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Difference between revisions of "Muscularis propria invasion in the urinary bladder"
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Muscularis propria invasion in the urinary bladder (view source)
Revision as of 15:35, 27 January 2017
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[[Image: Muscle invasive urothelial carcinoma -- intermed mag.jpg |thumb|350px|right | Muscle invasive urothelial carcinoma. [[H&E stain]].]] | |||
The presence or absence of '''muscularis propria invasion in the urinary bladder''' is a ''very important'' determination, as the clinical management changes between T1 and T2: | The presence or absence of '''muscularis propria invasion in the urinary bladder''' is a ''very important'' determination, as the clinical management changes between T1 and T2: | ||
*T1: usually conservative treatment (local excision). | *T1: usually conservative treatment (local excision). | ||
| Line 4: | Line 5: | ||
A thin layer of discontinous muscularis mucuosae (MM) is present and, especially if hypertrophic, may be confused with muscuaris propria (MP). | A thin layer of discontinous muscularis mucuosae (MM) is present and, especially if hypertrophic, may be confused with muscuaris propria (MP). | ||
Staging of bladder cancer is dealt with in the ''[[bladder cancer staging]]'' article. | |||
'''''Muscle invasive bladder cancer''''' redirects to this article and refers to invasion of the ''muscularis propria''. | |||
''Bladder muscularis propria invasion'' and ''urinary bladder muscularis propria invasion'' redirect to this article. | |||
==General== | ==General== | ||
| Line 53: | Line 60: | ||
#Multiple bundles must be adjacent to one another. | #Multiple bundles must be adjacent to one another. | ||
#Should '''not''' be superficial - surface epithelium if present should be distant. | #Should '''not''' be superficial - surface epithelium if present should be distant. | ||
DDx: | |||
*Invasion of hypertrophic muscularis mucosae. | |||
====Images==== | |||
<gallery> | |||
Image: Muscle invasive urothelial carcinoma -- very low mag.jpg | MIUC - very low mag. | |||
Image: Muscle invasive urothelial carcinoma -- low mag.jpg | MIUC - low mag. | |||
Image: Muscle invasive urothelial carcinoma - alt -- intermed mag.jpg | MIUC - intermed. mag. | |||
Image: Muscle invasive urothelial carcinoma -- high mag.jpg | MIUC - high mag. | |||
</gallery> | |||
==IHC== | |||
''Smoothelin'' [[immunostain]]:<ref name=pmid18936687>{{Cite journal | last1 = Paner | first1 = GP. | last2 = Shen | first2 = SS. | last3 = Lapetino | first3 = S. | last4 = Venkataraman | first4 = G. | last5 = Barkan | first5 = GA. | last6 = Quek | first6 = ML. | last7 = Ro | first7 = JY. | last8 = Amin | first8 = MB. | title = Diagnostic utility of antibody to smoothelin in the distinction of muscularis propria from muscularis mucosae of the urinary bladder: a potential ancillary tool in the pathologic staging of invasive urothelial carcinoma. | journal = Am J Surg Pathol | volume = 33 | issue = 1 | pages = 91-8 | month = Jan | year = 2009 | doi = 10.1097/PAS.0b013e3181804727 | PMID = 18936687 }}</ref> | |||
*Muscularis propria - usu. strong. † | |||
*Muscularis mucosae - negative/weak. † | |||
Note: | |||
*† Overlap between the patterns is described;<ref name=pmid20154589>{{Cite journal | last1 = Miyamoto | first1 = H. | last2 = Sharma | first2 = RB. | last3 = Illei | first3 = PB. | last4 = Epstein | first4 = JI. | title = Pitfalls in the use of smoothelin to identify muscularis propria invasion by urothelial carcinoma. | journal = Am J Surg Pathol | volume = 34 | issue = 3 | pages = 418-22 | month = Mar | year = 2010 | doi = 10.1097/PAS.0b013e3181ce5066 | PMID = 20154589 }}</ref> this limits the utility of the immunostain. | |||
**Immunostain '''not''' used in many practice environments. | |||
==Sign out== | ==Sign out== | ||
===Cannot exclude MP invasion=== | |||
<pre> | <pre> | ||
Urinary Bladder Tumour, Transurethral Resection: | Urinary Bladder Tumour, Transurethral Resection: | ||
- INVASIVE HIGH-GRADE UROTHELIAL CARCINOMA. | - INVASIVE HIGH-GRADE UROTHELIAL CARCINOMA. | ||
-- Extensive invasion into at least the lamina propria. | -- Extensive invasion into at least the lamina propria. | ||
- Negative for definite muscularis propria, see comment. | |||
Comment: | Comment: | ||
| Line 66: | Line 94: | ||
propria cannot be excluded. | propria cannot be excluded. | ||
Correlation with the clinical findings is required. Additional sampling | Correlation with the clinical findings is required. Additional transurethral | ||
and/or imaging is suggested. | sampling and/or imaging to assess the muscularis propria is suggested. | ||
</pre> | </pre> | ||
==See also== | ==See also== | ||
*[[Urothelial carcinoma]]. | *[[Urothelial carcinoma]]. | ||
*[[Bladder cancer staging]]. | |||
*[[Cancer staging systems]]. | *[[Cancer staging systems]]. | ||