Difference between revisions of "Urothelial carcinoma"

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Urothelial carcinoma (view source)

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===Muscularis propria invasion===
===Muscularis propria invasion===
The presence or absence of muscularis propria invasion is a '''very important''' determination, as the clinical management changes between T1 and T2:
{{Main|Muscularis propria invasion in the urinary bladder}}
*T1: usually conservative treatment (local excision).
*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).
 
====Comparing MM and MP====
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>
{| class="wikitable sortable"
! Feature
! Muscularis mucosae
! Muscularis propria
|-
| Outline/border
| typically irregular (frayed edges)
| usually regular (circumscribed)
|-
| Size of bundles ‡
| classically "small", often "large" (hypertrophic)
| usually "large"
|-
| Isolated fibres
| yes
| no
|-
| Location in bladder
| less common in trigone, dome very common
| everywhere
|-
| Depth †
| superficial, occ. deep
| deep
|}
 
Notes:
*† 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).
*‡ Small is defined as <4 muscle fibres; large >= 4 muscle fibres.
**The presence of hyperplastic bundles ranges from ~20% in the trigone to ~70% in the dome.
 
=====Images=====
<gallery>
Image: Urinary bladder muscularis mucosae -- intermed mag.jpg | MM - intermed. mag. (wc)
Image: Urinary bladder muscularis mucosae -- high mag.jpg | MM - high mag. (WC)
Image: Urinary bladder muscularis mucosae -- very high mag.jpg | MM - very high mag. (WC)
</gallery>
 
====Rational assessment of muscularis propria invasion====
To call muscularis propria invasion:
#Definite tumour must be between muscle.
#Muscle bundles must be thick.
#Multiple bundles must be adjacent to one another.
#Should '''not''' be superficial - surface epithelium if present should be distant.


==Images==
==Images==
Michael
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