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If cancer is detected during microscopy:*Determine the histopathological Mainly look for '''type[[urothelial carcinoma]]''' of cancer. (also called transitional cell carcinoma), which constitutes 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
;High gradeOther possibilities:
;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}}
→Bladder cancer: Edema
===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>
*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>
===Microscopy===
<gallery mode=packed heights=200>
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.File:Papillary urothelial carcinoma (low-grade), low mag.jpg|Low magnificationFile:Papillary urothelial carcinoma (low-grade), very high mag.3.jpg|'''Low High grade[[urothelial carcinoma]]''': Loss of polarity and severe abnormal cytology.File:Papillary Histopathology of inverted urothelial carcinoma (low-grade) - inverted variantpapilloma, very high magmagnification.jpg|In contrast, an '''Low gradeinverted urothelial papilloma'''Filehas 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:Papillary urothelial carcinoma (low-grade) - inverted variant, intermed//www.pathologyoutlines. magcom/topic/bladderinvertedpapilloma.jpghtml|Lowtitle=Bladder, ureter & renal pelvis -magnification of the same case, showing inverted growthUrothelial neoplasms - noninvasive - Inverted urothelial papilloma|website=Pathology Outlines|author=Monika Roychowdhury}} Topic Completed: 1 December 2014.Minor changes: 3 December 2020</ref>
</gallery>
<gallery mode=packed heights=200>
File:Papillary urothelial Histopathology of squamous cell carcinoma (high-grade)of the urinary bladder, very high maglow magnification.jpg|'''High gradeSquamous cell carcinoma''': Loss of polarity and severe abnormal cytologythe urinary bladder.{{further|Urothelial versus squamous cell carcinoma|linebreak=no}}File:Papillary urothelial carcinoma (high-grade), intermed. mag.1Histopathology of radiation cystitis.jpg|Low-magnification of same case, showing papillary architecture.File:Urothelial carcinoma '''Radiation cystitis''' with marked pleomorphismatypical stromal cells (“radiation fibroblasts”), very high magedema and inflammation.2Check whether the patient has received radiation before making the diagnosis.jpg|With giant, bizarre, anaplastic cellsFile:Papillary Histopathology of non-specific urothelial carcinoma with early invasion, high magedema.jpg|High grade, with early '''invasionEdema''', showing single cells (clear spaces of both the lamina propria and irregularly shaped nests cytoplasm of tumor multiple urothelial cells infiltrating the underlying stroma), which is non-specific.
</gallery>
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