Difference between revisions of "Urinary bladder"

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===Gross reporting of transurethral resections===
 
===Gross reporting of transurethral resections===
*Generally submit all material.<ref group=notes>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.</ref>
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*Generally submit '''all''' material.<ref group=notes>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.</ref>
 
*Submit in tea bags or equivalent.<ref>Tissue from transurethral resections are generally very brittle and may escape the openings of a conventional cassette.</ref>
 
*Submit in tea bags or equivalent.<ref>Tissue from transurethral resections are generally very brittle and may escape the openings of a conventional cassette.</ref>
  
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===Microscopy===
 
===Microscopy===
If cancer is detected during microscopy:
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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.
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File:Papillary urothelial carcinoma (low-grade), very high mag.jpg|'''Low grade [[urothelial carcinoma]]''': Urothelium is thickened but only slightly atypical and has maintained polarity.
File:Papillary urothelial carcinoma (low-grade), high mag.1.jpg|Intermediate magnification.
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File:Papillary urothelial carcinoma (high-grade), very high mag.jpg|'''High grade [[urothelial carcinoma]]''': Loss of polarity and severe abnormal cytology.
File:Papillary urothelial carcinoma (low-grade), low mag.jpg|Low magnification
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File:Histopathology of inverted urothelial papilloma, high magnification.jpg|In contrast, an '''inverted urothelial papilloma''' has smooth surface with minimal to absent exophytic component, is well circumscribed with smooth base, and has no obvious infiltration and no/minimal cytologic atypia.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/bladderinvertedpapilloma.html|title=Bladder, ureter & renal pelvis - Urothelial neoplasms - noninvasive - Inverted urothelial papilloma|website=Pathology Outlines|author=Monika Roychowdhury}} Topic Completed: 1 December 2014. Minor changes: 3 December 2020</ref>
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>
 
</gallery>
  
;High grade
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Other possibilities:
 
<gallery mode=packed heights=200>
 
<gallery mode=packed heights=200>
File:Papillary urothelial carcinoma (high-grade), very high mag.jpg|'''High grade''': Loss of polarity and severe abnormal cytology.
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File:Histopathology of squamous cell carcinoma of the urinary bladder, low magnification.jpg|'''Squamous cell carcinoma''' of the urinary bladder. {{further|Urothelial versus squamous cell carcinoma|linebreak=no}}
File:Papillary urothelial carcinoma (high-grade), intermed. mag.1.jpg|Low-magnification of same case, showing papillary architecture.
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File:Histopathology of radiation cystitis.jpg|'''Radiation cystitis''' with atypical stromal cells (“radiation fibroblasts”), edema and inflammation. Check whether the patient has received radiation before making the diagnosis.
File:Urothelial carcinoma with marked pleomorphism, very high mag.2.jpg|With giant, bizarre, anaplastic cells
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File:Histopathology of non-specific urothelial edema.jpg|'''Edema''' (clear spaces of both the lamina propria and cytoplasm of multiple urothelial cells), which is non-specific.
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}}

Latest revision as of 08:13, 27 September 2021

Author: Mikael Häggström [notes 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 2]
  • 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]

Other possibilities:

Notes

  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.
  2. 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.

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.
  3. Monika Roychowdhury. Bladder, ureter & renal pelvis - Urothelial neoplasms - noninvasive - Inverted urothelial papilloma. Pathology Outlines. Topic Completed: 1 December 2014. Minor changes: 3 December 2020