Urothelial carcinoma

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Author: Mikael Häggström [notes 1]
95% of bladder cancers are urothelial carcinoma (also called transitional cell carcinoma).[1]

Gross processing

Further information: Urinary bladder

Microscopic examination

Low grade urothelial carcinoma.

Urothelial carcinoma displays more crowding and layering, and more hyperchromasia and mitoses, than papillomas and papillary urothelial neoplasm of low malignant potential (also included in grading table below for comparison).[2]


Also consider non-urothelial cancer types (together constituting 5% of urinary bladder cancers): squamous cell carcinomas, adenocarcinomas, sarcomas, small cell carcinomas, and secondary deposits from cancers elsewhere in the body.[1]

If urothelial carcinoma, perform grading and staging.


Papillary urothelial neoplasms[3]
Papillary urothelial neoplasm of low malignant potential Low grade High grade
Architecture Papillae
  • Delicate
  • Rarely fused
  • Delicate
  • Occasionally fused
  • Delicate
  • Fused and branching
  • Normal polarity
  • Cohesive cells
  • Minimal crowding and loss of polarity
  • Cohesive cells
  • Crowding
  • Overlapping cells
  • Loss of polarity
  • Often discohesive cells
Nuclei Size and nuclear/cytoplasmic ratio Mildly increased Increased
Nuclear size variability No Some Marked
  • Elongated
  • Uniform
  • Elongated—oval—round
  • Slight variability
  • Pleomorphic
  • Fine
  • Fine with some variability
  • Frequently coarse with marked variability
  • Absent to inconspicuous
  • Usually inconspicuous
  • Prominent
  • Single to multiple
  • Rare
  • Basal if present
  • Infrequent
  • Mostly basal if present
  • Frequent
  • At any level
Low grade
High grade


In the TNM staging system (AJCC 8th Edn. 2017) for bladder cancer:[4][5]

T (Primary tumor)

  • TX Primary tumor cannot be assessed
  • T0 No evidence of primary tumor
  • Ta Non-invasive papillary carcinoma
  • Tis Carcinoma in situ ('flat tumor')
  • T1 Tumor invades subepithelial connective tissue
  • T2a Tumor invades superficial muscle (inner half of the detrusor muscle)[6]
  • T2b Tumor invades deep muscle (outer half of the detrusor muscle)[6]
  • T3 Tumor invades perivesical tissue:
    • T3a Microscopically
    • T3b Macroscopically (extravesical mass)
  • T4a Tumor invades prostate, uterus or vagina
  • T4b Tumor invades pelvic wall or abdominal wall

N (Lymph nodes)

  • NX Regional lymph nodes cannot be assessed
  • N0 No regional lymph node metastasis
  • N1 Metastasis in a single lymph node in true pelvis (hypogastric, obturator, external iliac, or presacral nodes)
  • N2 Metastasis in multiple lymph nodes in true pelvis (hypogastric, obturator, external iliac, or presacral nodes)
  • N3 Metastasis in common iliac lymph nodes

M (Distant metastasis) Can be performed if tissues have been submitted from distant sites.

  • MX Distant metastasis cannot be assessed
  • M0 No distant metastasis
  • M1 Distant metastasis.
    • M1a: The cancer has spread only to lymph nodes outside of the pelvis.
    • M1b: The cancer has spread other parts of the body.

Microscopy report

  • Histopathologic type of cancer
  • Grade
  • Stage. For biopsies, there should be a mention of the presence or absence of the muscularis propria in the sample, and if it is involved.


Papillary urothelial carcinoma with early invasion, high mag.jpg
High-grade papillary urothelial carcinoma with invasion into subepithelial connective tissue.
See also: General notes on reporting


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page


  1. 1.0 1.1 . Types of Bladder Cancer: TCC & Other Variants. CTCA.
  2. Rugvedita Parakh. Bladder, ureter & renal pelvis - Urothelial neoplasms-noninvasive - Noninvasive papillary urothelial carcinoma low grade. Pathology Outlines. Topic Completed: 1 December 2014. Minor changes: 30 March 2020
  3. Grignon, David J (2009). "The current classification of urothelial neoplasms ". Modern Pathology 22 (S2): S60–S69. doi:10.1038/modpathol.2008.235. ISSN 0893-3952. 
  5. "Staging of bladder cancer ". Histopathology 74 (1): 112–134. January 2019. doi:10.1111/his.13734. PMID 30565300. 
  6. 6.0 6.1 . Bladder Cancer: Stages and Grades. Cancer.net. Approved by the Cancer.Net Editorial Board 05/2019