Urinary bladder

Author: Mikael Häggström

Bladder cancer

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

If cancer is detected during microscopy:

• Determine the histopathological type of cancer. 95% of bladder cancers are transitional cell carcinoma (also called urothelial carcinoma).
• Perform grading and staging

Urothelial carcinoma

Low grade

• Low grade: Urothelium is thickened but only slightly atypical and has maintained polarity.
  Low grade: Urothelium is thickened but only slightly atypical and has maintained polarity.
• Intermediate magnification.
  Intermediate magnification.
• Low magnification
  Low magnification
• Low grade
  Low grade
• Low grade
  Low grade
• Low-magnification of the same case, showing inverted growth.
  Low-magnification of the same case, showing inverted growth.

High grade

• High grade: Loss of polarity and severe abnormal cytology.
  High grade: Loss of polarity and severe abnormal cytology.
• Low-magnification of same case, showing papillary architecture.
  Low-magnification of same case, showing papillary architecture.
• With giant, bizarre, anaplastic cells
  With giant, bizarre, anaplastic cells
• High grade, with early invasion, showing single cells and irregularly shaped nests of tumor cells infiltrating the underlying stroma.
  High grade, with early invasion, showing single cells and irregularly shaped nests of tumor cells infiltrating the underlying stroma.

Variants

• Micropapillary: Micropapillary clusters of tumor cells within lacunae
  Micropapillary: Micropapillary clusters of tumor cells within lacunae
• Cribriform, high magnification
  Cribriform, high magnification
• Cribriform, low magnification
  Cribriform, low magnification
• Another case of glandular differentiation, showing luminal spaces with proteinaceous secretions
  Another case of glandular differentiation, showing luminal spaces with proteinaceous secretions
• Another case of glandular differentiation
  Another case of glandular differentiation
• Another case of glandular differentiation
  Another case of glandular differentiation
• Plasmacytoid: Monotonous discohesive cells with eosinophilic cytoplasm and eccentric nuclei.
  Plasmacytoid: Monotonous discohesive cells with eosinophilic cytoplasm and eccentric nuclei.
• With inflammatory stromal reaction
  With inflammatory stromal reaction
• With squamous differentiation
  With squamous differentiation
• Villoglandular: glandular differentiation and villous architecture
  Villoglandular: glandular differentiation and villous architecture
• Another villoglandular case. Typical papillary urothelial carcinoma is seen on the left
  Another villoglandular case. Typical papillary urothelial carcinoma is seen on the left
• With prominent retraction artifacts
  With prominent retraction artifacts

Non-urothelial cancers

The other 5% of urinary bladder cancer types are squamous cell carcinomas, adenocarcinomas, sarcomas, small cell carcinomas, and secondary deposits from cancers elsewhere in the body.

Staging

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

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 Tumur invades subepithelial connective tissue
• T2a Tumour invades superficial muscle (inner half of the detrusor muscle)
• T2b Tumour invades deep muscle (outer half of the detrusor muscle)
• 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

Main page

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