doi = 10.1007/s00428-013-1456-7 | PMID = 23913166 }}</ref> 10-30% for low-grade versus 20-50% for high-grade. | |||
*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> | *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> | ||
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==Sign out== | ==Sign out== | ||
<pre> | |||
Urinary Bladder Tumour, Transurethral Resection: | |||
- HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMA. | |||
-- NEGATIVE for lamina propria invasion. | |||
-- NEGATIVE for lymphovascular invasion. | |||
-- Please see synoptic report. | |||
- Muscularis propria present and NEGATIVE for invasion. | |||
- NEGATIVE for (flat) urothelial carcinoma in situ. | |||
</pre> | |||
====Block letters==== | |||
<pre> | <pre> | ||
URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION: | URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION: | ||
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===Invasion into the lamina propria=== | ===Invasion into the lamina propria=== | ||
<pre> | |||
Urinary Bladder Tumour, Transurethral Resection: | |||
- INVASIVE HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMA with lamina propria invasion. | |||
-- Muscularis propria present, NEGATIVE for muscularis propria invasion. | |||
-- NEGATIVE for lymphovascular invasion. | |||
-- Please see synoptic report. | |||
</pre> | |||
====Block letters==== | |||
<pre> | <pre> | ||
URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION URINARY BLADDER TUMOUR (TURBT): | URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION URINARY BLADDER TUMOUR (TURBT): | ||
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====Micro==== | ====Micro==== | ||
The sections show urothelial mucosa with thick papillary structures. Focally, nuclei are large (~3-4x resting lymphocyte), hyperchromatic and have nucleoli. Mitotic activity is present and focally brisk (4 mitoses in 1 HPF, 1 HPF~0.2376 mm*mm). Umbrella cells are seen only focally. | |||
=====Alternate===== | |||
The sections show a small fragment of urothelial mucosa with two papillary structures, | 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 | enlarged nuclei (~3-4x resting lymphocyte) and moderate nuclear size variation. Mitotic activity is seen focally. Umbrella | ||
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contains a nest with smaller cells, cystic spaces and no appreciable mitoses | contains a nest with smaller cells, cystic spaces and no appreciable mitoses | ||
(cystitis cystica). | (cystitis cystica). | ||
==See also== | ==See also== | ||
*[[Urothelium]]. | *[[Urothelium]]. | ||