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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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| Bloodwork = | | Bloodwork = | ||
| Rads = | | Rads = | ||
| Endoscopy = | | Endoscopy = erythema or edema, may be unremarkable | ||
| Prognosis = | | Prognosis = | ||
| Other = | | Other = | ||
| ClinDDx = invasive (flat) [[urothelial carcinoma]] | | ClinDDx = invasive (flat) [[urothelial carcinoma]], inflammation (cystitis) | ||
| Tx = | | Tx = | ||
}} | }} | ||
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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=== | ||
<gallery> | |||
Image: Urothelial carcinoma in situ -- intermed mag.jpg | UCIS - intermed. mag. (WC) | |||
*[http://www.webpathology.com/image.asp?n= | Image: Urothelial carcinoma in situ -- high mag.jpg | UCIS - high mag. (WC) | ||
*[http://www.webpathology.com/image.asp? | Image: Urothelial carcinoma in situ - alt -- high mag.jpg | UCIS - high mag. (WC) | ||
*[http://www.webpathology.com/image.asp?n= | 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== | ||
[[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. | ||
* | *CD44 -ve. | ||
**Positive in ''indeterminant'' and ''negative''. | |||
===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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