Difference between revisions of "Urothelium"

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Urothelium (view source)

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→‎Low grade papillary urothelial carcinoma: split-out
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*Abbreviated ''LGPUC''.<ref name=pmid22857755>{{Cite journal  | last1 = Watts | first1 = KE. | last2 = Montironi | first2 = R. | last3 = Mazzucchelli | first3 = R. | last4 = van der Kwast | first4 = T. | last5 = Osunkoya | first5 = AO. | last6 = Stephenson | first6 = AJ. | last7 = Hansel | first7 = DE. | title = Clinicopathologic characteristics of 23 cases of invasive low-grade papillary urothelial carcinoma. | journal = Urology | volume = 80 | issue = 2 | pages = 361-6 | month = Aug | year = 2012 | doi = 10.1016/j.urology.2012.04.010 | PMID = 22857755 }}</ref>
*Abbreviated ''LGPUC''.<ref name=pmid22857755>{{Cite journal  | last1 = Watts | first1 = KE. | last2 = Montironi | first2 = R. | last3 = Mazzucchelli | first3 = R. | last4 = van der Kwast | first4 = T. | last5 = Osunkoya | first5 = AO. | last6 = Stephenson | first6 = AJ. | last7 = Hansel | first7 = DE. | title = Clinicopathologic characteristics of 23 cases of invasive low-grade papillary urothelial carcinoma. | journal = Urology | volume = 80 | issue = 2 | pages = 361-6 | month = Aug | year = 2012 | doi = 10.1016/j.urology.2012.04.010 | PMID = 22857755 }}</ref>
*[[AKA]] ''low grade papillary urothelial cell carcinoma''.
*[[AKA]] ''low grade papillary urothelial cell carcinoma''.
 
{{Main|Low-grade papillary urothelial carcinoma}}
===General===
*Very common.
*Very good prognosis - if it is non-invasive.
*Usually non-invasive.<ref name=pmid22510761/>
 
Note:
*Invasive low-grade UCC is:<ref name=pmid22510761/>
**~75% ''nested variant of urothelial carcinoma''.
**~25: ''low-grade papillary urothelial carcinoma''.
 
===Microscopic===
Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>
*Fused papillae.
*Papillae branch.
*Larger nuclei than PUNLMPs.
*+/-Invasion into the lamina propria.
 
Criteria for invasion:<ref name=pmid22510761>{{Cite journal  | last1 = Toll | first1 = AD. | last2 = Epstein | first2 = JI. | title = Invasive low-grade papillary urothelial carcinoma: a clinicopathologic analysis of 41 cases. | journal = Am J Surg Pathol | volume = 36 | issue = 7 | pages = 1081-6 | month = Jul | year = 2012 | doi = 10.1097/PAS.0b013e318253d6e0 | PMID = 22510761 }}</ref>
*[[Stromal reaction]].
*Infiltrating single cells.
*Small nests.
*Retraction artifact.
*Paradoxical differentiation.
 
Note:
*The presence/absence of muscle should be commented on in biopsy specimens.
*Adipose tissue may be seen in the lamina propria; tumour adjacent to adipose tissue on a biopsy does '''not''' imply invasion deep to the muscularis propria.<ref name=pmid7879346>{{Cite journal  | last1 = Bochner | first1 = BH. | last2 = Nichols | first2 = PW. | last3 = Skinner | first3 = DG. | title = Overstaging of transitional cell carcinoma: clinical significance of lamina propria fat within the urinary bladder. | journal = Urology | volume = 45 | issue = 3 | pages = 528-31 | month = Mar | year = 1995 | doi = 10.1016/S0090-4295(99)80030-2 | PMID = 7879346 }}</ref>
 
DDx:
*[[PUNLMP]].
*[[High grade papillary urothelial carcinoma]].
**Often under-diagnosed (~15% in one series) when reassessed by experts.<ref name=pmid20670136>{{Cite journal  | last1 = Miyamoto | first1 = H. | last2 = Brimo | first2 = F. | last3 = Schultz | first3 = L. | last4 = Ye | first4 = H. | last5 = Miller | first5 = JS. | last6 = Fajardo | first6 = DA. | last7 = Lee | first7 = TK. | last8 = Epstein | first8 = JI. | last9 = Netto | first9 = GJ. | title = Low-grade papillary urothelial carcinoma of the urinary bladder: a clinicopathologic analysis of a post-World Health Organization/International Society of Urological Pathology classification cohort from a single academic center. | journal = Arch Pathol Lab Med | volume = 134 | issue = 8 | pages = 1160-3 | month = Aug | year = 2010 | doi = 10.1043/2009-0403-OA.1 | PMID = 20670136 }}</ref>
**The three most predictive features of high-grade are ''architectural complexity'', ''nuclear size variation'', and ''absence of umbrella cells''.<ref name=pmid21980608>{{Cite journal  | last1 = Isfoss | first1 = BL. | last2 = Majak | first2 = B. | last3 = Busch | first3 = C. | last4 = Braathen | first4 = GJ. | title = Simplification of grading papillary urothelial neoplasia using a reduced set of diagnostic features. | journal = Anal Quant Cytol Histol | volume = 33 | issue = 2 | pages = 68-74 | month = Apr | year = 2011 | doi =  | PMID = 21980608 }}</ref>
*[[Inverted urothelial papilloma]] - often have peripheral palisading.
*[[Urothelial papilloma]].
 
===IHC===
*Ki-67:
**Rajcani ''et al.'':<ref name=pmid23944616>{{Cite journal  | last1 = Rajcani | first1 = J. | last2 = Kajo | first2 = K. | last3 = Adamkov | first3 = M. | last4 = Moravekova | first4 = E. | last5 = Lauko | first5 = L. | last6 = Felcanova | first6 = D. | last7 = Bencat | first7 = M. | title = Immunohistochemical characterization of urothelial carcinoma. | journal = Bratisl Lek Listy | volume = 114 | issue = 8 | pages = 431-8 | month =  | year = 2013 | doi =  | PMID = 23944616 }}</ref> <25% of tumour cells for low-grade versus >50% tumour cell for high-grade.
**Pich ''et al.'':<ref name=pmid7910097>{{Cite journal  | last1 = Pich | first1 = A. | last2 = Chiusa | first2 = L. | last3 = Comino | first3 = A. | last4 = Navone | first4 = R. | title = Cell proliferation indices, morphometry and DNA flow cytometry provide objective criteria for distinguishing low and high grade bladder carcinomas. | journal = Virchows Arch | volume = 424 | issue = 2 | pages = 143-8 | month =  | year = 1994 | doi =  | PMID = 7910097 }}</ref> 11%/17% for G1/G2 versus 34% for G3.
 
===Molecular===
Molecular changes:<ref name=pmid19468362>{{Cite journal  | last1 = Ehdaie | first1 = B. | last2 = Theodorescu | first2 = D. | title = Molecular markers in transitional cell carcinoma of the bladder: New insights into mechanisms and prognosis. | journal = Indian J Urol | volume = 24 | issue = 1 | pages = 61-7 | month = Jan | year = 2008 | doi = 10.4103/0970-1591.38606 | PMID = 19468362 | PMC = 2684226}}</ref>
*FGFR3
*HRAS
*Loss of heterozygosity - chromosome 9.
 
Note:
*Not currently used diagnostically.
===Sign out===
<pre>
URINARY BLADDER LESION ("TUMOUR"), RESECTION:
- LOW-GRADE PAPILLARY UROTHELIAL CARCINOMA.
-- NEGATIVE FOR LAMINA PROPRIA INVASION.
- NO MUSCULARIS PROPRIA IDENTIFIED.
</pre>
 
<pre>
URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION OF BLADDER TUMOUR (TURBT):
- LOW-GRADE PAPILLARY UROTHELIAL CARCINOMA.
- NEGATIVE FOR LAMINA PROPRIA INVASION.
- NO MUSCULARIS PROPRIA IDENTIFIED.
</pre>
 
<pre>
URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION OF BLADDER TUMOUR (TURBT):
- LOW-GRADE PAPILLARY UROTHELIAL CARCINOMA.
- NEGATIVE FOR LAMINA PROPRIA INVASION.
- MUSCULARIS PROPRIA PRESENT.
</pre>


==High grade papillary urothelial carcinoma==
==High grade papillary urothelial carcinoma==
Michael
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