Difference between revisions of "Low-grade papillary urothelial carcinoma"

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Low-grade papillary urothelial carcinoma (view source)

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Bladder_urothelial_carcinoma_(1)_pT1.JPG
| Image      = Low-grade papillary urothelial carcinoma -- high mag.jpg
| Width      =
| Width      =
| Caption    = Low-grade papillary urothelial carcinoma. [[H&E stain]].
| Caption    = Low-grade papillary urothelial carcinoma. [[H&E stain]].
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| IF        =
| IF        =
| Gross      = exophytic lesion, frond-like appearance, friable
| Gross      = exophytic lesion, frond-like appearance, friable
| Grossing  =
| Grossing  = [[radical cystectomy grossing]], [[cystoprostatectomy grossing]], [[nephroureterectomy grossing]]
| Staging    = [[bladder cancer staging]]
| Site      = [[urothelium]]
| Site      = [[urothelium]]
| Assdx      =
| Assdx      =
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**Often under-diagnosed (~15% in one series) when reassessed by experts.<ref name=pmid20670136>{{Cite journal  | last1 = Miyamoto | first1 = H. | last2 = Brimo | first2 = F. | last3 = Schultz | first3 = L. | last4 = Ye | first4 = H. | last5 = Miller | first5 = JS. | last6 = Fajardo | first6 = DA. | last7 = Lee | first7 = TK. | last8 = Epstein | first8 = JI. | last9 = Netto | first9 = GJ. | title = Low-grade papillary urothelial carcinoma of the urinary bladder: a clinicopathologic analysis of a post-World Health Organization/International Society of Urological Pathology classification cohort from a single academic center. | journal = Arch Pathol Lab Med | volume = 134 | issue = 8 | pages = 1160-3 | month = Aug | year = 2010 | doi = 10.1043/2009-0403-OA.1 | PMID = 20670136 }}</ref>
**Often under-diagnosed (~15% in one series) when reassessed by experts.<ref name=pmid20670136>{{Cite journal  | last1 = Miyamoto | first1 = H. | last2 = Brimo | first2 = F. | last3 = Schultz | first3 = L. | last4 = Ye | first4 = H. | last5 = Miller | first5 = JS. | last6 = Fajardo | first6 = DA. | last7 = Lee | first7 = TK. | last8 = Epstein | first8 = JI. | last9 = Netto | first9 = GJ. | title = Low-grade papillary urothelial carcinoma of the urinary bladder: a clinicopathologic analysis of a post-World Health Organization/International Society of Urological Pathology classification cohort from a single academic center. | journal = Arch Pathol Lab Med | volume = 134 | issue = 8 | pages = 1160-3 | month = Aug | year = 2010 | doi = 10.1043/2009-0403-OA.1 | PMID = 20670136 }}</ref>
**The three most predictive features of high-grade are ''architectural complexity'', ''nuclear size variation'', and ''absence of umbrella cells''.<ref name=pmid21980608>{{Cite journal  | last1 = Isfoss | first1 = BL. | last2 = Majak | first2 = B. | last3 = Busch | first3 = C. | last4 = Braathen | first4 = GJ. | title = Simplification of grading papillary urothelial neoplasia using a reduced set of diagnostic features. | journal = Anal Quant Cytol Histol | volume = 33 | issue = 2 | pages = 68-74 | month = Apr | year = 2011 | doi =  | PMID = 21980608 }}</ref>
**The three most predictive features of high-grade are ''architectural complexity'', ''nuclear size variation'', and ''absence of umbrella cells''.<ref name=pmid21980608>{{Cite journal  | last1 = Isfoss | first1 = BL. | last2 = Majak | first2 = B. | last3 = Busch | first3 = C. | last4 = Braathen | first4 = GJ. | title = Simplification of grading papillary urothelial neoplasia using a reduced set of diagnostic features. | journal = Anal Quant Cytol Histol | volume = 33 | issue = 2 | pages = 68-74 | month = Apr | year = 2011 | doi =  | PMID = 21980608 }}</ref>
**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>
*[[Inverted urothelial papilloma]] - often have peripheral palisading.
*[[Inverted urothelial papilloma]] - often have peripheral palisading.
*[[Urothelial papilloma]].
*[[Urothelial papilloma]].


===IHC===
===Image===
<gallery>
Image: Low-grade papillary urothelial carcinoma -- intermed mag.jpg | LGPUC - intermed. mag.
Image: Low-grade papillary urothelial carcinoma -- high mag.jpg | LGPUC - high mag.
Image: Low-grade papillary urothelial carcinoma - alt -- high mag.jpg | LGPUC - high mag.
</gallery>
 
==IHC==
*Ki-67:
*Ki-67:
**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.


===Molecular===
==Molecular==
Molecular changes:<ref name=pmid19468362>{{Cite journal  | last1 = Ehdaie | first1 = B. | last2 = Theodorescu | first2 = D. | title = Molecular markers in transitional cell carcinoma of the bladder: New insights into mechanisms and prognosis. | journal = Indian J Urol | volume = 24 | issue = 1 | pages = 61-7 | month = Jan | year = 2008 | doi = 10.4103/0970-1591.38606 | PMID = 19468362 | PMC = 2684226}}</ref>
Molecular changes:<ref name=pmid19468362>{{Cite journal  | last1 = Ehdaie | first1 = B. | last2 = Theodorescu | first2 = D. | title = Molecular markers in transitional cell carcinoma of the bladder: New insights into mechanisms and prognosis. | journal = Indian J Urol | volume = 24 | issue = 1 | pages = 61-7 | month = Jan | year = 2008 | doi = 10.4103/0970-1591.38606 | PMID = 19468362 | PMC = 2684226}}</ref>
*FGFR3  
*FGFR3  
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<pre>
Urinary Bladder Tumour, Transurethral Resection:
- LOW GRADE PAPILLARY UROTHELIAL CARCINOMA.
-- NEGATIVE for lamina propria invasion.
- NEGATIVE for carcinoma in situ.
- Benign muscularis propria present.
</pre>
<pre>
Urinary Bladder Tumour, Transurethral Resection:
- LOW-GRADE PAPILLARY UROTHELIAL CARCINOMA.
-- NEGATIVE for lamina propria invasion.
- NEGATIVE for carcinoma in situ.
- Definite muscularis propria ABSENT.
</pre>
====Block letters====
<pre>
<pre>
  URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION:
  URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION:
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- BENIGN MUSCULARIS PROPRIA PRESENT.
- BENIGN MUSCULARIS PROPRIA PRESENT.
</pre>
</pre>
===Micro===
The sections show urothelial mucosa with a tumour with fibrovascular cores. The nuclei are of uniform size (2-3 times a resting lymphocytes).  Rare foci of degenerative cells are seen.  The papillary structures are thick and appear to compress the lamina propria. Rare mitotic figures are identified. No atypical mitoses are apparent.  No lamina propria invasion is identified.  No muscularis propria is identified.


==See also==
==See also==
Michael
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