Difference between revisions of "Urinary bladder"

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===Microscopy===
 
===Microscopy===
If cancer is detected during microscopy:
+
Mainly look for '''[[urothelial carcinoma]]''' (also called transitional cell carcinoma), which constitutes 95% of bladder cancers.<ref name=CancerCenter>{{Cite web|url=https://www.cancercenter.com/bladder-cancer/types/|title=Types of Bladder Cancer: TCC & Other Variants|website=CTCA|access-date=2018-08-10}}</ref>
*Determine the histopathological '''type''' of cancer. 95% of bladder cancers are transitional cell carcinoma (also called urothelial carcinoma).<ref name=CancerCenter>{{Cite web|url=https://www.cancercenter.com/bladder-cancer/types/|title=Types of Bladder Cancer: TCC & Other Variants|website=CTCA|access-date=2018-08-10}}</ref>
 
*Perform '''grading''' and '''staging'''
 
  
====Urothelial carcinoma====
 
;Low grade
 
 
<gallery mode=packed heights=200>
 
<gallery mode=packed heights=200>
 
File:Papillary urothelial carcinoma (low-grade), very high mag.jpg|'''Low grade''': Urothelium is thickened but only slightly atypical and has maintained polarity.
 
File:Papillary urothelial carcinoma (low-grade), very high mag.jpg|'''Low grade''': Urothelium is thickened but only slightly atypical and has maintained polarity.
File:Papillary urothelial carcinoma (low-grade), high mag.1.jpg|Intermediate magnification.
 
File:Papillary urothelial carcinoma (low-grade), low mag.jpg|Low magnification
 
File:Papillary urothelial carcinoma (low-grade), high mag.3.jpg|'''Low grade'''
 
File:Papillary urothelial carcinoma (low-grade) - inverted variant, very high mag.jpg|'''Low grade'''
 
File:Papillary urothelial carcinoma (low-grade) - inverted variant, intermed. mag.jpg|Low-magnification of the same case, showing inverted growth.
 
</gallery>
 
 
;High grade
 
<gallery mode=packed heights=200>
 
 
File:Papillary urothelial carcinoma (high-grade), very high mag.jpg|'''High grade''': Loss of polarity and severe abnormal cytology.
 
File:Papillary urothelial carcinoma (high-grade), very high mag.jpg|'''High grade''': Loss of polarity and severe abnormal cytology.
File:Papillary urothelial carcinoma (high-grade), intermed. mag.1.jpg|Low-magnification of same case, showing papillary architecture.
 
File:Urothelial carcinoma with marked pleomorphism, very high mag.2.jpg|With giant, bizarre, anaplastic cells
 
File:Papillary urothelial carcinoma with early invasion, high mag.jpg|High grade, with early '''invasion''', showing single cells and irregularly shaped nests of tumor cells infiltrating the underlying stroma.
 
 
</gallery>
 
</gallery>
 
;Variants
 
<gallery mode=packed heights=200>
 
File:Micropapillary urothelial carcinoma, very high mag.jpg|'''Micropapillary''': Micropapillary clusters of tumor cells within lacunae
 
File:Papillary urothelial carcinoma with cribriform morphology, very high mag.jpg|'''Cribriform''', high magnification
 
File:Papillary urothelial carcinoma with cribriform morphology, low mag.jpg|'''Cribriform''', low magnification
 
File:Urothelial carcinoma with glandular differentiation, high mag.jpg|Another case of '''glandular differentiation''', showing luminal spaces with proteinaceous secretions
 
File:Papillary urothelial carcinoma with glandular differentiation, high mag.jpg|Another case of '''glandular differentiation'''
 
File:Urothelial carcinoma with glandular differentiation, very high mag.1.jpg|Another case of '''glandular differentiation'''
 
File:Plasmacytoid urothelial carcinoma, very high mag.1.jpg|'''Plasmacytoid''': Monotonous discohesive cells with eosinophilic cytoplasm and eccentric nuclei.
 
File:Urothelial carcinoma - stage pT1, high mag.jpg|With ''' inflammatory stromal reaction'''
 
File:Urothelial carcinoma with squamous differentiation, very high mag.jpg|With '''squamous''' differentiation
 
File:Urothelial carcinoma with villoglandular differentiation, high mag.jpg|'''Villoglandular''': glandular differentiation and villous architecture
 
File:Urothelial carcinoma with villoglandular differentiation, intermed. mag.2.jpg|Another '''villoglandular''' case. Typical papillary urothelial carcinoma is seen on the left
 
File:Urothelial carcinoma with micropapillary features, high mag.jpg|With prominent '''retraction artifacts'''
 
</gallery>
 
 
====Non-urothelial cancers====
 
The other 5% of urinary bladder cancer types are [[squamous cell carcinoma]]s, [[adenocarcinoma]]s, [[sarcoma]]s, [[small cell carcinoma]]s, and secondary deposits from cancers elsewhere in the body.<ref name=CancerCenter/>
 
 
====Staging====
 
In the TNM staging system (AJCC 8th Edn. 2017) for bladder cancer:<ref>{{cite web |title=EAU Guidelines - STAGING AND CLASSIFICATION SYSTEMS |url=https://uroweb.org/guideline/non-muscle-invasive-bladder-cancer/#4 |website=Uroweb}}</ref><ref>{{cite journal | vauthors = Magers MJ, Lopez-Beltran A, Montironi R, Williamson SR, Kaimakliotis HZ, Cheng L | title = Staging of bladder cancer | journal = Histopathology | volume = 74 | issue = 1 | pages = 112–134 | date = January 2019 | pmid = 30565300 | doi = 10.1111/his.13734 | doi-access = free }}</ref>
 
 
'''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)<ref name=CancerNet>{{cite web|url=https://www.cancer.net/cancer-types/bladder-cancer/stages-and-grades|title=Bladder Cancer: Stages and Grades|website=Cancer.net}} Approved by the Cancer.Net Editorial Board 05/2019</ref>
 
* '''T2b''' Tumor invades deep muscle (outer half of the detrusor muscle)<ref name=CancerNet/>
 
* '''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
 
 
Example:
 
{|class=wikitable
 
| [[File:Papillary_urothelial_carcinoma_with_early_invasion,_high_mag.jpg|180px|left]] High-grade papillary urothelial carcinoma with invasion into subepithelial connective tissue.
 
|}
 
{{Reporting}}
 
 
{{Bottom}}
 
{{Bottom}}

Revision as of 13:41, 3 September 2020

Author: Mikael Häggström [note 1]

Bladder cancer

The main condition of interest in urinary bladder cytologies and biopsies is bladder cancer.

Gross reporting of transurethral resections

  • Generally submit all material.[notes 1]
  • Submit in tea bags or equivalent.[1]

Example report:

Container A. Labeled "bladder tumor". The specimen is received in formalin and consists of multiple fragments of tan-gray, friable soft tissue measuring about __ x __ x __ cm in aggregate. The specimen is entirely submitted for microscopic examination in __ cassettes.

Microscopy

Mainly look for urothelial carcinoma (also called transitional cell carcinoma), which constitutes 95% of bladder cancers.[2]

Notes

  1. It may be sufficient to submit representative sections that include the muscular layer, if grossly identified. Yet, many departments require submission of the entire specimen regardless, so if unsure, that is the safe choice.
  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

References

  1. Tissue from transurethral resections are generally very brittle and may escape the openings of a conventional cassette.
  2. . Types of Bladder Cancer: TCC & Other Variants. CTCA.

Image sources