Difference between revisions of "Urothelial carcinoma in situ"
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==General== | ==General== | ||
*Lack papillae. | *Lack papillae. | ||
===Classification of flat urothelial lesions=== | |||
The World Health Organization classification is:<ref name=pmid19762067>{{Cite journal | last1 = Hodges | first1 = KB. | last2 = Lopez-Beltran | first2 = A. | last3 = Davidson | first3 = DD. | last4 = Montironi | first4 = R. | last5 = Cheng | first5 = L. | title = Urothelial dysplasia and other flat lesions of the urinary bladder: clinicopathologic and molecular features. | journal = Hum Pathol | volume = 41 | issue = 2 | pages = 155-62 | month = Feb | year = 2010 | doi = 10.1016/j.humpath.2009.07.002 | PMID = 19762067 }}</ref> | |||
*Reactive urothelial atypia. | |||
*Flat urothelial hyperplasia. | |||
*Urothelial atypia of unknown significance. | |||
*[[Urothelial dysplasia]] (low-grade dysplasia). | |||
*Urothelial carcinoma in situ (high-grade dysplasia). | |||
*Invasive [[urothelial carcinoma]]. | |||
==Microscopic== | ==Microscopic== | ||
Revision as of 13:57, 6 January 2014
Urothelial carcinoma in situ, also known as high-grade (urothelial) dysplasia, a non-invasive urothelial neoplasm without papillae.
It is also known as carcinoma in situ, abbreviated CIS. Urothelial carcinoma in situ may be abbreviated UCIS.
General
- Lack papillae.
Classification of flat urothelial lesions
The World Health Organization classification is:[1]
- Reactive urothelial atypia.
- Flat urothelial hyperplasia.
- Urothelial atypia of unknown significance.
- Urothelial dysplasia (low-grade dysplasia).
- Urothelial carcinoma in situ (high-grade dysplasia).
- Invasive urothelial carcinoma.
Microscopic
Features:
- Nuclear changes key feature.
- Enlargement of nuclei (often 4-5x the size of stromal lymphocytes) -- diagnostic.[2]
- Normal urothelium approx. 2x the size of stromal lymphocytes.
- Nuclear pleomorphism - marked variation in size of nuclei.
- Enlargement of nuclei (often 4-5x the size of stromal lymphocytes) -- diagnostic.[2]
- +/-Disordered arrangement/crowding of cells.
- In normal urothelium the cell line-up on the basement membrane.
- Umbrella cells often absent.
- +/-Mitoses present.
- +/-Enlarged nucleoli.
Note:
- The urothelium may be "depleted", i.e. exist only of rare large cells on the basement membrane.
- This is known as clinging urothelial carcinoma in situ.[3]
DDx:
- Urothelial atypia of unknown significance - waffle diagnosis.
- Urothelial dysplasia.
- Urothelial carcinoma, invasive.
Images
www:
- Urothelial CIS (webpathology.com).
- Urothelial CIS with shedding (webpathology.com).
- Urothelial CIS - low mag. (webpathology.com).
- Urothelial CIS - high mag. (webpathology.com).
IHC
Features:[4]
- p53 +ve.
- Ki-67 high.
Benign urothelium vs. CIS:[5]
- CK20 +ve in deep cells (23/26 cases).
- Normal urothelium -- only the umbrella cells.
- Ki-67 ~50% of cells - deep and superficial.
- Normal ~10% of cells, confined to basal aspect.
Sign out
URINARY BLADDER LESION ("TUMOUR"), TRANSURETHRAL RESECTION URINARY BLADDER TUMOUR (TURBT):
- UROTHELIAL CARCINOMA IN SITU.
- MUSCULARIS PROPRIA PRESENT.
See also
References
- ↑ Hodges, KB.; Lopez-Beltran, A.; Davidson, DD.; Montironi, R.; Cheng, L. (Feb 2010). "Urothelial dysplasia and other flat lesions of the urinary bladder: clinicopathologic and molecular features.". Hum Pathol 41 (2): 155-62. doi:10.1016/j.humpath.2009.07.002. PMID 19762067.
- ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 161. ISBN 978-0443066771.
- ↑ Amin, Mahul B. (2010). Diagnostic Pathology: Genitourinary (1st ed.). Amirsys. pp. 2-55. ISBN 978-1931884280.
- ↑ Lopez-Beltran, A.; Jimenez, RE.; Montironi, R.; Patriarca, C.; Blanca, A.; Menendez, CL.; Algaba, F.; Cheng, L. (Nov 2011). "Flat urothelial carcinoma in situ of the bladder with glandular differentiation.". Hum Pathol 42 (11): 1653-9. doi:10.1016/j.humpath.2010.12.024. PMID 21531007.
- ↑ Yin, H.; He, Q.; Li, T.; Leong, AS. (Sep 2006). "Cytokeratin 20 and Ki-67 to distinguish carcinoma in situ from flat non-neoplastic urothelium.". Appl Immunohistochem Mol Morphol 14 (3): 260-5. PMID 16932015.