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Papillary urothelial neoplasm of low malignant potential (view source)

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#redirect [[Urothelium#Papillary urothelial neoplasm of low malignant potential]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      =  Punlmp2.jpg
| Width      =
| Caption    = PUNLMP. [[H&E stain]].
| Synonyms  =
| Micro      = rare fused papillae, infrequent mitoses, nuclei larger than papilloma - but monotonous
| Subtypes  =
| LMDDx      = [[low grade papillary urothelial carcinoma]], [[urothelial papilloma]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[urothelium]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    =
| Tx        = excision and on-going follow-up - like non-invasive [[low grade papillary urothelial carcinoma]]
}}
'''Papillary urothelial neoplasm of low malignant potential''', abbreviated '''PUNLMP''', is an uncommon [[urothelium|urothelial]] lesion that is similar to [[low-grade papillary urothelial carcinoma]].
 
'''PUNLMP''' is pronounced ''pun-lump''.
 
''Inverted urothelial neoplasm of low malignant potential'' (abbreviated ''IUNLMP'') redirects here.
 
==General==
*Uncommon: prevalence ~ 0-3.5%.<ref name=pmid19346063>{{cite journal |author=May M, Brookman-Amissah S, Roigas J, ''et al.'' |title=Prognostic Accuracy of Individual Uropathologists in Noninvasive Urinary Bladder Carcinoma: A Multicentre Study Comparing the 1973 and 2004 World Health Organisation Classifications |journal=Eur. Urol. |volume= 57|issue= 5|pages= 850|year=2009 |month=March |pmid=19346063 |doi=10.1016/j.eururo.2009.03.052 |url=}}</ref>
*PUNLMP vs. [[low grade papillary urothelial carcinoma]] has a poor inter-rater reliability.<ref name=pmid17095142>{{cite journal |author=MacLennan GT, Kirkali Z, Cheng L |title=Histologic grading of noninvasive papillary urothelial neoplasms |journal=Eur. Urol. |volume=51 |issue=4 |pages=889–97; discussion 897–8 |year=2007 |month=April |pmid=17095142 |doi=10.1016/j.eururo.2006.10.037 |url=}}</ref>
 
Treatment:
*Excision and on-going follow-up - like non-invasive [[low grade papillary urothelial carcinoma]] (LGPUC).<ref name=pmid16697785>{{cite journal |author=Jones TD, Cheng L |title=Papillary urothelial neoplasm of low malignant potential: evolving terminology and concepts |journal=J. Urol. |volume=175 |issue=6 |pages=1995–2003 |year=2006 |month=June |pmid=16697785 |doi=10.1016/S0022-5347(06)00267-9 |url=}}</ref>
**Cheng ''et al.'' have advocated abandoning the term as they are treated like [[LGPUC]]s.<ref name=pmid22542126>{{Cite journal  | last1 = Cheng | first1 = L. | last2 = Maclennan | first2 = GT. | last3 = Lopez-Beltran | first3 = A. | title = Histologic grading of urothelial carcinoma: a reappraisal. | journal = Hum Pathol | volume = 43 | issue = 12 | pages = 2097-108 | month = Dec | year = 2012 | doi = 10.1016/j.humpath.2012.01.008 | PMID = 22542126 }}</ref>
 
==Microscopic==
Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>
*Rare fused papillae.
*Infrequent mitoses.
*Nuclei larger than papilloma - but monotonous.<ref name=Ref_GUP170>{{Ref GUP|170}}</ref>
 
Note:
*May grow downward; known as ''PUNLMP with inverted growth''<ref name=pmid25886613>{{Cite journal  | last1 = Maxwell | first1 = JP. | last2 = Wang | first2 = C. | last3 = Wiebe | first3 = N. | last4 = Yilmaz | first4 = A. | last5 = Trpkov | first5 = K. | title = Long-term outcome of primary Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP) including PUNLMP with inverted growth. | journal = Diagn Pathol | volume = 10 | issue =  | pages = 3 | month =  | year = 2015 | doi = 10.1186/s13000-015-0234-z | PMID = 25886613 }}</ref> and ''inverted urothelial neoplasm of low malignant potential'' (abbreviated ''IUNLMP'').<ref name=pmid21122976>{{Cite journal  | last1 = Montironi | first1 = R. | last2 = Cheng | first2 = L. | last3 = Lopez-Beltran | first3 = A. | last4 = Scarpelli | first4 = M. | last5 = Mazzucchelli | first5 = R. | last6 = Mikuz | first6 = G. | last7 = Kirkali | first7 = Z. | last8 = Montorsi | first8 = F. | title = Inverted (endophytic) noninvasive lesions and neoplasms of the urothelium: the Cinderella group has yet to be fully exploited. | journal = Eur Urol | volume = 59 | issue = 2 | pages = 225-30 | month = Feb | year = 2011 | doi = 10.1016/j.eururo.2010.11.018 | PMID = 21122976 }}</ref>
 
DDx:
*[[Low grade papillary urothelial carcinoma]].
*[[Urothelial papilloma|Papilloma]].
 
===Images===
<gallery>
Image:Punlmp1.jpg | PUNLMP - low mag. (WC/Nephron)
Image:Punlmp2.jpg | PUNLMP - high mag. (WC/Nephron)
</gallery>
 
==Sign out==
<pre>
Urinary Bladder Tumour, Transurethral Resection:
    - Papillary urothelial neoplasm of low malignant potential (PUNLMP).
</pre>
 
===Micro===
The sections show a papillary urothelial lesion with minimal anisonucleosis. The papillae are predominantly slender and branch. Minimal proliferative activity is present. The lesion is well demarcated in relation to the subepithelial tissue.
 
====Alternate====
The sections show a papillary urothelial lesion with monotonous nuclei and minimal atypia. The papillae are predominantly slender and branch. Mitotic figures are very rare. The lesion is well demarcated in relation to the subepithelial tissue.
 
===Inverted pattern predominant===
<pre>
Urinary Bladder Tumour, Transurethral Resection:
- Inverted urothelial neoplasm of low malignant potential with an
  exophytic papillary component.
 
Comment:
This lesion is a variant of papillary urothelial neoplasm of low malignant
potential (PUNLMP). Followup is required.
 
The case was reviewed by a second GU pathologist.
</pre>
 
==See also==
*[[Urothelium]].
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Urothelium]]
Michael
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