Urinary bladder: Difference between revisions
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The main condition of interest in urinary bladder cytologies and biopsies is bladder cancer. | The main condition of interest in urinary bladder cytologies and biopsies is bladder cancer. | ||
===Gross reporting of transurethral resections=== | |||
Example: | |||
{|class=wikitable | |||
| 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=== | |||
If cancer is detected during microscopy: | If cancer is detected during microscopy: | ||
*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> | *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''' | *Perform '''grading''' and '''staging''' | ||
===Urothelial carcinoma=== | ====Urothelial carcinoma==== | ||
;Low grade | ;Low grade | ||
<gallery mode=packed heights=200> | <gallery mode=packed heights=200> | ||
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</gallery> | </gallery> | ||
===Non-urothelial cancers=== | ====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/> | 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=== | ====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> | 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> | ||
Revision as of 09:59, 29 July 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
Example:
| 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
If cancer is detected during microscopy:
- Determine the histopathological type of cancer. 95% of bladder cancers are transitional cell carcinoma (also called urothelial carcinoma).[1]
- Perform grading and staging
Urothelial carcinoma
- Low grade
-
Low grade: Urothelium is thickened but only slightly atypical and has maintained polarity.
-
Intermediate magnification.
-
Low magnification
-
Low grade
-
Low grade
-
Low-magnification of the same case, showing inverted growth.
,_very_high_mag.jpg){kind=link}
,_high_mag.1.jpg){kind=link}
,_low_mag.jpg){kind=link}
,_high_mag.3.jpg){kind=link}
_-_inverted_variant,_very_high_mag.jpg){kind=link}
_-_inverted_variant,_intermed._mag.jpg){kind=link}
- High grade
-
High grade: Loss of polarity and severe abnormal cytology.
-
Low-magnification of same case, showing papillary architecture.
-
With giant, bizarre, anaplastic cells
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High grade, with early invasion, showing single cells and irregularly shaped nests of tumor cells infiltrating the underlying stroma.
,_very_high_mag.jpg){kind=link}
,_intermed._mag.1.jpg){kind=link}
- Variants
-
Micropapillary: Micropapillary clusters of tumor cells within lacunae
-
Cribriform, high magnification
-
Cribriform, low magnification
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Another case of glandular differentiation, showing luminal spaces with proteinaceous secretions
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Another case of glandular differentiation
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Another case of glandular differentiation
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Plasmacytoid: Monotonous discohesive cells with eosinophilic cytoplasm and eccentric nuclei.
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With inflammatory stromal reaction
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With squamous differentiation
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Villoglandular: glandular differentiation and villous architecture
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Another villoglandular case. Typical papillary urothelial carcinoma is seen on the left
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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.[1]
Staging
In the TNM staging system (AJCC 8th Edn. 2017) for bladder cancer:[2][3]
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)[4]
- T2b Tumor invades deep muscle (outer half of the detrusor muscle)[4]
- 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
Notes
- ↑ 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
- ↑ 1.0 1.1 . Types of Bladder Cancer: TCC & Other Variants. CTCA.
- ↑ . EAU Guidelines - STAGING AND CLASSIFICATION SYSTEMS. Uroweb.
- ↑ "Staging of bladder cancer ". Histopathology 74 (1): 112–134. January 2019. doi:. PMID 30565300.
- ↑ 4.0 4.1 . Bladder Cancer: Stages and Grades. Cancer.net. Approved by the Cancer.Net Editorial Board 05/2019
Image sources