Difference between revisions of "Urothelium"

Papillary urothelial lesions are grouped into one of five categories (listed from good to bad prognosis):<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>

#[[Urothelial papilloma]].

#[[Inverted papilloma]].

#[[Papillary urothelial neoplasm of low malignant potential]] (PUNLMP).

#*''PUNLMP'' is pronouced "pun-lump".

#[[Low grade papillary urothelial carcinoma]].

#[[High grade papillary urothelial carcinoma]].

==Urothelial papilloma==

===General===

*Very rare diagnosed.

**If the person has a history of a low grade papillary urothelial carcinoma... it is a low grade papillary urothelial carcinoma.

**These cases are a consensus diagnosis, i.e. you show it to a colleague... if they agree you can call it.  

*Papillary fronds.

*Cytological features of normal urothelium.

**Normal urothelium approx. 2x the size of stromal lymphocytes.<ref name=Ref_GUP161>{{Ref GUP|161}}</ref>

*No mitoses.

==Inverted papilloma==

===General===

*May be confused with papillary urothelial carcinoma with an inverted growth pattern.

Features:

*Like papillomas... but grow downward.<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>

*According to THvdK,<ref>THvdK. 21 June 2010.</ref> ''inverted papillomas'' '''never''' have an exophytic component; if an exophytic component is present it is urothelial carcinoma.  This is disputed by one paper from Mexico that examines two cases.<ref name=pmid19433293>{{cite journal |author=Albores-Saavedra J, Chable-Montero F, Hernández-Rodríguez OX, Montante-Montes de Oca D, Angeles-Angeles A |title=Inverted urothelial papilloma of the urinary bladder with focal papillary pattern: a previously undescribed feature |journal=Ann Diagn Pathol |volume=13 |issue=3 |pages=158–61 |year=2009 |month=June |pmid=19433293 |doi=10.1016/j.anndiagpath.2009.02.009 |url=}}</ref>

 

*[http://commons.wikimedia.org/wiki/File:Inverted_papilloma_high_mag.jpg Inverted papilloma - high mag. (WC)].

*[http://commons.wikimedia.org/wiki/File:Inverted_papilloma_intermed_mag.jpg Inverted papilloma - intermed. mag. (WC)].

==Low grade papillary urothelial carcinoma==

*[[AKA]] ''low grade urothelial cell carcinoma''.

**Abbreviated ''low grade UCC''.

*Fused papillae.

*Papillae branch.

*Larger nuclei than PUNLMPs.

==High grade papillary urothelial carcinoma==

*[[AKA]] ''high grade urothelial cell carcinoma''.

**Abbreviated ''high grade UCC''.

Features:<ref name=Ref_WMSP310>{{Ref WMSP|310}}</ref>

*"High grade nuclear features":

**Nuclear pleomorphism - often 4-5x the size of stromal lymphocytes.<ref name=Ref_GUP161>{{Ref GUP|161}}</ref>

*Architectural complexity.

**Fused papillary common.

**Papillae branch.

*Mitoses common.