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


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.


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

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]


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


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


  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


  1. 1.0 1.1 . Types of Bladder Cancer: TCC & Other Variants. CTCA.
  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