Urinary bladder

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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

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
High grade
Variants

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

Example:

Papillary urothelial carcinoma with early invasion, high mag.jpg
High-grade papillary urothelial carcinoma with invasion into subepithelial connective tissue.

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.

Main page

References

  1. 1.0 1.1 . Types of Bladder Cancer: TCC & Other Variants. CTCA.
  2. . EAU Guidelines - STAGING AND CLASSIFICATION SYSTEMS. Uroweb.
  3. "Staging of bladder cancer ". Histopathology 74 (1): 112–134. January 2019. doi:10.1111/his.13734. PMID 30565300. 
  4. 4.0 4.1 . Bladder Cancer: Stages and Grades. Cancer.net. Approved by the Cancer.Net Editorial Board 05/2019