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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'''.
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Urothelial carcinoma positive margin -- high mag.jpg
| Width      =
| Caption    = Urothelial carcinoma at a [[surgical margin]]. [[H&E stain]].
| Synonyms  = urothelial cell carcinoma
| Micro      =
| Subtypes  = [[microcystic urothelial carcinoma|microcystic]], [[micropapillary urothelial carcinoma|micropapillary]], glandular, inverted (growth pattern), [[nested urothelial carcinoma|nested]], papillary (dealt with separately in ''[[high-grade papillary urothelial carcinoma]]'' and ''[[low-grade papillary urothelial carcinoma]]''), [[plasmacytoid urothelial carcinoma]], others
| LMDDx      = [[urothelial carcinoma in situ]], metastatic carcinoma ([[prostate carcinoma]], [[colorectal carcinoma]]), [[inverted urothelial papilloma]] (for UCC with inverted growth pattern), [[epithelioid angiosarcoma]]
| Stains    =
| IHC        = [[GATA3]] +ve, p63 +ve, CK5/6 +ve, CK34betaE12 +ve, PSA -ve
| EM        =
| Molecular  = not used for diagnosis; typically: 9p deletions, 17p deletions; can be [[Classification of urothelial carcinoma by immunohistochemistry|subclassified with IHC]]; [[FGFR2/FGFR3]] mutations
| IF        =
| Gross      =
| Grossing  = [[transurethral resection of bladder tumour grossing]], [[radical cystectomy grossing]], [[cystoprostatectomy grossing]], [[nephroureterectomy grossing]]
| Staging    = [[bladder cancer staging]]
| Site      = [[urothelium]] - [[ureter]], [[urinary bladder]], proximal [[urethra]] (see [[urothelial carcinoma of the urethra]], renal pelvis
| Assdx      =
| Syndromes  = [[Lynch syndrome]] - esp. ureters
| Clinicalhx = typically [[smoking|smokers]]
| Signs      = hematuria
| Symptoms  =
| Prevalence = common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = dependent on grade and stage
| Other      =
| ClinDDx    =
| Tx        = dependent on grade and stage
}}
'''Urothelial carcinoma''', also '''urothelial cell carcinoma''', is a [[malignancy]] that arises from 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]]''.
This article deals with flat invasive urothelial carcinoma. The direct precursor is dealt with in ''[[urothelial carcinoma in situ]]''.


Papillary urothelial carcinomas are dealt with in ''[[low-grade papillary urothelial carcinoma]]'' and ''[[high-grade papillary urothelial carcinoma]]''.
Papillary urothelial carcinomas are dealt with in ''[[low-grade papillary urothelial carcinoma]]'' and ''[[high-grade papillary urothelial carcinoma]]''.
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See ''[[Urine_cytopathology#Urothelial_cell_carcinoma|urine cytology]]'' for the [[cytopathology]].
See ''[[Urine_cytopathology#Urothelial_cell_carcinoma|urine cytology]]'' for the [[cytopathology]].


==General==
=General=
*These lesions lack papillae and are typical flat.
*These lesions lack papillae and are typical flat.
*Clinically, it may not be possible to differentiate renal pelvis urothelial carcinoma and [[renal cell carcinoma]].
*Clinically, it may not be possible to differentiate renal pelvis urothelial carcinoma and [[renal cell carcinoma]].
*May be a part of [[Lynch syndrome]].


==Microscopic==
Prognosis:
*Women often have worse outcomes as they present with more advanced tumours.<ref name=pmid24239476>{{Cite journal  | last1 = Mitra | first1 = AP. | last2 = Skinner | first2 = EC. | last3 = Schuckman | first3 = AK. | last4 = Quinn | first4 = DI. | last5 = Dorff | first5 = TB. | last6 = Daneshmand | first6 = S. | title = Effect of gender on outcomes following radical cystectomy for urothelial carcinoma of the bladder: a critical analysis of 1,994 patients. | journal = Urol Oncol | volume = 32 | issue = 1 | pages = 52.e1-9 | month = Jan | year = 2014 | doi = 10.1016/j.urolonc.2013.08.007 | PMID = 24239476 }}</ref>
*Positive soft tissue [[margin status|margin]].<ref  name=pmid17936804>{{Cite journal  | last1 = Dotan | first1 = ZA. | last2 = Kavanagh | first2 = K. | last3 = Yossepowitch | first3 = O. | last4 = Kaag | first4 = M. | last5 = Olgac | first5 = S. | last6 = Donat | first6 = M. | last7 = Herr | first7 = HW. | title = Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival. | journal = J Urol | volume = 178 | issue = 6 | pages = 2308-12; discussion 2313 | month = Dec | year = 2007 | doi = 10.1016/j.juro.2007.08.023 | PMID = 17936804 }}</ref>
**Definition (radical cystectomy): tumour touching [[ink]].
 
Risk factors:
*[[Smoking]].
*Toxins.
*Drugs, e.g. cyclophosphamide.
*Others.
 
=Microscopic=
Features:
Features:
*Nuclear pleomorphism - '''key feature'''.
*Nuclear pleomorphism - '''key feature'''.
Line 17: Line 61:
*Increased N/C ratio.
*Increased N/C ratio.
*Lack of maturation to surface (important).
*Lack of maturation to surface (important).
*Cells become dyscohesive.
*Cells become dyscohesive.
**Mostly useless in my experience.


Invasion vs. in situ:
Invasion vs. in situ:
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*[[High-grade papillary urothelial carcinoma]].
*[[High-grade papillary urothelial carcinoma]].
*[[Low-grade papillary urothelial carcinoma]].
*[[Low-grade papillary urothelial carcinoma]].
*[[Prostate carcinoma]] - may have pseudopapillae<ref name=pmid24503758>{{cite journal |author=Gordetsky J, Epstein JI |title=Pseudopapillary features in prostatic adenocarcinoma mimicking urothelial carcinoma: a diagnostic pitfall |journal=Am. J. Surg. Pathol. |volume=38 |issue=7 |pages=941–5 |year=2014 |month=July |pmid=24503758 |doi=10.1097/PAS.0000000000000178 |url=}}</ref> - see ''[[urothelial carcinoma-like prostatic carcinoma]]''.
*[[Epithelioid angiosarcoma]] - have intracytoplasmic lumens and interspersed red blood cells, usually have a history radiation treatment.<ref name=pmid25929352>{{cite journal |authors=Matoso A, Epstein JI |title=Epithelioid Angiosarcoma of the Bladder: A Series of 9 Cases |journal=Am J Surg Pathol |volume=39 |issue=10 |pages=1377–82 |date=October 2015 |pmid=25929352 |doi=10.1097/PAS.0000000000000444 |url=}}</ref>


===Staging===
==Staging==
{{Main|Bladder cancer staging}}
*T1 - lamina propria.
*T1 - lamina propria.
**Several subdivisions of T1 exist:
**Several subdivisions of T1 exist:
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*T2 - muscularis propria.
*T2 - muscularis propria.


====Muscularis propria invasion====
Note:
The presence or absence of muscularis propria invasion is a '''very important''' determination, as the clinical management changes between T1 and T2:
*Approximately 25% of muscle invasive urothelial carcinoma on biopsy is a lower stage in the cystectomy specimen.<ref name=pmid22915241>{{Cite journal  | last1 = D'Souza | first1 = AM. | last2 = Pohar | first2 = KS. | last3 = Arif | first3 = T. | last4 = Geyer | first4 = S. | last5 = Zynger | first5 = DL. | title = Retrospective analysis of survival in muscle-invasive bladder cancer: impact of pT classification, node status, lymphovascular invasion, and neoadjuvant chemotherapy. | journal = Virchows Arch | volume = 461 | issue = 4 | pages = 467-74 | month = Oct | year = 2012 | doi = 10.1007/s00428-012-1249-4 | PMID = 22915241 }}</ref>
*T1: usually conservative treatment (local excision).
**In approximately 15% of cases it is pT0 (no primary tumour identified).
*T2: radical treatment (cystectomy or cystoprostatectomy).


A thin layer of discontinous muscularis mucuosae (MM) is present and, especially if hypertrophic, may be confused with muscuaris propria (MP).
===Muscularis propria invasion===
{{Main|Muscularis propria invasion in the urinary bladder}}


=====Comparing MM and MP=====
==Images==
A comparison between muscularis propria and muscularis mucosae - adapted from Paner ''et al.'':<ref name=pmid17721199>{{Cite journal  | last1 = Paner | first1 = GP. | last2 = Ro | first2 = JY. | last3 = Wojcik | first3 = EM. | last4 = Venkataraman | first4 = G. | last5 = Datta | first5 = MW. | last6 = Amin | first6 = MB. | title = Further characterization of the muscle layers and lamina propria of the urinary bladder by systematic histologic mapping: implications for pathologic staging of invasive urothelial carcinoma. | journal = Am J Surg Pathol | volume = 31 | issue = 9 | pages = 1420-9 | month = Sep | year = 2007 | doi = 10.1097/PAS.0b013e3180588283 | PMID = 17721199 }}</ref>  
<gallery>
{| class="wikitable sortable"
Image: Urothelial carcinoma positive margin -- intermed mag.jpg | Typical UCC pos. margin - intermed. mag.
! Feature
Image: Urothelial carcinoma positive margin -- high mag.jpg | Typical UCC pos. margin - high mag.
! Muscularis mucosae
Image: Urothelial carcinoma positive margin -- very high mag.jpg |Typical UCC pos. margin - very high mag.
! Muscularis propria
Image: Urothelial carcinoma positive margin - alt -- intermed mag.jpg | Typical UCC pos. margin - intermed. mag.
|-
Image: Urothelial carcinoma positive margin - alt -- high mag.jpg | Typical UCC pos. margin - high mag.
| Outline/border
</gallery>
| typically irregular
www:
| usually regular
*[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>
|-
| Size of bundles ‡
| classically "small", often "large" (hypertrophic)
| usu. "large"
|-
| Isolated fibres
| yes
| no
|-
| Location in bladder
| less common in trigone, dome very common
| everywhere
|-
| Depth †
| superficial, occ. deep
| deep
|}


Notes:
[[File:5 410253052 sl 1.png| High grade urothelial carcinoma]]
*† The lamina propria thickness varies with location. It is thinnest in the trigone (0.5-1.6 mm) and thickest in the dome (1.0-3.1 mm).
[[File:5 410253052 sl 2.png| High grade urothelial carcinoma]]
*‡ Small is defined as <4 muscle fibres; large >= 4 muscle fibres.
[[File:5 410253052 sl 3.png| High grade urothelial carcinoma]]
**The presence of hyperplastic bundles ranges from ~20% in the trigone to ~70% in the dome.
[[File:5 410253052 sl 4.png| High grade urothelial carcinoma]]
[[File:5 410253052 sl 5.png| High grade urothelial carcinoma]]
[[File:5 410253052 sl 6.png| High grade urothelial carcinoma]]
[[File:5 410253052 sl 7.png| High grade urothelial carcinoma]]
[[File:5 410253052 sl 8.png| High grade urothelial carcinoma]]<br>
High grade urothelial carcinoma in a 43 year old man. A. At low power, necrosis is seen, luminal, with viable invasive tumor elsewhere. B. Tumor partly fills right ureteral orifice. C.  Tumor cells sometimes form Indian files (black arrows), appear to have nuclei that mold (red arrows), and have granular chromatin (cyan arrows), raising possibility of neuroendocrine carcinoma. D. Tumor invades lymphatic spaces. E. Urothelial carcinoma in situ is present. F,G,H.  Tumor cells are diffusely positive for CK7, focally positive for CDX2, and diffusely positive for P40, with no positivity for chromogranin or synaptophysin.


=====Rational assessment of muscularis propria invasion=====
=[[IHC]]=
To call MP invasion:
Recommended by [[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>
#Definite tumour must be between muscle fibres.
*GATA3 +ve, CK20 +ve, p63 +ve, CK5/6, HMWCK (e.g. CK34betaE12) +ve.  
#Muscle bundles must be thick.
#Multiple bundles must be present.
#Should '''not''' be superficial - surface epithelium if present should be distant.


===Subtypes of urothelial carcinoma===
Others:
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>
*CK7 +ve.
*Squamous differentiation.
*PSA -ve.
*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'':
Notes:
*'''M'''icrocystic.
*CK20 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>
*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]]==
===Reactive changes versus UCIS===
Features:
:''See [[urothelial carcinoma in situ]]''.
*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 versus other cancers===
UCC vs. [[Prostate cancer|prostate]]:
UCC vs. [[Prostate cancer|prostate]]:
*UCC: p63+, PSA-, PSAP-, CK7+, CK20+.
*UCC: GATA3 +ve, PSA -ve, [[p63]] +ve, [[CK20]] +ve.
*Prostate: p63-, PSA+, PSAP+, CK7-, CK20-.
*Prostate: [[PSA]] +ve, [[GATA3]] -ve, [[PSAP]] +ve, CK7 -ve, CK20 -ve, p63 -ve.  


UCC vs. [[renal cell carcinoma|RCC]]:
UCC vs. [[renal cell carcinoma|renal cell carcinoma]]:
*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 }}
*UCC: p63 +ve.<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>
</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>
Metastatic UCC versus primary lung squamous cell carcinoma:
*Muscularis propria - usu. strong. †
:See ''[[Squamous_cell_carcinoma_of_the_lung#Lung_SCC_versus_metastatic_bladder_urothelial_carcinoma]]''.
*Muscularis mucosae - negative/weak. †


Note:
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.
*In a large series, PSA positivity is reported in 1.4% bladder UCC.<ref name=pmid19192675>{{Cite journal  | last1 = Chen | first1 = JC. | last2 = Ho | first2 = CL. | last3 = Tsai | first3 = HW. | last4 = Tzai | first4 = TS. | last5 = Liu | first5 = HS. | last6 = Chow | first6 = NH. | last7 = Yang | first7 = WH. | last8 = Cheng | first8 = HL. | title = Immunohistochemical detection of prostate-specific antigen expression in primary urothelial carcinoma of the urinary bladder. | journal = Anticancer Res | volume = 28 | issue = 6B | pages = 4149-54 | month = | year = | doi = | PMID = 19192675 }}
</ref>
**In half the cases the staining is weak and in the other half it is strong.<ref name=pmid19192675/>
 
===IHC for staging===
*''Smoothelin'' immunostain for [[bladder muscularis propria invasion|muscularis propria invasion]] versus muscularis mucosae invasion - see ''[[Muscularis_propria_invasion_in_the_urinary_bladder#IHC]]''.


==Molecular==
=Molecular=
Not used for diagnosis.
*Molecular testing usually ''not'' used for diagnosis.
**Molecular subtyping can be approximated with immunostaining - see ''[[Classification of urothelial carcinoma by immunohistochemistry]]''.


Changes:
Changes:
Line 166: Line 159:
*17p deletion -- site of PT53 (AKA p53).
*17p deletion -- site of PT53 (AKA p53).


==Sign out==
=Sign out=
===High grade UC===
==High grade UC==
<pre>
<pre>
URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION URINARY BLADDER TUMOUR (TURBT):  
URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION URINARY BLADDER TUMOUR (TURBT):  
- INVASIVE HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMA WITH SQUAMOUS DIFFERENTIATION AT LEAST INTO MUSCULARIS PROPRIA.
- INVASIVE HIGH-GRADE PAPILLARY UROTHELIAL CARCINOMA WITH SQUAMOUS DIFFERENTIATION AT LEAST  
  INTO MUSCULARIS PROPRIA.
- LYMPHOVASCULAR INVASION PRESENT.
- LYMPHOVASCULAR INVASION PRESENT.
</pre>
</pre>


===Nested variant===
==UCC with some suspicion for muscularis propria invasion==
<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>
 
===UCC with some suspicion for muscularis propria invasion===
<pre>
<pre>
URINARY BLADDER LESION ("TUMOUR"), DEEP, RE-RESECTION (TURBT):
URINARY BLADDER LESION ("TUMOUR"), DEEP, RE-RESECTION (TURBT):
Line 197: Line 183:
</pre>
</pre>


==See also==
===Alternate comment===
<pre>
The sections shows thickened muscle bundles with frayed edges between the
tumour cells. The muscle is thought to represent hypertrophic muscularis
mucosae. The large extent of lamina propria invasion raises the possibility
of a higher stage lesion that may not have been sampled.
</pre>
 
=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 urothelial carcinoma|Plasmacytoid]].
*[[Micropapillary urothelial carcinoma|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==
{{Main|Plasmacytoid urothelial carcinoma}}
 
==Microcystic urothelial carcinoma==
{{Main|Microcystic urothelial carcinoma}}
 
==Micropapillary urothelial carcinoma==
{{Main|Micropapillary urothelial carcinoma}}
 
==Lymphoepithelioma-like carcinoma==
{{Main|Lymphoepithelioma-like carcinoma of the urinary bladder}}
 
==Nested urothelial cell carcinoma==
*[[AKA]] ''nested variant of urothelial cell carcinoma''.
{{Main|Nested urothelial carcinoma}}
 
=See also=
*[[Urothelium]].
*[[Urothelium]].
*[[Urothelial dysplasia]].
*[[Urothelial dysplasia]].
Line 203: Line 230:
*[[Prostatic urothelial carcinoma]].
*[[Prostatic urothelial carcinoma]].


==References==
=References=
{{Reflist|2}}
{{Reflist|2}}


[[Category:Urothelium]]
[[Category:Urothelium]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]
Michael
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