"Mixed low- and high-grade papillary urothelial carcinoma: histopathogenetic and clinical significance.". ; Epstein, JI. Am J Surg Pathol. Context: Relatively little is known about estrogen receptor (ER) expression in papillary urothelial carcinoma (PUC) of the bladder. Medical school memory device P's: 1. January 2017, Vol. This page was last edited on 22 February 2017, at 01:43. Miyamoto H, Brimo F, Schultz L, Ye H, Miller JS, Fajardo DA, Lee TK, Epstein JI, Netto GJ. p53 +ve - more common in pT2 than pT1 and HGPUC than LGPUC... but not useful to definitively separate. This article will help you read and understand your pathology report for papillary urothelial carcinoma. , An essentially sessile, undulating lesion without well formed papillae, Epithelial lining is identical to normal urothelium, Papillary urothelial neoplasm of low malignant potential (PUNLUMP), Epithelial lining is identical to normal urothelium but increased in thickness, Lining epithelium is predominantly orderly with only mild abnormalities in maturation and polarity, High grade papillary urothelial carcinoma, Lining epithelium is disordered, lacking maturation and polarity, Frequent epithelial cells are markedly atypical, Distinction of very high grade prostatic adenocarcinoma from high grade urothelial carcinoma, non-invasive papillary urothelial neoplasms are staged as pTa and are not referred to as carcinoma in situ, Papillary urothelial neoplasm of uncertain malignant potential (PUNLUMP), Urothelial carcinoma with chordoid features, Urothelial carcinoma with squamous differentiation, Nested urothelial carcinoma with cystic structures, Papillae lining normal thickness, no atypia, Lining thicker than normal, atypia absent to minimal, rare mitoses, Orderly maturation, mild atypia, scattered mitoses and atypical nuclei, Disorderly, marked atypia, pleomorphism, frequent mitoses, Papillae lined by single layer of cells, frequently hobnailed, Papillae lined by normal multilayered transitional epithelium, Usually associated with tubular submucosal component, Mitotic figures and atypia present, appropriate to grade. ; Cheville, JC. The presence/absence of muscle should be commented on in biopsy specimens. Minimal branching or fusion. ; Taheri, D.; Chaux, A.; Guner, G.; Mendoza Rodriguez, MA. 2012 Oct;36(10):1472-6. Of the three markers, only GATA3 is useful for separation from squamous carcinoma 1.2.1. The sections show a small fragment of urothelial mucosa with two papillary structures, Stanford criteria has a 5% rule -- if the high-grade component is <5% it is low-grade. Types of Urothelial Cancer. Patients with secondary papillomas had a mean age of 66 years; two were male and one was a female. May be useful for separation from high grade prostate carcinoma local spread 1.2. Urothelial papilloma of the bladder: a review of 34 de novo cases. "Urothelial carcinoma of the upper urinary tract: inverted growth pattern is predictive of microsatellite instability.". (Jan 2016). Visual survey of surgical pathology with 11065 high-quality images of benign and malignant neoplasms & related entities. Normal urothelium approx. Psammoma bodies. PTC is associated with radiation exposure. . Bladder Pathology An Introduction Murali Varma Cardiff, UK wptmv@cf.ac.uk Sarajevo Nov 2013 Outline Bladder histology Terminology issues Natural history of TCC Papillary vs. flat lesions Divergent differentiation in TCC TCC variants: why variants? absent to minimal, Nuclei normal size to slightly enlarged but uniform, Frequent branching of fibrovascular cores, If present they should be small and uniform without other high grade features, Scattered hyperchromatic cells may be present, Occasional mitotic figures may be present, Foci with high grade features may be present but make up <5% of the tumor, Moderate to marked nuclear hyperchromatism and pleomorphism, High grade features make up ≥5% of the tumor, Variant patterns are described separately, Most cases positive for p63, high molecular weight keratin and GATA3, May be useful for separation from high grade prostate carcinoma local spread, Of the three markers, only GATA3 is useful for separation from squamous carcinoma, Anal and cervical SCC 20% positive but focal or weak, High grade urothelial carcinoma 70% moderate to strong diffuse positive, Thrombomodulin is variably positive in lung SCC, Uroplakin has low sensitivity for high grade invasive urothelial carcinoma (20-60%), PSA and PAP may miss some (20%?) urothelial tumours into LG and HG tumours, as introduced in the WHO2004 classification, remains part of 2016 system. Urology. Am J Surg Pathol. Adipose tissue may be seen in the lamina propria; tumour adjacent to adipose tissue on a biopsy does. 2010 Jan;60(1):1-8. Papillary urothelial carcinoma is a type of bladder cancer. 2010 Jun;18(3 Suppl):106S-111S. Pathology and genetics of tumors of the Urinary System and Male Genital Organs. urothelial carcinoma of the bladder [Hoang L et al. Role of urine cytology Bladder Histology Well developed muscularis mucosae in <5% Muscularis mucosae bundles may be relatively organised … Pre-Tx iodine scan. Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). Nevertheless, 10–15% of patients with superficial … et al. Find out more. Chang A, Amin A, Gabrielson E, Illei P, Roden RB, Sharma R, Epstein JI. Thickness < 7 cells. "Pseudopapillary features in prostatic adenocarcinoma mimicking urothelial carcinoma: a diagnostic pitfall". [citation needed] DDx: Low grade papillary urothelial carcinoma. "Cell proliferation indices, morphometry and DNA flow cytometry provide objective criteria for distinguishing low and high grade bladder carcinomas.". Surgical Pathology Criteria Greater understanding of this feature of PUCs could aid with the treatment and identification of the origin of metastases, particularly with relation to the morphologically similar entity of ovarian transitional cell carcinoma (TCC). contains a nest with smaller cells, cystic spaces and no appreciable mitoses The tumor was found to harbor low risk HPV 6/11 by in situ hybridization. McKenney JK, Amin MB, Young RH. by Jason Wasserman MD PhD FRCPC, updated December 31, 2020. Quick facts: Papillary urothelial carcinoma is a type of cancer. Koyuncuer, A.. "Immunohistochemical expression of p63, p53 in urinary bladder carcinoma.". Nuclear pleomorphism - often 4-5x the size of stromal lymphocytes. Although most of us are familiar with the features, behavior and treatment of the “usual” type urothelial (so-called transitional cell)carcinoma, what do we do when the pathology report comes back with an unexpected and unusual diagnosis? Mod Pathol. USCAP abstract 901; 2013] 78% urothelial carcinoma cases +ve across all grades (compared with 56% +ve for uroplakin III) Specific when compared with various tissues, incl. Neoplastic transformation of urothelial cells gives rise to urothelial carcinoma, the commonest form of bladder cancer in most of the countries. document.write('') surgpathcriteria.stanford.edu/...urothelial-carcinoma/printable.html Papillary thyroid carcinoma (PTC) is the most common type of thyroid carcinoma, defined by a set of distinctive nuclear features, including: Change of nuclear size and shape: nuclear enlargement, elongation and overlapping. 1 Cancer Control 79 urethral resection of a bladder tumor. (cystitis cystica). Printed from Surgical Pathology Criteria: The term Urothelial is preferred over Transitional as is is more specific and includes neoplasms with non-transitional differentiation arising in urothelium, Papillary urothelial lesions span a range from hyperplasia to high grade //--> http://surgpathcriteria.stanford.edu/, Robert V Rouse MD 2009 Oct;40(10):1391-8. Much less commonly, urothelial cancers can arise from other sites in the urinary tract, including the … Prior to becoming invasive, there are two different types of precursor lesions: non-invasive papillary urothelial carcinoma and in-situ urothelial carcinoma. Pich, A.; Chiusa, L.; Comino, A.; Navone, R. (1994). In order to spread outside of the urinary system, urothelial (bladder and upper tract) carcinoma must invade into the lamina propria and beyond. 3. Papillae with "architectural complexity": +/-Invasion into the lamina propria - relatively common. Papillary fronds. Rajcani, J.; Kajo, K.; Adamkov, M.; Moravekova, E.; Lauko, L.; Felcanova, D.; Bencat, M. (2013). Am J Surg Pathol. Epstein JI. The direct precursor is dealt with in urothelial carcinoma … Lung SCC negative 1.2.2. Miyamoto H, Miller JS, Fajardo DA, Lee TK, Netto GJ, Epstein JI. High-grade papillary urothelial carcinoma, abbreviated HGPUC, is a common form of cancer that arises from the urothelium. IARC Press: Lyon 2004. Epstein JI. Images Whilst recurrence is common (50–70%), the disease can usually be controlled by local treatment. The WHO/International Society of Urological Pathology (ISUP) consensus classification system of urothelial neoplasms of the urinary bladder was developed in 1998 and was revised most recently in 2003 (published in 2004). Department of Pathology 24, No. Hum Pathol. Palpable lymph nodes. pTa tumours do notinvade the lamina propria(no 4. World Health Organization Classification of Tumors. Notes: 1. 2004 Dec;28(12):1615-20. 6. The papillary mass was found to be a high grade urothelial carcinoma positive for GATA 3 expression, with focal areas of squamous differentiation. Invasive urothelial carcinoma is graded with the same criteria as papillary carcinomas; Invasion by low grade carcinomas is rare but can occur (Toll 2012) Staging. Stanford University School of Medicine 2003 Jul;16(7):623-9. 2. ; Blaszyk, H. (Mar 2003). Mitotic activity is seen focally. Samaratunga H, Makarov DV, Epstein JI. Magi-Galluzzi C, Epstein JI. Papillary urothelial carcinoma is a type of bladder cancer. Invasive low-grade papillary urothelial carcinoma: a clinicopathologic analysis of 41 cases. https://librepathology.org/wiki/Low-grade_papillary_urothelial_carcinoma Zhou, Ming; Magi-Galluzzi, Cristina (2006). Grading pTa papillary TCC Grading pTa papillary TCC WHO 1973 Papilloma – G1 – G2– G3 •No criteria defined for various grades •Large number of tumours end up as G2 •Significant number of G2 tumours progress •3 grades of TCC but only 2 Rx options •“Carcinoma” for non-invasive tumours Problems: Natural History of pTa G1 TCC The sections show urothelial mucosa with thick papillary structures. 2010 Aug;134(8):1160-3. prostate and renal carcinoma The Christie NHS Foundation Trust Immunohistochemical panel to identify the primary site of invasive micropapillary carcinoma Lotan TL … Inverted urothelial papilloma: may mimic endophytic growth in high-grade urothelial carcinoma; cytologically bland Low grade papillary urothelial carcinoma: nuclear and architectural features are less atypical; mitoses are variable but not on surface; cellular dyscohesion less common; prominent umbrella cells are occasionally seen Diagnosis and classification of flat, papillary, and invasive urothelial carcinoma: the WHO/ISUP consensus. Eble JN, Sauter G, Epstein JI, Sesterhenn IA eds. Urothelial (transitional cell) carcinoma is the predominant histologic type in the United States and Europe, where it accounts for 90 percent of all bladder cancers. Anal and cervical SCC … Mitotic activity is present and focally brisk (4 mitoses in 1 HPF, 1 HPF~0.2376 mm*mm). No mitoses. Frequent branching of fibrovascular cores Frequent fusing of papillae; Lining epithelium is disordered, lacking maturation and polarity. Bladder cancer is the most common malignancy involving the urinary system. By Bahram Robert Oliai, M.D. Although technically in situ, non-invasive papillary urothelial neoplasms are staged as pTa and are not referred to as carcinoma in situ 2003 Aug;47(2):83-9. 5. High grade papillary urothelial carcinoma. Reis, LO. "Significance of a minor high-grade component in a low-grade noninvasive papillary urothelial carcinoma of bladder.". In other areas of the world, non-urothelial carcinomas are more frequent. ; Skinner, DG. Most cases positive for p63, high molecular weight keratin and GATA3 1.1. of very high grade or treated carcinomas, Other backups p53 (cytoplasmic), NKX3.1 (nuclear), GATA3, p63 and/or high molecular weight cytokeratins are useful complementary markers, Only extremely rare prostate adenocarcinomas are reactive, Summary of differences, see Criteria page for details, See main criteria page for grading criteria, Invasive urothelial carcinoma is graded with the same criteria as papillary carcinomas, Invasion by low grade carcinomas is rare but can occur (Toll 2012), If possible, the extent of lamina propria / submucosa invasion should be reported, Muscularis mucosae is variable and its involvement does not affect staging, Muscularis propria involvement is significant and should be evaluated carefully, Depth of muscularis propria involvement cannot be assessed in transurethral specimens, Presence or absence of propria should be reported even if not involved, Lymphatic invasion should be confirmed by immunohistochemistry, Pseudovascular tissue retraction is common, Papillary hyperplasia may be seen with concurrent or prior papillary neoplasia, Primary/de novo hyperplasia is of unknown significance, Papilloma has a low rate of recurrence (0-30%), Very low rate of progression to higher grade if presenting de novo, Progressiion to higher grade is infrequent (<5%), Low grade carcinoma very frequently recurs (50-75%), Progression to high grade is not infrequent (5-20%), Urothelial carcinoma with sarcomatoid differentiation, Urothelial carcinoma with glandular differentiation, Metastatic/direct spread of non-bladder adenocarcinomas, Murphy WM, Grignon DJ, Perlman EJ. //www.ncbi.nlm.nih.gov/pmc/articles/PMC2684226/, urothelial carcinoma-like prostatic carcinoma, http://surgpathcriteria.stanford.edu/bladder/tcc-papillary-transitional-urothelial-carcinoma/, "Molecular markers in transitional cell carcinoma of the bladder: New insights into mechanisms and prognosis. carcinoma, Short stromal spikes but no thin fibrovascular cores, Spikes usually no longer than the thickness of the epithelium, Infrequent branching of fibrovascular cores, Occasional branching of fibrovascular cores, Atypia WebPathology is a free educational resource with 11065 high quality pathology images of benign and malignant neoplasms and related entities. Toll AD, Epstein JI. (Mar 1995). Pathol Int. The lamina propria ", https://librepathology.org/w/index.php?title=High-grade_papillary_urothelial_carcinoma&oldid=46992, Attribution-NonCommercial-ShareAlike 4.0 International, papillae with "architectural complexity" (fused papillae, branching of papillae), +/-nuclear pleomorphism, nuclear enlargement - often 4-5x the size of stromal lymphocytes, mitoses (common), +/-invasion into the lamina propria (common), exophytic mass, frond-like appearance, friable. Cytological features of normal urothelium. 2. It commonly starts in the bladder but it can also start in the ureters or the urethra. Utility of GATA3 immunohistochemistry in differentiating urothelial carcinoma from prostate adenocarcinoma and squamous cell carcinomas of the uterine cervix, anus, and lung. It starts in urothelial cells in the bladder lining. Prognosis is good. Mai, KT. 2012 Jul;36(7):1081-6. Often necrotic appearing - light-to-dark brown, soft/mushy, friable. Pathology Report Urothelial Carcinoma With Squamous Differentiation Is Associated With High Tumor Stage and Pelvic Lymph-Node Metastasis Yunguang Liu, MD, PhD, Marilyn M. Bui, MD, and Bo Xu, MD, PhD. Any of the following are evidence of invasion and exclude the diagnosis of inverted pattern Post-Sx iodine scan. The new World Health Organization/International Society of Urological Pathology (WHO/ISUP) classification for TA, T1 bladder tumors: is it an improvement? 2x the size of stromal lymphocytes. It is often slow growing, and effective treatment is possible in many cases. Papillary carcinoma with low grade spindle cell features has been described (Argani) Twelve of 14 had a benign clinical course with no recurrences; 1 developed a recurrent papilloma at 3 years, and 1 developed a pT3a high-grade papillary urothelial carcinoma at 4 years. Overlying surface may show usual urothelial carcinoma in situ, papillary carcinoma or micropapillary carcinoma Crit Rev Oncol Hematol. It is also known as high-grade papillary urothelial cell carcinoma, abbreviated HGPUCC. No patients were given chemotherapy or radiotherapy prior to cystecto - my. High-grade papillary urothelial carcinoma. "Immunohistochemical characterization of urothelial carcinoma.". Urothelial carcinoma is abbreviated UC and urothelial cell carcinoma is abbreviated UCC. Tavora F, Epstein JI. A mild lymphocyte-predominant inflammatory infiltrate is present. https://librepathology.org/wiki/Micropapillary_urothelial_carcinoma Urothelial carcinoma, also urothelial cell carcinoma, is a malignancy that arises from the urothelium. Popular - most common malignant neoplasm of the thyroid. There is some evidence to suggest low-grade with <5% high-grade behaves similar to low-grade. Moderate to … cells are seen only focally. Int J Surg Pathol. Gordetsky J, Epstein JI (July 2014). https://librepathology.org/wiki/High-grade_papillary_urothelial_carcinoma Arch Pathol Lab Med. emailE=('rouse' + '@' + 'stan' + 'ford.edu') Focused Variants of Urothelial Carcinoma with stained slides of pathology.