Difference between revisions of "Urothelial carcinoma in situ"

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Urothelial carcinoma in situ (view source)

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Urothelial carcinoma in situ -- high mag.jpg
| Image      = Urothelial carcinoma in situ -- very high mag.jpg  
| Width      =
| Width      =
| Caption    = Urothelial carcinoma in situ. [[H&E stain]].
| Caption    = Urothelial carcinoma in situ. [[H&E stain]].
| Synonyms  = high-grade dysplasia
| Synonyms  = urothelial cell carcinoma in situ, high-grade dysplasia
| Micro      = nuclear changes (enlargement of nuclei (often 4-5x the size of stromal lymphocytes), nuclear pleomorphism - marked variation in size of nuclei), +/-disordered arrangement/crowding of cells, +/-mitoses, +/-enlarged nucleoli
| Micro      = nuclear changes (enlargement of nuclei (often 4-5x the size of stromal lymphocytes), nuclear pleomorphism - marked variation in size of nuclei), +/-disordered arrangement/crowding of cells, +/-mitoses, +/-enlarged nucleoli
| Subtypes  =
| Subtypes  =
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| Signs      = +/-hematuria
| Signs      = +/-hematuria
| Symptoms  =
| Symptoms  =
| Prevalence =  
| Prevalence = relatively uncommon
| Bloodwork  =
| Bloodwork  =
| Rads      =
| Rads      =
| Endoscopy  =
| Endoscopy  = erythema or edema, may be unremarkable
| Prognosis  =
| Prognosis  =
| Other      =
| Other      =
| ClinDDx    =
| ClinDDx    = invasive (flat) [[urothelial carcinoma]], inflammation (cystitis)
| Tx        =
| Tx        =
}}
}}
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==General==
==General==
*Lack papillae.
*Lack papillae.
*Uncommon in relation to other urothelial lesions.
**Less common than invasive flat urothelial carcinoma ~3-4x more common than UCIS.<ref name=pmid24122346>{{Cite journal  | last1 = Nielsen | first1 = ME. | last2 = Smith | first2 = AB. | last3 = Meyer | first3 = AM. | last4 = Kuo | first4 = TM. | last5 = Tyree | first5 = S. | last6 = Kim | first6 = WY. | last7 = Milowsky | first7 = MI. | last8 = Pruthi | first8 = RS. | last9 = Millikan | first9 = RC. | title = Trends in stage-specific incidence rates for urothelial carcinoma of the bladder in the United States: 1988 to 2006. | journal = Cancer | volume = 120 | issue = 1 | pages = 86-95 | month = Jan | year = 2014 | doi = 10.1002/cncr.28397 | PMID = 24122346 }}</ref>


===Classification of flat urothelial lesions===
===Classification of flat urothelial lesions===
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*Urothelial carcinoma in situ (high-grade dysplasia).
*Urothelial carcinoma in situ (high-grade dysplasia).
*Invasive [[urothelial carcinoma]].
*Invasive [[urothelial carcinoma]].
==Gross==
*Flat lesion - erythema or edema, may be unremarkable.<ref name=pmid19176205>{{Cite journal  | last1 = Nese | first1 = N. | last2 = Gupta | first2 = R. | last3 = Bui | first3 = MH. | last4 = Amin | first4 = MB. | title = Carcinoma in situ of the urinary bladder: review of clinicopathologic characteristics with an emphasis on aspects related to molecular diagnostic techniques and prognosis. | journal = J Natl Compr Canc Netw | volume = 7 | issue = 1 | pages = 48-57 | month = Jan | year = 2009 | doi =  | PMID = 19176205 }}</ref>


==Microscopic==
==Microscopic==
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*[[Urothelial carcinoma]], invasive.
*[[Urothelial carcinoma]], invasive.
===Images===
===Images===
www:
<gallery>
*[http://www.webpathology.com/image.asp?n=3&Case=57 Urothelial CIS (webpathology.com)].
Image: Urothelial carcinoma in situ -- intermed mag.jpg | UCIS - intermed. mag. (WC)
*[http://www.webpathology.com/image.asp?n=5&Case=57 Urothelial CIS with shedding (webpathology.com)].
Image: Urothelial carcinoma in situ -- high mag.jpg | UCIS - high mag. (WC)
*[http://www.webpathology.com/image.asp?case=57&n=1 Urothelial CIS - low mag. (webpathology.com)].
Image: Urothelial carcinoma in situ - alt -- high mag.jpg | UCIS - high mag. (WC)
*[http://www.webpathology.com/image.asp?n=2&Case=57 Urothelial CIS - high mag. (webpathology.com)].
Image: Urothelial carcinoma in situ -- very high mag.jpg | UCIS - very high mag. (WC)
</gallery>
<gallery>
Image: Urothelial CIS -- low mag.jpg | UCIS - low mag. (WC)
Image: Urothelial CIS -- intermed mag.jpg | UCIS - intermed. mag. (WC)
Image: Urothelial CIS -- high mag.jpg | UCIS - high mag. (WC)
 
Image: Urothelial CIS - CK20 -- intermed mag.jpg | UCIS - CK20 - intermed. mag. (WC)
Image: Urothelial CIS - p63 -- intermed mag.jpg | UCIS - p63 - intermed. mag. (WC)
Image: Urothelial CIS - Ki67 -- high mag.jpg | UCIS - Ki-67 - high mag. (WC)
</gallery>
====www====
*[http://www.webpathology.com/image.asp?n=7&Case=57 Urothelial CIS (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=10&Case=57 Urothelial CIS with shedding (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=8&Case=57 Urothelial CIS - high mag. (webpathology.com)].


==IHC==
==IHC==
Features:<ref>{{Cite journal | last1 = Lopez-Beltran | first1 = A. | last2 = Jimenez | first2 = RE. | last3 = Montironi | first3 = R. | last4 = Patriarca | first4 = C. | last5 = Blanca | first5 = A. | last6 = Menendez | first6 = CL. | last7 = Algaba | first7 = F. | last8 = Cheng | first8 = L. | title = Flat urothelial carcinoma in situ of the bladder with glandular differentiation. | journal = Hum Pathol | volume = 42 | issue = 11 | pages = 1653-9 | month = Nov | year = 2011 | doi = 10.1016/j.humpath.2010.12.024 | PMID = 21531007 }}</ref>
[[ISUP]] consensus panel:<ref name=pmid25025364 >{{cite journal |author=Amin MB, Epstein JI, Ulbright TM, ''et al.'' |title=Best practices recommendations in the application of immunohistochemistry in urologic pathology: report from the international society of urological pathology consensus conference |journal=Am. J. Surg. Pathol. |volume=38 |issue=8 |pages=1017–22 |year=2014 |month=August |pmid=25025364 |doi=10.1097/PAS.0000000000000254 |url=}}</ref>
*CK20 +ve in deep cells.
**Normal urothelium -- only the umbrella cells.
*p53 +ve.
*p53 +ve.
*Ki-67 high.
*CD44 -ve.
**Positive in ''indeterminant'' and ''negative''.


Benign urothelium vs. CIS:<ref name=pmid16932015>{{Cite journal  | last1 = Yin | first1 = H. | last2 = He | first2 = Q. | last3 = Li | first3 = T. | last4 = Leong | first4 = AS. | title = Cytokeratin 20 and Ki-67 to distinguish carcinoma in situ from flat non-neoplastic urothelium. | journal = Appl Immunohistochem Mol Morphol | volume = 14 | issue = 3 | pages = 260-5 | month = Sep | year = 2006 | doi =  | PMID = 16932015 }}</ref>
===Another panel===
*CK20 +ve in deep cells (23/26 cases).
Another panel for benign urothelium versus CIS:<ref name=pmid16932015>{{Cite journal  | last1 = Yin | first1 = H. | last2 = He | first2 = Q. | last3 = Li | first3 = T. | last4 = Leong | first4 = AS. | title = Cytokeratin 20 and Ki-67 to distinguish carcinoma in situ from flat non-neoplastic urothelium. | journal = Appl Immunohistochem Mol Morphol | volume = 14 | issue = 3 | pages = 260-5 | month = Sep | year = 2006 | doi =  | PMID = 16932015 }}</ref>  
*[[CK20]] +ve in deep cells (23/26 cases).
**Normal urothelium -- only the umbrella cells.
**Normal urothelium -- only the umbrella cells.
*Ki-67 ~50% of cells - deep and superficial.
*Ki-67 ~50% of cells - deep and superficial.
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*CD44 -ve.<ref name=pmid24225842>{{Cite journal  | last1 = Aron | first1 = M. | last2 = Luthringer | first2 = DJ. | last3 = McKenney | first3 = JK. | last4 = Hansel | first4 = DE. | last5 = Westfall | first5 = DE. | last6 = Parakh | first6 = R. | last7 = Mohanty | first7 = SK. | last8 = Balzer | first8 = B. | last9 = Amin | first9 = MB. | title = Utility of a triple antibody cocktail intraurothelial neoplasm-3 (IUN-3-CK20/CD44s/p53) and α-methylacyl-CoA racemase (AMACR) in the distinction of urothelial carcinoma in situ (CIS) and reactive urothelial atypia. | journal = Am J Surg Pathol | volume = 37 | issue = 12 | pages = 1815-23 | month = Dec | year = 2013 | doi = 10.1097/PAS.0000000000000114 | PMID = 24225842 }}</ref>
*CD44 -ve.<ref name=pmid24225842>{{Cite journal  | last1 = Aron | first1 = M. | last2 = Luthringer | first2 = DJ. | last3 = McKenney | first3 = JK. | last4 = Hansel | first4 = DE. | last5 = Westfall | first5 = DE. | last6 = Parakh | first6 = R. | last7 = Mohanty | first7 = SK. | last8 = Balzer | first8 = B. | last9 = Amin | first9 = MB. | title = Utility of a triple antibody cocktail intraurothelial neoplasm-3 (IUN-3-CK20/CD44s/p53) and α-methylacyl-CoA racemase (AMACR) in the distinction of urothelial carcinoma in situ (CIS) and reactive urothelial atypia. | journal = Am J Surg Pathol | volume = 37 | issue = 12 | pages = 1815-23 | month = Dec | year = 2013 | doi = 10.1097/PAS.0000000000000114 | PMID = 24225842 }}</ref>
**Positive in ''indeterminant'' and ''negative''.
**Positive in ''indeterminant'' and ''negative''.
====Others====
*AMACR +ve (80% and 50% of untreated and treated CIS respectively<ref name=pmid24225842/>).
===Images===
<gallery>
Image: Urothelial carcinoma in situ - CK20 -- intermed mag.jpg | UCIS - CK20 - intermed. mag.
Image: Urothelial carcinoma in situ - CK20 -- high mag.jpg | UCIS - CK20 - high mag.
Image: Urothelial carcinoma in situ - CK20 -- very high mag.jpg | UCIS - CK20 - very high mag.
Image: Benign urothelium - CK20 -- high mag.jpg | Benign urothelium - CK20 - high mag.
</gallery>
<gallery>
Image: Urothelial carcinoma in situ - Ki-67 -- intermed mag.jpg | UCIS - Ki-67 - intermed. mag.
Image: Urothelial carcinoma in situ - Ki-67 -- high mag.jpg | UCIS - Ki-67 - high mag.
Image: Urothelial carcinoma in situ - Ki-67 -- very high mag.jpg | UCIS - Ki-67 - very high mag.
</gallery>


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