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# | '''Urothelial carcinoma''', also '''urothelial cell carcinoma''', is a [[malignancy]] that arises the [[urothelium]]. ''Urothelial carcinoma'' is abbreviated '''UC''' and ''urothelial cell carcinoma'' is abbreviated '''UCC'''. | ||
The article deals with flat invasive urothelial carcinoma. The direct precursor is dealth with in ''[[urothelial carcinoma in situ]]''. | |||
Papillary urothelial carcinomas are dealt with in ''[[low-grade papillary urothelial carcinoma]]'' and ''[[high-grade papillary urothelial carcinoma]]''. | |||
See ''[[Urine_cytopathology#Urothelial_cell_carcinoma|urine cytology]]'' for the [[cytopathology]]. | |||
===General=== | |||
*These lesions lack papillae and are typical flat. | |||
*Clinically, it may not be possible to differentiate renal pelvis urothelial carcinoma and [[renal cell carcinoma]]. | |||
==Microscopic== | |||
Features: | |||
*Nuclear pleomorphism - '''key feature'''. | |||
**Compare nuclei to one another. | |||
*Increased N/C ratio. | |||
*Lack of maturation to surface (important). | |||
*Cells become dyscohesive. | |||
**Mostly useless in my experience. | |||
Invasion vs. in situ: | |||
Useful features - present in invasion:<ref>Sternberg, SE. Histology for Pathologists. P.2047.</ref> | |||
*Thin-walled vessels. | |||
*Stromal reaction (hypercellularity). | |||
*Retraction artefact around the tumour cell nests. | |||
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: | |||
*[[Pseudocarcinomatous urothelial hyperplasia]]. | |||
===Staging=== | |||
*T1 - lamina propria. | |||
**Several subdivisions of T1 exist: | |||
***T1a - superficial or in muscularis mucosae. | |||
***T1b - beyond muscularis mucosae - into submucosa. | |||
*T2 - muscularis propria. | |||
===Subtypes of urothelial carcinoma=== | |||
There are numerous subtypes:<ref>URL: [http://www.nature.com/modpathol/journal/v22/n2s/full/modpathol200926a.html http://www.nature.com/modpathol/journal/v22/n2s/full/modpathol200926a.html]. Accessed on: 19 August 2011.</ref> | |||
*Squamous differentiation. | |||
*Clear cell. | |||
*Plasmacytoid. | |||
*Micropapillary. | |||
**Small nests (< ~10 cells/nest). | |||
*Sarcomatoid. | |||
**Images: [http://path.upmc.edu/cases/case615.html UCC with sarcomatoid differentiation (upmc.edu)]. | |||
*Many others... | |||
Benign patterns - mnemonic ''Much GIN'': | |||
*'''M'''icrocystic. | |||
*Small tubular/'''g'''landular. | |||
*'''I'''nverted. | |||
*'''N'''ested. | |||
====Plasmacytoid urothelial cell carcinoma==== | |||
Features: | |||
*Abundant gray cytoplasm, eccentric nucleus. | |||
Images: | |||
*[http://path.upmc.edu/cases/case267.html Plasmacytoid UCC - several images (upmc.edu)]. | |||
====Nested urothelial cell carcinoma==== | |||
*[[AKA]] ''nested variant urothelial cell carcinoma''. | |||
Features:<ref name=pmid2712189>{{Cite journal | last1 = Talbert | first1 = ML. | last2 = Young | first2 = RH. | title = Carcinomas of the urinary bladder with deceptively benign-appearing foci. A report of three cases. | journal = Am J Surg Pathol | volume = 13 | issue = 5 | pages = 374-81 | month = May | year = 1989 | doi = | PMID = 2712189 }}</ref> | |||
*High density of well-circumscribed nests. | |||
*Mild-to-moderate nuclear atypia. | |||
*+/-Foci of unequivocal conventional urothelial carcinoma. | |||
**Focally solid or gland fusion. | |||
**Moderate-to-severe nuclear atypia +/- abundant mitoses. | |||
*+/-Extension into the muscularis propria. | |||
DDx: | |||
*[[von Brunn nests]]. | |||
*[[Low grade papillary urothelial carcinoma]] with lamina propria invasion. | |||
===Images=== | |||
<gallery> | |||
Image:Nested_variant_of_urothelial_carcinoma_-_intermed_mag.jpg | Nested variant of urothelial carcinoma - intermed. mag. (WC/Nephron) | |||
Image:Nested_variant_of_urothelial_carcinoma_-_high_mag.jpg | Nested variant of urothelial carcinoma - high mag. (WC/Nephron) | |||
Image:Nested_variant_of_urothelial_carcinoma_-_very_high_mag.jpg | Nested variant of urothelial carcinoma - very high mag. (WC/Nephron) | |||
</gallery> | |||
www: | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3282447/figure/F2/ Several images of NUCC (nih.gov)].<ref name=pmid22355497>{{Cite journal | last1 = Terada | first1 = T. | title = Nested variant of urothelial carcinoma of the urinary bladder. | journal = Rare Tumors | volume = 3 | issue = 4 | pages = e42 | month = Oct | year = 2011 | doi = 10.4081/rt.2011.e42 | PMID = 22355497 | PMC = 3282447 }}</ref> | |||
==[[IHC]]== | |||
Features: | |||
*CK7 +ve CK20 +ve. | |||
**CK20 may be negative in over 50% of cases with metastases.<ref name=pmid11419977>{{Cite journal | last1 = Jiang | first1 = J. | last2 = Ulbright | first2 = TM. | last3 = Younger | first3 = C. | last4 = Sanchez | first4 = K. | last5 = Bostwick | first5 = DG. | last6 = Koch | first6 = MO. | last7 = Eble | first7 = JN. | last8 = Cheng | first8 = L. | title = Cytokeratin 7 and cytokeratin 20 in primary urinary bladder carcinoma and matched lymph node metastasis. | journal = Arch Pathol Lab Med | volume = 125 | issue = 7 | pages = 921-3 | month = Jul | year = 2001 | doi = 10.1043/0003-9985(2001)1250921:CACIPU2.0.CO;2 | PMID = 11419977 }}</ref> | |||
UCC vs. [[Prostate cancer|prostate]]: | |||
*UCC: p63+, PSA-, PSAP-, CK7+, CK20+. | |||
*Prostate: p63-, PSA+, PSAP+, CK7-, CK20-. | |||
UCC vs. [[renal cell carcinoma|RCC]]: | |||
*UCC: p63+.<ref>{{Cite journal | last1 = Langner | first1 = C. | last2 = Ratschek | first2 = M. | last3 = Tsybrovskyy | first3 = O. | last4 = Schips | first4 = L. | last5 = Zigeuner | first5 = R. | title = P63 immunoreactivity distinguishes upper urinary tract transitional-cell carcinoma and renal-cell carcinoma even in poorly differentiated tumors. | journal = J Histochem Cytochem | volume = 51 | issue = 8 | pages = 1097-9 | month = Aug | year = 2003 | doi = | PMID = 12871991 }} | |||
</ref> | |||
Staging - muscularis propria invasion versus muscularis mucosae invasion ''smoothelin'' stain:<ref>{{Cite journal | last1 = Paner | first1 = GP. | last2 = Shen | first2 = SS. | last3 = Lapetino | first3 = S. | last4 = Venkataraman | first4 = G. | last5 = Barkan | first5 = GA. | last6 = Quek | first6 = ML. | last7 = Ro | first7 = JY. | last8 = Amin | first8 = MB. | title = Diagnostic utility of antibody to smoothelin in the distinction of muscularis propria from muscularis mucosae of the urinary bladder: a potential ancillary tool in the pathologic staging of invasive urothelial carcinoma. | journal = Am J Surg Pathol | volume = 33 | issue = 1 | pages = 91-8 | month = Jan | year = 2009 | doi = 10.1097/PAS.0b013e3181804727 | PMID = 18936687 }}</ref> | |||
*Muscularis propria - usu. strong. † | |||
*Muscularis mucosae - negative/weak. † | |||
Note: | |||
*† Overlap between the patterns is described,<ref>{{Cite journal | last1 = Miyamoto | first1 = H. | last2 = Sharma | first2 = RB. | last3 = Illei | first3 = PB. | last4 = Epstein | first4 = JI. | title = Pitfalls in the use of smoothelin to identify muscularis propria invasion by urothelial carcinoma. | journal = Am J Surg Pathol | volume = 34 | issue = 3 | pages = 418-22 | month = Mar | year = 2010 | doi = 10.1097/PAS.0b013e3181ce5066 | PMID = 20154589 }}</ref> this limits the utility of the stain. | |||
==Molecular== | |||
Not used for diagnosis. | |||
Changes: | |||
*9p deletion -- site of CDKN2A<ref name=omim600160>{{OMIM|600160}}</ref> (AKA p16). | |||
*17p deletion -- site of PT53 (AKA p53). | |||
==Sign out== | |||
===High grade UC=== | |||
<pre> | |||
URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION URINARY BLADDER TUMOUR (TURBT): | |||
- INVASIVE HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMA WITH SQUAMOUS DIFFERENTIATION AT LEAST INTO MUSCULARIS PROPRIA. | |||
- LYMPHOVASCULAR INVASION PRESENT. | |||
</pre> | |||
===Nested variant=== | |||
<pre> | |||
URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION OF BLADDER TUMOUR (TURBT): | |||
- INVASIVE LOW-GRADE UROTHELIAL CARCINOMA, NESTED VARIANT. | |||
- TUMOUR PRESENT AT EDGE OF TISSUE. | |||
- NO MUSCULARIS PROPRIA IDENTIFIED. | |||
</pre> | |||
==See also== | |||
*[[Urothelium]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Urothelium]] | |||
[[Category:Diagnosis]] | |||