Difference between revisions of "Urothelium"

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Urothelium (view source)

Revision as of 12:46, 19 October 2011

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The '''urothelium''' lines the upper portion of the genitourinary tract... and a bit of the lower part.
The '''urothelium''' lines the upper portion of the genitourinary tract... and a bit of the lower part.
=Normal histology=
*Maturation (cuboidal at base - squamoid at surface).
**Surface cells called 'umbrella cells' (umbrella cells CK20+).
*Urothelium should be 4-5 cell layers thick.
*+/-Prominent nucleoli.
*Should NOT have papillary architecture -- if it does it is likely [[cancer]]!
**If it is 'papillary' -- it must have fibrovascular cores.


==Extent of urothelium==
==Extent of urothelium==
*Ureters.
*Renal pelvis.
*Bladder.
*Part of the urethra.
===Urethra in males===
===Urethra in males===
*Pre-prostatic urethra - transistional epithelium.
*Pre-prostatic urethra - transistional epithelium.
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*Spony urethra - pseudostratified columnar epi. (proximal) & strat. squamous (distal).
*Spony urethra - pseudostratified columnar epi. (proximal) & strat. squamous (distal).


==Normal histology==
=Approach=
*Prominent nucleoli (???).
*Maturation (cuboidal at base - squamoid at surface).
**Surface cells called 'umbrella cells' (umbrella cells CK20+).
*Urothelium should be 4-5 cell layers thick.
 
*Should NOT have papillary architecture -- if it does it is likely [[cancer]]!
**If it is 'papillary' -- it must have fibrovascular cores.
 
==Where to start==
==Where to start==
July 1st PGY-2:
July 1st PGY-2:
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#Fibrovascular cores = papillae... may be cancer!
#Fibrovascular cores = papillae... may be cancer!


==Note about terminology==
==A checklist-like approach==
*The bladder is rather unique in that "carcinoma" is a label used for things that are non-invasive.
**It has been suggested that many things that are called ''papillary urothelial carcinoma'', would be better described as ''papillary intraurothelial neoplasia''.<ref name=pmid19160695>{{Cite journal  | last1 = Van der Kwast | first1 = TH. | last2 = Zlotta | first2 = AR. | last3 = Fleshner | first3 = N. | last4 = Jewett | first4 = M. | last5 = Lopez-Beltran | first5 = A. | last6 = Montironi | first6 = R. | title = Thirty-five years of noninvasive bladder carcinoma: a plea for the use of papillary intraurothelial neoplasia as new terminology. | journal = Anal Quant Cytol Histol | volume = 30 | issue = 6 | pages = 309-15 | month = Dec | year = 2008 | doi =  | PMID = 19160695 }}</ref>
**If the terminology in the urinary bladder were applied to the colon, we'd call all ''adenomas'', i.e. pre-malignant lesions, ''carcinomas''.
 
==Approach==
# Papillary structure - with fibrovascular cores?
# Papillary structure - with fibrovascular cores?
#* Nuclear pleomorphism?
#* Nuclear pleomorphism?
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**Way to differentiate: paraganglioma = ''stippled chromatin'', UCC = ''single nucleoli''.
**Way to differentiate: paraganglioma = ''stippled chromatin'', UCC = ''single nucleoli''.


==Risk factors for UCC==
===Note about terminology===
Risk factors for UCC:
*The bladder is rather unique in that "carcinoma" is a label used for things that are non-invasive.
*[[Smoking]].
**It has been suggested that many things that are called ''papillary urothelial carcinoma'', would be better described as ''papillary intraurothelial neoplasia''.<ref name=pmid19160695>{{Cite journal  | last1 = Van der Kwast | first1 = TH. | last2 = Zlotta | first2 = AR. | last3 = Fleshner | first3 = N. | last4 = Jewett | first4 = M. | last5 = Lopez-Beltran | first5 = A. | last6 = Montironi | first6 = R. | title = Thirty-five years of noninvasive bladder carcinoma: a plea for the use of papillary intraurothelial neoplasia as new terminology. | journal = Anal Quant Cytol Histol | volume = 30 | issue = 6 | pages = 309-15 | month = Dec | year = 2008 | doi =  | PMID = 19160695 }}</ref>
*Toxins.
**If the terminology in the urinary bladder were applied to the colon, we'd call all ''adenomas'', i.e. pre-malignant lesions, ''carcinomas''.
*Drugs, e.g. cyclophosphamide.
 
*Marijuana.<ref name=pmid16413342>PMID 16413342.</ref>
=Specific entities=
*Chinese Herbs.<ref>URL: [http://content.nejm.org/cgi/content/full/343/17/1268 http://content.nejm.org/cgi/content/full/343/17/1268]. Accessed on: 27 May 2010.</ref>
Urothelial lesions can broadly be divided into:
#Flat lesions.
#*Lack papillae.
#*Tend to be more aggressive.  
#Papillary lesions.
#*Must have true papillae.
#*Very common.
#*More often benign/indolent.


==Premalignant/Hyperplasic/Reactive changes==
==Premalignant/Hyperplasic/Reactive changes==
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*Urothelial dysplasia.
*Urothelial dysplasia.


Cancer
Cancer:
*Urothelial carcinoma in situ.
*Urothelial carcinoma in situ.
*Invasive UCC.
*Invasive UCC.
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|}
|}
The '''bold''' entry is considered the key feature.
The '''bold''' entry is considered the key feature.
==Risk factors for UCC==
Risk factors for UCC:
*[[Smoking]].
*Toxins.
*Drugs, e.g. cyclophosphamide.
*Marijuana.<ref name=pmid16413342>PMID 16413342.</ref>
*Chinese Herbs.<ref>URL: [http://content.nejm.org/cgi/content/full/343/17/1268 http://content.nejm.org/cgi/content/full/343/17/1268]. Accessed on: 27 May 2010.</ref>


==Urothelial carcinoma in situ==
==Urothelial carcinoma in situ==
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*+/-Enlarged nucleoli.
*+/-Enlarged nucleoli.


==Urothelial cell carcinoma UCC (flat)==
==Urothelial cell carcinoma==
*Abbreviated ''UCC''.
===General===
*These lesions lack papillae and are typical flat.
===Microscopic===
Features:
*Nuclear pleomorphism.
*Nuclear pleomorphism.
**Most important feature.
**Most important feature.
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</ref>
</ref>


==UCC (papillary lesions)==
==Papillary urothelial cell carcinoma==
*[[AKA]] papillary urothelial carcinoma.
 
Papillary urothelial lesions are grouped into one of five categories (listed from bad to good prognosis):<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>
Papillary urothelial lesions are grouped into one of five categories (listed from bad to good prognosis):<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>
*High grade papillary.
*High grade papillary.
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*[http://www.archivesofpathology.org/action/showFullPopup?id=i1543-2165-134-10-1455-f01&doi=10.1043%2F2010-0226-CR.1 NA (archivesofpathology.org)].<ref name=pmid20923300>{{Cite journal  | last1 = Kunju | first1 = LP. | title = Nephrogenic adenoma: report of a case and review of morphologic mimics. | journal = Arch Pathol Lab Med | volume = 134 | issue = 10 | pages = 1455-9 | month = Oct | year = 2010 | doi = 10.1043/2010-0226-CR.1 | PMID = 20923300 }}</ref>
*[http://www.archivesofpathology.org/action/showFullPopup?id=i1543-2165-134-10-1455-f01&doi=10.1043%2F2010-0226-CR.1 NA (archivesofpathology.org)].<ref name=pmid20923300>{{Cite journal  | last1 = Kunju | first1 = LP. | title = Nephrogenic adenoma: report of a case and review of morphologic mimics. | journal = Arch Pathol Lab Med | volume = 134 | issue = 10 | pages = 1455-9 | month = Oct | year = 2010 | doi = 10.1043/2010-0226-CR.1 | PMID = 20923300 }}</ref>


==See also==
=See also=
*[[Prostate]].
*[[Prostate]].
*[[Genitourinary pathology]].
*[[Genitourinary pathology]].
*[[Kidney tumours]].


==References==
=References=
{{reflist|2}}
{{reflist|2}}


[[Category:Uropathology]]
[[Category:Uropathology]]
Michael
48,733

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