Papillary urothelial hyperplasia

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Papillary urothelial hyperplasia, abbreviated PUH, is a benign lesion of the urothelium that is associated with the subsequent development of low-grade papillary urothelial carcinoma.

General

  • Benign.
  • Strong association with papillary neoplasms.
    • On follow-up (in one study) >1/4, without prior history of urothelial neoplasia, have urothelial carcinoma; thus, follow-up is recommended.[1]

Microscopic

Features:[2]

  • Inflammation.
  • Papillary structures without well-developed fibrovascular cores.
    • Tent-like appearance or spike-like appearance - short/stubby papillae not longer than the urothelium is thick.[3]
  • No urothelial cell atypia.

DDx:

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URINARY BLADDER, BIOPSY:
- REACTIVE PAPILLARY HYPERPLASIA, SEE COMMENT.
- NO MUSCULARIS PROPRIA IDENTIFIED.
- CYSTITIS CYSTICA ET GLANDULARIS.
- NO EVIDENCE OF MALIGNANCY.

COMMENT:
The urothelial forms rare papillary structures; these are interpreted as reactive.

The urothelium stains as follow:
CK7: positive, patchy (normal).
CK20: only rare superficial cells (normal).
Ki-67: rare, focally increased, negative in papillary structures (<10%).
p53: negative (weak focal <20%), very rare weak in rare papillary structures (<5%).

Follow-up is recommended.

See also

References

  1. Readal, N.; Epstein, JI. (Jun 2010). "Papillary urothelial hyperplasia: relationship to urothelial neoplasms.". Pathology 42 (4): 360-3. doi:10.3109/00313021003767322. PMID 20438409.
  2. URL: http://pathology.jhu.edu/bladder/definitions.cfm. Accessed on: 27 January 2014.
  3. URL: http://surgpathcriteria.stanford.edu/bladder/tcc-papillary-transitional-urothelial-carcinoma/. Accessed on: 27 January 2014.